Relationship of Attention Deficit-hyperactivity Disorder on the Spectrum of Anorexia Nervosa to Obesity: A Case Report

Eating disorders are a growing health problem among adolescents and have increasingly become the focus of studies due to their prevalence. Both obesity and anorexia nervosa are associated maladaptive eating behaviours that may be relevant to development. With this case report, it is intended to discuss the diagnosis and management of a female adolescent patient, diagnosed with obesity and attention deficit-hyperactivity disorder (ADHD). A 16-year-old, female, obese adolescent was referred to our in-patient clinic due to maladaptive eating styles, depressive symptoms and ADHD symptoms. Her early course of illness, diagnostic process, treatment and short-term outcome are described. At the time of discharge, the patient’s Clinical Global Impression (CGI) scale severity item score was 2 (borderline mentally ill) and CGI improvement item score was 2 (much improved). We report the present case with the purpose of establishing a pediatric approach to obesity, a disease not included in Diagnostic and Statistical Manual-5 under eating disorders, yet we believe it shares common underlying genetic and environmental causes

Increased cerebral blood flow in the right anterior cingulate cortex and fronto-orbital cortex during go/no-go task in children with ADHD

Objective Arterial spin labeling (ASL) is a relatively new imaging modality in the field of the cognitive neuroscience. In the present study, we aimed to compare the dynamic regional cerebral blood flow alterations of children with ADHD and healthy controls during a neurocognitive task by using event-related ASL scanning. Methods The study comprised of 17 healthy controls and 20 children with ADHD. The study subjects were scanned on 3 Tesla MRI scanner to obtain ASL imaging data. Subjects performed go/no-go task during the ASL image acquisition. The image analyses were performed by FEAT (fMRI Expert Analysis Tool) Version 6. Results The mean age was 10.88 +/- 1.45 and 11 +/- 1.91 for the control and ADHD group, respectively (p = .112). The go/no-go task was utilized during the ASL scanning. The right anterior cingulate cortex (BA32) extending into the frontopolar and orbitofrontal cortices (BA10 and 11) displayed greater activation in ADHD children relative to the control counterparts (p < .001). With a lenient significance threshold, greater activation was revealed in the right-sided frontoparietal regions during the go session, and in the left precuneus during the no-go session. Conclusion These results indicate that children with ADHD needed to over-activate frontopolar cortex, anterior cingulate as well as the dorsal and ventral attention networks to compensate for the attention demanded in a given cognitive task

Dikkat eksikliği ve hiperaktivite bozukluğu ile birlikte ağır bilişsel tempo (sluggish cognitive tempo) olan olguların arterial spin labeling yöntemiyle değerlendirilmesi

Ağır Bilişsel Tempo (Sluggish Cognitive Tempo) uykulu görünüm, yavaş hareket etme, yavaş düşünme ve içe yönelim sorunları ile karakterize bir klinik belirti kümesidir. Son 20 yılda SCT alanında farklı araştırmalar ortaya çıkmıştır. SCT hastalarında erken veri işleme ve dikkati devam ettirmenin bozuk olduğu ve posterior beyin bölgelerinin dikkat sorunlarıyla ilişkili olduğu öne sürülmüştür. Böylelikle biz bu araştırmada posterior bölgeler özellikle olacak şekilde bazı beyin bölgelerini araştırmayı hedefledik. SCT komorbiditesi olan DEHB li çocuklarda spesifik beyin bölgelerinde kontrol grubuna kıyasla farklı bir pattern gösterip göstermediğini ölçmeyi amaçladık. SCT grubu 40 olgudan ve kontrol grubu 24 olgudan oluştu. MR çekimlerinde go-nogo testi kullanıldı ve Arterial Spin Labelling kullandığımız yöntemdi. MR verisinin istatiksel analizi go task i sırasında hem hasta hem kontrol grubunda aktivasyon olduğunu gösterdi. Bu aktivasyon en yaygın olarak SCT komorbid DEHB-Dikkat eksikliği baskın alt tipinde görüldü. No go task sırasında tüm hasta grubu ve koNtrol grubunda aktivasyon gözlendi fakat her iki hasta grubu arasında anlamlı istatiksel farklılık yoktu. Lingual gyrus, occipital fusiform gyrus, precuneus, posterior cingulat gyrus’un bazal(dinlenim) ve aktive halleri arasında anlamlı istatiksel farklılık görüldü. Bu dikkat sorunlarının geri döndürülmesi için bir kompansasyon mekanizmasına bağlı olabilir olarak düşünüldü. Sonuç olarak çalışmamızda hipotezimize paralel olarak posterior beyin bölgelerinde bozulma saptadık.Sluggish Cognitive Tempo is a clinical symptom cluster characterised with drowsy appearance, slow moving, slow thinking and internalizing symtomts. Variety of researchs in the field of SCT have just been emerged during last 20 years. It is stated that posterior brain regions are associated with attention deficits and early data processing and sustained attention is impaired in SCT cases. Therefore we targeted to investigate several brain areas, particularly posterior ones in this study. We aimed to measure differences in the specific brain regions in children with SCT comorbid ADHD in order to explore whether they show different pattern in comparison to control group. SCT group was comprised of 40 subjects and control group was 24. The go/no-go test paradigm was used during MRI scan sessions and arterial spin labelling was the technique which we used. Statistical analysis of MR data demonstrated activation in both patient and control group during “go” task. This activation was much more widespread in the patients with SCT comorbid ADHD-Inattention subtype. Activation was revealed in both patient and control group but there was no significant difference between patient subgroups. Significant difference between the resting and active state of lingual gyrus, occipital fusiform gyrus, precuneus, posterior cingulate cortex was noted. It was thought that this may be related to cerebellar compensating mechanism to reverse attention deficits. In sum paralel with our hypothesis we detected impairment in posterior brain regions in this study

Evaluation of a Neuropsychiatric Disorder: From PANDAS to PANS and CANS

WOS: 000379451400009PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) syndrome is a disorder seen before adolescence that possesses an abrupt onset of obsessive compulsive disorder symptoms and/or tics. Swedo and colleagues defined this disorder in 1998 as a syndrome related to Group A streptoccoccus (GAS) infection with neurological issues, such as motor hyperactivation and choreiform movements. The progress of the disorder may be described as wax-and-waning, apart from abrupt onset, and this relapse and remission course is associated with exacerbating infections, according to the creators of PANDAS syndrome Ruling out of Rheumatoid Fever and Sydenham's Chorea was a necessity for making a proper diagnosis. Since the recognition of this syndrome, clinicians encountered many children who could not fulfill all 5 criteria, which must be met for PANDAS diagnosis. In addition, due to literature showing failure and lack of strong evidence of a major role of GAS, the newly-defined categories PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and CANS (Childhood Acute Neuropsychiatric Syndrome) were created to encompass those of "almost met" non-PANDAS cases. PANS and CANS include concurrent significant psychiatric symptoms with abrupt onset of OCD symptoms and/or tics but do not require identification of any infection agent, immune dysfunction, or enviromental precipitants. In this paper, we aimed to discuss PANS/CANS, alterations of PANDAS, and diagnoses in which "almost met" PANDAS patients should be classified on the basis of a case who developed an abrupt onset of anxiety, obsessions, and vocal tics

Nöropsikiyatrik Bir Hastalığın Evrimi: PANDAS'tan PANS ve CANS'a

PANS and CANSPANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) syndrome is a disorder seen before adolescence that possesses an abrupt onset of obsessivecompulsive disorder symptoms and/or tics. Swedo and colleagues defined this disorder in 1998 as a syndrome related to Group A streptoccoccus (GAS) infection with neurological issues, such as motor hyperactivation and choreiform movements. the progress of the disorder may be described as wax-and-waning, apart from abrupt onset, and this relapse and remission course is associated with exacerbating infections, according to the creators of PANDAS syndrome. Ruling out of Rheumatoid Fever and Sydenham's Chorea was a necessity for making a proper diagnosis. Since the recognition of this syndrome, clinicians encountered many children who could not fulfill all 5 criteria, which must be met for PANDAS diagnosis. in addition, due to literature showing failure and lack of strong evidence of a major role of GAS, the newly-defined categories PANS (Pediatric Acute-onset Neuropsychiatric Syndrome) and CANS (Childhood Acute Neuropsychiatric Syndrome) were created to encompass those of "almost met" non-PANDAS cases. PANS and CANS include concurrent significant psychiatric symptoms with abrupt onset of OCD symptoms and/or tics but do not require identification of any infection agent, immune dysfunction, or enviromental precipitants. in this paper, we aimed to discuss PANS/ CANS, alterations of PANDAS, and diagnoses in which "almost met" PANDAS patients should be classified on the basis of a case who developed an abrupt onset of anxiety, obsessions, and vocal tics.PANDAS (Streptokok enfeksiyonu ile ilişkili pediatrik otoimmün nöropsikiyatrik hastalıklar) sendromu ergenlik dönemi öncesinde görülen ani başlangıçlı obsesif kompulsif bozukluk belirtileri ve/veya tikler ile ortaya çıkan bir hastalıktır. Bu hastalık Grup A Streptokok (GAS) enfeksiyonuyla birlikte, motor hiperaktivite ve koreiform hareketler gibi nörolojik bulgularla ilişkilidir. Hastalığın gidişatı ani başlangıç haricinde alevlenip sönmelerle gidebilmektedir ve PANDAS sendromu tanımlayıcılarına göre bu nüks ve iyileşmelerle giden gidişat, tetikleyici enfeksiyonlarla ilişkilidir. PANDAS tanısını koymak için Romatizmal Ateş (RA) ve Sydenham Koresi'nin dışlanması gerekmektedir. Sendromun tanımlanmasından sonra klinisyenler PANDAS sınıflaması için gerekli 5 ölçütün tamamını karşılayamayan hastalarla karşılaşmışlardır. GAS enfeksiyonun önemli rolü olduğuna dair kanıt eksikliğini ve yokluğunu gösteren yazın bulguları üzerine, "arada kalmış" PANDAS hastalarını karşılamak için yeni tanımlanmış PANS (Pediatrik Akut başlangıçlı Nöropsikiyatrik Sendrom) ve CANS (Çocukluk çağı Akut Nöropsikiyatrik Sendrom) sınıflandırmaları oluşturulmuştur. PANS ve CANS ani başlangıçlı OKB ve/veya tik bulgularıyla ilişkili psikiyatrik bulguları içermekte fakat herhangi bir enfeksiyon etkeninin, immün disfonksiyonun ya da çevresel tetikleyicilerin tanımlanmasına ihtiyaç duymamaktadırlar. Biz bu yazıda enfeksiyon sonrası ani başlangıçlı kaygı, obsesyon, vokal tik geliştiren bir olgu üzerinden PANS/CANS tanısını tartışmayı amaçladık. PANDAS sınıflama kriterlerinin gelişimini ve "arada kalmış" PANDAS hastalarının hangi tanı başlığında sınıflandırılabileceğini tartıştık

Risperidone, quetiapine and chlorpromazine may have induced priapism in an adolescent

WOS: 000369305300014PubMed ID: 26542690Priapism is the prolonged, painful erection of penile tissue not accompanied by sexual arousal. Priapism has been established as a rare adverse drug reaction to drugs such as antipsychotics, psychostimulants, antidepressants, and mood stabilizers. Immediate intervention is needed to prevent destructive and irreversible complications, such as erectile dysfunction, disfigurement, inability of the penis to stay erect, and related social/emotional problems. Antipsychotic-induced priapism may result from the alpha receptor occupancy property of those drugs. We report the case of a 13-year-old suffering from attention deficit-hyperactivity disorder plus conduct disorder with priapism related to antipsychotics. Episodes occurred with risperidone plus methylphenidate, quetiapine plus methylphenidate, and chlorpromazine alone

DIFFUSION TENSOR IMAGING FINDINGS IN CHILDREN WITH SLUGGISH COGNITIVE TEMPO COMORBID ADHD

WOS:000544087501097[No Abstract Available]Ege University Scientific Research Projects Coordination UnitEge University [16-TIP-047]Supported by the Ege University Scientific Research Projects Coordination Unit-Project 16-TIP-04