Effectıveness of family focused therapy-early onset young on adolecence wit bipolar disorder: Prelımınary results of a pılot study

Amaç: Bu çalışmanın amacı Bipolar Bozukluk (BB) tanısı olan ve ilaç tedavisi almakta olan 12-18 yaş arası ergenlerde Aile Odaklı Terapi- Yüksek Risk Grubu (AOT-YRG) uygulamasının ergenlerdeki BB belirtilerinin ve hastalık şiddetinin üzerine etkisini değerlendirmektir. Bu değerlendirmeye ek olarak, uygulamanın BB tanılı ergenlerin yaşam kalitesi, ailelerinin işlevselliği ve ebeveynlerinin depresif belirtileri üzerine etkilerinin değerlendirilmesi amaçlanmaktadır. Yöntem: Çalışma randomize kontrollü olarak planlanmıştır. Araştırmanın olgu grubu 8 ergen ve ebeveyninden, kontrol grubu ise 6 ergen ve ebeveyninden oluşturulmuştur. Sosyo-demografik Veri Toplama Formu, Okul Çağı Çocukları İçin Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi-Şimdi ve Yaşam Boyu Versiyonu (ÇDŞG-ŞY), Çocuklar için Depresyon Derecelendirme Ölçeği (ÇDDÖ), Young Mani Derecelendirme Ölçeği (YMDÖ), Duygudurum Şiddeti İndeksi (DŞİ), Çocuklar için Genel Değerlendirme Ölçeği (ÇGDÖ), Klinik Global İzlenim Ölçeği- hastalık şiddeti (KGİÖ-HŞ) klinisyen tarafından değerlendirilmiştir. Çocuklar İçin Yaşam Kalitesi Ölçeği (ÇİYKO) gençler ve ebeveynlere, Aile Değerlendirme Ölçeği (ADÖ), Beck Depresyon Ölçeği (BDÖ) ebeveynlere verilerek doldurulması sağlanmıştır. Olgu grubuna 16 hafta süren Aile Odaklı Terapi- Yüksek Risk Grubu uygulanmıştır. Veriler uygulama başlamadan önce ve uygulama bitiminin sonrasında toplanmıştır. Veriler Mann Whitney-U testi, Willcoxon işaretli sıralar testi, ki-kare analizi, Pearson korelasyon analizi kullanılarak değerlendirilmiştir. Bulgular: Çalışmaya katılan olguların yaş ortalaması 16,29±1,26, katılanların 8 tanesi kız (%57,1), 6 tanesi erkekti (%42,9). AOT-YRG uygulaması ile olgu grubunda kontrol grubuna göre ÇGDÖ puanlarında anlamlı artış ve KGİÖ-HŞ, ÇDDÖ, YMDÖ, DŞİ puanlarında anlamlı azalma bulunmuştur. ADÖ alt ölçeklerinden problem çözme, iletişim, aile içi roller, affektif duyarlılık, affektif bağlılık, davranış kontrolü ve genel işlevsellik alt ölçek puanlarının istatistiksel olarak anlamlı azalma, ÇİYKO alt ölçeklerinden ise duygusal işlevsellik, sosyla işlevsellik ve okul işlevselliği ve ölçek toplam skorlarında istatistiksel olarak anlamlı artış saptanmıştır. Uygulama ile ebeveynlerin depresif belirtilerinde istatistiksel olarak anlamlı azalma saptanmıştır. Tartışma: Bulgularımız AOT-YRG' nun BB belirtileri ve hastalık şiddeti, olguların yaşam kalitesi ve işlevsellikleri ile aile işlevselliği üzerine olumlu etkileri olduğunu göstermektedir ancak daha geniş örneklemlerle desteklenmeye ihtiyaç vardır. Purpose: The aim of this study is to evaluate the effectiveness of Family Focused Therapy- Early Onset Young (FFT-EOY), on depressive and manic symptoms, severity of disease, functionality of adolescence who are between 12 and 18 years-old and have Bipolar Disorder (BD) with used medication. An additional aim is to evaluate potential effects of FFT-EOY on life quality and family functioning of adolescence diagnosed with Bipolar Disorder and severity of depressive symptoms of their parents. Method:The study is a randomized controlled design. The sample of the study consisted of 14 adolescence, aged between 12-18 years, diagnosed with bipolar disorder confirmed by K-SADS-PL. Following randomization into two groups, cases participated in FFT-EOY for 16 weeks where as the control group did not. The two groups were compared right before and after the implementation on rates of sociodemographic, symptom severity and other variables. Sociodemographic data form, Chilren's Depression Rating Scale (CDRS), Young Mani Rating Scale (YMRS), Mood Severity Index (MSI), Children's Global Assessment Scale (CGAS) and Clinical Global Impression-Severity (CGI) are assessed by clinician. Data were collected by using Pediatric Quality of Life Inventory (PedsQL) that filled out by adolescence and parents, Family Assessment Device (FAD) and Beck Deprssion Inventory (BDI) that filled out by young and parents. The study data were evaluated with Mann Whitney U, Wilcoxon signed rank test, chi-square analysis, Person's correlation analysis. Findings: The average age of the cases participating in the study was 16,29±1,26, 8 of participants were female (%57,1), 6 of participants were male (%42,9). When we compared the results before and after the implementation of AOT-YRG in the case group, it was found that statiscally significant increase in CGAS scores, statiscally significant decrease in CGI, CDRS, YMRS and MSI scores. Also statiscally significant incrase in emotional, social and school functioning of adolescence and statiscally significant decrease in parent's BDI scores and problem solving, communication, roles in family, affective sensivity, affective cohesion, behaviour controlling, generel functioning subscale scores in FAD was found. Conclusions: Due to the results of our study we consider that AOT-YRG can be useful in the treatment of Turkish adolescence diagnosed with BD but further more studies about AOT-YRG on adolescence diagnosed with BD are needed

Evaluation of awake electroencephalography findings in children with attention deficit hyperactivity disorder before psychostimulant treatment

Attention deficit hyperactivity disorder is one of the most common neuropsychiatric disorders in childhood. Electroencephalographic abnormalities may be observed but it is controversial to perform electroencephalography before starting the treatment. Awake electroencephalography findings, demographic and psychometric variables of patients with attention deficit hyperactivity disorder treated between January 2005 and December 2010 were retrospectively evaluated. The study included 386 patients aged 4-18 (mean 9.61±3.04) years, who were diagnosed with attention deficit hyperactivity disorder according to the DSM-IV-TR (2000) diagnostic criteria. Epileptiform electroencephalography pattern was observed in 22/386 (5.7%) patients. Seven of 386 (1.8%) patients had a history of epilepsy diagnosis and antiepileptic medication. When patients with seizure history (with or without epilepsy diagnosis) and those with epileptic abnormalities on electroencephalography were excluded, the incidence of epileptiform abnormalities in attention deficit hyperactivity disorder patients was 12/386 (3.1%). After psychostimulant medication, epileptic seizures occurred in only three patients with epilepsy. The prevalence rate of epileptiform discharges on awake electroencephalography, observed in attention deficit hyperactivity disorder patients before psychostimulant treatment is similar to that in healthy schoolchildren. Since the seizures increased only in epileptic patients, we do not recommend routine awake electroencephalography evaluation in children with attention deficit hyperactivity disorder before psychostimulant medication

Sleep Structure in Children With Attention-Deficit/Hyperactivity Disorder

The authors evaluated basic sleep architecture and non-rapid eye movement (NREM) sleep alterations in drug-naive attention-deficit/hyperactivity disorder (ADHD) children without psychiatric or other comorbidities. This cross-sectional case-control study included 28 drug-naive children with ADHD and 15 healthy controls. This subjective studies revealed that children with ADHD had a worse sleep quality and increased daytime sleepiness. Polysomnography data showed that the sleep macrostructure was not significantly different in children with ADHD. Sleep microstructure was altered in ADHD children by means of reduced total cyclic alternating pattern rate and duration of cyclic alternating pattern sequences. This reduction was associated with a selective decrease of A1 index during stage 2 NREM. SpO2 in total sleep was slightly decreased; however, the incidence of sleep disordered breathing showed no significant difference. The authors suggest that cyclic alternating pattern scoring would provide a further insight to obtain a better understanding of the sleep structure in children with ADHD