Hiccup Due to Aripiprazole Plus Methylphenidate Treatment in an Adolescent with Attention Deficit and Hyperactivity Disorder and Conduct Disorder: A Case Report

Our case had hiccups arising in an adolescent with the attention deficit and hyperactivity disorder (ADHD) and conduct disorder (CD) after adding aripiprazole treatment to extended-release methylphenidate. Actually, antipsychotics are also used in the treatment of hiccups, but studies suggest that they can cause hiccups as well. Within 12 hours of taking 2.5 mg aripiprazole added to extended-release methylphenidate at a dose of 54 mg/day, 16-year-old boy began having hiccups in the morning, which lasted after 3-4 hours. As a result, aripiprazole was discontinued and methylphenidate was continued alone because we could not convince the patient to use another additional drug due to this side effect. Subsequently, when his behavior got worsened day by day, his mother administered aripiprazole alone again at the dose of 2.5 mg/day at the weekend and continued treatment because hiccup did not occur again. But when it was administered with methylphenidate on Monday, hiccup started again next morning and lasted one hour at this time. In conclusion, we concluded that concurrent use of methylphenidate and aripiprazole in this adolescent led to hiccups

Neuroleptic malignant syndrome due to risperidone misdiagnosed as status epilepticus

Neuroleptic malignant syndrome (NMS) is a rare but potentially fatal disease characterized by fever, muscle rigidity, delirium and autonomic instability. Here we report a child, with NMS due to the risperidone misdiagnosed as status epilepticus. Nine year old boy, who had been under high dose risperidone treatment for 8 weeks, admitted to the emergency room because of the contractions (evaluated as status epilepticus) persisting for 7 hours. Since there was neuroleptic treatment in the past medical history and, unconsciousness, muscular rigidity, diaphoresis, hypertermi and, hypotension in physical examination, leucocytosis and elevated creatininphosphokinase levels in laboratory tests, the patient was evaluated as NMS and discharged without any complications. We reported this case to point out that; NMS may be misdiagnosed as status epilepticus in children when EEG monitoring is unavailable. When a child admitted to the emergency room because of suspicious convulsion neuroleptic drug use must surely be asked

Dystonia in an Adolescent on Risperidone Following the Discontinuation of Methylphenidate: A Case Report

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder with common comorbidities that include oppositional defiant disorder, conduct disorder, anxiety disorder, and affective disorders. Because of these comorbidities, drug combination treatments and drug drug interactions are becoming increasingly more frequent. The present case report describes an acute dystonic reaction following the abrupt discontinuation of methylphenidate from a drug regimen with risperidone. The patient experienced acute dystonic reactions on three separate occasions when he forgot to take his methylphenidate medication. The present report informs clinicians about the possible side effects, such as dystonia, when psychostimulant and antipsychotic drug combinations are altered and suggests that the abrupt cessation of stimulants may lead to the development of movement disorders, Therefore, appropriate care is necessary when changing the dose of a drug or abruptly discontinuing a drug from a combination of psychostimulants and antipsychotics

Abused-Abuser Dilemma in Sexual Abuse and Forensic Evaluation: a Case Report

The factors such as having family problems, growing up in a disintegrated family, having parents with personality disorders, expressing physical and mental deficiencies, history of alcohol and substance abuse, previous history of sexual abuse, and lack of social support may increase the risk of being exposed to sexual abuse. According to the previous studies about one-third of children who are subjected to abuse may become abusers in the future. In such a condition, a dilemma of abuse-abuser has been experienced. Importantly, additional medical mistakes and lack of experience in such cases make legal evaluation processes more complex. In this case report, we discussed a pediatric patient who was abused by a babysitter with a history of abuse in her adolescence. Early recognition of sexual abuse, treatment of developing psychiatric disorders, and a follow-up program are necessary to minimize the vicious cycle of abused-abuser

The High Level of Psychiatric Disorders Associated with Migraine or Tension-type Headache in Adolescents

Objectives: This study aimed to evaluate the relation between psychiatric disorders, andmigraine or tensiontype headache (TTH), together with severity of depression and anxiety symptoms, in adolescents with headache. Methods: Headache types of 140 adolescents aged 12 to 18 years were investigated by a headache specialist, through facetoface interviews according to the diagnostic criteria of International Classification of Headache Disorders, 3rd edition beta version (ICHD3 beta). Psychiatric disorders of participants were assessed via DSMIV diagnostic criteria. Sociodemographic information form, Depression Scale, and the StateTrait Anxiety Scale for Children were applied to the patients accordingly. Results: Higher rates of psychiatric disorders (82%) were observed in the migraine and tensiontype headache (TTH) groups. The most frequent comorbid psychiatric disorder was anxiety disorder. In patients with TTH, the number of attacks was statistically higher. In patients with migraine, the frequency of throbbing headache was elevated with the co-occurrence of anxiety disorder and attention deficit hyperactivity disorder (ADHD). In patients with TTH, the description of worsening of pain with movement was raised with anxiety disorder comorbidity. A weak correlation existed between headache prevalence and headache severity in patients with migraine. Similarly, in the TTH group, a weak association between headache prevalence and depressionanxiety scores were reported. Conclusions: Our findings support the association between migraine or TTH and anxiety and depression symptoms in adolescents. This highlights the importance of headache considering possible comorbid psychiatric disorders. This implies a necessity for multidisciplinary and prospective clinical studies to make clear the importance of the chronification hypothesis

Achalasia as a complication of bulimia nervosa: A case report

Objective: Oesophageal achalasia is a medical condition characterised by oesophageal aperistalsis, an increased resting pressure with partial or incomplete relaxation of the lower oesophageal sphincter. Bulimia nervosa (BN) is an eating disorder manifested by binge eating attacks followed by recurrent inappropriate compensatory behaviours, such as self-induced vomiting and excessive exercise. Dysphagia, regurgitation, vomiting, retrosternal pain, heartburn, weight loss, avoidance of eating, consumption of large amount of liquids and aberrant eating behaviours are symptoms of both achalasia and BN. Owing to these common signs and symptoms, oesophageal achalasia can be misdiagnosed as an eating disorder. In addition, oesophageal achalasia can occur as a complication of BN. It is often difficult to distinguish organic and psychological vomiting or comorbidity because of overlapping of the symptoms. Case report: We report the case of a patient who developed oesophageal achalasia following severe, repetitive vomiting as a complication of BN. Conclusion: We want to raise awareness regarding the development of a medical illness in the presence of a psychiatric disorder. Importantly, physicians should have a fundamental knowledge of these two diseases regarding their clinical patterns to differentially diagnose one or both disorders as quickly as possible

Cutaneous allergic reaction due to alprazolam in a child

Cutaneous allergic reactions due to drug intake may be triggered by many types of drugs such as atropine, anticonvulsants and benzodiazepines. But allergic reactions due to benzodiazepines are extremely rare. Alprazolam is a benzodiazepine which may be useful for refractory idiopathic urticaria due to antihistaminergic effect. Although antihistaminergic effect of alprazolam, a cold urticaria case and an angioedema case induced by alprazolam are known in the literature. In the case, we present a child suffering from cutaneous allergic reaction due to alprazolam at the first dose taken

Determination of Beliefs, Attitudes of Consulting Teachers towards Mental Diseases, and Referral Reasons of Their Students to a Child and Adolescent Psychiatrist

Objective: In the present study, the aim was to evaluate the beliefs and attitudes of school counselors about mental illnesses, and reasons why counselors referred students to psychiatrists. Method: The study was carried out with 118 school counselors. Data were collected with sociodemographic information form and Beliefs toward Mental Illness Scale (BMIS). Results: According to study results, 15.3% of school counselors stated that they referred to a psychiatrist for their own psychological problems at some time, and 32% of subjects referred their own children to a child and adolescent psychiatrist. The proportion of teachers who referred their students to a child and adolescent psychiatrist was 89.8%. Scores of school counselors were 80.41 +/- 9.32 in overall BMIS, 28.82 +/- 5.35 in dangerousness, 43.83 +/- 4.93 in poor social and interpersonal skills, and 7.76 +/- 1.81 points in incurability subscales. No statistically significant relationship was determined between mean scores of participants and gender, age, marital status, institution where they work, working duration, and graduate program they attended. The four most frequent student referral causes were conduct disorder (31.10%), attention deficit (16.10%), depressive mood (14.72%) and hyperactivity (12.20%). Conclusion: It is noticed that school counselors have negative beliefs about mental disorders, feel shame because of them, and they regard these patients dangerous. On the other hand, participants believe that these disorders lead to despair in individuals and impair interpersonal communication. According to the literature search, this study is the first investigating beliefs and attitudes of school counselors about mental illnesses, and reasons why they refer students to psychiatrists

No Association between Polymorphisms of Vitamin D and Oxytocin Receptor Genes and Autistic Spectrum Disorder in a Sample of Turkish Children

Objective: Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairment in social skills and communication with repetitive behaviors. Etiology is still unclear although it is thought to develop with interaction of genes and environmental factors. Oxytocin has extensive effects on intrauterine brain development. Vitamin D, affects neural development and differentiation and contributes to the regulation of around 900 genes including oxytocin receptor gene. In the present study, the contribution of D vitamin receptor and oxytocin receptor gene polymorphisms in the development of ASD in Turkish community was investigated. To our knowledge, this is the first study examining these two associated genes together in the literature. Methods: Eighty-five patients diagnosed with ASD according to DSM-5 who were referred to outpatient clinics of Child and Adolescent Psychiatry of Baskent University and Mersin University and 52 healthy, age and gender-matched controls were included in the present study. Vitamin D receptor gene rs731236 (Taq1), rs2228570 (Fok1), rs1544410 (Bsm1), rs7975232 (Apa1) polymorphisms and oxytocin receptor gene rs1042778 and rs2268493 polymorphisms were investigated using real time polymerase chain reaction method. Results: No significant difference between groups in terms of distribution of genotype and alleles in each of polymorphisms for these genes could be found. Conclusion: Knowledge of genes and polymorphisms associated with the development of ASD may be beneficial for early diagnosis and future treatment. Further studies with larger populations are required to demonstrate molecular pathways which may play part in the development of ASD in Turkey