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

Neurodevelopmental Disorders and Sensory Processing

Sensory processing is defined as the coordination and integration of the sensory inputs received by the brain through the tactile, visual, auditory, olfactory, gustatory, vestibular, proprioceptive and interoceptive senses, and generating appropriate responses. Although interpersonal differences in sensory processing exist among healthy individuals, specific differences in sensory profile and sensory processing problems are encountered in some of the psychopathologies. Variations in sensory processing and associated clinical conditions are present among many neurodevelopmental disorders (NDDs) including principally autism spectrum disorder and others such as attention-deficit/hyperactivity disorder, intellectual disability, tic disorder and Tourette’s syndrome. In this article, studies on sensory processing in NDDs are reviewed. According to studies; symptom severity, comorbidities, adaptive behaviors, functionality, daily life activities, and participation in activities are associated with sensory processing differences and difficulties in NDDs. The sensory processing difficulties are posited to be based on differences in the activity of peripheral and central sensory systems. Neurophysiological and neuroimaging studies have tried to explain and enlighten the mechanisms underlying these problems. In this context, the main mechanisms are thought to be related to somatosensory inhibition, sensory gating, multiple sensory integration defects, and differences in gamma aminobutyric acid concentrations. There have been an increasing number of recent studies on sensory processing in NDDs. In this field, further randomized controlled studies supported by neurophysiological and neuroimaging techniques are needed. Due to the relationships between sensory processing features and the clinical symptoms of NDDs that they accompany, those features should be borne in mind in clinical evaluations and in treatment programs of children and adolescents

OTİZM YELPAZE BOZUKLUKLARINDA NÖROPSİKOLOJİK PROFİL

Objective: In this Article, we aimed to review the theory of mind, executive functions and weak central coherence diffi culties in autism spectrum disorders (ASD). Method: We browsed the pubmed search engine by using keywords “Autism, autistic spectrum disorders, theory of mind, social cognition, executive functions, central coherence, weak central coherence” and extended the search by scanning related Articles, reviewing collected data. Results: A wide range of studies with different methods from relatively easy false belief test and deception tests to more complicated ToM tasks (Strange Stories Test, Reading The Mind in the Voice/Films/Eyes tests) were with defi cits in the ASD group. It is well documented that ASD group has some executive function defi cits like defi cits in cognitive fl exibility, planning, generativitiy, and spatial working memory. Along with these defi cits, ASD group performed better on the visuospatial tasks that evaluated the weak central coherence than controls while they showed a global advantage on a hierarchization task (e.g. Navons’ hierarchical fi gures) similar to the controls; however they had defi cits in the verbal-semantic fi eld. Discussion: Identifi cation of the specifi c cognitive profi les in ASD is important since it is believed that it shall have an impact on discovering the responsible genetic factors as well as contributing to aproppriate educational approaches. However it is also clear that attempting to explain ASD signs with only one theory will fail inevitably since ASD is an also heterogeneous group within itself.Amaç: Bu makalede; Otizm Yelpaze Bozukluklarında (OYB), Zihin Kuramı (ZK), Yürütücü İşlevler ve Zayıf Merkezi Bütünleştirme güçlüklerinin gözden geçirilmesi amaçlanmıştır. Yöntem: PubMed arama motoru ile “autism (otizm), autism-spectrum disorders (otizm yelpaze bozuklukları), theory of mind (zihin kuramı), social cognition (sosyal biliş), executive functions (yürütücü işlevler), central coherence (merkezi bütünleştirme), weak central coherence (zayıf merkezi bütünleştirme)” anahtar kelimeleri kullanılarak ve ayrıca ilişkili makaleler taranarak çalışmalara ulaşılmış ve veriler gözden geçirilmiştir. Sonuçlar: OYB grubunda, gerek göreceli daha basit yanlış inanç testleri ve aldatma testlerinin kullanıldığı çalışmalarda gerekse daha karmaşık hikâyelerden, gözlerden ve sesten başkasının niyetini algılamayı ölçen gelişmiş ZK testlerinde, bozukluklar gösterilmiştir. OYB grubunda, bilişsel esneklik, üretebilirlik, planlama ve uzamsal işleyen bellek gibi yürütücü işlevlerde yetersizlikler saptanmıştır. Bu yetersizlikler yanı sıra otizm grubunda zayıf merkezi bütünleştirmeyi değerlendiren görsel-uzaysal testlerde kontrollere göre daha iyi performans ve Navon Hiyerarjik Figürler testinde kontrol grupları gibi global bir avantaj gösterildiği, ancak sözel-semantik alanda yetersizlikler gözlendiği belirtilmektedir. Tartışma: OYB’de özgün bilişsel yapıların belirlenmesinin, hastalıklardan sorumlu genetik faktörlerin keşfi nde önemli olabileceği gibi uygun eğitsel yaklaşımlara da katkı sağlayabileceği düşünülmektedir. Ancak kendi içinde de heterojen bir grup olan OYB belirtilerini tek teori ile açıklamaya çalışmanın yetersiz kalacağı açıktır

Çoklu Antipsikotik İlaç Kullanımı ile Tetiklenen Atipik Nöroleptik Malign Sendromda Antipsikotik İlaç Başlama Güçlükleri: Cotard Sendromu Olgusu

Nöroleptik malign sendrom (NMS), nöroleptik ajanların kullanımıyla ortaya çıkan, bilinçte değişiklikler, rijidite, ateş yüksekliği ve otonomik değişiklikler ile karakterize olan, nadir fakat ölümcül bir idiosenkratik reaksiyondur. Cotard sendromu ise, kişinin bedeni ya da yaşamı ile ilişkili nihilistik sanrılarla karakterize bir sendromdur. Bu olgu sunumu ile, NMS sonrasında katatoni ve Cotard sendromu gelişen hastada, ayırıcı tanıları ve tedavi planını literatür eşliğinde tartışmayı amaçladık.Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal idiosyncratic reaction to neuroleptics and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia. Cotard's syndrome is characterized by the appearance of nihilistic delusions concerning one's own body or life. By presenting this case, we aim to discuss the differential diagnosis and treatment plan of a patient with catatonia and Cotard's syndrome, which were noted after NMS, in light of the literature

Antipsychotic Drugs Rechallenge in Multi-antipsychotic Drug Induced Atypical Neuroleptic Malignant Syndrome: A Case of Cotard’s Syndrome

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal idiosyncratic reaction to neuroleptics and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia. Cotard’s syndrome is characterized by the appearance of nihilistic delusions concerning one’s own body or life. By presenting this case, we aim to discuss the differential diagnosis and treatment plan of a patient with catatonia and Cotard’s syndrome, which were noted after NMS, in light of the literature

ICP-MS Analysis and Validation by Microwave Digestion System for Determination of Heavy Metals in Allergy and Cancer Drugs Taken Orally

The drug, one of the most important products that cannot be replaced in the field of health, prevents all threats to human health when used in place and dosage. Therefore, it has an important place in public health. Determination of the amounts and impurities of various elements used in drug production is an important parameter. According to the ICH Q3D(R1) international compliance conference guide, methods by which limit concentrations can be determined for elemental impurities by applying inductively coupled plasma (ICP) analysis to drugs are specified. In this study, the sample preparation step in the analysis of 23 elements in cancer and allergy drugs in tablet form was optimized by microwave digestion, and method development and validation studies were carried out for these drugs with inductively coupled plasma-mass spectrometry (ICP-MS). When the analysis results were evaluated, it was seen that the data obtained were by the limit values specified in the ICH. Detection and quantification limits of the developed method, and relative standard deviation values were determined, and recovery studies were carried out by adding standards at 4 different concentrations to determine the method's precision. The correlation coefficients obtained for heavy metals in this study ranged from 0.9993 to 1.000, while the detection limit was found to be between 0.001 and 1.756 µg/L. Thus, the reliability and precision of the validation study developed has been determined and it has been shown that this method can be used in similar drug samples

Social cognition in pervasive developmental disorders

Otizmin de içinde bulunduğu yaygın gelişimsel bozukluklar (YGB) iletişim, sosyal biliş ve duygusal işaretlerin işlenmesi gibi kişiler arası ilişkileri oluşturan birçok alanda ciddi ve süregen bozukluklarla karakterize, genetik temelleri olan ve anormal beyin gelişiminin görüldüğü nörogelişimsel hastalıklardır. Otistik bozukluk (OB) ve diğer YGB’si olan çocuklardaki bilişsel yetersizlikler; zihin kuramı bozukluğu, yürütücü işlev bozukluğu ve zayıf merkezi bütünleşme gibi nöropsikiyatrik modellerle açıklanmaya çalışılmaktadır. Bu makalede YGB’de sosyal bilişi açıklamaya çalışan zihin kuramı ve sosyal bilişin nörobiyolojik temellerinin gözden geçirilmesi amaçlanmıştır. OB ve diğer YGB’deki sosyal biliş ve zihin kuramını inceleyen çalışmalara PubMed arama motoru kullanılarak ulaşılmış ve elde edilen veriler bu derleme kapsamında ele alınmıştır. Sosyal biliş, diğerlerinin düşüncelerini ve niyetlerini anlayabilme aracılığıyla onların davranışlarının anlamını çıkarabilme, öngörebilme ve karmaşık sosyal çevreler ile etkileşime girebilme yeteneği olarak tanımlanabilir. Zihin kuramı yetersizliği OB’deki temel sorunlardan biridir ve otizmi olan bireylerde zihinsel süreçlerin kavranmasında, kendi zihinsel temsillerinin ve diğer insanların zihinsel temsillerinin kavranmasında yetersizlik bulunmaktadır. OB olan bireylerde, normalde olması gereken, yüz tanıma, göz göze ilişki kurma, yüzdeki emosyonu okuma gibi, kişilerarası ilişkilerin ve sosyal gruptaki işlevselliğin önemli bir parçası olan sosyal işlevlerin bozukluğu söz konusudur. Sosyal biliş ile ilişkili beyin alanları; frontal lob, temporal lob, ön singulat korteks, fusiform girus, amigdala, ve arka assosiasyon korteksi ile bunların iç bağlantılarıdır. Fusiform girus ve amigdala yüz tanıma ve algılamasında görev alır ve yapılan çalışmalarda özellikle erken gelişim dönemlerinde amigdaladaki bir bozukluğun, ileride yüz kimliği ve yüz ifadelerinin dışavurumunu algılamada sosyal algısal bozukluklara yol açtığından bahsedilmektedir. YGB’si olan bireylerin yüzleri algılarken fusiform girus aktivasyonunda düşüklük saptanmıştır. Amigdalanın fusiform girus üzerine düzenleyici bir etkisi bulunduğundan, amigdala lezyonlarında, emosyon yüklü yüzlere karşı fusiform girusdaki azalmış aktivasyon, amigdaladaki işlevsizliğin derecesiyle bağlantılıdır. Birçok çalışmanın ortak bulgusu, OB’deki fusiform girus hipoaktivasyonunun amigdalaya bağlı bazı süreçlerden kaynaklandığı yönündedir. OB olan bireylerde, gözlerin bakış yönü, hareketleri ve karşıdaki kişinin beden hareketlerinden sosyal uyaranın anlaşılmasında rolü bulunan üst temporal sulkusun hipoaktivasyonu ve anormal hacim ölçümleri saptanmıştır. Temelde bir sosyal biliş bozukluğu olduğunu söyleyebileceğimiz OB, beynin bu sistemlerinin mikroskopik ve/veya makroskopik düzeydeki aksaklıklarına bağlı olarak açığa çıkmaktadır. Sonuç olarak, OB ve diğer YGB’de sosyal biliş nörobiyolojisine bakıldığında, erken bebeklikte amigdalada ve amigdalanın fusiform girus, üst temporal sulkusu içeren diğer temporal alanlarla bağlantısında varolan bir bozukluğun, çocuğun yüzlere ve diğer sosyal olarak anlamlı olan uyaranlara karşı ilgisinin azalmasına ya da yok olmasına neden olduğu görülmektedir. Bu da normal uyarana bağlı aktivasyon gerektiren fusiform girus gibi beyin bölgelerinin normal gelişimlerinden sapmasına neden olduğu anlaşılmaktadır. Otizmdeki sosyal kognisyon sorunlarının anlaşılması üzerine çalışırken, temelde bilinmesi gereken şey, otizmin bir tek nöroanatomik yapı ya da döngünün hastalığı değil, daha yaygın, birçok nöronal sistemin etkilendiği nörogelişimsel bir bozukluk olduğudur.Pervasive developmental disorders (PDDs) and autistic disorder (AD) are neurodevelopmental disorders with genetic basis and abnormal brain development, and characterized by severe and permanent deficits in many interpersonal relation areas like communication, social cognition and processing of emotional signs. Cognitive impairments in AD and other PDDs are tried to be explained by neuropsychiatric models like theory of mind deficits, executive dysfunction and weak central coherence. This article aimed to review neurobiological bases of social cognition and theory of mind which try to explain social cognition. PubMed medical search engine was queried to find out the studies and review articles on social cognition and theory of mind in AD and PDDs. Social cognition may be defined as the ability to interact in complex social areas with understanding the others’ intentions and thoughts. The mind deficit is theorized to be one of the basic difficulties in autism. Individuals with autism have deficits in recognizing mental processes and mental representations of self and others’. Patients with AD have deficits in social functions which an important part of interpersonal interactions and functioning within a social group; like face recognition, eye contact and emotional expression recognition. Frontal lobe, temporal lobe, anterior cingulate cortex, fusiform gyrus, amygdala, posterior association cortex and their internal associations are brain areas associated with social cognition. Fusiform gyrus and amygdala are effective in face perception and recognition. Studies suggest that a deficit in amygdala may lead to social perceptional deficits like face identity and emotional expression recognition. It is determined that individuals with PDDs have hypoactivation in fusiform gyrus during perception of faces. Amygdala has a regulatory effect on fusiform gyrus and in lesions of amygdala, the hypoactivation of fusiform gyrus for emotional salient faces are parallel to the level of amygdala lesion. The common result of many studies is that the hypoactivation of fusiform gyrus is based on some processes related to amygdala. Superior temporal sulcus hypoactivations and abnormal volume measures were found in patients with autistic disorder. Superior tempral sulcus has a role in perception of social stimulus from gaze directions, and eye and body movements of others’. Autism can be defined as a social cognition disorder and is caused by deficits at microscopic and/or macroscopic levels in these brain systems. The review of the neurobiology of social cognition in AD and other PPDs defisits in amygdala and in connections of amygdala with other temporal areas including fusiform gyrus, superior temporal sulcus in early infancy and that leads to a deficit or absence of infant’s interest for faces and other stimuli which are socially significant. This causes abnormal development of brain areas like fusiform gyrus which needs a stimulus dependent activation. When studying social cognition deficits, it is important to note that autism is not a disorder of a unique neuroanatomical system or cyclus; but it is a neurodevelopmental disorder in whichmany pervasive neural systems are affected