Psychiatric Disorders in Children and Adolescents with Epilepsy

Epilepsy is a chronic disease with a high morbidity. Many recent studies have shown that psychiatric disorders are commonly encountered in children and adolescents with epilepsy. Depression, anxiety disorders and attention deficit hyperactivity disorder are among the most common psychiatric disorders. Many factors, including demographic variables, epilepsy related factors and psychosocial factors, have been suggested to have a role on the development of psychiatric disorders in epilepsy. In the management of psychiatric comorbidities, cooperation between disciplines, education of the patient and family and psychosocial support are of vital importance. Recent studies have shown that some psychotropic agents can be used with a generally high safety and efficacy in children and adolescents with epilepsy

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

Brainstem evaluation in children with primary nocturnal enuresis.

We investigated the brainstem integrity in children with primary nocturnal enuresis (PNE) using auditory brainstem responses (ABR), blink reflex and exteroceptive suppression of the masseter muscle. We examined 23 children with PNE (16 male, 7 female; mean age: 10.4 years) and 19 control subjects (11 male, 8 female; mean age: 11.8 years). ABR parameters such as wave latencies, amplitudes and interpeak latencies and blink reflex parameters such as R1 and R2 amplitude and latencies were not significantly different between the 2 groups. Although S2 parameters of the exteroceptive suppression of the masseter muscle were easily and completely obtained from the control subjects, in the PNE group S2 onset latency and duration were not recorded in 26% of the study children (n = 6) (P = 0.01). S2 duration time was significantly lowered in the enuretic group (left side: P = 0.001 and right side: P = 0.003). S2 duration time changes in the enuretic group supports a possible brainstem dysfunction in children with PNE.</p

Determination of depression risk factors in children and adolescents by regression tree methodology.

We used a regression tree method (RTM) to determine risks of depression in children/adolescents. The survey records of 4,143 children/adolescents in a study based in Mersin, Turkey served as data in this study, and multi-step, stratified, and cluster sampling were used. Effects of 24 variables (sex, smoking, parental problems, etc.) were evaluated on depression scores. The Child Beck Depression Inventory (CBDI) was used to determine the level of depression. Subjects were into 12 different groups based on magnitudes of mean depression scores. The interactions among 7 variables determined to be risk factors are shown on a schema. The STATISTICA (ver.6.0) package program was used for all computations. Although traditional statistical methods have often been used for analysis in this field, such approaches are associated with certain disadvantages such as missing values, ignorance of interaction effects, or restriction of the shape of the distribution. To avoid such disadvantages, we therefore suggest the use of the RTM in studies involving numerical-based outcome variables and for the investigation of a large number of variables and it may be more effective than traditional statistical methods in epidemiological studies which determine risk factors.</p

Psychostimulant toxicity in children

Methylphenidate is used for the treatment of attention deficit hyperactivity disorder in children above the age of 6 with a high safety and tolerability. When used above the recommended dosage, methylphenidate has been reported to cause toxicity symptoms including neuro-psychiatric and cardiac adverse reactions. In this overview paper, the available literature on psyhcostimulant toxicity in children and the clinical symptoms and follow-up of a 4-year-old child who accidentally used high dose of methylphenidate will be discussed. [Archives Medical Review Journal 2013; 22(2.000): 184-193

Sociodemographic and clinical characteristics of patients with conversion disorder

Amaç: Alkol bağımlılığı geliştirmeye yatkın kişilerin önceden belirlenmesi ve yatkınlığa yol açan risk etkenlerinin bulunmasının, bireylerin alkolizmden korunması için önceden önlem alınması, alkolizmin etiyolojisinin aydınlatılması, ve belki de yeni tedavi yöntemlerinin bulunması gibi yararları olabilecektir. Bu yazıda özellikle son yıllarda yoğunlaştığı gözlenen alkol bağımlılığına yatkınlık belirleyicileri çalışmalarının sonuçlarının gözden geçirilmesi amaçlanmıştır. Araştırmaların sonuçları bazı özelliklerin alkolizmde veya alkol bağımlısı olan hastaların bazı alt gruplarında yatkınlık beirleyicisi oldukları yönünde umut vericidir: anormal adenilat siklaz (AC) aktivitesi, azalmış monoamin oksidaz (MAO) düzeyleri, hipotalamo-pitüiter-adrenal (HPA) eksen bozuklukları, b-endorfin anormallikleri, düşük P300 uyarılmış potansiyel amplitüdü, D2 dopamin reseptör duyarlılığının azlığı ve alkole düşük duyarlılık gösterme risk etkenleri olarak; anormal aldehit dehidrogenaz izoenzim örüntüsü ise koruyucu etken olarak çalışmalara konu edilmiştir. Sonuç olarak, henüz alkolizmin kesin bir yatkınlık belirleyicisi saptanabilmiş olmasa da, ilerde en azından bazı alkol bağımlılığı alt grupları için duyarlı biyolojik yatkınlık belirleyicilerinin bulunması mümkün olabilir.Objective: The early detection of individuals at high risk for the future development of alcohol dependence and the identification of trait markers for alcoholism may be useful for taking necessary measures to protect the individuals from alcoholism, for enlightening the aetiology of the illness, and even for the development of the new treatment methods. This paper reviews in detail the results of studies of trait markers in alcoholism, which have intensified particularly in recent years. Some data of the investigations indicate that a trait marker for alcoholism or a subgroup of alcohol-dependent patients may be developed: with abnormal adenylyl cyclase (AC) activity, reduced monoamine oxidase (MAO) levels, hypothalamo-pituitary-adrenal (HPA) axis abnormalities, b-endorphin abnormalities, reduced amplitude of P300 event-related potential, D2 receptor down-regulation, and decreased sensitivity to alcohol challenge as risk factors; and abnormal aldehyde dehydrogenase isoenzyme patterns as a protective factor. The review concludes that although a comprehensive trait marker for alcoholism has not yet been identified, one can hope for the identification of some consistent biological markers in a subgroup of alcohol dependents over the course of time

Ergenlerde İnternet kullanımı ile uyku problemleri arasındaki ilişki

Giriş: Uyku sorunları ergenlerde sık olarak görülmektedir. Elektronik medyanın ergenlerin uyku kalitelerini ve günlük işlevselliklerini olumsuz etkilediği gösterilmiştir. Bu çalışma ergenlerde internet kullanımı ile uyku problemleri arasındaki ilişkiyi incelemeyi amaçlamaktadır. Yön­tem­: Toplam 1212 ergen çalışmaya dahil edildi. Kendi bildirim çalışma anketi iki ana bölüm içeriyordu: Young’ın İnternet Bağımlılık Ölçeği (İBÖ) ve uyku alışkanlıkları/uyku problemleri üzerine yarı yapılandırılmış bir ölçek. Bul­gu­lar: Çalışma örnekleminin %16’sı uyku kalitelerini kötü ya da çok kötü değerlendirdi. Örneklemin dörtte biri interneti hergün kullandığını bildirirken, %27’si online olduğunda bir saatten fazla zaman geçirdiğini bildirdi. Ortalama İBÖ total skoru 35,56±13,87 idi. Yüksek İBÖ skoru olan ergenlerin düşük İBÖ skoru olanlara göre gece yatağa daha geç gittiği, uykuya dalmak için daha uzun süreye ihtiyaç duyduğu ve gece daha sık uyandığı bildirildi (p=0,001). Yüksek İBÖ skoru olan ergenlerde içlerinde uykuya dalma ve sürdürme güçlükleri, uyanma güçlüğü ve gün içinde uykulu hissetmeyi içeren çok sayıda uyku probleminin daha sık olduğu bulundu. Ayrıca, uyku kaliteleri düşük İBÖ skoru olan ergenlere göre daha kötü idi (p=0,001). So­nuç: Problemli uyku alışkanlıkları ve uyku sorunlarının yüksek İBÖ skoru olan ergenlerde daha sık olduğu bulundu. Sağlık çalışanları, aşırı ve kontrolsüz internet kullanımının ergenlerin uyku alışkanlıkları üzerine yaptığı muhtemel olumsuz etkiler konusunda farkında olmalıdırlar.Introduction: Sleep problems are commonly encountered in adolescents. It has been shown that electronic media have a negative influence on the sleep quality and daytime functioning in adolescents. This study aims to investigate the association between internet use and sleep problems in adolescents. Met&shy;hod: A total of 1212 adolescents were recruited to the study. Self-report study questionnaire included two main parts: Young’s Internet Addiction Scale (IAS) and a semi-structured inquiry on sleep habits/problems. Re&shy;sults: Of the study sample, 16% (n=198) reported their sleep quality as bad or very bad. One-fourth of the sample reported using internet everyday and 27% of them reported spending more than one hour when online. The mean IAS total score was 35.56&plusmn;13.87. Adolescents with a higher IAS score reported getting to bed later in the night, needing more time to fall asleep and having an increased number of awakenings in the night than the adolescents with lower IAS score (p=0.001). They were also found to have higher frequencies of several sleep problems including difficulty in initiating and sustaining sleep, difficulty in waking up and feelings of sleepiness in day. In addition, sleep quality of them was worse when compared to the adolescents with a lower IAS score (p=0.001). Conc&shy;lu&shy;si&shy;on: Problematic sleep habits and sleep problems were found to be more frequent in adolescents with a higher IAS total score. Health care providers must be aware of the possible negative impact of excessive and uncontrolled internet use on adolescents’ sleep habits

Malawi [cartographic material].

Political and administrative map. Relief shown by shading.; "800184 (A04821) 4-85".; Also available online http://nla.gov.au/nla.map-vn449699

Cinsel İstismarda Uyurgezerlik Olgu Sunumu

Çocukluk çağında maruz kalınan fiziksel, cinsel ve duygusal ihmal ve/veya istismar birçok ruhsal bozukluğa yol açabilmektedir. Cinsel istismar sonrası en sık karşılaşılan ruhsal bozukluklar; anksiyete bozuklukları, depresyon, posttravmatik stres bozukluğu, yeme bozukluğu ve uyku bozukluklarıdır. Hemen hemen her ruhsal bozukluk uyku düzenini etkilemesine rağmen cinsel istismarın uyurgezerliği tetiklemesi nadir görülmektedir. Bu olgu sunumunda, cinsel istismar ile tetiklenen uyurgezerlik olgusu tartışılacaktır. Anahtar kelimeler: Cinsel istismar; uyurgezerlik; posttravmatik stres bozukluğ

Stuttering in children: A comprehensive study

Kekemeliğin sebebi bilinmemekle birlikte genetik, psikososyal stres etmenlerine maruz kalma, obsesif, özgüveni yetersiz kişilik özelliğine sahip olma, merkezi sinir sistemi anomalileri, ailenin ilk çocuğu olma risk etmenleri olarak bildirilmektedir. Bu çalışmada, kekemeliği olan çocuk ve ergenlerin sosyodemografık özelliklerini, psikososyal stres etmenlerini belirlemek, düzeleri ve düzelmeyen kekeme gruplar arasındaki sosyodemografik faklılıkları saptamak hedeflenmiştir. Çocuk ve ergen psikiyatri polikliniğine başvuran 188 çocuk ve ergen kekeme olgusu çalışmaya alındı. 83'üne ulaşılarak muayeneleri yeniden yapıldı: 43 olguda son 6 aydır kekemelik yoktu (Grup 1). 40 olguda kekemelik değişen sıklıkta devam ediyordu (Grup 2). Grup 1' deki olgular polikliniğe daha erken yaşta başvurmuştu ve üç kelimeli cümle kurmaya Grup 2'deki olgulara göre daha erken başlamışlardı. Grup 1'deki olgularda daha fazla stres faktörü saptandı.Although the cause of stuttering is unknown, genetic, psychosocial stress factors, having obsessive personality or low-selfesteem, central nervous system anomalities, being first child in family are risk factors. In this study we aimed; first, to under-stand sociodemographic pattern of the patients with stuttering, second, to evaluate the features o f psychosocial stress factors and to find the sociodemographic differences between recovered and unrecovered groups. 188 children/adolescents with stuttering referred to the departments of child and adolescent psychiatry were enrolled this study. 83 of all children with stuttering were interviewed again, and 43 of this have not have stuttering for 6 months (Group 1). 40 of this cases have stuttering (Group 2). Group 1 was earlier referral at department of child and adoles-cent psychiatry than Group 2. The onset time of starting speak with sentences using three words was earlier in Group 1. There was much more stress factors before begining of stuttering in Group L