Investigating the effects of age, IQ, dosing, and anthropometric measures on the treatment persistence in long-term methylphenidate use.

Objectives This study aimed to determine anthropometric and clinical correlates of persistence to methylphenidate (MPH) treatment in Turkish youth with attention-deficit hyperactivity disorder (ADHD). Methods Data from medical records of 518 children and adolescents with ADHD were recorded between March 2012 and January 2022. Clinical variables of patients persistent to MPH >= 2 years were compared with those of the non-persistent group. Children and adolescent age groups were compared using Kaplan-Meier estimates for treatment drop-outs. Cox regression analysis until the treatment drop-out was implemented to calculate hazard ratios (HRs) for gender, age, full-scale IQ, and anthropometric measures. Weight, height, and body mass index (BMI) z-scores were calculated per national guidelines. Results Persistent and non-persistent study groups had similar full-scale IQ, weight, height, and BMI z-scores at treatment onset. The mean MPH dose was significantly higher in the persistent group compared to the non-persistent counterparts (31.43 +/- 10.70 vs. 24.28 +/- 9.60 mg/d, p < 0.001, d = 0.70). Compared to children, the adolescents showed earlier treatment drop-outs in males (p < 0.001) but not in females (p = 0.110). Younger age showed a positive effect on treatment persistence. Conversely, baseline BMI and IQ scores were not associated with long-term persistence. Discussion Our study demonstrated lower daily doses and older age-onset were associated with early drop-outs in MPH treatment. These findings supported the notion that effective dosing strategies at younger ages could increase the sustainability of the treatment with MPH in the Turkish population

Psychosocial Evaluation of Girls with Rapidly Progressive Puberty Presenting with Early Menarche

Introduction-Aim: In cases with early puberty, neuroendocrine,physical, and psychological changes are considered to resultin several mood disorders. The aim of this research was to assessthe mental problems of pubertal girls with rapidly progressivepuberty (RPP) with menarche before the 10 years of age. To thebest of our knowledge, there is no similar prospective cross-sectionalresearch in the medical literature.Method: In this prospective study, females with RPP (breastdevelopmental Tanner stage ≥ 3 and basal LH value &gt;0.3 IU/L)who presented with menarche under the age of 10 years wereincluded in Group I. The control group (Group II) consisted ofprepubertal girls aged 9 to 10 years. All cases were evaluated concurrentlyat the Department of Child and Adolescent MentalHealth and Diseases. Cases with a previous diagnosis of mood disorderor psychiatric treatment for any reason or chronic diseaseswere excluded. All subjects underwent relevant psychiatric tests: 1)Affective Disorders and Schizophrenia Form-Now And LifelongForm DSM-5- Turkish version (CDSG-PL-DSM-5-T), 2) Screenfor Child Anxiety Related Disorders (SCARED), 3) Child BehaviorChecklist (CBCL/6-18), and 4) the revised form of a DepressionRating Scale for children (CDRS-R).Results: A total of 49 girls (Group I, n=28; Group II, n=21) wereincluded in the study. Height, weight, and BMI SDS values weresignificantly higher in Group I (p&lt;0,01) while target height wassimilar among groups. Predicted adult height was higher than targetheight in Group I. Mood disorder was detected in four cases:Group I (n=2, 7%, social phobia-depression/adjustment disorderwith depressive symptoms) and Group II (n=2, 9.0%, childhooddepression). There was no significant difference between the twogroups in terms of the total and sub-group scores obtained fromanxiety, behavior, and depression assessment criteria.Conclusion: There was no significant difference in the prevalenceof mood disorders between the early menarche and controlgroups. GnRH analogue therapy should not be based on theassumption that premature pubertal development will cause psychosocialeffects and should only be considered after a thoroughpsychiatric evaluation.</p

Electroconvulsive therapy or clozapine for adolescents with treatment-resistant schizophrenia: an explorative analysis on symptom dimensions

ObjectiveThis study sought to compare pre-intervention patient characteristics and post-intervention outcomes in a naturalistic sample of adolescent inpatients with treatment-resistant psychotic symptoms who received either electroconvulsive therapy (ECT) or clozapine.MethodsData of adolescents with schizophrenia/schizoaffective disorder receiving ECT or clozapine were retrospectively collected from two tertiary-care psychiatry-teaching university hospitals. Subscale scores of the Positive and Negative Symptom Scale (PANSS) factors were calculated according to the five-factor solution. Baseline demographics, illness characteristics, and post-intervention outcomes were compared.ResultsThere was no significant difference between patients receiving ECT (n = 13) and clozapine (n = 66) in terms of age, sex, and the duration of hospital stay. The ECT group more commonly had higher overall illness and aggression severity. Smoking was less frequent in the clozapine group. Baseline resistance/excitement symptom severity was significantly higher in the ECT group, while positive, negative, affect, disorganisation, and total symptom scores were not. Both interventions provided a significant reduction in PANSS scores with large effect sizes.ConclusionBoth ECT and clozapine yielded high effectiveness rates in adolescents with treatment-resistant schizophrenia/schizoaffective disorder. Youth receiving ECT were generally more activated than those who received clozapine