Distributions Of Sociodemographic Characteristics, Symptoms and Diagnoses in Cases Who Referred To Child and Adolescent Psychiatry Outpatient Clinic

Amaç: Bu çalışmada, Tekirdağ Namık Kemal Üniversitesi Tıp Fakültesi Çocuk ve Ergen Psikiyatrisi polikliniğine başvuran çocuk ve ergenlerin sosyodemografik özellikleri, semptom ve psikiyatrik tanı dağılımlarının incelenmesi amaçlanmıştır.Materyal ve Metot: Ağustos 2015 ve Nisan 2017 tarihleri arasında Tekirdağ Namık Kemal Üniversitesi Tıp Fakültesi Çocuk ve Ergen Psikiyatrisi polikliniğine başvuran 1221 çocuk ve ergenin geriye dönük dosya taraması yapılmıştır. Olguların sosyodemografik özellikleri, DSM-5 tanı kriterleri temel alınarak yapılan klinik değerlendirmeler sonucunda aldıkları psikiyatrik tanılar ve tedavi bilgileri değerlendirilmiştir.Bulgular: Çalışmaya alınan olguların yaş ortalaması 9.45±4.42 yıl ve %9,7’si (n=119) 0-3 yaş aralığında, %19.3’ü (n=236) 4-6 yaş aralığında, %37.7’si (n=460) 7-12 yaş aralığında, %33.3’ü (n=406) 13-19 yaş aralığındaydı. Olguların %38.9’u (n=475) kız, %61.1’i (n=746) erkekti. En sık başvuru şikayetleri %26.4 (n=322) dikkat eksikliği/hareketlilik, %17.9 (n=218) sinirlilik ve %12.3 (n=150) korkular/kaygılardı. Psikiyatrik muayene sonucunda olguların %77’si (n=940) en az bir psikiyatrik tanı alırken, %18.2’sinde (n=222) ise en az iki psikiyatrik tanı birlikteydi. En sık konulan tanılar %29.7 (n=363) dikkat eksikliği hiperaktivite bozukluğu, %16.4 (n=200) anksiyete bozukluğu, %7.4 (n=90) depresif bozukluktu. Olguların %76.6’sına (n=935) en az bir tedavi seçeneği önerilmişti.Sonuç: Bulgularımız yaşa ve cinsiyete göre sık görülen tanı ve semptomları ortaya koymak ve poliklinik hizmetlerini düzenlemede bölgesel farklılıkları anlamak açısından faydalı olacaktır.Aim: The purpose of this study was to determine the sociodemographic characteristics, and distributions of symptom and psychiatric diagnoses in children and adolescents presenting to the Tekirdağ Namık Kemal University Child and Adolescent Psychiatry outpatient clinic. Materials and Methods: The records for 1221 children and adolescents presenting to the Tekirdağ Namık Kemal University Child and Adolescent Psychiatry outpatient clinic between August 2015 and April 2017 were reviewed retrospectively. Cases’ sociodemographic characteristics, psychiatric diagnoses resulting from clinical evaluations based on DSM-5 diagnostic criteria, and treatment information were examined. Results: The meanage of the cases included in the study was 9.45±4.42 years; 9.7% (n=119) were aged 0-3 years, 19.3% (n=236) 4-6, 37.7% (n=460) 7-12, and 33.3% (n=406) 13-19. Girls constituted 38.9% (n=475) of cases and boys 61.1% (n=746). The most common presentation symptoms were attention deficit/hyperactivity in 26.4% (n=322), irritability in 17.9% (n=218), and fears/anxieties in 12.3% (n=150). Seventy-seven percent of cases (n=940) received at least one psychiatric diagnosis as a result of evaluation, while at least two comorbid psychiatric diagnoses were present in 18.2% (n=222). The most common diagnoses were attention deficit hyperactivity disorder in 29.7% (n=363), anxiety disorder in 16.4% (n=200), and depressive disorder in 7.4% (n=90). At least one therapeutic option was recommended in 76.6% (n=935) of cases. Conclusion: Our findings will be useful in terms of revealing common diagnoses and symptoms by age and sex, and of understanding regional differences in the organization of polyclinic services

Distributions of Sociodemographic Characteristics, Symptoms and Diagnoses in Cases Who Referred To Child and Adolescent Psychiatry Outpatient Clinic

Aim:The purpose of this study was to determine the sociodemographic characteristics, and distributions of symptom and psychiatric diagnoses in children and adolescents presenting to the Tekirdağ Namık Kemal University Child and Adolescent Psychiatry outpatient clinic.Materials and Methods:The records for 1221 children and adolescents presenting to the Tekirdağ Namık Kemal University Child and Adolescent Psychiatry outpatient clinic between August 2015 and April 2017 were reviewed retrospectively. Cases’ sociodemographic characteristics, psychiatric diagnoses resulting from clinical evaluations based on DSM-5 diagnostic criteria, and treatment information were examined.Results:The meanage of the cases included in the study was 9.45±4.42 years; 9.7% (n=119) were aged 0-3 years, 19.3% (n=236) 4-6, 37.7% (n=460) 7-12, and 33.3% (n=406) 13-19. Girls constituted 38.9% (n=475) of cases and boys 61.1% (n=746). The most common presentation symptoms were attention deficit/hyperactivity in 26.4% (n=322), irritability in 17.9% (n=218), and fears/anxieties in 12.3% (n=150). Seventy-seven percent of cases (n=940) received at least one psychiatric diagnosis as a result of evaluation, while at least two comorbid psychiatric diagnoses were present in 18.2% (n=222). The most common diagnoses were attention deficit hyperactivity disorder in 29.7% (n=363), anxiety disorder in 16.4% (n=200), and depressive disorder in 7.4% (n=90). At least one therapeutic option was recommended in 76.6% (n=935) of cases.Conclusion:Our findings will be useful in terms of revealing common diagnoses and symptoms by age and sex, and of understanding regional differences in the organization of polyclinic services

Relationship between WISC-R subtests and psychiatric symptom groups in attention and learning disorders

Purpose: In this study, in children with attention deficit hyperactivity disorder (ADHD) and/or learning disorder (LD), we aimed to investigate the differentiating capacity of several instruments including Weschler Intelligence Tests (WISC-R) and Learning Disorder Battery. Materials and Methods: The children (72-131 mo.) that where diagnosed with ADHD and/or LD (total n: 81, boy n: 63 [77.8%]) were included. While the children were tested, active symptoms were remitted in a part of children (Clinical Global Impression below 3). Therefore, participants' active diagnoses were ADHD: 11, LD: 33, both: 15, or remitted: 22, and the children were grouped accordingly. Weschler Intelligence Scale for Children-Revised (WISC-R) and LD Battery were used. Results: The cases with LD (LD plus both) had significantly worse scores in all tests of LD Battery except for duration of reading and all subscores of WISC-R except for similarities compared to the cases without LD. The cases with ADHD (ADHD plus both) had significantly worse scores only in draw a clock of LD Battery and cipher of WISC-R compared to the cases without ADHD. Conclusion: WISC-R and LD Battery are valid and reliable instruments to differentiate several interrelated disorders (LD, ADHD, and/or both) and they have a good predictive validity to differentiate the cases that respond well to the treatments

Neurological soft signs might be endophenotype candidates for patients with deficit syndrome schizophrenia

BACKGROUND: Schizophrenia is a chronic, disabling, disorder that affects approximately 1% of the population. The nature of schizophrenia is heterogeneous, and unsuccessful efforts to subtype this disorder have been made. Deficit syndrome schizophrenia (DS) is a clinical diagnosis that has not been placed in main diagnostic manuals. In this study, we aimed to investigate and compare neurological soft signs (NSS) in DS patients, non-deficit schizophrenia (NDS) patients, and healthy controls (HCs). We suggest that NSS might be an endophenotype candidate for DS patients. METHODS: Sixty-six patients with schizophrenia and 30 HCs were enrolled in accordance with our inclusion and exclusion criteria. The patients were sub-typed as DS (n=24) and NDS (n=42) according to the Schedule for the Deficit Syndrome. The three groups were compared in terms of sociodemographic and clinical variables and total scores and subscores on the Physical and Neurological Examination for Soft Signs (PANESS). Following the comparison, a regression analysis was performed for predictability of total PANESS score and its subscales in the diagnosis of DS and NDS. RESULTS: The groups were similar in terms of age, sex, and smoking status. The results of our study indicated that the total PANESS score was significantly higher in the DS group compared to the NDS and HC groups, and all PANESS subscales were significantly higher in the DS group than in the HC group. The diagnosis of DS was predicted significantly by total PANESS score (P<0.001, odds ratio =9.48, 95% confidence interval: 0.00–4.56); the synergy, graphesthesia, stereognosis, motor tasks, and ability to maintain posture subscales were found to be significant predictors. CONCLUSION: This study confirms that NSS were higher in patients with DS. In addition, we suggest that our results might support the notion of DS as a different and distinct type of schizophrenia. NSS might also be a promising candidate as an endophenotype for DS. However, large sampled, multicentric studies are needed to clarify the place of NSS as an endophenotype in DS

The effectiveness of psychoanalytic psychotherapy in individuals diagnosed with PTSD due to torture and severe human right violations

Abstract Introduction: Various psychotherapies have been applied to individuals who have been subjected to torture and severe human rights and to patients with PTSD, however, studies assessing the effectiveness of such therapies are limited. Psychoanalytic psychotherapy is said to be used frequently in practice for these patient groups. Yet, there are scarcely any studies assessing its efficacy. In this study, we aim to assess the effectiveness of psychoanalytic psychotherapy in patients with PTSD associated with torture and severe human rights violations. Additionally, the study seeks to monitor the continuity of therapy within the first year and its relationship with overall clinical change. Methods: 70 patients with PTSD related to torture and severe human rights violations who applied to the Human Rights Foundation of Turkey were given psychoanalytic psychotherapy. CGI-S and CGI-I scales were applied to the patients (in Months 1, 3, 6, 9, and 12); and the patients' continuity of therapy and the changes in their recovery during the one-year psychotherapy period were assessed. Results: 38 (54.3%) of the patients were female. Their mean age was 37.7 years (SD = 12.25), while their mean baseline CGI-S score was 4.67. The mean length of treatment was 21.9 sessions (SD = 20.30). As the number of sessions increased, the final CGI-I scores of the patients improved significantly (p &lt;.001) towards recovery. The change towards recovery became more evident particularly in the patients who had continued the therapy for more than 12 sessions. Mean scores for CGI-I scale were 3.46, 2.95, 2.23, 2.00, and 1.54 for months 1, 3, 6, 9 and 12 respectively. In addition, the drop-out rate was 34% (24 patients) for those who dropped out of therapy prematurely without any CGI-I assessment (9 patients) and those who dropped out of therapy with no improvement in their CGI-I scores –i.e. with CGI-I scores of 4-7 (15 patients). Conclusions: Considering the limited literature in the field, this study has provided significant data on the effectiveness of the use of psychoanalytic psychotherapy in individuals diagnosed with PTSD related to torture and severe human rights violations, despite its limitations –including not involving a control group. Furthermore, the findings might offer important clues regarding the relationship between continuity of therapy and clinical change

A Left Temporal Arachnoid Cyst in a Patient with Early Onset Schizophrenia

Arachnoid cysts are mostly asymptomatic and diagnosed incidentally. In the literature, some case studies report a probable etiological association between arachnoid cysts and psychiatric disorders. We report an early onset schizophrenia case who had a left temporal arachnoid cyst and who had an inadequate response to antipsychotic treatment. We discuss the potential association between arachnoid cysts and psychiatric disorders in the light of the literature

Dikkat Eksikliği Ve Hiperaktivite Bozukluğu Tanılı Çocuklar Ve Annelerinde Metilentetrahidrofolat Redüktaz Gen Polimorfizminin İncelenmesi

Dikkat Eksikliği ve Hiperaktivite Bozukluğu (DEHB) çocukluk çağının en sık görülen ve önemli fonksiyonel kayıplara neden olan nöropsikiyatrik bozukluklarındandır. Davranışsal genetik ve moleküler genetik araştırmalar DEHB etiyolojisini açıklamaya yönelik önemli kanıtlar sunar. Gebelik sırasında görülen folat eksikliğinin fetal nörogelişimi olumsuz etkilediği bilinmektedir. Metilentetrahidrofolat redüktaz (MTHFR) ve MTHFR C667T polimorfizmi folatın aktif folata dönüşümünü bozarak folat eksikliğine yol açabilir. Bu araştırmada DEHB tanılı 64 çocuk ve anneleri ile 40 sağlıklı çocuk ve annelerinde MTHFR polimorfizmi incelenmiştir. DEHB tanılı ve sağlıklı kontrol gruplarındaki anneler karşılaştırıldığında DEHB tanılı çocuğu olan annelerde C677CT genotipi (Hardy-Weinberg Principle Analysis) istatistiksel olarak anlamlı düzeyde fazla bulunmuştur. DEHB tanılı çocuk ve kontrol grubunu oluşturan çocuklar arasında ise anlamlı fark saptanmamıştır. Bu araştırmanın en önemli sonucu C677C MTHFR gen polimorfizmi DEHB etyolojisinde önemli bir faktör olabileceğini ve DEHB tanılı çocukların anneleri gebelik döneminde yeterli miktarda folat alsalar dahi fetusun folat eksikliğine maruz kalabileceğini göstermiş olmasıdır. Bu verileri destekleyecek yeni araştırmalara gereksinim vardır

The Effect of Methylphenidate Treatment on Heart Rate Variability and Cardiac Autonomic Functions in Children with Attention Deficit Hyperactivity Disorder

Aim:Attention deficit hyperactivity disorder (ADHD) is the most common childhood psychiatric disorder. Psychostimulant drugs are frequently used in the treatment regimen. The possible cardiac side effects of drugs are of concern. In our study, we aimed to determine possible cardiac autonomic effects with heart rate variability (HRV) in ADHD patients receiving methylphenidate (MPH).Materials and Methods:We used a retrospective pre-post treatment study design to measure the change in HRV parameters in ADHD patients receiving MPH therapy. A total of 49 patients (mean age, 8.3±2.5 years) diagnosed with ADHAB and 30 sex- and age-matched healthy controls (mean age, 8.2±2.7 years) were examined. Rhythm Holter recordings were made for the patients before MPH treatment and in the first month of treatment and for the control group, and HRV parameters were evaluated in the computer environment.Results:There was no difference in age, gender, weight and height in the patient and control groups (p>0.05). In the analysis of time-dependent HRV parameters, SDNN, SDANN, which shows the sympathetic influence, and rMSSD, which shows the parasympathetic influence, were statistically significantly lower in the patient group than in the control group (p0.05).Conclusion:Our study showed that there was increased sympathetic and decreased parasympathetic activity in HRV parameters in ADHD patients. Both sympathetic and parasympathetic improvement was observed with MPH treatment. Although our study shows that MPH treatment has a curative effect on cardiac autonomic functions, further studies are needed

An Examination of Emotion Regulation and Associated Factors in Attention Deficit-Hyperactivity Disorder

Objective: Emotion regulation difficulties (ERD) such as anger, irritability and frustration intolerance leading to severe functional losses may be observed in attention deficit-hyperactivity disorder (ADHD). The purpose of this study was to compare children and adults diagnosed with ADHD and a healthy control group in terms of emotion regulation characteristics and to examine factors potentially associated with ERD. Methods: The study was performed with 72 children/adults aged 6-18 diagnosed with ADHD based on DSM-V diagnostic criteria at the Namik Kemal University Medical School of Child and Adolescent Psychiatry Polyclinic, Turkey, and 30 healthy controls. The Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL), a semi-structured interview form, was used to determine comorbidities. ERD scores (ERD=attention+anxiety/depression+aggression sub scales) were determined using the Childhood Behavior Checklist (CBCL). Results: Mean ERD scores were 189.45 +/- 19.33 in the ADHD group and 164.13 +/- 9.94 in the healthy control group. A significant difference was determined in ERD scores between the two groups (p<0.001**). When the ADHD group was evaluated in terms of clinical characteristics, comorbid psychiatric disorders were not associated with ERD, but combined type ADHD characteristics emerged as significant predictors for ERD (p=0.011*). Conclusions: The results of this research revealed significantly greater ERD in individuals diagnosed with ADHD compared to healthy controls, and that combined type ADHD is a predictor for ERD. Since ERD accompanying ADHD lead to greater function loss in the individual and are associated with persistence of the disorder in adulthood, these are important clinical characteristics also requiring evaluation during the diagnosis and treatment of ADHD

An Examination of Emotion Regulation and Associated Factors in Attention Deficit-Hyperactivity Disorder

Objective: Emotion regulation difficulties (ERD) such as anger, irritability and frustration intolerance leading to severe functional losses may be observed in attention deficit-hyperactivity disorder (ADHD). The purpose of this study was to compare children and adults diagnosed with ADHD and a healthy control group in terms of emotion regulation characteristics and to examine factors potentially associated with ERD. Methods: The study was performed with 72 children/adults aged 6-18 diagnosed with ADHD based on DSM-V diagnostic criteria at the Namik Kemal University Medical School of Child and Adolescent Psychiatry Polyclinic, Turkey, and 30 healthy controls. The Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL), a semi-structured interview form, was used to determine comorbidities. ERD scores (ERD=attention+anxiety/depression+aggression sub scales) were determined using the Childhood Behavior Checklist (CBCL). Results: Mean ERD scores were 189.45 +/- 19.33 in the ADHD group and 164.13 +/- 9.94 in the healthy control group. A significant difference was determined in ERD scores between the two groups (p<0.001**). When the ADHD group was evaluated in terms of clinical characteristics, comorbid psychiatric disorders were not associated with ERD, but combined type ADHD characteristics emerged as significant predictors for ERD (p=0.011*). Conclusions: The results of this research revealed significantly greater ERD in individuals diagnosed with ADHD compared to healthy controls, and that combined type ADHD is a predictor for ERD. Since ERD accompanying ADHD lead to greater function loss in the individual and are associated with persistence of the disorder in adulthood, these are important clinical characteristics also requiring evaluation during the diagnosis and treatment of ADHD