Aylin Özbek

Maternal psychosocial aspects in hypernatremic dehydration with high sodium concentrations in breast milk: a case-control study.

Objective:  To investigate whether mothers, with no known biological reason to account for elevated breast milk sodium (BMS) and associated hypernatremic dehydration (HND) in their exclusively breastfed infants, have more adverse psychosocial characteristics compared with controls.

Adjunctive olanzapine treatment in bipolar adolescents responding insufficiently to mood stabilizers. Four case reports.

This report was aimed to evaluate the efficacy of olanzapine treatment as an adjunct therapy to mood stabilizers in the treatment of four adolescents responding insufficiently to mood stabilizers. All patients were diagnosed with bipolar I disorder according to DSM IV criteria. YMRS (Young mania rating scale) and CGI (Clinical global impression, improvement and therapeutic effectiveness scales) were used to evaluate overall response of the episode to the drugs. All patients with no adequate response to mood stabilizers did respond to adjunctive olanzapine treatment (10–30 mg/per day). It has been suggested that antipsychotics may be useful as an adjunct to mood stabilisers in bipolar disorder. However, further research is warranted regarding the use of atypical antipsychotics in children and adolescents.

Development and behavior of non-handicapped preterm children from a developing country

Abstract  Background : There are many studies, mainly conducted in industrialized countries, concerning developmental and behavioral outcomes of preterm children. However, little is known about the outcomes of preterm children from developing countries.

Is Triple P effective in childhood anxiety disorder? A randomized controlled study

ABSTRACT OBJECTIVES: Considering the role of parenting in the aetiology and maintenance of anxiety disorders, working with parents is a promising treatment strategy. Triple P-positive parenting programme is a parent-focused cognitive behaviour therapy. In this study, we aimed to investigate the effectiveness of Triple P in improvement in childhood anxiety disorders and also to assess its effects on behavioural and emotional problems, general anxiety level, severity of the disorder, and general psychosocial functioning. Parents’ mental health and general well-being were also evaluated. METHODS: In this randomized controlled study, the sample consisted of 74 children, aged between 8 and 12 years, who were diagnosed as anxiety disorder by Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Life-time Kiddie (K-SADS-PL). Following randomization into two equal groups, mothers of the first group participated to Group Triple P Programme, while the second group was receiving no treatment. The two groups were compared right before and after the intervention on rates of anxiety symptoms, emotional, and behavioural variables. RESULTS: Children’s general anxiety level was significantly lower in the intervention group following Triple P implementation. Behavioural and emotional problems were also reduced in the intervention group. Parental anxiety and general well-being were not significantly different between two groups. CONCLUSION: It is considered that Triple P may be useful in the treatment of children’s anxiety disorder but further studies about Triple P on children’s anxiety disorders are needed.

Cerebellar volume in early-onset schizophrenia and its association with severity of symptoms

Objectives This study aimed to investigate whether early-onset schizophrenia (EOS) cases differ from controls regarding volumes of the total cerebellum and the right and left cerebellar hemispheres, and volumetric asymmetry. Correlations of cerebellar volumes and asymmetry indices with severity of symptoms and general functioning in cases of EOS were also assessed. Methods Adolescents with EOS (n = 23) were compared with controls (n = 23). Sociodemographic and clinical data, and magnetic resonance imaging scans that were acquired for routine clinical purposes were collected retrospectively. Cerebellar volumes were evaluated using the stereological method. Asymmetry indices were subsequently calculated. Scores of the Positive and Negative Syndrome Scale and the Children’s Global Assessment Scale were used to assess the severity of symptoms and general functionality. Results There were no significant differences in any of the cerebellar volumes and asymmetry indices between the two groups. Neither cerebellar volumes nor asymmetry indices were correlated with the severity of symptoms and general functionality in EOS. Conclusions Our findings suggest that the early-onset form of schizophrenia does not show apparent volumetric changes of the cerebellum. Additionally, the neural circuits involved in formation of symptomatology may not reflect any correlation with cerebellar volumes at mid-adolescence.

Do mothers with high sodium levels in their breast milk have high depression and anxiety scores

Objective This study aimed to assess the possible association of high breast milk sodium levels with postpartum depression and anxiety. Methods A total of 150 mothers and their healthy, exclusively breastfed newborns aged 8 to 15 days were recruited. Mothers were asked to complete scales for evaluation of postnatal depression and anxiety following an interview for consent and sociodemographic data collection. Breast milk samples were obtained to measure sodium and potassium (K) levels. Results Forty-nine mothers had higher than expected breast milk Na concentrations and a high Na/K ratio. These mothers scored significantly higher on the scales of postnatal depression and state anxiety (P = 0.018 and P = 0.048, respectively). Conclusions This study shows that compared to normal breast milk Na levels and Na/K ratio, high breast milk Na and high Na/K ratio, with possible serious consequences in infants, are associated with maternal depressive and anxious symptoms in the postpartum period.

Factors affecting improvement of children and adolescents who were treated in the child and adolescent psychiatry inpatient unit

Objective This study aimed to assess the correlates and predictors of improvement in general functioning of children and adolescents who are treated in the child and adolescent psychiatry (CAMHS) inpatient unit. Methods Hospital records of 308 children and adolescents who were treated for at least 1 month in the CAMHS inpatient unit from 2005–2016 were included. Associations with individual, familial, and clinical variables and the difference in Children’s Global Assessment Scale (ΔCGAS) scores at admission and discharge were evaluated. Results Positive predictors of ΔCGAS were older age and lower CGAS scores at admission, whereas high familial risk scores at admission and diagnosis of early-onset schizophrenia negatively predicted ΔCGAS (B = 0.698, p = 0002; B = −0.620, p < 0.001; B = −0.842, p = 0.002; B =−9.184, p = 0.000, respectively). Familial risk scores were significantly and negatively correlated with ΔCGAS (p = 0.004, Spearman’s rho = −0.2). Conclusions This study indicates that improvement in general functioning during inpatient treatment in CAMHS is better at an older age and with lower general functioning at admission. However, high familial risks and diagnosis of early-onset schizophrenia weakens this improvement.

Assessment for Sexual Abuse in A Case Presenting with Genital Herpes

Assessment for sexual abuse in a case presenting with genital herpes Child sexual abuse is defined as the use of a child by an adult or a significantly older person for the purpose of sexual stimulation. Sexual relations within the family (incest) “particularly involving children” is prohibited in all faiths and societies; hence, incestuous child sexual abuse is the form of abuse most difficult to determine. Prepubertal genital herpes is a presentation that definitely needs to be assessed as a potential indication for sexual abuse. Even though in adults transmission is often by sexual route, it has been pointed out that especially in cases below the age of 5 years, anogenital herpes can be transmitted by non-sexual mechanisms. As paths for a possible non-sexual transmission of genital herpes, autoinoculation, finger contact by an adult changing nappies leading to infection, hand contact between children, or transmission via infected objects (plate, fork, garments, etc.) have been reported. Guidelines helping in the assessment of sexual abuse are insufficient regarding the question how the issue should be confronted in pediatric cases of genital herpes. More evidence is required to solve this problem. In our presentation, we discuss the process of assessment for sexual abuse in the case of a girl aged 2 years 3 months presenting to the emergency department with anogenital herpes.

Psychosocial aspects of Turkish mothers of children with juvenile idiopathic arthritis

To the editor: Juvenile idiopathic arthritis (JIA) is the most common chronic pediatric rheumatic disease. In JIA, as in other chronic pediatric illnesses, a child’s illness affects the daily activities and functioning of the entire family. Families must deal with illness-related stressors such as the need for frequent medical visits, demands of the multicomponent treatment regimen, and unpredictable illness course. Adjustment problems were reported among mothers of children with JIA. Fifty percent of the mothers reported psychiatric distress [1]. We investigated the psychological profile of mothers of children with JIA, their attitudes to their children and their family functioning. In addition, parameters such as severity and duration of JIA, and pain that could affect the status of mothers were evaluated. Twenty-seven children with JIA, 29 healthy controls, and their mothers were evaluated in our outpatient clinic. Childhood Health Assessment Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Parental Attitude Research Instrument, and Family Assessment Device were used for assessment parameters. The three criteria of the core set of outcome variables [2] such as physician’s global assessment, number of joints with active arthritis, and erythrocyte sedimentation rate (ESR) were selected as severity parameters. The duration and severity of JIA, and pain were correlated with mothers’ psychological well-being, attitudes, and functioning. There were statistically significant correlations between ESR in JIA cases and state anxiety (r=0.416, P=0.034), and between pain assessment-visual analog scale in JIA cases and attitude of maternal hostility and rejection (r=0.466, P=0.016) and marital discordance (r=0.418, P=0.034) in mother’s scales who have children with JIA. There was a significant positive correlation between the duration of JIA and behavior control (r=0.441, P=0.024) in mothers’ scales who had children with JIA. In addition, statistically significant negative correlation was found between the duration of JIA and state anxiety between the duration of JIA and state anxiety (r= 0.445, P=0.02). We showed increased duration of JIA-caused problems in the behavioral control of mothers of children with JIA. It was indicated that state anxiety of the mothers, which is defined as a transient momentary emotional status that results from situational stress that fluctuates in time and intensity, was associated with increased ESR in children with JIA in the present study. The ESR is an objective parameter in monitoring the disease activity of children with JIA. In addition, the sudden increase in ESR levels could be easily recognized by the mothers of children with chronic arthritis. This condition might have contributed to the mothers’ awareness, leading to anxiety. Because of this reason the mothers might be overprotective and behave in a more controlling manner toward their child. As in our findings, Scharloo et al. [3] indicated that a strong illness identity, passive coping, long illness duration, and unfavorable score on medical variables were associated with worse outcome on disease-specific measures of functioning in mothers. There was a positive correlation between pain in JIA cases and hostility and rejection of maternal role and marital discordance in mothers’ scales who have children with JIA. Williamson et al. [4] suggested that the A. P. Akay (&) AE A. Ozbek AE B. Baykara Department of Child and Adolescent Psychiatry, Dokuz Eylul University Faculty of Medicine, Inciralti, Izmir, Turkey E-mail: pekcanlara@yahoo.com Tel.: +90-232-4123559 Fax: +902322776686