Ayse Avci

Internet use among Turkish adolescents.

The aim of this study was to investigate Internet use habits and problematic Internet use (PIU) in Turkish adolescents. Participants were 3,975 undergraduate students, 7.6% of whom used the Internet for more than 12 hours weekly. The Online Cognition Scale (OCS) was used. The most common purpose for using the Internet was playing games, followed by general information search. Female users mostly preferred searching for general information; male users preferred playing games (p < 0.001, gamma = 995.205). The most preferred type of game was violent games. While preference for strategy and fantasy role-play (FRP) games increased with age, preference for other games decreased (p < 0.0001, gamma = 283.767). Participants who used the Internet mostly for general information searches and school-related searches had lower OCS scores (p < 0.0001). The highest OCS scores were related to violent games, followed by FRP, strategy, and sports and motor racing games. Computers and the Internet are useful, important inventions, but like other inventions, if used improperly, they may be harmful. Risk of harm raises concerns about who should use the Internet and computers, and where, when, and why the Internet and computers should be used.

Short-Term Effects of Playing Computer Games on Attention

Objective: The main aim of the present study is to investigate the short-term cognitive effects of computer games in children with different psychiatric disorders and normal controls. Method: One hundred one children are recruited for the study (aged between 9 and 12 years). All participants played a motor-racing game on the computer for 1 hour. The TBAG form of the Stroop task was administered to all participants twice, before playing and immediately after playing the game. Results: Participants with improved posttest scores, compared to their pretest scores, used the computer on average 0.67 ± 1.1 hr/day, while the average administered was measured at 1.6 ± 1.4 hr/day and 1.3 ± 0.9 hr/day computer use for participants with worse or unaltered scores, respectively. According to the regression model, male gender, younger ages, duration of daily computer use, and ADHD inattention type were found to be independent risk factors for worsened posttest scores. Conclusion: Time spent playing computer games can exert a short-term effect on attention as measured by the Stroop test. (J. of Att. Dis. 2010; 13(6) 668-676)

An Open-Label Trial of Risperidone in Children with Autism

Abstract Background: Risperidone has potent effects on serotonin and dopamine neuronal systems, both of which have been implicated in the pathophysiology of autism. Risperidone is increasingly being used to treat specific symptoms in children with autism. Objective: The purpose of this study was to investigate the efficacy and tolerability of risperidone in young children with autism. Methods: In this single-site, 6-month, open-label study, young autistic children aged 3 to 7.5 years were administered risperidone 0.5 mg/d for 15 days and then 1 mg/d until 3 months; doses were thereafter individually adjusted to a maximum of 2 mg/d between the third and sixth month. The Clinical Global Impression—Severity of Illness (CGI-SI) scale, Childhood Autism Rating Scale (CARS), and Abnormal Involuntary Movement Scale (AIMS) were used to assess efficacy. The CGI-Adverse Effect scale and the Adverse Effect Checklist were used to assess the incidence and severity of adverse events. Results: A total of 20 children (mean age, 4.95 ± 1.18; range, 3–7.5 years) were enrolled; 16 completed the 6-month study. Two children were withdrawn due to noncompliance with the treatment protocol during the first month, and 2 children were withdrawn from the study during the first month because of marked agitation, anger, and aggression thought to be related to treatment. The mean dose of risperidone was 1.53 mg/d (range, 0.04–0.11 mg/kg per day). Thirteen of the 16 children (81%) demonstrated at least 1 grade improvement on CGI-SI scores. Mean total CARS score significantly decreased from 39.06 ± 6.23 to 32.03 ± 8.73 after 6 months ( P = 0.001). Scores on 11 of the 15 subscales of the CARS showed significant improvement ( P Conclusion: In this population of young autistic children, risperidone had positive effects on most symptoms of autistic disorder. Additional double-blind, placebo-controlled studies are needed to determine the effectiveness of risperidone in the management of autism.

Mania profile in a community sample of prepubertal children in Turkey

BACKGROUND Mania in youth is increasingly recognized and accompanied by substantial psychiatric and psychosocial morbidity. There are no data on prepubertals in the general population and we aimed to search for mania symptoms and its clinical correlations in a community sample of prepubertal Turkish children. METHODS Among all children (n = 56,335) aged 7-11 in Adana, Turkey, 2,468 children (48% girls) were randomly included. Parents completed Child Behavior Checklist (CBCL) 4-18 and Parent-Young Mania Rating Scale (P-YMRS). Cut-off scores of 17 and 27 on total P-YMRS were defined as efficient (probable-mania group) and specific (mania group), respectively, for bipolar profile. We searched for clinical correlations and used logistic regression to show how well each CBCL subscale predicted the presence of mania and probable-mania, after adjusting for any demographic differences. RESULTS Parent-Young Mania Rating Scale scores were > or =17 but <27 (probable-mania) in 155 (6.3%) children and > or =27 (mania) in 32 (1.3%) children. Elevated mood, increased activity levels, and poor insight were the most frequent manic symptoms in our sample. Children with probable-mania and mania had higher scores on all CBCL subscales and the CBCL-Pediatric Bipolar Disorder (CBCL-PBD) profile (sum of attention, aggression, and anxiety/depression subscales). Logistic regression analysis revealed only thought problems on CBCL that predicted probable-mania and mania. CONCLUSION Our study shows that mania profile is common in the community sample of Turkish prepubertal children and does not support the thought that mania is rare outside the US. We need further population-based studies that will use diagnostic interviews and multiple informants.

Association between pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections disease and tumor necrosis factor-α gene−308 g/a, −850 c/t polymorphisms in 4-12-year-old children in Adana/Turkey

OBJECTIVES: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a newly defined disease in neuropsychiatry and occurs with an autoimmune mechanism after Group A Beta Hemolytic Streptococcus (GABHS) infection. Tumor necrosis factor (TNF), encoded by TNF-α gene has an important role in the apoptotic mechanisms of autoimmune diseases. Recently, TNF-α polymorphisms and autoimmune/psychiatric disorders have been reported to be related. In this regard, we focused on to investigate a possible relation between the TNF-α gene promoter region−308 G/A and − 850 C/T polymorphisms and PANDAS. MATERIALS AND METHODS: In this study, ages of PANDAS patient and control groups were ranging from 4 years to 12-year-old. Patient group includes childhood onset PANDAS patients (n = 42) and control group includes healthy children (n = 58). Diagnoses have been carried out according to Diagnostic and Statistical Manual of Mental Disorder (DSM-IV) criteria with Affective Disorders and Schizophrenia-Present and Lifetime (KSAD-S-PL) and Children Yale-Brown Obsessive Compulsive Scale Moreover, PANDAS criteria established by the American National Psychiatry Institute have been employed for diagnoses. For identifying polymorphisms; Polymerase Chain Reaction, Restriction Fragment Length Polymorphism and Polyacrylamid Gel Electrophoresis were used. RESULTS AND DISCUSSION: For −308 polymorphism, 37 of 42 PANDAS patients’ results and for −850 C/T polymorphism, 38 of 42 PANDAS patients’ results were obtained. According to our statistical analysis there is a positive relationship between PANDAS patients for −308 G/A polymorphism but not for −850 C/T polymorphism. There is no positive relationship between −308 G/A polymorphism and antistrep-tolysin O (ASO) titers and no relationship between −850 C/T polymorphism and ASO titers. We found, however, positive relationship between genders of patients (boys) and the disease. According to our results, we propose that the AA polymorphism of −308 G/A polymorphism can be used as a molecular indicator for PANDAS.

Periodic fever and hyperimmunoglobulin D syndrome in a boy with pediatric autoimmune neuropsychiatric disorders associated with group A β-Hemolytic streptococcus.

The importance of the immune system in pediatric psychiatric disorders has been known since the 1990s. Swedo et al. (1998) have reported that obsessive-compulsive disorder (OCD), tics, and other neuropsychiatric symptoms, such as separation anxiety, irritability, hyperactivity, and attention and concentration deficits, are usually triggered by infections, and have reported a phenomenon known as pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). The diagnostic criteria for PANDAS are as follows: 1) Presence of a tic disorder or OCD; 2) onset by puberty (usually at 3–12 years of age); 3) abrupt symptom onset or episodic course of symptom severity; 4) temporal association between symptom exacerbation and streptococcal infections; and 5) presence of neurologic abnormalities during periods of symptom exacerbation (Swedo et al. 1998). To the best of our knowledge, there is no reported case or controlled study describing the psychiatric signs or symptoms accompanying hyperimmunoglobulin D syndrome (HIDS). HIDS is among the periodic fever syndromes that are genetically inherited and share some common features, including recurrent fever, inflammation of serosal membranes, musculoskeletal involvement, skin rashes, and amyloidosis. HIDS was originally described in patients of Dutch ancestry by van der Meer et al. (1984). HIDS is characterized by sustained high fever, lymphadenopathy, abdominal pain, arthritis, and skin rashes; episode duration is from 4 to 8 weeks. HIDS is caused by mutations in the gene that encodes mevalonate kinase (MVK), an enzyme involved in the isoprenoid and cholesterol biosynthesis pathway. The four most prevalent mutations of MVK (V377I, I268T, H20P/N, and P167L) account for 71.5% of the known mutations (van der Hilst et al. 2008; Steichen et al. 2009). The differential diagnosis of HIDS is broad and includes familial mediterranean fever (FMF), tumor necrosis factor receptor associated periodic syndrome (TRAPS), periodic fever adenitis pharyngitis aphthous ulcer (PFAPA), adult-onset Still’s disease, juvenile idiopathic arthritis, rheumatic fever, and Behçet’s disease (Long 2005; Steichen et.al. 2009). Although MVK gene mutations have been suggested to be the genetic defect responsible for the etiopathogenesis of HIDS, they were not observed in a substantial proportion of those with the disease; therefore, the pathophysiology of the disease remains unclear. More than 66% of HIDS patients present to physicians within the first year of life. An earlier study of ours suggested later onset of the HIDS (Tas et al. 2012). Episodic attacks of fever (lasting 3–7 day) are generally accompanied by chills, cervical lymphadenopathy, abdominal pain, and vomiting or diarrhea. Patients may also present with headache, arthralgia or arthritis, aphthous ulceration, rash, and splenomegaly (van Der Hilst et al. 2008). Attacks may be precipitated by vaccination, viral infection, trauma, and stress (Drenth et al.1994). Laboratory test results generally show the presence of characteristic abnormalities such as an Immunoglobulin D (IgD) level >100 kU/L, and some patients also have an elevated immunoglobulin A level. We report a case with concurrent HIDS and OCD comorbid with attention-deficit/hyperactivity disorder (ADHD) combined type, speech disorder (stuttering), and Tourette’s disorder (TD).

Atomoxetine-induced wake-time teeth clenching and sleep bruxism in a child patient

Bruxism is an involuntary, nonfunctional movement of the masticatory system. It is characterised by grinding or clenching of the teeth, which results in characteristic grinding sounds, abnormal tooth wear, and jaw and muscle pain. Bruxism can occur both during the day and at night. It can be classified as primary/idiopathic or secondary/iatrogenic bruxism, which is associated with medication or medical diseases. Approximately one-third of these patients have at least one family member with a positive medical history for bruxism [1]. Atomoxetine, a selective norepinephrine reuptake inhibitor, is approved for the treatment of attention deficit hyperactivity disorder (ADHD) in various countries, including the United States [2], United Kingdom, and Turkey [3]; its efficacy has been documented in shortand long-term studies [4]. We present a case of wake-time teeth clenching and sleep bruxism, induced by atomoxetine and successfully treated with buspirone, which was observed in a child with ADHDrelated symptoms and the diagnosis of oppositional defiant disorder (ODD). A 7-year-old boy was diagnosed with disturbance of activity and attention and ODD according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10), in the child and adolescent psychiatry outpatient clinic of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. The boy exhibited symptoms of inattention, excessive activity, disorganisation, and oppositional traits presenting with inattention to detail, distractibility, running excessively, social disinhibition, restlessness, impulsivity, reckless behaviour, and anger dysregulation. He did not have a medical history of bruxism. His father had had childhood sleep bruxism that decreased gradually through adolescence and rarely emerged in his adult years. The patient had not been treated previously with any medications for ADHD and ODD. He had never been diagnosed with a chronic disease and was not a chronic user of medication. His body weight was 27 kg, and a physical examination revealed no abnormalities. ADHD treatment was initiated with an extended release of methylphenidate HCl (Concerta ) 18 mg/day. At the 1-month follow-up, the patient showed minimal improvement in the ADHD symptoms; therefore, his methylphenidate dosage was gradually increased to 27 mg/ day, and finally, to 36 mg/day in the third month of treatment. The patient began to experience some mild side effects on the 27 mg/day dosage of methylphenidate, without any significant reduction of his symptoms. On the 36 mg/day dosage, he experienced mild dry mouth, moderate weakness, severe appetite loss, and moderate introverted behaviour. These adverse events were considered acceptable reasons for terminating the methylphenidate, and we prescribed atomoxetine 18 mg/day instead. Within 1 week, the dose of atomoxetine was increased to 25 mg/ day, which he tolerated well. At the first-month follow-up, This paper was presented to be a poster presentation in the 5th International Congress on Psychopharmacology and International Symposium on Child and Adolescent Psychopharmacology, AntalyaTurkey, October 30–November 3, 2013.

Sexual Abuse in a Classroom of Ten Male Students: A Group Victimization

The term “professional perpetrator” is used to describe individuals who commit sexual abuse in the capacity of a position of trust such as a teacher, household member, or employer. There is an increasing body of evidence focusing on educator sexual abuse in the school environment. However, data are limited about this topic. The aim of this paper is to present the rare occurrence of the case of a male teacher in Turkey who sexually abused his students in an elementary school. Although it is unknown which populations are most vulnerable to sexual abuse, in Turkey we think that the indigenous population is at risk. Abuse cases are not logged into the criminal justice system because the majority of abuse allegations are ignored or disbelieved by families.

Selective serotonin reuptake inhibitor discontinuation syndrome in children: Six case reports

Abstract Background: Antidepressant discontinuation syndrome refers to a cluster of symptoms that occur after abrupt dose reduction or discontinuation of antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) are increasingly being used for the treatment of depression and other psychiatric disorders in children and adolescents, but published data on SSRI discontinuation syndrome in children are limited. Objective: This paper presents 6 case reports of SSRI discontinuation syndrome in children. Results: SSRI discontinuation syndrome was diagnosed in 6 patients (4 boys, 2 girls; mean age, 11.33 ± 1.75 years) according to established criteria. Three patients had been taking paroxetine, 2 fluvoxamine, and 1 sertraline for an average of 4.00 ± 1.67 months (range, 3–6 months) before abrupt discontinuation or dose reduction. Dizziness/lightheadedness/drowsiness, poor concentration, nausea, headache, and fatigue were the most frequent symptoms. As in previous studies in adults, the 6 patients experienced SSRI discontinuation symptoms 1 to 5 days (mean 2.92 ± 1.63 days) after SSRI discontinuation or dose reduction. In all patients, symptoms resolved on reinitiation of treatment with the same SSRI or a different one. Conclusions: The case reports presented in this article suggest that SSRI discontinuation syndrome can and does occur in children when treatment is stopped or the SSRI dose is reduced abruptly, and is quite similar to that reported in adults. Placebo-controlled prospective studies are needed in children to further assess the prevalence and clinical presentation of SSRI discontinuation syndrome and to develop management strategies for this condition.

Open-Label Trial of Paroxetine in Children with Obsessive-Compulsive Disorder

Abstract Objective The aim of this study was to assess the safety and effectiveness of paroxetine in a group of pediatric patients with obsessive-compulsive disorder (OCD) who had not previously been treated for that condition. Methods In a 12-week, open-label study, 47 children (aged 9 to 15 years) were given a fixed dosage of paroxetine 20 mg/d for 6 weeks. During the next 6 weeks the treating psychiatrist could maintain or change the dosage based on therapeutic effectiveness or side effects. No additional medication was used. Scores on the Clinical Global Impressions-Severity of Illness (CGI-SI) scale, Maudsley Obsessive Compulsive Inventory (MOCI), Childrens Depression Inventory (CDI), and Spielbergers State-Trait Anxiety Inventory for Children (SAI-C and TAI-C), were used to assess efficacy. Adverse effects were assessed by the Adverse Experience Scale and the CGI-Adverse Effect score. Results The mean paroxetine dosage was 20.7 mg/d. Five patients dropped out of the study at week 6; 42 of 47 patients completed the trial and were assessed. At the end of 6 weeks the children were found to have significantly lower scores on MOCI (total) and the MOCI dirt, doubt, control, and slowness subscales and on the CGI-SI scale, CDI, SAI-C, and TAI-C. Twenty-six patients showed ≥50% improvement according to the MOCI. At the end of the study 12 children were classified as normal, 14 as borderline, and 11 as mild on the CGI-SI scale; all the patients were classified as moderate to most severe at baseline. The mean reduction in the CGI-SI score was 56.8% ± 19.4%. No patient experienced side effects severe enough to discontinue the drug. Sleepiness (23.4%), increase in anger (8.5%), fatigue (8.5%), behavioral disinhibition (4.3%), gastrointestinal distress (4.3%), and increase in preexisting tics (4.3%) were the most common side effects. Conclusions Paroxetine was effective in the treatment of OCD in this sample of Turkish children, and the incidence of adverse events was low.