Ayşe Kutlu

No Beneficial Effects of Adding Parent Training to Methylphenidate Treatment for ADHD + ODD/CD Children A 1-Year Prospective Follow-Up Study

Objective: The aim of this study was to compare the effect of methylphenidate (MPH) versus MPH + parent training in children with ADHD and oppositional defiant disorder/conduct disorder (ODD/CD) over a 12-month period. Method: After careful screening, 120 children diagnosed with ADHD + ODD/CD were included in the study. Treatment consisted of ongoing medication management for 12 months, with or without participation in a parent-training program beginning after the 1st month. Participants were not randomly assigned to treatment groups because of ethical, practical, and methodological reasons. Results: Data analyses revealed that mother–child relationship improvements and symptom severity did not benefit from parent training. Conclusion: The results of this study highlighted the positive role of MPH in ADHD. No significant effects were observed after the addition of parent training to MPH treatment. Clinicians should carefully follow patients’ improvements and titrate the MPH dosage during long-term treatment.

Outstanding Awards Brief Reports

Objective: Smith and Burger developed the Structured Inventory of Malingered Symptomatology (SIMS) in 1997 as a self-report measure for malingering of psychiatric symptoms. The SIMS consists of 75 dichotomous (True–False) items that form into five subscales Psychosis (P), Neurologic Impairment (NI), Affective Disorder (AF), Amnestic Disorders (AM), Low Intelligence (LI), with each subscale containing 15 items. In this study, we aimed to examine the reliability, validity, and factor structure of the SIMS in a Turkish forensic psychiatry sample. Methods: A sample of 103 forensic patients (9 female, 94 male), aged 18–75, undergoing an inpatient forensic evaluations for competency assessment for criminal responsibility were recruited from a large forensic hospital in Turkey. The study protocol was approved by the local ethics committee. Socio-demographic information of the participants was collected and the SIMS, Miller Forensic Assessment of Symptoms Test (M-FAST), the Scales of Psychological Well-being, 36-Item Short Form Survey (SF-36), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered. All statistical analyses were performed by using SPSS version 23.0 for Windows. Results: The Cronbach’s alpha coefficients for the Turkish SIMS were ranging from 0.42 to 0.87. The lowest alpha coefficient was observed for the Amnestic Disorders (0.46). For the whole scale, Cronbach’s alpha coefficient was found to be 0.93. The test–retest (at after 1 week) correlation coefficients for Psychosis (P), Neurologic Impairment (NI), Affective Disorder (AF), Amnestic Disorders (AM), Low Intelligence (LI), and whole scale were found to be 0.97, 0.97, 0.95, 0.91, and 0.96, respectively. A positive and statistically significant correlation was found between the Turkish SIMS and BDI (r = 0.593, p < .01), BAI (r = 0.578, r < 0.01), M-FAST subscale Reported versus Observed Symptoms (r = 0.660, p <.01), M-FAST subscale Extreme Symptomatology (r = 0.686, p <.01), M-FAST subscale Rare Combinations (r = 0.729, p <.01), M-FAST subscale Unusual Hallucinations (r = 0.698, p <.01), M-FAST subscale Unusual Symptom Course (r = 0.568, p <.01), M-FAST subscale Negative Image (r = 0.514, p <.01), M-FAST subscale Suggestibility (r = 0.426, p <.01), and M-FAST Total (r = 0.794, p <.01) scores. Principal axis factor analyses with promax rotation were performed and four-factor solution that accounted for 39.87% of the variance observed. Conclusions: Our preliminary findings suggested that Turkish SIMS was a valid and reliable tool with a robust factorial structure for further use in detecting malingering of forensic psychiatric cases in Turkey.

Quality of life, depression, and anxiety in Turkish children with vitiligo and their parents

ABSTRACT BACKGROUND: Vitiligo is a chronic skin condition among psychocutaneous diseases that significantly affect psychiatric well-being of patients, social interactions, and overall quality of life. Only a limited number of studies about psychiatric well-being and quality of life in children with vitiligo and their parents are available. AIMS: With this study, we aimed to assess anxiety, depression, and quality of life in children diagnosed with vitiligo and their parents. METHODS AND MATERIAL: Forty-one vitiligo patients aged 9–16 years 30 healthy controls along with their parents were asked to fill out self-report forms that assessed quality of life (Pediatric Quality of Life Inventory – Child Form; PedsQL-C and Pediatric Quality of Life Inventory – Parent Form; PedsQL-P), anxiety (State–Trait Anxiety Inventory – STAI-C for children and Beck Anxiety Inventory – BAI for parents), and depression (Children’s Depression Inventory – CDI and Beck Depression Inventory – BDI for parents). RESULTS: Between groups, significant differences were found in PedsQL-C subscales measuring school functioning, psychosocial health, and overall quality of life. Regarding PedsQL-P scores, there was a significant difference in physical functioning, social functioning, and overall quality of life. No statistical significance was found between groups regarding CDI and STAI-C scores. There was a significant difference in BDI, with higher scores in parents of children with vitiligo. CONCLUSIONS: We believe measuring life quality with standardized instruments and techniques would be important in the assessment of the patient to evaluate the efficacy of treatment, specifically in chronic disorders. Further studies addressing these issues, especially in children, adolescents, and their parents are warranted.

Is ADHD an inflammation-related disorder?

Objective: The current study investigated whether attention deficit hyperactivity disorder (ADHD) was associated with increased inflammatory response by assessing neutrophil/lymphocyte (NLR) and platelet/ lymphocyte ratios (PLR) which are new biomarkers of systemic inflammation in children with ADHD compared to healthy controls. Methods: In this study, 65 children in the ages of 6-11 years who were diagnosed with newly ADHD according to DSM-IV diagnostic criteria were included in the case group, whereas 65 healthy children without any psychiatric or physical disorder in the similar age and gender were included as the control group. The study group included 130 children with normal mental capacity, without known acute or chronic medical and/or inflammatory disease, and no concurrent drug use. Complete blood count analyses were made in the morning after 12 hour fasting, NLR and PLR were calculated using the absolute cell counts. Results: There was statistically significant difference in NLR, PLR and other complete blood count parameters between ADHD and healthy control groups. Higher MPV values de-tected in the case group were normalized after adjusting for comorbidity and body mass index values. Conclusion: Similar NLO and TLO values in the ADHD and healthy control groups do not support the hypothesis of increased inflammatory response involvement in the etiology of the disease. However, considering the heterogeneity about ADHD’s clinical presentation and etiopathogenesis, it is clear that wide systematic follow up studies are needed in this area.

The prevalance of attention deficit hyperactivity disorder and the frequency of medication use among preschool children in a district children hospital

Objective: This study analyzed the prevelance of Attention Deficit Hyperactivity Disorder (ADHD) and frequency of medication use among preschool children in a district children hospital between January 1 and December 31, 2016. Methods: We reviewed the medical files of children who admitted to the outpatient clinics of Child and Adolescent Psychiatry within the age range of 36 to 60 months, diagnosed with preschool ADHD (PS-ADHD) according to ICD-10 criteria. Children with comorbid intellectual disability, mood disorders, anxiety disorders, autism spectrum disorders and chronic medical disorders were excluded from the study. Medical files with incomplete data were not included in the analysis. Results: The study sample consisted of 218 preschool children with ADHD. The prevalance of ADHD among preschool children was 7.8 percent Sixty-one (28%) patients had at least one comorbid disorder and the disruptive behaviour disorders (oppositional defiant and conduct disorder) were the most common diagnoses with tha rate of 32.1 percent. Treatment with psychosocial interventions was applied to 116 (53.2%) children, whereas 102 (46.8%) children were started on pharmacotherapy. Risperidone was the most prescribed medication at a rate of 98%. In children within the age group of 49-60 months greater number of comorbidities were detected and drug therapy was more frequently used compared to 36-48-month-group. The higher number of comorbid disorders was the determinative factor for drug use (p<0.05). Conclusion: Even though psychosocial treatment is the first-line treatment, additional pharmacotherapy seems to be required. The first choice of psychopharmacological agent was risperidone. Older age and higher number of comorbidities seem to predict the drug use.