Cem Gokcen

INVESTIGATION OF THE RELATION BETWEEN ANAEROBIC BACTERIA GENUS CLOSTRIDIUM AND LATE-ONSET AUTISM ETIOLOGY IN CHILDREN

The aim of this study was to investigate the relation between the etiology of late-onset childhood autism and anaerobic bacteria. Thirty children diagnosed with autistic disorder and control group have been included in the study. 3-(3-hydroxy phenyl)-3-hydroxypropionic acid (HPHPA) excretion rates which is a metabolic product of the genus Clostridium, were measured via mass spectrometry-gas chromatography (MS-GC) method from urine samples. When the assayed average HPHPA values compared with each group, a statistically significant difference was found (p < 0.05). Data obtained from this study support the existence of a significant correlation between autism etiology and anaerobic bacteria.

Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit

BACKGROUND Chest pain is a common presenting complaint to paediatrics, paediatric cardiology, and paediatric emergency departments. In this study, we prospectively evaluated clinical characteristics and causes of chest pain in children referred to our paediatric cardiology unit. METHODS A total of 380 children were included. Associated symptoms and past and family histories were evaluated. All patients underwent physical examination. The following studies were performed: complete blood count in all patients; fasting lipid profiles in overweight and obese children and children with a family history of premature cardiovascular disease; and electrocardiogram, chest X-ray, and echocardiogram in all patients. If necessary, 24-hour electrocardiogram monitoring or exercise stress tests were performed. Patients with a history of positive psychological findings were evaluated by a child psychiatrist. RESULTS The most common causes of chest pain were musculoskeletal disorders (37.1%), idiopathic chest pain (29.2%), and miscellaneous disorders, for example precordial catch syndrome (15%), respectively. Only 1 of 380 (0.3%) patients had chest pain due to a cardiac disorder. Electrocardiograms were abnormal in 4 of 380 (1.1%) patients. A total of 9 of 380 patients (2.3%) had dyslipidaemia. CONCLUSIONS Although a paediatric cardiology referral may provide reassurance to the primary care and emergency department physicians, our results show that cardiac aetiologies for paediatric chest pain are very rare. We think that many patients in our study were adequately evaluated only by careful history, and physical examination. Therefore, we suggest that it may not be necessary to use echocardiogram in the routine evaluation of children with chest pain.

Oral megadose methylphenidate ingestion for suicide attempt

Attention deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric syndrome with onset in childhood. Stimulants are the primary therapeutic agents in children with ADHD. Methylphenidate (MPH) comprises >90% of stimulant use for ADHD in the USA. There is evidence to suggest that stimulants in ADHD populations are being used more broadly, for longer periods and without interruptions. As therapeutic use increases, the risk of unintentional overdoses, therapeutic errors, and intentional overdoses due to abuse, misuse or suicide attempts increase. In the present report we describe a suicide attempt involving high-dose immediate-release MPH in an 8-year-old girl with ADHD.

Effects of atomoxetine on cardiovascular functions and on QT dispersion in children with attention deficit hyperactivity disorder

BACKGROUND Atomoxetine is a central norepinephrine reuptake inhibitor used to treat attention deficit/hyperactivity disorder. The effects of atomoxetine on cardiovascular functions and QT dispersion in children with attention deficit/hyperactivity disorder have not been previously reported. The aim of this study was to analyse cardiovascular functions and QT dispersion on the surface electrocardiogram of children with attention deficit/hyperactivity disorder during atomoxetine therapy. METHODS A total of 40 children - with a mean age of 8.6 plus or minus 2.3 years and a median age of 11 years; ranged from 8 to 14 years - with attention deficit/hyperactivity disorder - with six girls and 34 boys - were included in the study. We recorded the mean systolic and diastolic blood pressure, heart rate, corrected QT interval, QT dispersion, and left ventricular systolic functions at baseline and 5 weeks after atomoxetine therapy. RESULTS Atomoxetine decreased baseline mean systolic and diastolic blood pressure; baseline mean heart rate decreased; and baseline mean corrected QT interval and QT dispersion mildly increased. Atomoxetine decreased baseline mean ejection fraction and baseline mean shortening fraction. CONCLUSION The results of our study suggest that atomoxetine does not cause clinically significant alterations in QT dispersion, systolic and diastolic blood pressure, heart rate, corrected QT interval, and left ventricular systolic functions during short-term treatment in children with attention deficit/hyperactivity disorder.

Association between the self-insertion of nasal and aural foreign bodies and attention-deficit/hyperactivity disorder in children

OBJECTIVE To investigate whether the prevalence of attention-deficit/hyperactivity disorder (ADHD) is higher in children presenting with nasal and aural foreign bodies than in the control group. METHODS The present study was conducted between April 2012 and December 2012 and included 60 pediatric patients presenting with self-inserted nasal and aural foreign bodies and 50 healthy controls aged between 3 and 9 years. The Conner Parent Rating Scale (CPRS) and Turgays DSM-IV based ADHD and disruptive behavior disorders screening scale (T-DSM-IV-Scale) were used to investigate ADHD. RESULTS The difference between the patient group and the control group was significant with respect to the abnormal scores obtained from all the subscales (p < 0.05). In children between 5 and 9 years of age, the abnormal scores were significantly higher in the patients than the controls for all the subscales (p < 0.05). However, in children between 3 and 4 years of age, there were no significant differences between the patients and the controls for the scores obtained from all the subscales (p > 0.05). No statistically significant difference was found between the patients with a previous history of self-inserted foreign bodies and those without any history of foreign body insertion (p > 0.05). CONCLUSIONS The findings of our study demonstrated a possible association between the self-insertion of nasal and aural foreign bodies and ADHD. Clinicians should be aware of the possible presence of ADHD in children, especially in those patients between 5 and 9 years of age who present with self-inserted nasal and aural foreign bodies.

Association between penetrating eye injuries and attention deficit hyperactivity disorder in children

Purpose To investigate whether there is an association between penetrating eye injuries and attention deficit hyperactivity disorder (ADHD) symptoms in children. Methods 45 children aged 3–18 years who were treated due to penetrating ocular injuries (patient group) and 75 control subjects (control group) were enrolled in the study. The symptoms of ADHD were evaluated by the Turkish adapted and validated form of the Conner Parent Rating Scale (CPRS). Results The mean age was 8.9±4.1 years in the patient group and 9.7±3.7 years in the control group. All subscale scores of CPRS were higher in the patient group compared with the control group (all p<0.05). Gender-specific analyses showed that the boys of the patient group had significantly higher mean scores of all subscales, including inattentiveness, hyperactivity, oppositional defiant disorder and conduct disorder, compared with the boys of the control group (all p<0.05). However, the girls of the patient group had higher mean scores of only the conduct disorder subscale (p<0.05) compared with the girls of the control group. Three of 45 patients (6.6%) and 0 of 75 control subjects (0%) had a history of previous ocular trauma (p<0.05). Conclusions There was an association between penetrating eye injuries and inattentiveness, hyperactivity, oppositional defiant disorder and conduct disorder in boys, and conduct disorder in girls. An appropriate evaluation of ADHD symptoms may prevent vision loss due to penetrating eye injuries in children. In addition, evaluation by a child psychiatrist of children presenting with penetrating eye injuries may prevent repetition of injuries.

Relationship between soluble intercellular adhesion molecules and attention-deficit/hyperactivity disorder

Objective Attention-deficit/hyperactivity disorder (ADHD) is a common childhood-oneset psychiatric disease, characterized by excessive overactivity, inattention, and impulsiveness. In recent studies, it is emphasized that inflammation may have a role in ADHD. In this study, we aimed to investigate whether there are associations between ADHD and serum levels of soluble intercellular adhesion molecules (s-ICAMs) which have important role in inflammatory diseases. We also measured the levels of these molecules after treatment with oros-methylphenidate. Methods Twenty-five patients diagnosed with ADHD according to Diagnostic and Statistical Manual of Mental Disorders-IV-TR criteria and 18 healthy volunteer controls were included in this study. The levels of sICAMs were measured in the serum of the patients and healthy volunteers by ELISA kit as described. Results The levels of sICAM-1 and sICAM-2 were significantly higher in patients compared with controls. The level of sICAM-2 was decreased significantly in group treated with oros-methylphenidate. Conclusions This is the first study pointing out the relationship between sICAMs and ADHD. The changes in sICAM-2 level may have a role in the effect mechanism of oros-methylphenidate, used for the treatment of ADHD.

Haloperidol: A possible medication for the treatment of exacerbation of intractable psychogenic sneezing

Sneezing is one of the physiological defense mechanisms that develops generally due to nasal irritation. But intractable sneezing episodes are uncommon and generally detected among the adolescents. It is difficult to distinguish physiologic sneezing from psychogenic sneezing. Herein, we report a 12-year-old girl who was complaint with intractable sneezing. She was diagnosed as intractable psychogenic sneezing and haloperidol treatment was started. All symptoms had resolved completely within 2 weeks. As a result, haloperidol can be considered as a different treatment modality for intractable psychogenic sneezing.

L-2 hydroxyglutaric aciduria presenting with anxiety symptoms.

l-2 Hydroxyglutaric aciduria is a rare autosomal recessively inherited metabolic disorder of organic acid metabolism. Cerebellar and pyramidal signs with progressive neurological syndromes, mental deterioration, tremors, seizures, epilepsy and rarely macrocephaly are clinical findings of the disease. The diagnosis depends on increased levels of l-2 hydroxyglutaric acid in urine, plasma and cerebrospinal fluid. Brain MRI shows peripheral white matter abnormalities in cerebral hemispheres, bilateral symmetrically abnormal signal intensity in basal ganglia and dentate nuclei. In this case report, we present a 13-year-old patient who presented with tremors and anxiety symptoms and was diagnosed as l-2 hydroxyglutaric aciduria after consultation with the child neurology department. We present a patient suffering from psychiatric symptoms with a metabolic disorder.

Our experience with Syrian refugee patients at the child and adolescent psychiatry clinic in Gaziantep, Turkey

Abstract Reporting from Turkey’s frontier with the civil war in Syria, we examined the demographic characteristics, psychiatric diagnoses and treatments for the Syrian refugee patients who have presented to Gaziantep University, Child and Adolescent Psychiatry Clinic through 2016 and the first half of 2017 retrospectively, having aimed to understand the special characteristics and needs of this novel patient group. Within a year and a half, we evaluated 51 children and adolescents and 25 (51%) had come from refugee camps, where primary healthcare services are available. Twenty-eight patients (54.9%) had special educational needs. Among our patients, there were only 15 (29.4%) girls. After our experience with refugee patients, we conclude that the role of primary healthcare services in reaching psychiatric treatment should be investigated for child refugees that special educational needs of Syrian refugees in Turkey needs urgent attention and that more research is needed to establish whether gender may be a factor in negligence of internalising symptoms by refugee families.