Eyup Sabri Ercan

Associated features of conversion disorder in Turkish adolescents.

Abstract Background : Conversion disorder in adolescents has not been studied extensively. A limited number of studies have focused on the features related to conversion disorder in adolescents. However, most of these studies used either retrospective data or did not have a control group that would allow comparison with the index cases.

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.

Long-term efficacy of sertraline in the prevention of alcoholic relapses in alcohol-dependent patients: A single-center, double-blind, randomized, placebo-controlled, parallel-group study

Background: Alcoholism may be related to dysfunction of the serotonergic system in some patients. Therapy with a selective serotonin reuptake inhibitor (SSRI) may help to reduce alcohol consumption in these patients. Objective: The aim of this study was to examine the long-term efficacy of the SSRI sertraline in preventing alcoholic relapse and in increasing the number of abstinent days after alcohol withdrawal in alcohol-dependent patients. Methods: Male patients who met the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) diagnostic criteria for alcohol dependence with no concurrent disorders on Axis I participated in this single-center, double-blind, randomized, placebo-controlled, parallel-group study. All of the patients had been withdrawn from alcohol for 7 to 21 days when included in the study during their inpatient treatment and were followed up for 6 months with monthly assessments. Patients were given either two 50-mg capsules of sertraline hydrochloride daily (100 mg/d) or 2 placebo capsules daily. Results: A total of 59 patients (mean [SD] age, 43.8 [8.5] years) were enrolled (30 in the sertraline group and 29 in the placebo group). The 2 groups differed significantly in terms of the mean (SD) number of abstinent days (sertraline, 125.5 [60.6] days; placebo, 91.9 [66.4] days; P = 0.047). Although the percentage of relapse was lower in the sertraline group in all monthly assessments, the difference in percentage of relapse between the 2 groups reached statistical significance only at month 4 (P = 0.027). Conclusions: Sertraline seems to increase the number of abstinent days and thus has a preventive effect on alcoholic relapse. However, this finding needs to be supported by further controlled studies.

Zuclopenthixol-induced neuroleptic malignant syndrome in an adolescent girl

We present the case of a 14-year-old female who had many characteristics of neuroleptic malignant syndrome (NMS) without pyrexia following a single depot injection of 200 mg of zuclopenthixol. The patient presented with a change in mental status that had progressed over the preceding 48 hours. Subsequently, she became increasingly agitated and confused, and developed diffuse muscular rigidity, mutism, tremor, tachycardia, diaphoresis, sialorrhea, and incontinence. Results of laboratory tests showed elevated CPK levels, leukocytosis, and a low serum iron level. Bromocriptine and diazepam were used as initial treatment of a probable NMS and provided significant improvement. During the next seven days, she clinically improved but continued to exhibit emotional lability, logorrhea, elevated mood, and increased psychomotor activity. Therefore, bromocriptine and diazepam were discontinued and lorazepam and lithium were administered as treatment of a bipolar disorder. Four weeks later, she was discharged in stable condition. The presentation of this case report suggests that the primary psychiatric diagnosis is important in antipsychotic usage in the pediatric population, and that young patients receiving neuroleptic treatment should be monitored for the early signs of NMS. Using the diagnostic criteria of a neuroleptic toxicity spectrum may result in greater clinical awareness and earlier recognition of NMS.

White matter alterations related to attention-deficit hyperactivity disorder and COMT val 158 met polymorphism: children with valine homozygote attention-deficit hyperactivity disorder have altered white matter connectivity in the right cingulum (cingulate gyrus)

Introduction In this article, the COMT gene val158met polymorphism and attention-deficit hyperactivity disorder (ADHD)-related differences in diffusion-tensor-imaging-measured white matter (WM) structure in children with ADHD and controls were investigated. Patients and methods A total of 71 children diagnosed with ADHD and 24 controls aged 8–15 years were recruited. Using diffusion tensor imaging, COMT polymorphism and ADHD-related WM alterations were investigated, and any interaction effect between the COMT polymorphism and ADHD was also examined. The effects of age, sex, and estimated total IQ were controlled by multivariate analysis of covariance (MANCOVA). Results First, an interaction between the COMT val158met polymorphism and ADHD in the right (R) cingulum (cingulate gyrus) (CGC) was found. According to this, valine (val) homozygote ADHD-diagnosed children had significantly lower fractional anisotropy (FA) and higher radial diffusivity (RD) in the R-CGC than ADHD-diagnosed methionine (met) carriers, and val homozygote controls had higher FA and lower RD in the R-CGC than val homozygote ADHD patients. Second, met carriers had higher FA and axial diffusivity in the left (L)-uncinate fasciculus and lower RD in the L-posterior corona radiata and L-posterior thalamic radiation (include optic radiation) than the val homozygotes, independent of ADHD diagnosis. Third, children with ADHD had lower FA in the L-CGC and R-retrolenticular part of the internal capsule than the controls, independent of the COMT polymorphism. Conclusion Significant differences reported here may be evidence that the COMT gene val158met polymorphism variants, as well as ADHD, could affect brain development. ADHD and the COMT polymorphism might be interactively affecting WM development in the R-CGC to alter the WM connectivity in children with val homozygote ADHD.

A Promising Preliminary Study of Aripiprazole for Treatment-Resistant Childhood Obsessive-Compulsive Disorder.

BACKGROUND Obsessive-compulsive disorder (OCD) is a relatively frequent disease in childhood, which is generally treated with selective serotonin reuptake inhibitors (SSRIs) and/or clomipramine and cognitive behavioral therapy (CBT). However, nearly half of the cases are treatment resistant. Aripiprazole was shown to be beneficial in augmentation therapy in treatment-refractory OCD. This study evaluated its effectiveness as a single agent in these cases. METHODS Sixteen children (nine girls, seven boys), who were nonresponders to treatment with at least two types of SSRIs and CBT, were administered 12 weeks of aripiprazole treatment with a mean dose of 4.75 mg/day (range: 2-7.5 mg/day). Treatment outcomes were evaluated by the Childhood Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and the Clinical Global Impressions-Severity and Improvement (CGI-S and CGI-I) scales. RESULTS Children with a mean age of 10.9±2.9 years had severe obsessive compulsive symptoms at baseline, and >80% of them had another comorbid psychiatric disease. Significant improvements in symptoms were achieved after 12 weeks of aripiprazole treatment, which were evaluated by significant decreases in symptom scores in the CY-BOCS, and improvements in CGI-I scores. CONCLUSIONS This very small study of aripiprazole, given to children with OCD resistant to at least 12 weeks treatment with at least two SSRIs and CBT, demonstrated striking improvement in CGI scores (all subsets, p≤0.002) for 13 of 16 children, and halved all CY-BOCS subscores after ∼12 weeks of treatment.

Psychiatric Comorbidity and Demographic Characteristics of 1,000 Children and Adolescents With ADHD in Turkey

Objective: The objective was to examine the frequency of comorbid disorders in children and adolescents with ADHD in Turkey and to evaluate the distribution of comorbidities according to the subtypes of ADHD and sociodemographic features. Method: The sample consisted of 1,000 children, 6 to 18 years of age, including 242 females and 758 males, from Ege University who were diagnosed with ADHD. Results: The overall prevalence rate of psychiatric comorbidity in the study was 56.3%. The most frequently observed comorbidity was oppositional defiant disorder with a rate of 37.4%. Conduct disorder, depressive disorder, obsessive-compulsive disorder, and anxiety disorder accompanied ADHD, respectively. The results revealed that 70.2% of the children with ADHD-Combine type had at least one psychiatric comorbidity. Oppositional defiant disorder, conduct disorder, depressive disorder, and obsessive-compulsive disorder accompanied ADHD-Combine type in 54.6%, 12.6%, 8.1%, and 8.8% of the participants, respectively. Conclusion: These findings provide valuable information about the comorbid disorders in children and adolescents with a very large clinical sample of ADHD children.

Effect of methylphenidate on neurocognitive test battery: an evaluation according to the diagnostic and statistical manual of mental disorders, fourth edition, subtypes.

Abstract The aims of this study were to evaluate the neuropsychological characteristics of the restrictive (R) subtype according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the attention-deficit/hyperactivity disorder (ADHD) combined (CB) type and predominantly inattentive (PI) type subtypes and to evaluate whether methylphenidate (MPH) affects neurocognitive test battery scores according to these subtypes. This study included 360 children and adolescents (277 boys, 83 girls) between 7 and 15 years of age who had been diagnosed with ADHD and compared the neuropsychological characteristics and MPH treatment responses of patients with the R subtype—which has been suggested for inclusion among the ADHD subtypes in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition—with those of patients with the PI and CB subtypes. They did not differ from the control subjects in the complex attention domain, which includes Continuous Performance Test, Stroop test, and Shifting Attention Test, which suggests that the R subtype displayed a lower level of deterioration in these domains compared with the PI and CB subtypes. The patients with the CB and PI subtypes did not differ from the control subjects in the Continuous Performance Test correct response domain, whereas those with the R subtype presented a poorer performance than the control subjects. The R subtype requires a more detailed evaluation because it presented similar results in the remaining neuropsychological evaluations and MPH responses.

Predicting aggression in children with ADHD

ObjectiveThe present study uses structural equation modeling of latent traits to examine the extent to which family factors, cognitive factors and perceptions of rejection in mother-child relations differentially correlate with aggression at home and at school.MethodsData were collected from 476 school-age (7–15 years old) children with a diagnosis of ADHD who had previously shown different types of aggressive behavior, as well as from their parents and teachers. Structural equation modeling was used to examine the differential relationships between maternal rejection, family, cognitive factors and aggression in home and school settings.ResultsFamily factors influenced aggression reported at home (.68) and at school (.44); maternal rejection seems to be related to aggression at home (.21). Cognitive factors influenced aggression reported at school (.-05) and at home (-.12).ConclusionsBoth genetic and environmental factors contribute to the development of aggressive behavior in ADHD. Identifying key risk factors will advance the development of appropriate clinical interventions and prevention strategies and will provide information to guide the targeting of resources to those children at highest risk.

Successful Treatment Response with Aripiprazole Augmentation of SSRIs in Refractory Obsessive–Compulsive Disorder in Childhood

The aim of this study is to evaluate the aripiprazole augmentation of selective seratonine reuptake inhibitors (SSRIs) in children and adolescents with treatment-resistant OCD. Forty-eight children and adolescents (14 girls, 34 boys), who are non-responders to treatment with at least two types of SSRIs and CBT, were administered a 12-week of augmentation. Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and Clinical Global Impression-Severity and Improvement (CGI-S and CGI-I) sub-scales were used for evaluation of the treatment outcomes. The results showed that total CY-BOCS scores were decreased from 33.3 ± 7.5 to 11.7 ± 9.3 (p < 0.001), CGI-S scores decreased from 6.3 ± 0.9 to 2.7 ± 1.6 (p < 0.001), and CGI-I scores improved from 4.3 ± 0.6 to 2.2 ± 1.1 (p < 0.001). Sensitivity analyses in 29 patients without SSRI dose escalation along with aripiprazole augmentation have also revealed that improvement effect was still significant, and CY-BOCS scores were improved from 34.2 ± 7.9 to 13 ± 10.3, CGI-S improved from 6.4 ± 1.0 to 3.0 ± 1.7, and CGI-I improved from 4.4 ± 1.0 to 2.3 ± 1.1 (p < 0.001 for all). Analyses revealed that a significant clinical improvement has been observed with aripiprazole augmentation. Aripiprazole augmentation of SSRIs is a promising strategy in the management of treatment-refractory OCD children and adolescents.