Gökçe Nur Say

Effect of methylphenidate treatment on appetite and levels of leptin, ghrelin, adiponectin, and brain-derived neurotrophic factor in children and adolescents with attention deficit and hyperactivity disorder

Abstract Objectives. We aimed to explore whether the use of methylphenidate relates leptin, ghrelin, adiponectin, and brain-derived neurotrophic factor (BDNF). In addition, the relationship between methylphenidate-related weight loss in attention deficit hyperactivity disorder (ADHD) patients and these biomolecules were evaluated. Methods. Thirty ADHD patients receiving methylphenidate and 20 healthy controls were included. Leptin, ghrelin, adiponectin, and BDNF levels were measured at baseline and after two-month treatment in both groups. Results. At baseline, leptin, ghrelin, adiponectin, and BDNF levels were similar in the ADHD and control groups. The most common adverse events occurring in the ADHD group after a 2-month treatment period included loss of appetite (70%) and weight loss (66.7%). A significant difference was found in body weight, BMI, and CGI scores of the ADHD patients after the treatment. While post-treatment ghrelin and adiponectin levels were significantly higher in the ADHD group, BDNF level was significantly lower. Post-treatment decrease in leptin levels was not significant. Conclusions. Leptin and BDNF were not associated with poor appetite and/or weight loss due to methylphenidate treatment. However, ghrelin and adiponectin might be biomolecules that play a role in underlying neurobiological mechanisms of methylphenidate-related appetite or weight loss.

Decreased dehydroepiandrosterone sulphate levels in adolescents with post-traumatic stress disorder after single sexual trauma

Background: Recent evidence shows that the hypothalamic–pituitary–adrenal (HPA) axis can be dysregulated in chronic sexual abuse victims with post-traumatic stress disorder (PTSD). We hypothesized that PTSD in adolescents exposed to a single sexual trauma may function as a chronic stressor leading to HPA-axis dysregulation. Aims: The objective of this study was to assess dehydroepiandrosterone sulphate (DHEA-S) and cortisol levels in female adolescents |with single sexual trauma-related PTSD compared to healthy controls. Method: We assessed 20 female adolescent (age 12–18) single sexual trauma victims with PTSD from the Ondokuz Mayis University Department of Child and Adolescent Psychiatry between December 2013 and December 2014. PTSD symptoms were assessed using the Child Depression Inventory (CDI) and Child Posttraumatic Stress Reaction Index (CPSRI). Blood cortisol and DHEA-S were measured in 20 female adolescent sexual abuse victims with PTSD and 20 healthy adolescents after 12-h fasting using the chemiluminescence method. Results: Compared to age-matched controls, female adolescent sexual abuse victims with PTSD had significantly lower DHEA-S levels (U = 70.00, Z = − 3.517, p = 0.01, r = 0.55). There was also a significant negative correlation between DHEA-S and CDI scores (Spearman r = − 0.522, p < 0.01). Conclusions: Decreased DHEA-S levels and correlation with depressive symptoms are evidence for a dysregulated HPA-axis in female adolescent single sexual trauma victims with PTSD. Further research is now recommended with large patient groups in order to maximize generalizations.

Increased Laterality of the Thalamus in Children and Adolescents with Asperger's Disorder: An MRI and Proton Spectroscopy Study

Objective Thalamic abnormalities have been reported in people with pervasive developmental disorders (PDD) including Aspergers Disorder (ASP). The aim of the present study was to compare the volume and volume fraction of the thalamus and the metabolite concentrations in children and adolescents with ASP using the magnetic resonance imaging and proton magnetic resonance spectroscopy. Additionally, the relationships between thalamic abnormalities and clinical features were examined. Methods Volume and volume fractional and metabolic measurements of bilateral thalamus were collected from 15 boys with ASP with a total IQ over 70 (age range 7-18 years, mean age 11.6±3.79 years), and 15 healthy controls matching age, sex and IQ. The thalamic volumes, hemisphere volumes and total brain volumes (TBV) were estimated using the stereological methods on magnetic resonance images. Chemical metabolites of thalamus were evaluated by 1H spectroscopy. Results No differences in thalamic volumes, volume fractions and metabolites were observed between the groups. There were significant correlation between thalamic volume and total brain volume in both groups. The ASP group showed a significant left-minus-right thalamus difference as well as a significantly greater laterality index. In addition, a significant correlation between the laterality index and Autism Behavior Checklist language scores was observed. Conclusion Findings from this investigation point to a significant increase in laterality of the thalamus and a relationship with language problems in individuals with ASP. Our findings suggest that thalamic abnormalities may be related to mild language problems observed in ASP.

Maternal stress and perinatal features in autism and attention deficit/hyperactivity disorder.

We investigated the shared and non‐shared perinatal risk factors for autism spectrum disorders (ASD) and attention deficit/hyperactivity disorder (ADHD) in a clinical sample. Additionally, we compared these groups regarding pre/postpartum maternal stress and the duration of breastfeeding.

Self-Esteem and Psychiatric Features of Turkish Adolescents with Psychogenic Non-Epileptic Seizures: A Comparative Study with Epilepsy and Healthy Control Groups

Objective: Children and adolescents with psychogenic non-epileptic seizures (PNES) and epilepsy are known to have psychosocial problems. The aim of the present study was to compare the psychosocial difficulties, history of stressful life events/abuse, psychiatric diagnosis, and self-esteem of adolescents with PNES to the ones with epilepsy and healthy controls at a tertiary care center in Turkey. Method: Thirty-four adolescents with PNES diagnosed by video-EEG were compared with 23 adolescents that have epilepsy and 35 healthy volunteers. Comorbid psychiatric diagnoses of participants were examined by semi-structured interviews using Schedule for Affective Disorders and Schizophrenia for School Age Children—Present and Lifetime Version (KSADS-PL). Self-esteem of adolescents was evaluated by Rosenberg Self Esteem Scale (RSES). Results: No differences in sociodemographic features were observed between the groups. The PNES group showed significantly higher rates of parental conflicts, difficulties in relationship with siblings/peers, school under-achievement, and history of stressful events/abuse. The rates of comorbid psychiatric disorders were 64.7% in PNES and 47.8% in epilepsy group. The most common disorders in both groups were attention deficit hyperactivity disorder (ADHD) and depressive disorder. The rate of posttraumatic stress disorder (PTSD) was significantly increased in the PNES group. Additionally, adolescents with PNES displayed significantly lower levels of self-esteem than the other groups. Conclusion: It could be concluded that both disorders involved a high risk for developing psychiatric disorders; additionally, adolescents with PNES have higher rates of stressors and lower levels of self-esteem. Findings from this investigation point to the importance of psychiatric interventions in pediatric PNES and also epilepsy.

Semiological and psychiatric characteristics of children with psychogenic nonepileptic seizures: Gender-related differences

PURPOSE To compare semiological characteristics, precipitating stress factors and psychiatric diagnoses of girls and boys with psychogenic nonepileptic seizures (PNESs). METHODS We retrospectively reviewed medical records of children diagnosed with PNES and who also underwent psychiatric evaluation. Sixty-two children (44 girls, 18 boys), aged 11-18 years (mean age 14.19 ± 1.96 years) were included. Diagnosis of PNES was established by any of the following: (1) observation of the seizure by a neurologist and routine EEG, (2) evaluation of amateur video records of the typical seizure and routine EEG, or (3) video-EEG monitoring. Psychiatric examinations of patients were performed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (KSADS-PL). RESULTS Tremor was the most prevalent ictal motor sign in both girls and boys. Atonic falls and longer episodes were significantly more frequent in girls than boys. Tonic-clonic-like movements of the extremities were significantly more prevalent in boys than girls. No gender-specific differences were observed in the rates of semiological types. Academic underachievement was the most prevalent precipitating stressor for boys, and was significantly more prevalent in boys than girls. The rate of major depression was significantly higher in girls than boys. The most prominent diagnosis in boys was attention deficit/hyperactivity disorder, and this was significantly more prevalent than in girls. CONCLUSION PNES in males of juvenile age may be a distinct entity from that in girls with different semiological and psychogenic correlates. Consideration of these gender-related differences may be beneficial for the early recognition and treatment of PNES.

Abuse Characteristics and Psychiatric Consequences Associated with Online Sexual Abuse.

The current study examined the rate and psychiatric correlates of sexual abuse involving the use of digital technologies by the offender in a wide sample of juvenile victims. Sociodemographic, abuse, and psychiatric characteristics of 662 sexually abused children and adolescents were evaluated. Of these, 93 reported that digital devices were used by the offender in several ways to facilitate the sexual abuse. The offender-victim relationship was initiated through the Internet in 39 victims. Involvement of digital technologies in sexual abuse was significantly associated with penetrative and recurrent form of sexual abuse commited by multiple offenders with coexisting violence. Additionally, victims of sexual abuse with a digital component were 4.21 times more likely to develop any psychopathology, 3.77 times more likely to have depression, and 2.14 times more likely to have post-traumatic stress disorder as a result of sexual abuse. These results indicated that the offenders use of digital technology may aid the initiation and facilitation of the sexual abuse of youths and may relate to more severe outcomes. This study revealed the importance of raising the awareness of professionals and the community about the potential risks associated with digital technologies and sexual abuse. Mental health professionals should consider this additional form of victimization, especially when dealing with sexual abuse victims.

Breastfeeding History in Children with Autism and Attention Deficit Hyperactivity Disorder

Autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) are both lifelong neurodevelopmental conditions that begin in early childhood, and there are suggestions that insufficient breastfeeding may be related to development of either ASD or ADHD. In the present study, we compared breastfeeding durations of ASD and ADHD groups with each other and with healthy controls. The study included 98 children 3–18 years of age with ASD, 96 ageand gender-matched children with ADHD, and 79 ageand gender-matched healthy controls. Subjects with ASD or ADHD were recruited from among outpatients of the Department of Child and Adolescent Psychiatry, Ondokuz Mayis University Medical Hospital, Samsun, Turkey. The diagnoses of ASD and ADHD were established by interviews with patients and parents based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition, criteria. Demographic features and duration of breastfeeding were evaluated by a questionnaire that was prepared by the authors and completed by the mothers of participants. The mean age of the ASD group was 8.73 – 3.86 years (77% boys, 23% girls), that of the ADHD subjects was 8.80 – 1.98 years (71% boys, 21% girls), and that of the healthy control group was 8.45 – 4.61 years (78% boys, 22% girls). There were no significant differences among groups regarding age/gender of children, maternal age at birth, and education of parents. The mean duration of breastfeeding was significantly shorter in the ADHD group (9.10 – 7.847 months) compared with the ASD (12.18– 10.480 months) and healthy control (12.99– 8.658 months) groups ( p = 0.005). We also evaluated the rates of children who were never breastfed and those who continued breastfeeding at 1 month, 3 months, 6 months, 12 months, and 24 months of age. The rate of children who were never breastfed was significantly higher in the ADHD group (9.6%) compared with the healthy control group (1.3%) ( p= 0.034). The ADHD group showed significantly lower rates of exclusive breastfeeding at 1, 3, and 6 months of age than the other groups. At 1 month of age, 84% of children with ADHD were still breastfed, whereas 93% of the ASD group were breastfed, and 98% of the healthy controls were breastfed ( p= 0.001). At 3 months of age, 71% of the ADHD group were still breastfeeding compared with 78% in the ASD group and 88% in the healthy control group ( p= 0.025). By 6 months of age, breastfeeding rates were as follows: 50% in the ADHD group, 58% in the ASD group, and 72% in the healthy control group ( p= 0.012). The ASD group did not show any significant differences regarding mean duration and rates of breastfeeding compared with either the ADHD or healthy control group. The rates of breastfeeding were similar in all groups at 1 and 2 years of age. The results are summarized in Table 1. Breastfeeding has promoting effects on mental and motor development of the newborn. This preliminary study noted that children with ADHD were more likely to be less breastfed, especially during the first 6 months after birth, compared

Buspirone Use in the Treatment of Atomoxetine-Induced Bruxism

Attention-deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder characterized by common inattention and hyperactivity-impulsivity symptoms, leading to psychosocial impairments. In society samples, the prevalence of ADHD in school-age children varies between 2% and 18% (Rowland et al. 2002). Pharmacotherapy is the most important component of ADHD treatment. Psychostimulants are the most common treatment for ADHD (Taylor et al. 2004). Atomoxetine is a selective noradrenergic reuptake inhibitor that was approved by the United States Food and Drug Administration (FDA) in 2002 for the treatment of ADHD in children ‡ 6 years of age (Michelson et al. 2002). The most common side effects of atomoxetine are headache, abdominal pain, loss of appetite, asthenia, nausea, vomiting, and vertigo (Michelson et al. 2002; Wolraich et al. 2007). These effects are generally temporary and do not require the tapering of therapy (Wolraich et al. 2007; GarnockJones and Keating 2009). Bruxism is a common disorder defined as excessive activity that results from grinding or clenching of the teeth and certain strong jaw movements (Clark and Ram 2007). Bruxism affects 8–21% of the population. It is more common at young ages and its incidence decreases with age (Bader and Lavigne 2000). The etiology of bruxism is a controversial issue, but it is thought to be multifactorial ( Jaffe and Bostwick 2000). Bruxism can occur in association with anxiety, benzodiazepines, use of alcohol, or selective serotonin reuptake inhibitors (SSRIs). It is thought that dopamine agonist medications can cause bruxism or worsen preexisting symptoms (Ellison and Stanziani 1993; Micheli et al. 1993; Bader and Lavigne 2000; Wise 2001; Winocur et al. 2003; Clark and Ram 2007). Bruxism can cause serious damage to tooth enamel, and temporomandibulary articular pain in severe cases (Bader and Lavigne 2000; Clark and Ram 2007). SSRIs have significant effects on bruxism, and their use has increased in recent years. However, bruxism seems to be less frequent, as bruxism is overlooked by psychiatrists or not presented as a complaint by patients especially when it is mild. There are previous reports of bruxism induced by SSRIs or venlafaxine (Ellison and Stanziani 1993; Jaffee and Bostwick 2000; Wise 2001). Various agents such as buspirone, gabapentin, and tandospirone have been used to treat SSRIs-induced bruxism (Ellison and Stanziani 1993; Jaffee and Bostwick 2000; Wise 2001; Winocur et al. 2003). A patient with aggravating bruxism caused by atomoxetine was reported in the literature (Mendhekar and Lohia 2009). As far as we know, this is the second reported case of bruxism related to atomoxetine.

Basal blood DHEA-S/cortisol levels predicts EMDR treatment response in adolescents with PTSD

Abstract Objective: In literature, recent evidence has shown that the hypothalamic–pituitary–adrenal (HPA) axis can be dysregulated in patients with post-traumatic stress disorder (PTSD) and HPA axis hormones may predict the psychotherapy treatment response in patients with PTSD. In this study, it was aimed to investigate changing cortisol and DHEA-S levels post-eye movement desensitization and reprocessing (EMDR) therapy and the relationship between treatment response and basal cortisol, and DHEA-S levels before treatment. Method: The study group comprised 40 adolescents (age, 12–18 years) with PTSD. The PTSD symptoms were assessed using the Child Depression Inventory (CDI) and Child Post-traumatic Stress Reaction Index (CPSRI) and the blood cortisol and DHEA-S were measured with the chemiluminescence method before and after treatment. A maximum of six sessions of EMDR therapy were conducted by an EMDR level-1 trained child psychiatry resident. Treatment response was measured by the pre- to post-treatment decrease in self-reported and clinical PTSD severity. Results: Pre- and post-treatment DHEA-S and cortisol levels did not show any statistically significant difference. Pre-treatment CDI scores were negatively correlated with pre-treatment DHEA-S levels (r: −0.39). ROC analysis demonstrated that the DHEA-S/cortisol ratio predicts treatment response at a medium level (AUC: 0.703, p: .030, sensitivity: 0.65, specificity: 0.86). Conclusion: The results of this study suggested that the DHEA-S/cortisol ratio may predict treatment response in adolescents with PTSD receiving EMDR therapy. The biochemical parameter of HPA-axis activity appears to be an important predictor of positive clinical response in adolescent PTSD patients, and could be used in clinical practice to predict PTSD treatment in the future.