Gulen Guler

Persistent hiccups due to aripiprazole in an adolescent with obsessive compulsive disorder responding to dose reduction and rechallenge

Our case involves persistent hiccup arising in an adolescent with obsessive compulsive disorder (OCD) who was using aripiprazole as an augmentation to fluoxetine and whose hiccups remitted with dose reduction and rechallenge. Treatment suggested that aripiprazole might lead to hiccups. Antipsychotics are also used for the treatment of hiccups, but recent case reports suggest that they cause hiccups as well. Within 12 h of taking 5 mg aripiprazole, the 13-year-old girl began having continuous hiccups, which lasted for 3–4 h. The hiccups resolved when the dose of aripiprazole was reduced to 2.5 mg. To achieve augmentation, aripiprazole was replaced with risperidone 0.5 mg/day for 1 month, but excess sedation was observed. As a result, aripiprazole was restarted at a dose of 2.5 mg/day, and 1 week later, it was increased to 5 mg/every other day. No hiccups were observed.

Migraine and associated comorbidities are three times more frequent in children with ADHD and their mothers

OBJECTIVE Attention deficit and hyperactivity disorder (ADHD) is a neuro-developmental disorder related to internalizing and externalizing disorders as well as somatic complaints and disorders. This study was conducted to evaluate the prevalence of headache subtypes, epilepsy, atopic disorders, motion sickness and recurrent abdominal pain among children and adolescents with ADHD and their parents. METHODS In a multi-center, cross-sectional, familial association study using case-control design, treatment naïve children and adolescents between 6 and 18 years of age diagnosed with ADHD according to the DSM-5 criteria as well as age- and gender-matched healthy controls and their parents were evaluated by a neurologist and analyzed accordingly. RESULTS 117 children and adolescents with ADHD and 111 controls were included. Headache disorder diagnosis was common for both patients and healthy controls (59.0% vs. 37.8%), with a significantly elevated rate in the ADHD group (p = 0.002). Migraine was found in 26.0% of ADHD patients and 9.9% of healthy controls. Tension headache was found in 32.4% of ADHD patients and 27.9% of healthy controls. Headache diagnosis was also found to be significantly more common in mothers of children with ADHD than control group mothers (90.5% vs. 36.6%, p < 0.001). CONCLUSION Headache diagnoses and specifically migraines were significantly more common among children with ADHD and their mothers, while recurrent abdominal pain was elevated in both parents and ADHD patients. Migraine is an important part of ADHD comorbidity, not only for children but also for mothers. Motion sickness may be reduced among families of ADHD probands.

Achalasia as a complication of bulimia nervosa: A case report

Objective Oesophageal achalasia is a medical condition characterised by oesophageal aperistalsis, an increased resting pressure with partial or incomplete relaxation of the lower oesophageal sphincter. Bulimia nervosa (BN) is an eating disorder manifested by binge eating attacks followed by recurrent inappropriate compensatory behaviours, such as self-induced vomiting and excessive exercise. Dysphagia, regurgitation, vomiting, retrosternal pain, heartburn, weight loss, avoidance of eating, consumption of large amount of liquids and aberrant eating behaviours are symptoms of both achalasia and BN. Owing to these common signs and symptoms, oesophageal achalasia can be misdiagnosed as an eating disorder. In addition, oesophageal achalasia can occur as a complication of BN. It is often difficult to distinguish organic and psychological vomiting or comorbidity because of overlapping of the symptoms. Case report We report the case of a patient who developed oesophageal achalasia following severe, repetitive vomiting as a complication of BN. Conclusion We want to raise awareness regarding the development of a medical illness in the presence of a psychiatric disorder. Importantly, physicians should have a fundamental knowledge of these two diseases regarding their clinical patterns to differentially diagnose one or both disorders as quickly as possible.

Tibia stress fracture secondary to obsessive compulsive disorder

Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder characterized by obsessions and compulsions. Early-onset OCD is one of the most common mental illnesses of children and adolescents, with a prevalence of 1% to 3%. It is related to worse lifespan symptoms and prognosis. Therefore, the treatment of OCD in children and adolescent has gained importance. If it is not treated successfully, the compulsive behaviors may cause extreme stress for children and their parents. Although minor complications of OCD are commonly observed, major complications are considerably rare due to the nature of compulsive behaviors. Apparently, loss of vision, autocastration, rectal prolapse are examples of major complications secondary to OCD. As far as we know, it is the first case of tibia stress fracture secondary to OCD. In the present case report, we will discuss tibia stress fracture developing secondary to compulsive behavior due to OCD.

Developmental delays and psychiatric diagnoses are elevated in offspring staying in prisons with their mothers

The aim of the study was to describe the sociodemographic and clinical features of the mothers and their offspring staying with them in prison. The study was planned as a cross-sectional, single-center study of mothers residing in Tarsus Closed Women’s Prison of Turkish Ministry of Justice along with their 0 to 6 years old offspring. Mothers were evaluated via Structured Clinical Interview for DSM-IV Axis I Disorders. A psychologist blind to maternal evaluations applied the Denver Developmental Screening Test II (DII-DST). Children/mothers were also evaluated by a child and adolescent psychiatrist via K-SADS-PL. Twenty-four mothers with a mean age of 29.3 years were included. Most common diagnoses in mothers were nicotine abuse (n = 17, 70.8%), specific phobia (n = 8, 33.3%), alcohol abuse (n = 7, 29.2%) and substance abuse (n = 5, 20.8%). Twenty-six children (53.9% female) were living with their mothers in prison, and the mean age of those was 26.3 months. Results of the D-II-DST were abnormal in 33.3% of the children. Most common diagnoses in children were adjustment disorder (n = 7, 26.9%) separation anxiety disorder (n = 3, 11.5%) and conduct disorder (n = 2, 7.7%). A multi-center study is necessary to reach that neglected/under-served population and address the inter-generational transmission of abuse, neglect, and psychopathology.

Amenorrhea as a Side Effect of Low Dose Aripiprazole: An Adolescent Case

Amenorrhea, oligomenorrhea, galactorrhoea, gynecomastia, infertility, and sexual dysfunction may arise as a consequence of hyperprolactinemia. Hyperprolactinemia is one of major side effects of treatment with antipsychotics, but aripiprazole is known as a dopamine stabilizer antipsychotic which can be used to improve hyperprolactinemia. In this report, it was described that an adolescent patient experienced amenorrhea after adding very low dose aripiprazole to ongoing fluoxetine treatment regime for major depressive disorder. Additionally, this case showed that the patient recovered from the amenorrhea with replacement of aripiprazole with quetiapine.

Evaluation of Clinical and Sociodemographic Characteristics of the Children Dragged to Crime

Objective: In the evaluation of children dragged to crime aged between 13 and 15 years-old, risk factors should be examined in detail. In this study, the primary goal of is evaluation of sociodemographic and clinical characteristics of juvenile offenders and the secondary goal is to examine the features that the clinician considers while setting up reports. Materials and Methods: Medical records of children dragged to crime aged between 13 and 15 years old were evaluated retrospectively. The sociodemographic characteristics of children and their parents’ crime type, crime story, family crime story and report result were included in the study. Results: The majority of cases (87.1%) were males. 31.7% of the cases left school. 55.4% were able to perceive the legal meaning and outcome of the crime and to direct their behavior. 43.6% had a mental disorder and the most common disorder was attention deficit hyperactivity disorder. The most common type of crime was wounding. 32.7% had repetitive crime stories. Both in the group that perceives the legal meanings and consequences of the crime and in the group of repetitive crime revealed statistically significant school failure, parental consanguinity, crime story in first-degree relative, cigarette/alcohol/substance abuse, and mental illness. Beck depression and trait anxiety scale (STAI-2) scores were higher in the group of repetitive crime. Theft (p=0.012) and battery crimes (p=0.046) tended to repeat more often. Discussion: Prominent risk factors in both criminal responsibility and repetitive crime groups are school failure, parental consanguinity, crime stories in relatives, cigarette/alcohol/substance abuse, and mental disorders. Although it is known that these risk factors may be a genetic ground, it is striking that many of them are features that can be prevented by protective and supportive studies. Social projects need to be developed for the children dragged to crime.

Abused-abuser dilemma in sexual abuse and forensic evaluation: a case report

The factors such as family problems, growing up in a disintegrated family, personality disorders in parents, physical and mental deficiencies, alcohol and substance abuse, previous history of sexual abuse, and lack of social support may increase the risk of being exposed to sexual abuse. According to the previous studies, it is known that about one third of children who are subjected to abuse may become abusers in the future. In such a condition, a dilemma of abuse-abuser has been experienced. Importantly, additional medical mistakes and lack of experience make legal evaluation processes more complex. A pediatric patient who was abused by her babysitter and had a history of abuse in her adolescence is discussed in this case report. Early recognition of sexual abuse, treatment of developing psychiatric disorders and a follow up program are necessary in order to minimize the vicious cycle of abused-abuser.

Hiccup Due to Aripiprazole Plus Methylphenidate Treatment in an Adolescent with Attention Deficit and Hyperactivity Disorder and Conduct Disorder: A Case Report

Our case had hiccups arising in an adolescent with the attention deficit and hyperactivity disorder (ADHD) and conduct disorder (CD) after adding aripiprazole treatment to extended-release methylphenidate. Actually, antipsychotics are also used in the treatment of hiccups, but studies suggest that they can cause hiccups as well. Within 12 hours of taking 2.5 mg aripiprazole added to extended-release methylphenidate at a dose of 54 mg/day, 16-year-old boy began having hiccups in the morning, which lasted after 3–4 hours. As a result, aripiprazole was discontinued and methylphenidate was continued alone because we could not convince the patient to use another additional drug due to this side effect. Subsequently, when his behavior got worsened day by day, his mother administered aripiprazole alone again at the dose of 2.5 mg/day at the weekend and continued treatment because hiccup did not occur again. But when it was administered with methylphenidate on Monday, hiccup started again next morning and lasted one hour at this time. In conclusion, we concluded that concurrent use of methylphenidate and aripiprazole in this adolescent led to hiccups.

Adli Psikiyatrik Değerlendirme ve Çocuk ile İletişim

Cocuk ve ergen ruh sagligi pratiginde adli psikiyatrik degerlendirmenin klinik degerlendirmeden farkli anahtar noktalari vardir. Adli degerlendiricinin gorevi hastayi tedavi etmekten cok; kisi, mahkeme ya da kurumun hastayi degerlendirme talebi ile ilgili konularda tibbi gorus vermektir. Dunyada ve ulkemizde cocuk ve ergenleri de icerisine alan adli olaylarin sayisi giderek cogalmaktadir. Adli psikiyatrik degerlendirmelerde cocugun yasindan gorusmenin suresine, gorusmelerin sayisindan aile ici ebeveyn catismalarina, cocugun gelisim basamaklarindan ebeveynin psikopatolojisine kadar bircok faktor goz onunde bulundurulmalidir. Etkin bicimde yurutulemeyen adli degerlendirmeler, yasal surecte yanlis iddialarin ortaya atilmasina, aile ve cocugun stresinin artmasina, gerceklerin carpitilmasina, failin mahkumiyet suresinin artmasina ya da azalmasina sebep olabilmektedir. Cocuk yas grubunda etkin bir adli psikiyatrik degerlendirmenin yurutulebilmesi icin cocugun gelisimsel sureclerinin iyi bilinmesi ve cocuk ile yasma uygun iletisim kurulmasi onem kazanmaktadir. Bu derlemede, ozellikle cinsel istismar olgularinda cocuk ile iletisim ve adli psikiyatrik degerlendirme sureci guncel bilgiler isiginda tartisilacaktir.Anahtar kelimeler: Ergen; Iletisim; Cocuk; Adli degerlendirme; Cinsel istismar.