Hasan Kandemir

Psychiatric comorbidity distribution and diversities in children and adolescents with attention deficit/hyperactivity disorder: a study from Turkey.

Objective We aimed to determine distribution and diversities of psychiatric comorbidities in children and adolescents with attention deficit/hyperactivity disorder (ADHD) in terms of age groups, sex, and ADHD subtype. Materials and methods The sample included 6–18 year old children and adolescents from Turkey (N=108; 83 boys, 25 girls) diagnosed with ADHD. All comorbid diagnoses were determined based on the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version assessment. Results 96.3% of the cases were found to have at least one psychiatric comorbid diagnosis. The most frequent psychiatric comorbid disorder was oppositional defiant disorder (69.4%) followed by anxiety disorders (49%) and elimination disorders (27.8%). Disruptive behavior disorders were more common in ADHD-combined type. Depression and anxiety disorders were more common in girls. Separation anxiety disorder and elimination disorder were more common in children, whereas depression, bipolar disorder, obsessive–compulsive disorder, and social phobia were more common in the adolescents. Conclusion According to our results, when a diagnostic tool was used to assess the presence of comorbid psychiatric disorders in children and adolescents diagnosed with ADHD, almost all cases had at least one comorbid diagnosis. Therefore, especially in the clinical sample, ADHD cases should not be solely interpreted with ADHD symptom domains, instead they should be investigated properly in terms of accompanying psychiatric disorders.

Self-reported mental health problems among adolescents in developing countries: results from an international pilot sample.

Objective: To evaluate the prevalence, pattern, and sociodemographic correlates of self-reported mental health problems among a pilot sample of adolescents from 5 developing countries and to speculate the methodology and design of a larger scale study. Methods: The sociodemographic questionnaire was developed based on extant literature on the sociodemographic correlates of mental health problems among adolescents. Additional information about the socioeconomic status of parents/caregivers of the participants was obtained using the Family Affluence Scale (FAS). Mental health problems were evaluated using the Strength and Difficulty Questionnaire (SDQ). Logistic regression analysis was done to determine independent sociodemographic correlates of mental health problems. Results: A total of 1894 adolescents sampled from 5 countries completed the study. The prevalence of self-reported mental health problems was 10.5% (range, 5.8–15) with conduct and emotional problems being the most prevalent. When the raw total-SDQ scores were adjusted for age, gender, and FAS scores, there was a statistically significant difference in the mean scores among the adolescents from different countries (F = 17.23, p < .001). After controlling for all potential sociodemographic confounders, living with single parents or other nonparent care givers, having a chronic disabling physical condition, lower maternal education, and coming from a family in the lower FAS-score category were all independently associated with higher odds of mental health problems. Conclusions: Study has added to the currently limited data on prevalence of mental health problems among adolescents in developing countries. It further established that socioeconomic and family factors still play a major role in the mental health of children irrespective of region of the world. Significant but surmountable methodological issues for a larger scale study were raised.

Oxidative imbalance in child and adolescent patients with obsessive compulsive disorder

Various psychological, social, genetic and biochemical factors are thought to be involved in etiology of obsessive-compulsive disorder (OCD). To the best of our knowledge there are no studies investigating the effects of free radicals in children and adolescents with OCD. This study evaluated total oxidant and antioxidant status, oxidative stress index, and arylesterase and paraoxonase activity in children and adolescents with OCD. The study included 28 patients diagnosed with OCD and 36 healthy children as an age- and sex-matched control group. Their serum total oxidant status (TOS) and total antioxidant status (TAS) were measured and the oxidative stress index (OSI) was calculated. Although serum TOS and OSI values in the OCD patients were significantly higher than those in the control group (p = 0.008, p < 0.001, respectively), TAS and paraxonase activity were significantly lower ( p < 0.001 for both). However, no statistically significant difference in arylesterase activity was found (p > 0.05). The increase in oxidative status and decrease in antioxidants in patients with OCD demonstrate that oxidative stress may have an important role in the pathophysiology of the disease. It has been suggested that drugs that contain antioxidants should be added to conventional pharmacotherapy during follow-up.

Evaluation of several micro RNA (miRNA) levels in children and adolescents with attention deficit hyperactivity disorder

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent childhood disorders, although disorders etiology and pathogenesis remains unknown, several theories about ADHD development have been proposed and many researchers believe that it is caused by both genetic and environmental factors. In this study we evaluated miR18a-5p, miR22-3p, miR24-3p, miR106b-5p, miR107, miR125b-5p and miR155a-5p levels in child and adolescent ADHD patients. The research sample consisted a group of 52 ADHD patients, and 52 healthy volunteer controls. There was no significant difference in age and sex between the two groups (p>0.05). miRNA 18a-5p, 22-3p, 24-3p, 106b-5p and 107 levels were statistically significantly decreased in ADHD patients(p<0.05). miRNA 155a-5p levels were increased in patients group (p<0.05). The positive predictive value (PPV) and negative predictive value of miR107 was estimated for the cutoff point of 0.4480. PPV was 70% and NPV was 86.5% for the taken cut off point. There could be a close relationship between levels of circulating miRNAs and ADHD. If we could understand how the signaling pathways arranged by miRNAs, impact on CNS development, function and pathology this can improve our knowledge about ADHD etiology and treatment.

Does the Strengths and Difficulties Questionnaire - self report yield invariant measurements across different nations? Data from the International Child Mental Health Study Group

AIMS This study evaluated the measurement invariance of the strengths and difficulties questionnaire (SDQ) self-report among adolescents from seven different nations. METHODS Data for 2367 adolescents, aged 13-18 years, from India, Indonesia, Nigeria, Serbia, Turkey, Bulgaria and Croatia were available for a series of factor analyses. RESULTS The five-factor model including original SDQ scales emotional symptoms, conduct problems, hyperactivity-inattention problems, peer problems and prosocial behaviour generated inadequate fit degree in all countries. A bifactor model with three factors (i.e., externalising, internalising and prosocial) and one general problem factor yielded adequate degree of fit in India, Nigeria, Turkey and Croatia. The prosocial behaviour, emotional symptoms and conduct problems factor were found to be common for all nations. However, originally proposed items loaded saliently on other factors besides the proposed ones or only some of them corresponded to proposed factors in all seven countries. CONCLUSIONS Due to the lack of a common acceptable model across all countries, namely the same numbers of factors (i.e., dimensional invariance), it was not possible to perform the metric and scalar invariance test, what indicates that the SDQ self-report models tested lack appropriate measurement invariance across adolescents from these seven nations and it needs to be revised for cross-country comparisons.

Elevated serum S-100B levels in children with temporal lobe epilepsy

PURPOSE An elevated level of S-100B in serum is generally considered to be a biochemical marker of nervous tissue damage. According to our knowledge, no studies have evaluated the serum S-100B protein concentration in children with temporal lobe epilepsy. The objective of this study was to measure the serum levels of S-100B protein in pediatric cases with temporal epilepsy. METHODS This case-controlled cross-sectional study was performed at the Department of Pediatric Neurology, Harran University School of Medicine, Sanliurfa, in Turkey. Serum S-100B protein levels were studied in 19 (12 females, 7 males) children with temporal lobe epilepsy and in 25 (15 females, 10 males) healthy control subjects. Serum samples were collected within 30min after a complex partial seizure, and serum S-100B protein levels were measured with an electrochemiluminescence immunoassay for the quantification of protein (ECLIA kit, Roche(®) Diagnostics, Germany). RESULTS The mean serum concentration of S-100B protein was 0.12±0.02μg/L in the temporal lobe epilepsy group and 0.07±0.01μg/L in the control group. The patients showed significantly elevated S-100B protein levels compared with healthy controls (P<0.001). CONCLUSION Our data suggest that increased S-100B protein levels in the serum might reflect neuronal damage in the brains of children with temporal lobe epilepsy. These results do confirm the previous findings of elevated S-100B protein levels in adult patients with temporal lobe epilepsy.

Evaluation of Oxidative Metabolism in Child and Adolescent Patients with Attention Deficit Hyperactivity Disorder

Objective Oxidative metabolism is impaired in several medical conditions including psychiatric disorders, and this imbalance may be involved in the etiology of these diseases. The present study evaluated oxidative balance in pediatric and adolescent patients with attention deficit hyperactivity disorder (ADHD). Methods The study included 48 children and adolescents (34 male, 14 female) with ADHD who had no neurological, systemic, or comorbid psychiatric disorders, with the exception of oppositional defiant disorder (ODD), and 24 sex- and age-matched healthy controls (17 male and seven female). Results TAS was significantly lower, and TOS and OSI were significantly higher in patients with ADHD than in healthy controls. Total antioxidant levels were lower in patients with comorbid ODD than in those with no comorbidity. No difference was found in TOS or OSI among the ADHD subtypes; however, TAS was higher in the attention-deficient subtype. Conclusion Our findings demonstrated that oxidative balance is impaired and oxidative stress is increased in children and adolescents with ADHD. This results are consistent with those of previous studies.

Role of personal and family factors in alcohol and substance use among adolescents: an international study with focus on developing countries

Most studies examining adolescent alcohol and substance use or abuse hardly include samples from developing countries. To bridge some gap, the prevalence and associated social correlates of alcohol and substance use and abuse was examined among a cohort of school-going adolescents sampled from seven developing countries. Alcohol and substance abuse was measured using the CRAFFT instrument, independent socio-demographic correlates were determined using regression models. A total of 2454 adolescents completed the study, among which 40.9% reported using either alcohol or at least one other substance during the previous 12 months. This was mostly alcohol (37.8%), followed by marijuana/hashish (8.6%) and other substances (8.1%). Among the adolescents who reported using at least one substance, 45% (18.3% of total sample) had CRAFFT scores indicative of problematic or hazardous substance use. Several personal and family factors were independently associated with use/abuse, and the modifiable nature of these factors calls for appropriate intervention strategies.

Increased oxidative stress in children with attention deficit hyperactivity disorder

Objectives: The purpose of this study was to investigate oxidative stress in children with attention deficit hyperactivity disorder (ADHD). Methods: Total oxidant status (TOS), total antioxidant status (TAS), paraxonase-1 (PON-1) and arylesterase (ARE) activity were measured in 76 children (44 boys, 32 girls) diagnosed with ADHD according to the DSM-IV and 78 healthy children (46 boys, 32 girls). Results: Age and sex were similar between the groups (P > 0.05). TOS and the oxidative stress index (OSI) were higher in the patient group than the control group (P < 0.001). PON-1 (P = 0.002), ARE (P = 0.010) activity and TAS (P < 0.001) were lower in the patient group than the control group. Discussion: We found decreased PON-1, ARE activity and TAS, and increased TOS and OSI in children with ADHD. Our study showed that there is significantly increased oxidative stress in children with ADHD.

Childhood trauma in the lives of substance-dependent patients: The relationship between depression, anxiety and self-esteem

Abstract Background: High levels of childhood traumatic experiences have been observed among substance abusers. There has been insufficient study of the effects of childhood trauma in adulthood. Objective: The aim of this study is to research the relationship between childhood trauma, self-esteem, and levels of depression and anxiety in substance-dependent (SD) people. Method: This study took place between March 2012 and April 2013, at Balıklı Rum Hospital (Istanbul) substance dependency clinic. It included 50 patients diagnosed as substance dependent according to the criteria of DSM-IV as compared with 45 healthy controls. The Structured Clinical Interview for DSM-IV Diagnosis (SCID-I) was used to identify Axis I disorders. All other data was collected using a semi-structured socio-demographic questionnaire, the Childhood Trauma Questionnaire (CTQ), the Rosenberg Self Esteem Scale (RSES), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). Findings: The total scores of the SD group on the CTQ and on its Emotional Abuse/Emotional Neglect (EA/EN), Physical Abuse (PA) and Sexual Abuse (SA) subscales were statistically significant. In relation to the healthy controls, the SD group scored higher on the RSES, BDI and BAI. A correlation was observed between the total scores of SD individuals on the CTQ and their scores on the RSES, BDI and BAI. Conclusion: This study showed high levels of childhood traumatic experiences for SD people and indicates that there may be a relationship between these experiences and their levels of self-esteem, depression and anxiety.