Ipek Percinel

Iron Deficiency Parameters in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

The aim of this study is to compare iron deficiency parameters in patients with stimulant-naive attention-deficit/hyperactivity disorder (ADHD) and healthy controls, to investigate whether there are differences among the ADHD presentations, and to evaluate the relationship between ADHD symptom severity and serum ferritin levels. In addition, ADHD-Predominantly Inattentive (ADHD-PI) patients with restrictive hyperactivity/impulsivity symptoms were evaluated as a separate group with “restrictive inattention presentation” (ADHD-Rest) and were compared with other groups. Patients with ADHD-Rest are typically defined as having six or more symptoms of inattention and fewer than three symptoms of hyperactivity/impulsivity. A total of 200 ADHD cases consisting of 100 ADHD-Combine (ADHD-C) and 100 ADHD-PI and a total of 100 healthy control cases were included in the study. The Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version was performed in a semi-structured interview during the diagnosis. The Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale, the Conners’ Rating Scale-Revised: Long Form (Parent–Teacher) (CPRSR:L, CTRS-R:L) were used for clinical evaluation. Hemogram, serum iron, iron binding capacity and serum ferritin levels were assessed. There were no significant differences between the ADHD patients and the healthy control cases in terms of iron deficiency parameters. Further, there were no significant differences among the ADHD presentations in terms of the same parameters, nor were there any significant differences when the groups were examined after the identification of the ADHD-Rest. The CPRS-R:L Hyperactivity and the CTRS-R:L Hyperactivity scores were negatively correlated with serum ferritin level in the ADHD group. To our knowledge, our current study is the first to compare serum ferritin levels in ADHD-Rest with other presentations of ADHD, and included the largest number of patients that were classified by ADHD presentations. Elucidation of these findings is important for both the etiology and treatment of ADHD.

Glutamatergic dysfunction in skin-picking disorder: treatment of a pediatric patient with N-acetylcysteine.

To the Editors: Skin-picking disorder (SPD) is characterized by repetitive and compulsive picking behaviors that result in skin lesions. Cognitive behavioral therapy and psychopharmacological agents (ie, selective serotonin reuptake inhibitors, mood stabilizers, typical/atypical antipsychotics, and naltrexone) are generally used to treat SPD, but there is no standardized treatment protocol. N-Acetylcysteine (NAC) is an antioxidant that modulates glutamate (glu) transmission in the brain. N-Acetylcysteine is an effective treatment for patients with obsessive-compulsive disorder (OCD), as glutamatergic dysfunction is known to play a significant role in its pathophysiology. Because of this, NAC has been increasingly prescribed to patients with SPD. In this case report, we discuss the clinical course of a 12-year-old female patient diagnosed with SPD that was treated with NAC.

Atomoxetine-associated akathisia: a case report.

To the Editors: L iterally, the term augmentation refers to the act of enlarging, increasing something. In psychopharmacology, this term is widely used to designate therapeutic strategies that aim at maximizing the efficacy of a monotherapy by adding a second drug. The accepted definition of antidepressant augmentation, validated by international guidelines, assumes that augmentation of antidepressants involves adding a second drug, other than an antidepressant, to the treatment regimen when no response or only partial response has been achieved, with the goal of enhancing treatment. Although enhancing the effectiveness of one another, the adding of an antidepressant to an ongoing antidepressant treatment is designated by the neutral generalist terms: association or combination. To test this definition against the literature, we performed a computerized literature search (National Library of Medicine/Medline) using the following words: ‘‘augmentation’’ and ‘‘antidepressant.’’ Articles included were both in English and non-English and up to January 2014. Abstracts of all retrieved occurrences were carefully read by F.M., F.H., and O.D. The corresponding publications were extracted and scrutinized when necessary. Articles retained had to deal with antidepressant combination strategies in treating depression as well as psychotic or anxiety disorders in humans. We ensured that the use of the term augmentation was not related to a translation error of nonEnglish articles. A total of 1388 occurrences were retrieved, and 531 were excluded as nonrelevant. In 768 publications, the use of the term augmentation was in accordance with the current definition. In 91 studies, the term augmentation was used to designate the combination of 2 antidepressants. The added antidepressant was bupropion in 32 articles, a tricyclic antidepressant in 21 articles, mirtazapine in 16 articles, an selective serotonin reuptake inhibitor (SSRI) in 8 articles, each of mianserin, agomelatine, and trazodone, as well as an monoamine oxidase inhibitor in 3 articles. Augmentation of an SSRI with nortriptyline was reported in 1 article. Although widely accepted as the definition of combining an antidepressant to another drug that is not an antidepressant, the concept of augmentation is used, in some cases, to designate the association of 2 antidepressants. The ‘‘augmenting’’ agent either adds a different mechanism of action (pharmacodynamic augmentation) or affects plasma concentration of the ongoing treatment by modifying its metabolism (pharmacokinetic augmentation). When added to an SSRI, bupropion augmentation is mainly pharmacodynamic because bupropion adds to serotonin reuptake inhibition, norepinephrine reuptake inhibition, and dopamine reuptake inhibition. Even for SSRIs, we could hardly omit that these drugs actually display different mechanisms of action. Fluoxetine is not only a serotonin reuptake inhibitor but also a potent 5-HT2C antagonist. Besides serotonin reuptake inhibition properties, paroxetine has mild anticholinergic (M1 receptor antagonism) and weak norepinephrine reuptake inhibition actions. Theoretically, adding fluoxetine to paroxetine enhances its antidepressant effectiveness by adding new pharmacodynamics mechanisms. Thus, paroxetine and fluoxetine combination should, theoretically, be considered as an augmentation strategy. With a view toward the development of a new antidepressant with innovating mechanism of action and for the sake of clarity, we suggest that the term augmentation should be used whenever the combination of 2 antidepressants results in the enhancement of pharmacodynamic or pharmacokinetic action of the ongoing treatment.

Increased deficits in emotion recognition and regulation in children and adolescents with exogenous obesity

Abstract Objectives: In this study we aimed to evaluate emotion recognition and emotion regulation skills of children with exogenous obesity between the ages of 11 and 18 years and compare them with healthy controls. Methods: The Schedule for Affective Disorders and Schizophrenia for School Aged Children was used for psychiatric evaluations. Emotion recognition skills were evaluated using Faces Test and Reading the Mind in the Eyes Test. The Difficulties in Emotions Regulation Scale was used for evaluating skills of emotion regulation. Results: Children with obesity had lower scores on Faces Test and Reading the Mind in the Eyes Test, and experienced greater difficulty in emotional regulation skills. Conclusions: Improved understanding of emotional recognition and emotion regulation in young people with obesity may improve their social adaptation and help in the treatment of their disorder. To the best of our knowledge, this is the first study to evaluate both emotional recognition and emotion regulation functions in obese children and obese adolescents between 11 and 18 years of age.

Social Cognition in Child and Adolescents with Anorexia Nervosa

Sosyal bilis, kisinin kendisi ve digerleri arasindaki sosyal etkilesimle ilgili zihinsel surecleri temsil eder. Son yillarda yeme bozuklugu olgularinin sosyal bilis becerilerine yonelik ilgi artmistir. Anoreksiya nervosa, etiyolojisi coklu etmenlerle iliskili olan bir yeme bozuklugu tablosudur. Tedavisi halen tartismalidir. Yeme bozuklugu hastalari icinde en zor iliski kurulan grubun anoreksiya nervosa tanili gencler oldugu bilinmektedir. Calismalar cogunlukla, anoreksiya nervosa olgularinin sosyal bilissel islevlerinde guclukler olduguna isaret etmektedir. Bununla birlikte farkli sonuclarin bildirildigi calismalar da mevcuttur. Goruldugu kadariyla, anoreksiya nervosa olgularinda sosyal bilissel islevleri degerlendiren calismalarin buyuk cogunlugu, eriskin yas grubu ile yapilmis calismalardir. Cocuk ve ergen yas grubu ile yapilmis calismalarin kisitli sayida oldugu dikkati cekmektedir. Bu yazida, literaturdeki, anoreksiya nervosa tanili cocuk ve ergenlerin sosyal bilissel becerileri ile ilgili calismalarin incelenmesi ve genel ozelliklerinin sunulmasi amaclanmistir.

Social Cognition in Child and Adolescent Diagnosed with Anorexia Nervosa

Sosyal bilis, kisinin kendisi ve digerleri arasindaki sosyal etkilesimle ilgili zihinsel surecleri temsil eder. Son yillarda yeme bozuklugu olgularinin sosyal bilis becerilerine yonelik ilgi artmistir. Anoreksiya nervosa, etiyolojisi coklu etmenlerle iliskili olan bir yeme bozuklugu tablosudur. Tedavisi halen tartismalidir. Yeme bozuklugu hastalari icinde en zor iliski kurulan grubun anoreksiya nervosa tanili gencler oldugu bilinmektedir. Calismalar cogunlukla, anoreksiya nervosa olgularinin sosyal bilissel islevlerinde guclukler olduguna isaret etmektedir. Bununla birlikte farkli sonuclarin bildirildigi calismalar da mevcuttur. Goruldugu kadariyla, anoreksiya nervosa olgularinda sosyal bilissel islevleri degerlendiren calismalarin buyuk cogunlugu, eriskin yas grubu ile yapilmis calismalardir. Cocuk ve ergen yas grubu ile yapilmis calismalarin kisitli sayida oldugu dikkati cekmektedir. Bu yazida, literaturdeki, anoreksiya nervosa tanili cocuk ve ergenlerin sosyal bilissel becerileri ile ilgili calismalarin incelenmesi ve genel ozelliklerinin sunulmasi amaclanmistir.

Çocuk Psikiyatrisi Pratiğinde Nadir Bir Durum : Çocukluk Çağı Dezintegratif Bozukluğu

Childhood disintegrative disorder is a very rare pervasive developmental disorder characterized by normal development of verbal and nonverbal communication skills, social interaction, play, bladder and bowel control and motor behavior at least in the first two years, followed by regression between 2-10 years of age in two or more of the mentioned developmental areas. Estimated prevalence of the childhood disintegrative disorder is around 1.1-6.4 per 100.000 children and the common age of onset is 3.36 years. The present report describes a boy who developed childhood disintegrative disorder after approximately 3 years of normal development and clinical features are discussed in the light of the clinical literature.