Meral Berkem

Depression and anxiety in children and adolescents with epilepsy: prevalence, risk factors, and treatment.

Among the psychiatric comorbid conditions in children and adolescents with epilepsy, depression and anxiety disorders require further attention because they carry the risk of reduced quality of life and life-threatening complications (e.g., suicide). Research in recent years has shed light on both the prevalence of emotional problems in youth with epilepsy and the safety and efficacy of treatment options. A number of challenges exist in treating patients with epilepsy. This is particularly true when seizures are difficult to control and medication regimens are more complex. Some pharmaceutical options may provide assistance with both seizures and emotional distress, but care is needed when considering such treatment approaches. In addition, integration of mental health professionals into the care of patients is necessary when cases are complicated and risk factors are high. Thorough methods to accurately diagnose emotional conditions and regular monitoring of symptoms can help prevent serious problems that can negatively affect the success of children and adolescents in everyday life. Collaboration between disciplines offers the best hope for early identification and treatment of these conditions.

EEG abnormalities and epilepsy in autistic spectrum disorders: Clinical and familial correlates

Our aim was to examine the characteristics of EEG findings and epilepsy in autistic spectrum disorders (ASD) and the associated clinical and familial risk factors. Fifty-seven children (86% male) with ASD, mean age 82+/-36.2 months, were included in the study. Thirty-nine (68.4%) children had the diagnosis of autism, 15 (26.3%) had Pervasive Developmental Disorder Not Otherwise Specified, and 3 (5.3%) had high-functioning autism. One hour of sleep and/or awake EEG recordings was obtained for each child. All patients were evaluated with respect to clinical and familial characteristics and with the Childhood Autism Rating Scale, the Autism Behavior Checklist, and the Aberrant Behavior Checklist. The frequency of interictal epileptiform EEG abnormalities (IIEAs) was 24.6% (n=14), and the frequency of epilepsy was 14.2% (n=8). IIEAs were associated with a diagnosis of epilepsy (P=0.0001), Childhood Autism Rating Scale Activity scores (P=0.047), and a history of asthma and allergy (P=0.044). Epilepsy was associated with a family history of epilepsy (P=0.049) and psychiatric problems in the mother during pregnancy (P=0.0026). Future studies with larger samples will help to clarify the possible associations of epilepsy/IIEAs with asthma/allergy, hyperactivity, and familial factors in ASD.

Fluoxetine‐induced sleep bruxism in an adolescent treated with buspirone: a case report

Sleep bruxism, the involuntary grinding and/or clenching of teeth during sleep, may occur in young children and may be secondary to medication use, especially selective serotonin reuptake inhibitors (SSRIs). The mesocortical disinhibition produced by SSRIs may lead to dopamine depletion that manifests itself as nocturnal bruxism, a specific form of akathisia. This may be prevented by using buspirone, a 5-HT1A agonist that reduces serotonergic activity and increases dopaminergic activity. This article reports on a case history of an adolescent with fluoxetine-induced bruxism that was successfully treated with buspirone. As SSRI use is on the rise for treating childhood psychiatric disorders, this case report highlights the importance of recognizing SSRI-induced bruxism and the possible related adverse dental side effects. Furthermore, this report supports the efficacy of a treatment strategy in adolescents, which has previously been reported only for adult patients.

Association of sleep duration with socio‐economic status and behavioural problems among schoolchildren

Aim:  In this population‐based study, we aimed to determine the total sleep duration (TSD), its association with socio‐economic status (SES) and behavioural symptoms among schoolchildren.

The phenomenology of autistic regression: subtypes and associated factors

This study aimed to investigate the association of autistic regression (AR) and subtypes of AR with medical, developmental and psychiatric factors. Fifty-seven children with autistic spectrum disorders (ASD) were included in the study. Two types of AR are defined as regression after a normal social/language development (type 1) and regression as the worsening of previously reported autistic features (type 2). The frequency of history of AR was 56.1%. Male gender and sleep problems were found to be associated with a positive history of AR. The frequency of gastrointestinal complaints/diseases was higher in children with regression type 2 when compared to the children with regression type 1. Future studies with larger sample size and prospective design will contribute to clarifying the phenomenology and the associated factors of AR.

Cognitive Flexibility and Social Responsiveness in Children and Adolescents with Tourette Syndrome

This study examined cognitive flexibility and social responsiveness in children and adolescents with Tourette Syndrome (TS). Thirty one subjects with TS were compared to 32 age-matched healthy controls. Assessments included semi-structured interviews to assess psychopathology, parent-rated Social Responsiveness Scale (SRS) and a brief neuropsychological battery selected as measures of cognitive flexibility. Completion time for both Trail Making Tests (TMT-A and TMT-B) were significantly longer for TS group than controls, however the difference in perseverative errors on Wisconsin Card Sorting Test (WCST) was not significant. SRS total score was significantly higher in the TS group compared to controls, indicating greater impairment in social responsiveness. Group difference for TMTs and SRS failed to reach significance after controlling for co-occurring conditions. Clinicians might consider social impairment in the evaluation plan of children and adolescents with Tourette syndrome

The association of music preferences and depressive symptoms in high school students: A community-based study from Istanbul

We investigated the association of music preferences with depressive symptoms among high school students in Istanbul; 10th-, 11th- and 12th-grade students (N = 1226) were chosen for the study. The Children’s Depression Inventory (CDI) and a detailed, semi-structured, self-report inquiry assessing music preferences and various psychosocial variables were administered to the students. Adolescents reporting heavy metal music and arabesque music in their playlists had significantly higher CDI total scores compared to adolescents who did not report these genres in their playlists. The percentage of students with problematic parent relations was highest for those with preferences for heavy metal music. Alcohol use was highest among students with preferences for dance/hip-hop music, followed by those with preferences for heavy metal. Negative thoughts and feelings when listening to music were related to higher CDI scores regardless of the favourite music genre. Future studies are needed to clarify the relationship between music preferences and specific psychopathologies in adolescents.

X-Linked adrenoleukodystrophy in a 7-year-old boy presenting with psychiatric symptoms

X-linked adrenoleukodystrophy (ALD) is a white matter disease, the initial presentation of which can be with psychiatric symptoms [1, 2] and thus can be misdiagnosed as a primary psychiatric disorder [1]. We describe a child, presenting with symptoms of anxiety and emotional withdrawal, who was later diagnosed as having ALD. ‘‘H’’, a 7-year-old boy whose mother died 4 years ago and who was living with his father and step-mother, presented with a 4-week history of emotional withdrawal, sleep problems, and anxiety. The child was in the first grade of primary school, just started reading but his teacher had concerns about his inattention. He was at the age of 3 when his mother died and was described as having no emotional problems until he saw his uncle (his mother’s brother) a month ago. He was asking frequent questions about the death of his mother, was less responsive to external stimuli, was talking about death and could not sleep. During the psychiatric interview, the child was anxious, had difficulty in separation from his stepmother, had a blunt affect, poor eye contact and hardly engaged in spontaneous communication. Differential diagnosis included depression, pathological grief reaction, and posttraumatic stress disorder. Follow-up visits were planned on a weekly basis. Within a few weeks, the child’s cognitive abilities and speech deteriorated with accompanying bizarre behaviors (smelling socks, catatonic postures) and impaired motor coordination which are not typical for the course of the mentioned psychiatric differential diagnoses. The child did not have a history of compulsive behavior and the newly onset behaviors did not seem to have a compulsive nature. Rapid deterioration of behavior, social responsiveness, and speech were counted as signs of a possible neurologic disorder. In order to rule out any organic pathology a cranial magnetic resonance imaging (MRI) and electroencephalography (EEG) were ordered, and he was referred to pediatric neurology. EEG was normal but MRI scan revealed lesions consistent with a diagnosis of leukodystrophy. Urinary and leukocyte arylsulphatase-A levels were normal. Contrast-enhanced cranial MRI confirmed the diagnosis of X-linked ALD based on the pathognomonic pattern of distribution of leukodystrophy (widespread bilateral parietooccipital and deep subcortical white matter). Within 6 months after the establishment of the diagnosis of ALD, the child progressively lost vision and hearing, he began to have difficulty in walking and swallowing. He was hospitalized in the pediatric inpatient unit for feeding problems. Progressive neurological deterioration with motor and sensory loss dominated the clinical picture, while initial psychiatric symptoms decreased in severity. This case illustrates that new-onset psychiatric symptoms inappropriately severe for the age of the child should be investigated for organic causes. Behavioral changes, affective symptoms, and cognitive deterioration with dysarthric speech within a short period of clinical follow-up suggested an underlying progressive neurologic disorder. This report was presented as a poster at 12th National Adolescent Psychiatry Congress, at November 14–17, 2007, in Istanbul, Turkey.

The Presentation of Childhood Obsessive--Compulsive Disorder across Home and School Settings: A Preliminary Report.

This study aimed to determine the exact pattern of obsessive–compulsive disorder (OCD) symptoms in children displayed across school and home settings. Twenty-six school children (aged 7 through 17) with OCD were tested using the Childrens Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the Clinical Global Impression (CGI) – severity subscale and a questionnaire which consists of items serving to compare the symptoms between home and school settings. The mean obsession and compulsion subscores on the CY-BOCS were found to be 10.73 ± 3.14 and 10.88 ± 3.17, respectively, both summing up a Total score of 21.61 ± 5.52. The mean CGI-severity scores, rated for home and school settings were 4.42 ± 0.90 and 2.42 ± 1.13 respectively, indicating a strong difference in the presentation of OCD between those settings (t= 7.02, df = 50, p< 0.0001). No gender, diagnosis (pure versus comorbid) and age effect (7 to = 12 years versus > 12 to 17 years) was found on the CY-BOCS and CGI-severity subscale (Mann–Whitney U test, all p> 0.05). The presentation difference we have noted in this study is a significant finding. Further studies are needed to delineate the characteristics of this phenomenon with possible implications for diagnosis, management and treatment.

Parental report of sleep habits and sleep problems in primary school children with ADHD and community control subjects

Background Sleep-related problems are frequently encountered in many of the developmental psychopathologies. Considerable clinical, as well as emprical data support an association between sleep problems and Attention Deficit Hyperactivity Disorder (ADHD) in children [1]. This relationship is probably more complex [2,3]. In fact, there seems to be a bidirectional relation; children with inadequate or divided sleep profile are overactive and have concentration difficulties in the daytime, and the behavioral problems associated with ADHD might have adverse effects on sleep, as well.