Murat Coskun

Prevalence and patterns of psychiatric disorders in referred adolescents with Internet addiction

To investigate prevalence and patterns of psychiatric disorders in young subjects with Internet addiction (IA).

Effectiveness of mirtazapine in the treatment of inappropriate sexual behaviors in individuals with autistic disorder.

OBJECTIVE The aim of this study was to investigate the efficacy and safety of mirtazapine in the treatment of excessive masturbation and other inappropriate sexual behaviors (ISB) in individuals with the diagnosis of autistic disorder (AD). METHOD Subjects (n = 10; 2 females, 8 males; age range: 5.2-16.4 years) who suffered from excessive masturbation with or without other ISB were treated with mirtazapine for 8 weeks. Clinical Global Impressions-Severity (CGI-S) and Clinical Global Impressions-Improvement (CGI-I) scales were used for the evaluation of symptoms severity and effectiveness. Mirtazapine was started at 7.5-15 mg/day and titrated up to 15-30 mg/day (mean 21.6 +/- 7.9 mg/day). The data for this study were collected from reviewing medical records of all subjects that suffered from ISB and treated with mirtazapine. RESULTS CGI scores at baseline and end point ranged from 5 to 7 (mean 6.22 +/- 0.83) and 2 to 4 (mean 3 +/- 0.7), respectively. A nonparametric t-test showed significant difference in CGI-S scores between baseline and end point assessments (Z = -2.725; p = 0.006, p < 0.01). Five subjects showed very much, 3 showed much, and 1 showed moderate improvement in excessive masturbation on the CGI-I scale. One subject dropped out from clinical follow up. Mirtazapine was generally tolerated well. The most frequently reported side effects were increased appetite, weight gain (n = 3; mean 0.78 +/- 1.20 kg), and sedation. CONCLUSIONS Mirtazapine could be an effective treatment to ameliorate ISB in a young population with a diagnosis of AD. Well-designed, placebo-controlled studies are needed regarding this topic.

Efficacy and Safety of Fluoxetine in Preschool Children with Obsessive-Compulsive Disorder

OBJECTIVE The aim of this study was to investigate the efficacy and safety of fluoxetine in the treatment of obsessive-compulsive disorder (OCD) in preschool children. METHOD Six preschool children (age range 40-61 months; mean 51.5 +/- 8.8 months) with severe, distressing symptoms of OCD were treated with an initial 5 mg/day oral dose of fluoxetine by mouth. Baseline and end-point symptom severity was assessed using the Clinical Global Impressions-Severity (CGI-S) scale. The data for this study were collected by reviewing medical records of the subjects. RESULTS CGI-S baseline scores were 6-7 (mean 6.66 +/- 0.5) and end-point scores were 3-7 (mean 4 +/- 1.54). The Wilcoxon nonparametric paired t-test revealed a significant difference between baseline and end-point CGI-S scores (Z = -2.121; p = 0.034). The range of fluoxetine dosage was 5-15 mg/day (mean 10 +/- 3.16). Fluoxetine was effective in treating OCD in this sample. Four subjects showed much and 1 subject showed very much improvement in OCD symptoms. One subject, who discontinued medication after 4 weeks due to side effects, did not show any improvement with 5 mg/day fluoxetine. Two subjects developed significant symptoms of behavioral disinhibition (SBD) that required dose reduction and addition of 0.25-0.5 mg/day risperidone in 1 subject and discontinuation of medication in the second subject. Side effects were mild to moderate in severity and did not require medication discontinuation or dosage reduction in the remaining three subjects. One subject did not report any side effects. Overall the most frequently reported side effects were SBD, decreased appetite and weight loss (n = 3; range: 0-1200 grams; mean, 466 +/- 546.5 grams), sleep disturbance, headache, and abdominal pain. CONCLUSIONS Fluoxetine may be effective in the treatment of OCD in preschool children. However side effects, particularly SBD, remain an important concern.

Phenomenology, psychiatric comorbidity and family history in referred preschool children with obsessive-compulsive disorder

ObjectiveThe study aimed to investigate phenomenology, psychiatric comorbidity, and family history of obsessive-compulsive disorder (OCD) in a clinical sample of normally developing preschool children with OCD.MethodSubjects in this study were recruited from a clinical sample of preschool children (under 72 months of age) who were referred to a university clinic. Subjects with a normal developmental history and significant impairment related to OCD symptoms were included in the study. Children’s Yale-Brown Obsessive-Compulsive Scale was used to assess OCD symptoms. Each subject was assessed for comorbid DSM-IV psychiatric disorders using a semi-structured interview. Parents were evaluated for lifetime history of OCD in individual sessions.ResultsFifteen boys and ten girls (age range: 28 to 69 months; 54.12±9.08 months) were included. Mean age of onset of OCD was 35.64±13.42 months. All subjects received at least one comorbid diagnosis. The most frequent comorbid disorders were non-OCD anxiety disorders (n=17; 68.0%), attention-deficit hyperactivity disorder (ADHD) (n=15; 60.0%), oppositional defiant disorder (ODD) (n=12; 48.0%), and tic disorders (n=6; 24.0%). Mean number of comorbid disorders was 3.65 and 2.35 for boys and girls, respectively. At least one parent received lifetime OCD diagnosis in 68 percent of the subjects.ConclusionsThe results indicated that OCD in referred preschool children is more common in males, highly comorbid with other psychiatric disorders, and associated with high rates of family history of OCD. Given the high rates of comorbidity and family history, OCD should be considered in referred preschool children with disruptive behavior disorders and/or with family history of OCD.

Suicide Rates among Turkish and American Youth: A Cross-Cultural Comparison

This study compares youth (<24 years) suicide rates in Turkey and the United States; a demographic and cross-cultural comparison and exploration of possible causative factors. Publicly available data were compared for children, adolescents, and young adults for years 1992–2004. The mean general population suicide rate in Turkey (per 100,000) was, male = 3.53 and female = 2.31 (for the US, males = 18.37, females = 4.31); for ages below 15 years the rate was, males = 0.28 and females = 0.39 (for the US, males = 1.09 and females = 0.38); while for aged 15–24 years the rate was, males = 4.58 and females = 5.22 (for the US, males = 18.84 and females = 3.36). The patterns for Turkey are: (a) Female youth had a higher suicide rate than male youth; this was the reverse of the U.S. pattern, (b) Youth suicide increased during the time period in Turkey, whereas it was relatively stable in the US, (c) However, suicide rates in Turkey were generally lower than the US, (d) Fifty percent of all female suicide victims in Turkey were under the age of 24 years (versus 11% in the US). Possible psychosocial causative factors may include (a) negative social status of females (forced marriage, young marriage age, low literacy, honor killings); (b) substantial rural to urban migration which disrupts ties and exposes migrants to a less traditional cultural system; (c) shortage of mental health services; (d) and possibly, reduced religious education enrollment may be an additional factor.

A Report of Two Cases of Sexual Side Effects with OROS Methylphenidate

Hypersexual behaviors or increased sexual arousal have been reported during stimulant treatment (Bartlik et al. 1995; Bilgic et al. 2007) or with stimulant abuse (Koblin et al. 2007; Volkow et al. 2007). In children and adolescents, there have been just two reports of methylphenidate (MPH)-related excessive masturbation and hypersexual behaviors in a 7year-old girl (Bilgic et al. 2007) and stuttering priapism associated with withdrawal from OROS MPH in a 15-year-old boy with attention-deficit=hyperactivity disorder (ADHD) (Schwartz and Rushton 2004). In both reports, symptoms were dose dependent and they emerged or disappeared within a few days following administration or discontinuation of MPH. In addition, it has been reported that stimulant treatment may increase hypersexual behaviors in individuals with Kleine–Levin syndrome (Arnulf et al. 2005). On the other hand, Weissenberger et al. (2001) reported a 5-year-old boy with ADHD and familial male precocious puberty whose hypersexual behaviors were treated successfully with MPH. In addition, it has been reported that stimulant augmentation during treatment with selective serotonin reuptake inhibitors (SSRIs) in men with paraphilias and paraphilia-related disorders was related to decreases in hypersexual behaviors (Kafka and Hennen 2000). The presence of various reports with different results may raise questions about the sexual effects of MPH. Here we present 2 young subjects with ADHD who developed multiple erections with or without hypersexual behaviors during OROS MPH (Concerta) treatment. We will discuss the clinical picture of those cases as well as to review the sexual effects of stimulants and possible psychopathological mechanisms of stimulant-related hypersexual behaviors and erections.

OROS methylphenidate-induced skin eruptions.

The subject is an 8-year-old boy who presented with his mother due to typical symptoms of ADHD. He was given a diagnosis of ADHD combined type with normal intellectual capacity. His prenatal, postnatal, and early developmental history was unremarkable. He had a generalized tonic–clonic seizure at 3 years of age, but has been seizure free since then. He had been on valproate 150– 250 mg=day treatment between 3 and 4 years of age. However because his control electroencephalogram (EEG) revealed abnormality, he was restarted with valproate 400 mg=day for the last 3 months. He has no known drug or food allergies so far. He has never been treated with any psychopharmacological agent except for the previous and current antiepileptic treatments. No dermatologic reactions or eruptions have been reported with valproate. He first started IR MPH at 10–20 mg=day. He generally tolerated IR MPH well with some level of decreased appetite but without significant change in his weight. He did not report any SE with IR MPH. He was in school all day and reported forgetting to take his medication sometimes. Therefore, although his ADHD symptoms showed moderate improvement on IR MPH 20 mg=day, we switched to OROS MPH 18 mg=day treatment after 2 months. He then presented in an emergency department due to emergence of maculopapular pruritic SE on his neck, arms, and legs 1 week after starting OROS MPH treatment. The mother was recommended to stop the medication. We saw him again after 1 week of a medication-free period. He had multiple scabby skin lesions, particularly on his legs, arms, and neck. He reported that they were extremely pruritic, and he scratched them until they bled and scarred over. A general pediatric and dermatological consultation revealed no significant cause to explain these eruptions. Meanwhile, neurology switched his antiepileptic medication from valproate to gabapentine 300 mg=day. He was reviewed after 5 weeks of a medication-free period; his skin lesions almost were healed, although leaving some visible scars. His ADHD symptoms continued and the mother consented to readminister OROS MPH 18 mg=day. However, he developed the same SE at the ninth day of OROS MPH treatment with the same severity. The mother and child denied eating any unusual food, taking other medication rather than OROS MPH and gabapentine, or being exposed any allergic environment during that time. A dermatologist designated these SE as maculopapular. He did not have mucosal lesions or constitutional symptoms suggestive of Stevens–Johnson syndrome (SJS) or more severe toxic epidermal necrosis (TEN). We discontinued medication and skin lesions abated within the next several weeks. We interpreted these SE as an unusual adverse event related with OROS MPH treatment. Subsequently we restarted IR MPH 10–20 mg=day. He did not develop any SE while he was on IR MPH 20 mg=day during the next 4 months. However, his previous skin lesions persisted in that they left some amount of visible scarring (Fig. 1).

Risperidone treatment in preschool children with disruptive behavior disorders: a chart review study / Yıkıcı davranış bozuklukları olan okulöncesi çocuklarda risperidon tedavisi: Bir dosya tarama çalışması

Objective: To gather data about the efficacy and safety of risperidone in normally developing preschool children with disruptive behavior disorders (DBDs).Methods: This is a retrospective chart rev...

Diffuse Maculopapular Rash With Increasing Dosage of Methylphenidate.

FIGURE 1. Diffuse maculopapuler rash after increasing dosage of OROS-methylphenidate. CASE E is an 11-year-old boy who has been followed up with diagnosis of social and generalized anxiety and attention deficit disorders for the last 2 years. His developmental history and intellectual capacity were within normal limits. He had no significant medical or neurological history but had several episodes of itching and mild and local skin eruptions on his arms and

Denver Developmental Test Findings and their Relationship with Sociodemographic Variables in a Large Community Sample of 0–4-Year-Old Children

INTRODUCTION The aim of this study was to investigate the prevalence of developmental problems and relationship with sociodemographic variables in a community sample of young children. METHODS Participants included 1000 children (558 males, 442 females, age range 1-48 months, mean 18.4 months, SD 7.8 months). Children were referred generally by their parents for developmental evaluation and consultation in response to a public announcement in a district area in Istanbul, Turkey. An interview form and the Denver Developmental Screening Test II (DDST) were used for sociodemographic data and developmental evaluation. The χ2 test and Pearsons correlation test were used for data analysis. RESULTS Seven hundred forty-one out of 1000 children (74.1%) had normal, 140 (14%) had risky, and 119 (11.9%) had abnormal findings on the DDST results. The probability of abnormal findings on the DDST results was significantly higher in males (p=0.003), the 2-4-year-old group (p<0.05), families with more than one child (p=0.001), consanguineous marriages (p<0.01), low parental educational levels and low household income (p<0.01), and in children without a history of breastfeeding (p=0.000). Immigration status and delivery mode did not have a significant effect on the probability of abnormal findings on the DDST results (p>0.05). CONCLUSION Sociodemographic factors have a noteworthy impact on development. Determining these factors is important especially during the first years of life.