Neşe Perdahlı Fiş

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.

Executive dysfunction in Turkish children at high risk for schizophrenia

AbstractObjectiveTo explore different aspects of executive function (i.e. sequencing, set shifting and mental flexibility) in children who are at high risk for schizophrenia by comparing them with normal controls.MethodThe high risk (HR) group consisted of 30 children whose parents were diagnosed as schizophrenia. As the control group (CG) 30 children, whose parents did not meet any DSM IV diagnostic criteria for any psychiatric disorder, participated. They were age and sex matched with the HR group. For the evaluation of different domains of cognitive functions Wechsler intelligence scale for children-revised (WISC-R), and a group of neuropsychological tests, including Trail Making A-B Tests, Color Form Test, and Progressive Figures Test were administered. Behavioral problems were assessed using Hacettepe Adjustment Scale.ResultsThe subjects in the high risk group had significantly lower scores on Trail Making A-B, Color Form, Progressive Figures Tests, as well as subtests and scores of WISC-R (Information, Comprehension, Similarities, Picture Completion, Block Design, Object Assembly and Coding subtests, Verbal, Performance and Full Scale IQ scores). There is no significant difference between the two groups in the frequency and severity of behavioral problems. ConclusionChildren of parents with schizophrenia displayed significantly greater number of difficulties in several areas of executive function, such as sequencing, set shifting, and mental flexibility, when compared to their controls.

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.

Gender dysphoria and attention problems: possible clue for biological underpinnings

ABSTRACT OBJECTIVES: Development of gender identity is a complicated process. Several biological, familial, environmental, and cognitive factors thought to play role during this process. When a person has a persistent discomfort with his/her assigned gender and exhibits cross-gender identification, gender dysphoria is to be considered. In this study, we aimed to determine the rates of psychiatric diagnoses in youth presenting with gender dysphoria and compare them with a control group in terms of family functioning, emotional, and behavioural problems. METHODS: The study sample consisted of 20 cases with gender dysphoria and 40 controls (5–17 years of age). The instruments included were Sociodemographic Form, Family Assessment Device (FAD), Child Behavior Checklist, and Schedule for Affective Disorders and Schizophrenia for School Aged Children Present-Lifetime Version. RESULTS: Ninety per cent of the cases with gender dysphoria had at least one psychiatric diagnosis. Attention-deficit/hyperactivity disorder (ADHD) (75%) was the leading comorbidity, followed by major depressive disorder (25%). Gender dysphoria group had significantly higher scores in communication, roles, affective involvement, and general family functioning subscales of FAD and in all Child Behavior Checklist subscales. High Child Behavior Checklist attention subscale score was significantly associated with the diagnosis of gender dysphoria in binary logistic regression analysis (odds ratio: 0.82; p < .001). CONCLUSIONS: Our results pointed out a possible biological background for gender dysphoria, along with psychosocial/psychodynamic explanations. The individuals with gender dysphoria will benefit from an integrative approach where all possible contributing factors are considered. Therefore, in addition to psychosocial and psychodynamic evaluation, assessment and interventions regarding ADHD will help to improve well-being and quality of life of these individuals.

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.