Neslihan İnal Emiroğlu

Effects of sociodemographic factors and maternal anxiety on preoperative anxiety in children

Objective To investigate the effects of sociodemographic factors and maternal anxiety levels on behaviour in children undergoing surgery. Methods This study included children aged 3–12 years who were scheduled for surgery, and their respective mothers. Each mother completed a questionnaire concerning sociodemographic and economic characteristics. Maternal anxiety was assessed using the State-Trait Anxiety Inventory (STAI) form Tx-1, following transfer of the child to the operating room. An anaesthesiologist rated preoperative anxiety in each child using the Frankl Behaviour Rating Scale (FBRS) and Venham Picture Test (VPT). Results One hundred children (mean ± SD age 7 ± 2.7 years) who received dental (47%), plastic (39%) or urological (14%) surgery, and 100 mothers (mean ± SD age 34 ± 6.6 years) were included. A statistically significant difference between maternal STAI Tx-1 scores and children’s VPT scores was revealed. There was no significant difference between maternal STAI Tx-1 scores and children’s FBRS scores. Maternal education level and socioeconomic status had no effect on FBRS, VPT and STAI Tx-1 scores. Conclusion Maternal knowledge and experience of anaesthesia, and high levels of maternal anxiety, may be related to increased anxiety in children undergoing surgery.

A Case with Unexplained Bleeding from Multiple Sites: Munchausen Syndrome by Proxy

Munchausen syndrome by proxy (MBP) is an extreme form of child abuse where children were unnecessarily treated or investigated for medical conditions that were falsified by their caregivers. Here the authors report a 16-year-old female with the complaints of bleeding from multiple and unusual sites, including hemoptysis, hematuria, bloody tears, and bloody nipple discharge, all of which are only witnessed by her mother. Extensive investigation revealed no organic etiologies for bleeding. The diagnosis of MBP was put by a multidisciplinary team. The diagnosis of MBP must be kept in mind in conditions where there is no underlying organic pathology in a bleeding patient.

Allele frequencies of dopamine D4 receptor gene (DRD4) and Catechol-O-methyltransferase (COMT) Val158Met polymorphism are associated with methylphenidate response in adolescents with attention deficit/hyperactivity disorder: a case control preliminary study

ABSTRACT OBJECTIVES: In this study, it was aimed to analyse the relationship between clinical improvement in adolescents with attention deficit/hyperactivity disorder (ADHD) and the presence of allele frequencies of dopamine D4 receptor (DRD4), and Val158Met polymorphism of catechol-O-methyltransferase (COMT) genes. METHODS: Thirty-four adolescents (age range, 13–18 years) with ADHD participated in this study. Thirty-two patients were males and two were females. Du Paul ADHD Rating Scale-Clinician version (ARS) and Clinical Global Impression-severity of impairment (CGI-S) were used for the evaluation of symptom severity. Fifty healthy age-matched adolescents were recruited as controls. RESULTS: When the groups with (n = 9) and without (n = 25) 7-repeat alleles for DRD4 were considered, there was a statistically significant decrease of DuPaul ARS total and hyperactivity scores in those treated with OROS-methylphenidate. When the Val/Met allele-positive group for COMT gene (n = 17) was compared with the Val/Val allele-positive group (n = 13) and Met/Met allele-positive group (n = 4), there was a statistically significant decrease of ARS total scores, ARS attention scores, and CGI scores in adolescents with ADHD treated with OROS-MPH. CONCLUSIONS: Specific data from further studies with a larger sample sizes would provide more insights to replicate the current findings.

Genetic imaging study with [Tc-99m] TRODAT-1 SPECT in adolescents with ADHD using OROS-methylphenidate

Aim: To examine theeffects on the brain of 2‐month treatment withamethylphenidate extended‐release formulation (OROS‐MPH) using [Tc‐99m] TRODAT‐1SPECT in a sample of treatment‐naïve adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). In addition, to assess whether risk alleles (homozygosity for 10‐repeat allele at the DAT1 gene were associated with alterations in striatal DAT availability. Methods: Twenty adolescents with ADHD underwent brain single‐photon emission computed tomography (SPECT) scans with [Tc‐99m] TRODAT‐1 at baseline and two months after starting OROS‐MPH treatment with dosages up to 1 mg/kg/day. Severity of illness was estimated using the Clinical Global Impression Scale (CGI‐S) and DuPaul ADHD Rating Scale‐Clinician version (ARS) before treatment,1 month and 2 months after initiating OROS‐MPH treatment. Results: Decreased DAT availability was found in both the right caudate (pretreatment DAT binding: 224.76 ± 33.77, post‐treatment DAT binding: 208.86 ± 28.75, p = 0.02) and right putamen (pre‐treatment DAT binding: 314.41 ± 55.24, post‐treatment DAT binding: 285.66 ± 39.20, p = 0.05) in adolescents with ADHD receiving OROS‐MPH treatment. Adolescents with ADHD who showed a robust response to OROS‐MPH (n = 7) had significantly greater reduction of DAT density in the right putamen than adolescents who showed less robust response to OROS‐MPH (n = 13) (p = 0.02). However, between‐group differences by treatment responses were not related with DAT density in the right caudate. Risk alleles (homozygosity for the 10‐repeat allele of DAT1 gene) in the DAT1 gene were not associated with alterations in striatal DAT availability. Conclusion: Two months of OROS‐MPH treatment decreased DAT availability in both the right caudate and putamen. Adolescents with ADHD who showed a robust response to OROS‐MPH had greater reduction of DAT density in the right putamen. However,our findings did not support an association between homozygosity for a 10‐repeat allele in the DAT1 gene and DAT density, assessedusing[Tc‐99m] TRODAT‐1SPECT. HighlightsMethylphenidate decreased DAT availability in both right caudate and putamen.Robust response to Methylphenidate greatly reduced DAT density in right putamen.No relation between homozygosity of 10‐repeat allele in DAT1 gene and DAT density was observed.

Effectiveness and adverse effects of methylphenidate treatment in children diagnosed with disruptive mood dysregulation disorder and attention-deficit hyperactivity disorder: a preliminary report

ABSTRACT Objective: Comorbidity with attention deficit hyperactivity disorder (ADHD) and disruptive mood dysregulation disorders (DMDD) is very common in children and adolescents In this study, we aimed to present a retrospective study of methylphenidate (MPH) treatment in 12 cases who were diagnosed with DMDD and ADHD. Method: All patients were followed-up in our outpatient clinic and the effectiveness and side effects of MPH were explored. Mood Symptom Questionnaire (MSQ-7) and Clinical Global Impression-Severity (CGI-S) were used for assessing the mood symptoms and their severity. Results: The differences between initiation time and the end-point time in CGI-S and MSQ-7 scores were statistically significant. Conclusion: In this present study, the usage of MPH was found to lead to an increase in irritability in children with ADHD and DMDD evidently.

Atomoxetine treatment may decrease striatal dopaminergic transporter availability after 8 weeks: pilot SPECT report of three cases.

Attention deficit/hyperactivity disorder is one of the most common neurodevelopmental disorders. The pathophysiology is thought to involve noradrenaline and dopamine. The role of dopamine transporter (DAT) was evaluated in imaging studies using mostly dopamine reuptake inhibitors. Atomoxetine is a selective noradrenaline reuptake inhibitor. Here we report the results of a pilot study conducted to evaluate changes in striatal DAT after 8 weeks of atomoxetine treatment. Our results suggest that 8 weeks of atomoxetine treatment may change striatal DAT bioavailability as measured via SPECT but that change was not correlated with genotype or clinical improvement.