Osman Sabuncuoglu

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.

Risperidone-to-methylphenidate switch reaction in children: three cases:

As atypical antipsychotics are increasingly used in the treatment of childhood behavioural disorders either as monotherapy or in combination with other medications, there is a need to know more about their safety, in particular during switching to and from methylphenidate treatment, as antipsychotics and methylphenidate have opposing effects on dopaminergic neurotransmission. This report is about three cases of children who developed severe adverse reactions during switching from risperidone to methylphenidate. The first patient was a 6-year-old boy, diagnosed with attention deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). He developed severe hyperactivity and agitation on taking methylphenidate after the discontinuation of risperidone treatment. The second patient was a girl of 6, already on risperidone for ADHD and borderline intellectual functioning when referred. She displayed severe hyperactivity, agitation and irritability upon switching to methylphenidate medication. The third patient was a 15-year-old female adolescent with a similar clinical course as the previous patients. In all the cases described here, it is only with the discontinuation of methylphenidate that the adverse reactions resolved and readministration of methylphenidate in two patients did not produce any adverse effect after a drug-free interval. Functional regulation of certain neuroreceptors during risperidone treatment may lead to altered behavioural responses upon switching to methylphenidate. Thus, a drug-free interval is recommended in order to prevent adverse reactions.

Prevalence of dieting, overweight, body image satisfaction and associated psychological problems in adolescent boys

Purpose – The aim of the present study is to examine the severity of dieting and its association with obesity, body satisfaction and psychological problems in adolescent boys.Design/methodology/approach – A representative sample of 800 boys in the age group of 14–19 in Qatar was approached during the period from October to December, 2004 and 593 boys gave consent to participate in this study, thus giving a response rate of 74.1 per cent. Self‐reports were obtained from 593 teenage boys using the adolescent dieting scale (ADS), and the self‐reporting questionnaire (SRQ‐20) for psychopathology.Findings – Of the studied subjects, 33.1 per cent were overweight, 10.1 per cent were extreme dieters and 37.4 per cent were intermediate dieters. Among the dieters, 34 per cent were overweight. Dieting was more likely in subjects who practiced exercise and who were perceived by peers or themselves as overweight. The extreme dieters experienced more psychological problems than the intermediate dieters and non‐dieters....

Understanding the relationships between breastfeeding, malocclusion, ADHD, sleep-disordered breathing and traumatic dental injuries

Attention-deficit/hyperactivity disorder (ADHD), one of the most common neuropsychiatric disorders that present at young age, may occasionally be associated with physical problems and disorders. Among them exists a group of oral-pharyngeal conditions with considerable clinical morbidity. Previous research that identified absence or short duration of breastfeeding in ADHD children has been reviewed. Essential nutritional factors in breast milk can affect brain development and regulate the manifestation of ADHD symptoms. Low ferritin levels caused by insufficient breastfeeding may contribute to ADHD susceptibility because of the role of iron in dopaminergic activity. Insufficient breast feeding and subsequently excessive bottle-feeding may lead to increased rates of non-nutritive sucking habits, such as pacifier use and thumb-sucking, all of which are associated with the risk of development of malocclusions. Malocclusion refers to an unacceptable deviation from the ideal relationship of the upper and lower teeth and necessitates orthodontic treatment. Sleep-disordered breathing in children may present with neurocognitive symptoms that resemble ADHD and abnormal craniofacial developments, as well as malocclusions, have been cited as part of the syndrome. Obesity, which is an outcome of insufficient breastfeeding, is a shared comorbidity of ADHD and sleep-disordered breathing. The risk of traumatic dental injury is higher in children with ADHD and presence of malocclusions further increases the likelihood of dental injuries. In this review, certain oral-pharyngeal conditions relating to ADHD have been reviewed and links among them have been highlighted in a tentative explanatory model. More research that will provide increased awareness and clinical implications is needed.

High rates of same-sex attraction/gender nonconformity in the offspring of mothers with thyroid dysfunction during pregnancy: proposal of prenatal thyroid model

Both youngsters and adults with same-sex attraction are at greater risk for negative health outcomes. Despite mounting efforts to determine the biological background, a satisfactory conclusion has not been reached and there is a need to explore alternate factors like functioning of thyroid system during pregnancy. A retrospective chart review was undertaken of 790 eligible children and adolescents who had been admitted to child psychiatry between 2005 and 2013. This population consisted of 520 (65%) males and 270 (35%) females, aged 8 to 17 years. Fifteen mothers (1.8%) were found to have a history of thyroid dysfunction during pregnancy. Sixteen youngsters (2%) had a history of same-sex attraction. Twelve overlapping cases with both same-sex attraction and maternal thyroid dysfunction during pregnancy were identified, which was extremely significant (P<0.0001, by Fisher’s exact test). The association was also significant for each sex (P<0.0001, by Fisher’s exact test). There is evidence that thyroid gland plays a crucial and decisive role in determining sexual orientation in people. Maternal thyroid dysfunctions during pregnancy may result in homosexual orientation in the offspring.

Pregnancy health problems and low birth weight associated with maternal insecure attachment style

We aimed to determine the association between attachment style and health problems during pregnancy, as well as perinatal health variables. In 122 mothers who were 2–18 months postpartum, hot flushes, vaginal discharge, back pain, breast tenderness, hair changes, and psychological problems were shown to be associated with insecure attachment as measured by the Adult Attachment Style Questionnaires. Babies born to mothers with insecure attachment were more likely to have a low birth weight. It is vital to increase awareness of insecure attachment style as a risk factor among perinatal health care providers to optimize services.

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.

The attention‐deficit/hyperactivity disorder model for traumatic dental injuries: a critical review and update of the last 10 years

It has been more than 10 years since the proposal of attention-deficit/hyperactivity disorder (ADHD) model as an explanatory construct for traumatic dental injuries (TDIs) in children. The aim of this review was to address developments in the study of the issue after 2005-2016. A systematic literature search covering the period from 2005 to 2016 was conducted on PubMed, the Cochrane library and Google Scholar using relevant keywords. Fourteen studies exploring the relationship between ADHD and TDIs from 2005 and onward (including the proposal paper) were identified. Of the 12 controlled studies, nine reported confirming findings for a link with ADHD in the occurrence of TDIs. More than one-third of all children with ADHD may suffer from TDIs. In ADHD children, the most common types of injury were uncomplicated/complicated crown fractures and subluxation of maxillary central incisors resulting from falls and collisions. There is also evidence that ADHD represents an independent risk factor other than the well-established risk factor of incisor overjet. Over the last 10 years, convincing evidence has accumulated that ADHD is an important and common risk factor for TDIs. Increased awareness and side-by-side work of medical, dental and mental professionals at both clinical and research settings are necessary.

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.

Sibling Death after Being Thrown from Window by Brother with Autism: Defenestration, an Emerging High-Risk Behavior.

Children diagnosed with autistic spectrum disorders (ASD) may have serious behavioral problems such as aggression, self-injury, and violence. However, the literature on ASD either overrules any correlation between aggression and ASD or maintains the fact that the efforts to link them have so far been inconclusive. Although severe forms of violence are extremely rare in children with autism, there are a few cases reported in the literature with significant harm to siblings. We hereby report an 8-year-old boy with ASD who caused the death of his sibling by throwing her out of the window. Shared similarities of all defenestration cases indicate a pattern of high-risk behavior threatening the survival of minors. We recommend precautions against this high-risk behavior in children with ASD.