Ozden Sukran Uneri

Impact of Gender, Age at Onset, and Lifetime Tic Disorders on the Clinical Presentation and Comorbidity Pattern of Obsessive-Compulsive Disorder in Children and Adolescents

BACKGROUNDnObsessive-compulsive disorder (OCD) is a heterogeneous disorder; therefore, there is a need for identifying more homogeneous subtypes. This study aimed to examine the clinical characteristics and comorbidity pattern of a large sample of pediatric OCD subjects, and to examine the impact of gender, age at onset, and lifetime tic disorders on the clinical presentation and comorbidity pattern.nnnMETHODSnA total of 110 children and adolescents diagnosed with OCD were assessed using the Kiddle Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) for psychiatric comorbidity, and a clinical data form was filled out. The cutoff for differentiating prepubertal from adolescent onset was 11 years of age.nnnRESULTSnA total of 83.6% of the subjects had at least one comorbid psychiatric disorder. Oppositional defiant disorder and contamination/somatic obsessions were significantly higher in males (p=0.036 and p=0.03, respectively) than in females. Depressive disorders and religious obsessions were significantly higher in the adolescent-onset group (p=0.02, p=0.05, respectively) whereas disruptive behavior disorders were higher in the prepubertal-onset group (p=0.037). Disruptive behavior disorders were significantly more frequent in the tic (+) group than in tic (-) group (p=0.021).nnnCONCLUSIONSnThere were differences in the comorbidity pattern and clinical expression between genders and between prepubertal and adolescent-onset cases. Findings of this study supported the introduction of tic-related OCD as a specifier in Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), and the necessity of a detailed assessment of other psychiatric disorders in youth with OCD.

Methylphenidate and atomoxetine for treatment of nocturnal enuresis in a child with attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) and nocturnal enuresis (NE) are the most common childhood disorders in child and adolescent psychiatry clinical practice. The prevalence of ADHD is in a range of 3–7 % in school-aged children [1]. Methylphenidate, dexamphetamine and atomoxetine are widely used in European countries and North America for the pharmacological treatment of ADHD [2]. Enuresis is a common comorbid disorder in children with ADHD [3, 4]. The rate of enuresis in children with ADHD has been reported as about 30 % [3]. The management of enuresis includes supportive approaches (which involve educating parents about enuresis, reducing fluids, keeping a dry bed chart, and awakening the child to void during the night), conditioning with a urine alarm, or medications like imipramine or desmopressin acetate [5]. We report a case where, after initiating a treatment of both methylphenidate and atomoxetine at different time periods, a cessation of enuresis occurred during the use of both drugs in a child with ADHD and comorbid NE. A 7-year-old girl was diagnosed with combined type ADHD, and NE according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, in Child and Adolescent Psychiatry Department of Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. She presented with lack of attention to detail, distractibility, forgetfulness, impulsiveness, and nocturnal bedwetting as the symptoms of ADHD and NE. Enuresis was occurring almost every night. She had not been treated previously with any medications for ADHD or NE. Her body weight was 32 kg and physical examination did not reveal any abnormality. ADHD treatment was initiated with an extended release of methylphenidate HCl (Concerta ) 18 mg/day. At the 1 month of follow-up, she had experienced minimal improvement in ADHD symptoms, while cessation of enuresis occurred immediately after the initiation of methylphenidate. She had no enuresis on the days she had taken the methylphenidate, but on 3 days she had forgotten to take the pill she had experienced enuresis during the 1 month of treatment duration. Because of significant weight loss (about 8 kg) on the 1 month of treatment, we could not increase the dosage of methylphenidate to effective dosage. For this reason, we prescribed atomoxetine 10 mg/day instead of methylphenidate. Within 2 weeks, the dose of atomoxetine was increased to 25 mg/day, in which she tolerated well. The patient’s ADHD symptoms improved considerably on atomoxetine and the enuresis disappeared completely within 2 weeks of initiating atomoxetine. She had no enuresis on the days she had taken the atomoxetine, but bedwetted on 2 days when she had forgotten to take the medication. She regained weight during the use of atomoxetine without using any other drug to increase appetite. The reported case has no confounding medications and shows clear resolution of enuresis with the introduction and subsequent removal of both methylphenidate and atomoxetine. No previous reports identify the cessation of enuresis in a child with ADHD who was treated with both methylphenidate and atomoxetine in distinct times. There are two case series related about cessation of enuresis after initiating treatment of methylphenidate or atomoxetine in This case was presented as a poster presentation in the 20th World IACAPAP Congress.

Increased levels of serum neopterin in attention deficit/hyperactivity disorder (ADHD).

Attention deficit/hyperactivity disorder (ADHD) is the most frequently occurring neuropsychiatric disorder in childhood with an etiology that is not fully understood. A number of reviews that have addressed the neurobiology of ADHD have focused on imaging and genetics. Relatively little attention has been given to factors/mechanisms involved in the brain dysfunction. We suggest that changes in cellular immunity may be involved. Neopterin is a good indicator of cellular immunity, and we evaluated serum levels of neopterin in patients with ADHD. The study group consisted of 49 patients with ADHD. An age- and gender-matched control group was composed of 31 healthy subjects. Venous blood samples were collected, and the levels of neopterin were measured. The levels of neopterin were significantly higher in ADHD than in the comparison subjects. Cellular immunity may have a role in the etiopathogenesis of ADHD.

Effects of atomoxetine on heart rhythm in children and adolescents.

The aim of this study was to examine the effects of atomoxetine on heart rhythm using 12‐lead electrocardiography (ECG) and 24 h Holter monitoring.

The Quality of Life (QoL) in Attention Deficit Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, impulsivity, and hyperactivity of core symptoms, affect‐ ing 3-10% of school age children, as well as 4% of adults. Quality of Life (QoL) is an individual perception in regard to his/her position in life, in the context of culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns. Then it has a multidimensional concept, the core of which consists of the physical, psychological, cognitive, and social aspects of functioning. Several studies on QoL in ADHD have been published pointing out that QoL do‐ mains in ADHD have been found to be negatively affected compared to the healthy persons. This situation suggests that ADHD not only affects academic achievements of a person but it also has a deteriorating effect on all aspects of life, including social and occupational. Mostly used pharmacological agents are atomoxetine, methylpheni‐ date and other stimulants related to QoL and ADHD context. These agents of ADHD treatments have been correlated with an improvement in QoL scores. Non-pharmaco‐ logical interventions and their effects on QoL in patients with ADHD or the effective‐ ness of combined treatment modalities should be carried out in the near future.

Atomoxetine-induced hypomania-like symptoms in a preadolescent patient.

[Author Affiliation]Esra Guney. Ankara Pediatric & Pediatric Hematology Oncology Training and Research Hospital, Child and Adolescent Psychiatry Department, Ankara, Turkey.Ozden Sukran Uneri. Ankara Pediatric & Pediatric Hematology Oncology Training and Research Hospital, Child and Adolescent Psychiatry Department, Ankara, Turkey.Address correspondence to: Esra Guney, MD, Ankara cocuk sagligi ve hastaliklari egitim arastirma hastanesi, Ziraat Mah, Irfan Bastug Cad. Kurtdereli Sk. No: 10, Diskapi-Ankara, Turkey, E-mail, : dresraguney@gmail.comTo The Editor:Atomoxetine, a selective noradrenaline reuptake inhibitor, is the first nonstimulant drug approved by the Food and Drug Administration for the treatment of attention- deficit/hyperactivity disorder (ADHD) (Kaplan and Newcorn 2011). It has been reported that atomoxetine can be safely used in comorbid anxiety disorder and tic disorders (Christman et al. 2004). In this article, we aimed to report hypomania-like symptoms triggered by atomoxetine in a patient with ADHD and social anxiety disorder.Case ReportA 10-year-old male patient presenting with attention deficit, forgetfulness, difficulty in memorizing, and low school success underwent a Wechsler Intelligence Scale For Children-Revised (WISC-R) test to assess his mental capacity. The test revealed that his verbal subtest score was 64, performance subtest score was 68, and total subtest score was 63. According to observations of the psychologist applying the test, attention deficit and performance anxiety affected the test result unfavorably. In addition, it was determined that the patient could not express himself properly in social settings, avoided activities requiring performance, such as not attending classes out of fear of making mistakes, and was usually quiet and shy; therefore, his daily functions were unfavorably affected by his condition.Assessment with respect to ADHD revealed that his time spent studying was limited. In addition, he made careless mistakes in homework, was easily distracted, forgot daily activities easily, and, hence, was frequently warned by his family and teacher. The assessment indicated no activity or impulsivity that had an impact on functionality. He had been advised to take methylphenidate for similar symptoms at the age of 7, but the treatment had been stopped by the family because of side effects such as marked sedation, appetite loss, and irritability. The teacher notification form that was sent via the family also supported these findings.For diagnosis, semistructured interviews based on the American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) diagnostic criteria were conducted with the child and his parents (American Psychiatric Association 1994). Moreover, Conners Parent and Teacher Rating Scales (Goyette et al. 1978; Conners 1997) were applied. According to the evaluation of the patient, it was determined that he fulfilled the diagnostic criteria for ADHD--attention-deficit subtype and social anxiety disorder--common type. The patient was also evaluated through a semistructured interview based on the DSM-IV diagnostic criteria for any symptoms of other anxiety disorders, mood disorder, and oppositional defiant disorder/conduct disorder, as well as tics and elimination disorders; no signs of these psychiatric disorders were observed. He was begun on atomoxetine 10 mg/day (body weight 36 kg) with gradual dose increases. Special educational support was postponed until a repeat WISC-R test could be administered at 6 months after the treatment.The patient was brought to our polyclinic with nervousness, defiance to parents, and overactivity on 7th day of atomoxetine treatment. A repeat evaluation revealed that his self-esteem increased; he also developed behavioral and emotional changes in the form of occasional anxiety and irritability, and sometimes excessive joy, restlessness, impatience, pugnaciousness, pressured speech, speech interruption behavior, tendency to commit violence against friends, one attempt to kiss one of his friends on her cheeks, and very frequent and irritating kissing behavior toward his mother. …

Birth order and reproductive stoppage in families of children with autism spectrum disorder

ABSTRACT OBJECTIVES: The objective of the study was to evaluate the birth order of children with Autism Spectrum Disorder (ASD) and ways of delivery at birth, together with the phenomenon of reproductive stoppage and the number of siblings in the case families (families of children with ASD in the study). METHODS: One hundred and ninety-six subjects with ASD and 54 healthy children were included into the study. Demographics were collected. Autism Behaviour Checklist (ABC), Aberrant Behaviour Checklist (AbBC), and Childhood Autism Rating Scale (CARS) were administered. Depending on the type of data and on the objective of the assessment, Mann–Whitney U-test, chi-square test, and Spearman tests were used for statistical analysis. A p-value smaller than .05 was considered to be statistically significant. RESULTS: In the study group consisting of children with ASD, the rate of being the first-born child was determined to be more frequent, significantly, compared to the rate in the control group (pu2009=u2009.001). It was also found that 86.7% (nu2009=u2009170) of the children in the ASD group had at least one sibling compared to the rate of 81.5% (nu2009=u200944) for their counterparts in the control group. CONCLUSIONS: Our study compared ASD group to controls in terms of birth order, demonstrating a significant difference for being the first-born child in the ASD group. Birth order can be considered to be one of the several environmental factors that will help in understanding ASD, in which environmental factors can be the cause of phenotypic complexity. For all that, in our study, it was observed that having a child with autism in the Turkish sample did not affect the decision for the next pregnancy.

The Assessment of Serum Lipid Profiles of Children with Attention Deficit Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent psychiatric disorders in children and the pathophysiology remains obscure. Some studies show that lipid imbalances are associated with ADHD etiology. We studied the association of serum total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglyceride (TG) levels in ADHD. We examined 88 children aged 8-12 years who were diagnosed with ADHD and 88 healthy children. The exclusion criteria were as follows: obesity, any psychotropic use in the last 3 months, presence of a chronic disease and/or malignancy, history of medically treated lipid metabolism disease in family members, intelligence quotient (IQ)u202f<u202f70, and comorbidities, with the exception of oppositional defiant disorder. The sample was evaluated using a semi-structured clinical assessment interview and Conners rating scales. Despite controlling for age, sex, and body mass index (BMI) variables, the total cholesterol and LDL levels were significantly higher in the ADHD group than the levels of healthy controls, whereas the TG and HDL cholesterol levels were similar among groups. Conners rating scales, reflecting symptom severity, and total cholesterol, TG, HDL, and LDL levels of the ADHD group were not correlated. The study results support the difference in serum lipid and lipoprotein profiles of children with ADHD compared with healthy controls. This difference is thought to be related with changes in oxidant/antioxidant balance states in ADHD.

Gender dysphoria in an adolescent diagnosed with Klinefelter syndrome over a follow-up period

Although genetic factors have been thought to be main cause for gender dysphoria, its etiology is still not clearly understood. Klinefelter syndrome is the most seen sex chromosomal disorder. In the literature, there are fewer case reports in connection with Klinefelter syndrome and gender dysphoria. Herein, we report a 16-year-old adolescent patient displaying gender dysphoria features, who has revealed Klinefelter syndrome after genetic examination, and has been treated with testosterone hormone, and his gender dysphoria symptoms have disappeared. In our case, chromosomal anomaly and lower levels of androgen could play a role in the etiopathogenesis of gender dysphori. Bringingxa0 Klinefelter syndrome disorder to mind in gender dysphoria cases, even it is a rare disorder, could positively affect the course of the treatment as was in our case. The relation between psychiatric symptoms, which can be seen in gender dysphoria, and testosterone does not known exactly. Further studies, which are randomized-controlled ones, can help to better understand the subject.

Overview of young people attempting suicide by drug overdose and prevention and protection services

Overview of young people attempting suicide by drug overdose and prevention and protection services Objective: Suicide is the second leading cause of death among 15-29 year-old-people in the world. The aim of this study is to present the characteristics of children and adolescents attempting suicide by drug overdose and to draw attention to preventive measures that can be taken in Turkey. Method: Records of the patients who admitted to a training and research hospital in one year period due to a suicide attempt by drug overdose were reviewed retrospectively. Sociodemographic data and psychiatric evaluation records of attempters were documented. Results: During the study period, 163 adolescents applied to the hospital with suicidal drug overdose. Child psychiatry consultation was ordered for 61.3% (n=100) of them. It was the first attempt of 90% of the cases. The frequency of having previous psychiatric diagnosis was significantly higher in patients with recurrent suicide attempts. In both impulsive and planned suicide attempts, the most preferred times were evening and night time. Women more often attempted suicide due to family conflict, while men attempted due to emotional relationship problems. All cases without psychiatric disorder or with externalizing problems attempted impulsive suicide. The most preferred drugs for suicide were, nonsteroidal anti-inflammatory drugs, antidepressants, paracetamol, antibiotics and antipsychotics. Of the all cases, 22.5% attempted suicide by self medications. It has not been possible to maintain pediatric psychiatric follow up of the 71% of the cases. Conclusion: It is considered that public attention should be drawn to the increasing number of adolescent suicide attempts in order to prevent this issue. Family-oriented protective approaches, school-based preventive programs and new legal regulations on drug safety could help to reduce the frequency of suicide attempts..