Özlem Gencer

Establishment of interdisciplinary child protection teams in Turkey 2002–2006: Identifying the strongest link can make a difference!

OBJECTIVES The University of Iowa Child Protection Program collaborated with Turkish professionals to develop a training program on child abuse and neglect during 2002-2006 with the goals of increasing professional awareness and number of multidisciplinary teams (MDT), regional collaborations, and assessed cases. This paper summarizes the 5-year outcome. METHODS A team of instructors evaluated needs and held training activities in Turkey annually, and provided consultation when needed. Descriptive analysis was done via Excel and SPSS software. RESULTS Eighteen training activities were held with 3,570 attendees. Over the study period, the number of MDTs increased from 4 to 14. The MDTs got involved in organizing training activities in their institutions and communities. The number of medical curriculum lectures taught by MDTs to medical students/residents, conferences organized by the MDTs, and lectures to non-medical professional audiences increased significantly (R(2)=91.4%, 83.8%, and 69.2%, respectively). The number of abuse cases assessed by the MDTs increased by five times compared to pre-training period. CONCLUSIONS A culturally competent training program had a positive impact on professional attitudes and behaviors toward recognition and management of child abuse and neglect in Turkey. The need to partner with policy makers to revise current law in favor of a greater human services orientation became clear. PRACTICE IMPLICATIONS Pioneers in developing countries may benefit from collaborating with culturally competent instructors from countries with more developed child protection systems to develop training programs so that professional development can improve recognition and management of child abuse and neglect.

Maternal psychosocial aspects in hypernatremic dehydration with high sodium concentrations in breast milk: a case-control study.

Objective:  To investigate whether mothers, with no known biological reason to account for elevated breast milk sodium (BMS) and associated hypernatremic dehydration (HND) in their exclusively breastfed infants, have more adverse psychosocial characteristics compared with controls.

Adjunctive olanzapine treatment in bipolar adolescents responding insufficiently to mood stabilizers. Four case reports.

This report was aimed to evaluate the efficacy of olanzapine treatment as an adjunct therapy to mood stabilizers in the treatment of four adolescents responding insufficiently to mood stabilizers. All patients were diagnosed with bipolar I disorder according to DSM IV criteria. YMRS (Young mania rating scale) and CGI (Clinical global impression, improvement and therapeutic effectiveness scales) were used to evaluate overall response of the episode to the drugs. All patients with no adequate response to mood stabilizers did respond to adjunctive olanzapine treatment (10–30 mg/per day). It has been suggested that antipsychotics may be useful as an adjunct to mood stabilisers in bipolar disorder. However, further research is warranted regarding the use of atypical antipsychotics in children and adolescents.

Is Triple P effective in childhood anxiety disorder? A randomized controlled study

ABSTRACT OBJECTIVES: Considering the role of parenting in the aetiology and maintenance of anxiety disorders, working with parents is a promising treatment strategy. Triple P-positive parenting programme is a parent-focused cognitive behaviour therapy. In this study, we aimed to investigate the effectiveness of Triple P in improvement in childhood anxiety disorders and also to assess its effects on behavioural and emotional problems, general anxiety level, severity of the disorder, and general psychosocial functioning. Parents’ mental health and general well-being were also evaluated. METHODS: In this randomized controlled study, the sample consisted of 74 children, aged between 8 and 12 years, who were diagnosed as anxiety disorder by Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Life-time Kiddie (K-SADS-PL). Following randomization into two equal groups, mothers of the first group participated to Group Triple P Programme, while the second group was receiving no treatment. The two groups were compared right before and after the intervention on rates of anxiety symptoms, emotional, and behavioural variables. RESULTS: Children’s general anxiety level was significantly lower in the intervention group following Triple P implementation. Behavioural and emotional problems were also reduced in the intervention group. Parental anxiety and general well-being were not significantly different between two groups. CONCLUSION: It is considered that Triple P may be useful in the treatment of children’s anxiety disorder but further studies about Triple P on children’s anxiety disorders are needed.

Factors affecting improvement of children and adolescents who were treated in the child and adolescent psychiatry inpatient unit

Objective This study aimed to assess the correlates and predictors of improvement in general functioning of children and adolescents who are treated in the child and adolescent psychiatry (CAMHS) inpatient unit. Methods Hospital records of 308 children and adolescents who were treated for at least 1 month in the CAMHS inpatient unit from 2005–2016 were included. Associations with individual, familial, and clinical variables and the difference in Children’s Global Assessment Scale (ΔCGAS) scores at admission and discharge were evaluated. Results Positive predictors of ΔCGAS were older age and lower CGAS scores at admission, whereas high familial risk scores at admission and diagnosis of early-onset schizophrenia negatively predicted ΔCGAS (B = 0.698, p = 0002; B = −0.620, p < 0.001; B = −0.842, p = 0.002; B =−9.184, p = 0.000, respectively). Familial risk scores were significantly and negatively correlated with ΔCGAS (p = 0.004, Spearman’s rho = −0.2). Conclusions This study indicates that improvement in general functioning during inpatient treatment in CAMHS is better at an older age and with lower general functioning at admission. However, high familial risks and diagnosis of early-onset schizophrenia weakens this improvement.

Assessment for Sexual Abuse in A Case Presenting with Genital Herpes

Assessment for sexual abuse in a case presenting with genital herpes Child sexual abuse is defined as the use of a child by an adult or a significantly older person for the purpose of sexual stimulation. Sexual relations within the family (incest) “particularly involving children” is prohibited in all faiths and societies; hence, incestuous child sexual abuse is the form of abuse most difficult to determine. Prepubertal genital herpes is a presentation that definitely needs to be assessed as a potential indication for sexual abuse. Even though in adults transmission is often by sexual route, it has been pointed out that especially in cases below the age of 5 years, anogenital herpes can be transmitted by non-sexual mechanisms. As paths for a possible non-sexual transmission of genital herpes, autoinoculation, finger contact by an adult changing nappies leading to infection, hand contact between children, or transmission via infected objects (plate, fork, garments, etc.) have been reported. Guidelines helping in the assessment of sexual abuse are insufficient regarding the question how the issue should be confronted in pediatric cases of genital herpes. More evidence is required to solve this problem. In our presentation, we discuss the process of assessment for sexual abuse in the case of a girl aged 2 years 3 months presenting to the emergency department with anogenital herpes.