Özlem Özcan

Is there any role of Toxoplasma gondii in the etiology of obsessive-compulsive disorder?

Obsessive-compulsive disorder (OCD) is a common psychiatric illness. Although the aetiology of OCD is still unknown, the family-genetic data show that familial forms of OCD may be associated with a specific genetic susceptibility. Recent investigations have associated development of OCD with infectious illness. Toxoplasmic encephalitis (TE) is a common presentation of Toxoplasma gondii infection of the central nervous system (CNS). The most commonly affected CNS region in TE is the cerebral hemisphere, followed by the basal ganglia, cerebellum and brain stem. The basal ganglia has been implicated in the development of OCD. Therefore, in this study, it was aimed to investigate a possible association between Toxoplasma infection and OCD. We selected 42 patients with OCD and 100 healthy volunteers, and investigated the sero-positivity rate for anti-Toxoplasma IgG antibodies by Enzyme Linked Immunosorbent Assay (ELISA). The sero-positivity rate for anti-T. gondii IgG antibodies among OCD patients (47.62%) was found to be significantly higher than the rate in healthy volunteers (19%). This is the first report to examine a potential association between Toxoplasma infection and OCD. The main finding of the present study is an increased level of IgG antibodies to T. gondii in OCD patients when compared with the level in healthy controls. There might be a causal relationship between chronic toxoplasmosis and the aetiology of OCD.

Malnutrition and Obesity in Children With ADHD

Objective: Low threshold of dissatisfaction and frustration in child and adolescent patients with ADHD lead to changes in dietary pattern with contribution to the development of obesity and other nutritional disorders. Methods: A total of 362 patients with the diagnosis of ADHD and 390 children without any chronic disease were included to the study. We evaluated the anthropometric measurements for all cases. Results: The overweight/obese cases according to weight for height (WFH) and body mass index scores were more likely in ADHD cases than control group. Malnourished cases according to WFH were more common in ADHD cases. Patients with weight standard deviation scores between <−2 and >2 were significantly higher in ADHD cases than the control group patients. Conclusion: Frequency of malnutrition and overweight/obese patients was found higher in ADHD cases compared with control group, and this situation suggested that ADHD is a risk factor for the development of eating disorders.

Frequency of celiac disease in attention-deficit/hyperactivity disorder.

Objective: Although it is well known that celiac disease (CD) is associated with neurologic disorders, association with psychiatric problems is not well defined. In this report, we aimed to detect CD prevalence in patients with attention-deficit hyperactivity disorder (ADHD). Methods: A total of 362 patients between the ages 5 and 15 years with the diagnosis of ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria and 390 sex- and age-matched healthy children were included in the present study. Serum levels of tissue transglutaminase (tTg) immunoglobulin (Ig) A and IgG were studied in both groups. Serum IgA levels were also studied in patients with positive tTG IgG for the exclusion of selective IgA deficiency. Endoscopic duodenal biopsy was provided in seropositive patients, whose parents approved the procedure. Biopsy samples were evaluated according to Marsh-Oberhuber classification. Results: tTg IgA was positive in 4 patients with ADHD (1.1%). Endoscopic duodenal biopsy was suggestive of CD in one of them (0.27%). tTg IgA was positive in 3 of control group patients (0.8%). Duodenal biopsy of the only patient from control group, who underwent upper gastrointestinal endoscopy, revealed normal intestinal mucosa. Conclusions: The seropositivity rates for CD were found similar in ADHD and control groups. Thus, neither routine screening for CD nor empirical recommendation of gluten-free diet seems necessary in children with ADHD.

EEG and MRI findings and their relation with intellectual disability in pervasive developmental disorders

BackgroundThe diagnostic category pervasive developmental disorders (PDDs) refer to a group of five disorders: autism, Rett syndrome, childhood disintegrative disorder, Asperger syndrome, and pervasive developmental disorder not otherwise specified (PDD-NOS). EEG abnormalities and seizures are considered much frequent in autistic subjects with comorbid intellectual disability (ID). In this study, we aimed to evaluate the EEG and MRI findings and their relation with ID in pervasive developmental disorder.MethodsA retrospective, cross-sectional and non-experimental study was performed. Subjects included 81 patients diagnosed with autism or PDD-NOS according to the DSM-IV criteria. The age range of the patients was 2–15 years (mean 6.6 years, SD 3.0). Among them, 21 (25.9%) were girls and 60 boys (74.1%).ResultsPatients with severe ID had a higher rate of EEG abnormalities (P=0.03) than patients without ID as well as patients with mild or moderate ID. The association remained significant after the structural MRI abnormalities were controlled (P=0.04). The severity of ID was not associated with abnormal MRI. The most frequent EEG and MRI abnormalities were active epileptic anomaly/paroxysmal abnormality and cerebral atrophy/periventricular leukomalacia, respectively. Almost a third of the EEG abnormalities were associated with temporal cortex and adjacent cortical structures.ConclusionsConsistent with previous studies, almost a fourth of the patients in this relatively large sample of patients with pervasive developmental disorders had EEG and/or MRI abnormalities. EEG results indicate that temporal cortex may play a significant role in pervasive developmental disorders.

Social phobia and other psychiatric problems in children with strabismus

OBJECTIVE To investigate the rate of social phobia, anxiety, depression, and other psychiatric problems in children with strabismus. DESIGN Prospective, cross-sectional, case-control study. PARTICIPANTS Forty-two children with strabismus and 47 control subjects 8-13 years of age were enrolled in this study. METHODS After the ophthalmologists examination, all cases were assessed by a psychiatrist based on the structured interview technique of Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version (Kiddie-SADS-PL). The Screen for Child Anxiety Related Emotional Disorders (SCARED) was administered to each subject to evaluate social phobia. All participants completed the Childrens Depression Inventory (CDI). RESULTS Age as well as sex and income were comparable between the strabismus patients and control groups. Social phobia was diagnosed in 8 (19.04%) of the 42 strabismic children and in 1 (2.12%) of the control subjects. The CDI and SCARED (total score, social phobia, separation anxiety) scores of strabismus patients were significantly higher than the control group (p = 0.001, p = 0.004, p = 0.0001, p = 0.05, respectively). CONCLUSIONS A relationship between strabismus in children and social phobia, depression, and anxiety on a symptom basis was underlined by our data.

Plasma Leptin, Adiponectin, Neuropeptide Y Levels in Drug Naive Children With ADHD

Objective: ADHD is one of the most common childhood psychiatric disorders. Research indicates that there is some link between obesity/overweight and ADHD, though the mechanism of this association remains uncertain. It is the aim of the present study to explore the association between ADHD, obesity, and plasma leptin, neuropeptide Y (NPY), and adiponectin levels. Method: Thirty-six patients diagnosed with ADHD were included in the study. The control group consisted of 40 healthy children and adolescents who had similar age and gender features with the patient group. Plasma leptin, adiponectin, NPY levels were measured, and body mass index (BMI), weight for height, and standard deviation scores (SDS) of height, weight, and BMI were calculated. Results: No significant difference was found between patients and healthy children in terms of BMI and BMI percentile. Participants were classified into three groups according to their weight to height values. There was no significant difference between the two groups, but 10% of the control group and 30.6% of the ADHD group were classified as overweight, which was 3 times higher than the control group. The adiponectin plasma level was significantly lower and leptin/adiponectin (L/A) ratio was significantly higher in the ADHD group. There was no significant difference between serum NPY levels. In the ADHD group, the mean leptin plasma level was high, but was not statistically significant. Conclusion: We think that a low adiponectin level and high L/A ratio may be the underlying mechanism of the obesity in ADHD patients.

Gender Differences in Sexually Abused Children and Adolescents: A Multicenter Study in Turkey

ABSTRACT The purpose of this study was to examine gender-based differences in abuse-related characteristics and post-abuse psychiatric disorders among sexually abused children and adolescents. The researchers retrospectively examined files, judicial reports, and social examination reports of 1,250 sexually abused youth cases. Results showed that boys were more often victimized by penetration, force, and physical violence. Incidence of sexual abuse by family members, familiar persons, and multiple persons was higher among girls. In addition, a higher rate of major depressive disorder as well as alcohol consumption and cigarette smoking were found in sexually abused girls. No difference was observed between boys and girls in terms of post-traumatic stress disorder, conduct disorder, and other mental disorders. Intellectual disability was more frequent in boys.

Self-injury behavior in an adolescent with Wilson’s disease

Wilson’s disease (WD) is an autosomal recessive genetic disorder of copper metabolism that results in failure of the biliary excretion of copper. Copper accumulates in tissues, such as brain, liver, kidneys and the cornea. Owing to the copper deposits in the brain, neurological and psychiatric symptoms may appear [1]. About half of the patients with WD have neurological or psychiatric problems. The first manifestations of the disease can be psychiatric, which accounts for only 10% of the cases. Most patients initially have mild cognitive deterioration and clumsiness, as well as changes in behavior. Several psychiatric manifestations reported are mood disorders, anxiety disorders, personality changes, phobias, cognitive impairment, psychosis and compulsive and impulsive behavior. Those manifestations might be seen in different stages of the disease and often co-occur with neurological symptoms, but not with hepatic manifestations [1, 2]. Data on psychiatric manifestations in WD are mainly based on the adult studies. To the best of our knowledge, association of WD and self-mutilation has not been reported so far. In that paper, a 16-year-old adolescent girl with WD referred to child and adolescent psychiatry clinic because of self-mutilation is presented. Her complaints were irritability, short temper and scratching her own skin. Skin scratching was consistent for about 3 months and it was almost on a daily basis. The patient stated that she could not control herself, especially when she was angry and told that she relaxed after that action. The patient was premorbidly well adjusted with no past suicide attempts or any major psychiatric disorder. There was no history of substance abuse and familial history of any major psychiatric disorder. She had a diagnosis of WD for 9 years. The diagnosis was based on the low-serum ceruloplasmin, high urine and liver copper value and the presence of Kayser–Fleischer ring. She was on trientine and zinc therapy from the beginning, but not very compliant to the treatment. Within the last 2 years, her speech deterioration got worse and tremors started in her hands. On physical examination, there were lacerations about 1 cm length on chest skin. The mental status examination showed that her speech was dysarthric and mood was anxious. The brain MRI revealed altered signal intensity in right dentate nucleus, both two red nuclei, basal ganglia and thalami and atrophy in cerebellar folium both in the T1and T2-weighted images. Our patient was diagnosed as impulse control disorder not otherwise specified according to Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision (DSM-IV-TR) diagnostic criteria. We started low-dose haloperidol (2 mg/day) and escitalopram (10 mg/ day). During the treatment period, a decrease in selfmutilation was objectified after 3 months. As mentioned above, self-injurious behavior has not been described in WD before. Self-injurious behavior (selfmutilation, self-harm) has been described as a complex group of behavior resulting in deliberate destruction of body tissue without conscious suicidal intent. Mental Ö. Özcan Department of Child Psychiatry, Medical Faculty, _ Inönü University, Malatya, Turkey

Melatonin Treatment for Childhood Sleep Terror

[Author Affiliation]Ozlem Ozcan. Department of Child and Adolescent Psychiatry, Inonu University Medical Faculty, Malatya, Turkey.Yunus Emre Donmez. Department of Child and Adolescent Psychiatry, Inonu University Medical Faculty, Malatya, Turkey.Address correspondence to: Yunus Emre Donmez, MD, Department of Child and Adolescent Psychiatry, Inonu University School of Medicine, Malatya, Turkey, E-mail: dryemredonmez@yahoo.comTo The Editor:Sleep terror is a parasomnia seen during nonrapid eye movement (NREM) sleep, and characterized by extreme terror, motor agitation, intense vocalization, and high levels of autonomic discharge (profuse sweating, mydriasis, tachycardia, and tachypnea). The episode usually lasts no more than a few minutes; afterward, the child usually relaxes and returns spontaneously to sleep. Sleep terrors are classified as arousal disorders by The International Classification of Sleep Disorders (ICSD-2) (American Academy of Sleep Medicine 2005; Provini et al. 2011).Sleep terror is reported to affect ∼ 3% of children and The etiology of sleep terror is not fully understood, and there is, to date, no clearly defined treatment for it. Different therapeutic strategies have been proposed for sleep terror such as a behavioral approach, reinforcing age-appropriate sleep patterns, reassuring and guiding parents, and pharmacotherapy (Weissbluth 1984). The most commonly used medications in the pharmacological treatment of sleep terror are benzodiazepines and antidepressants (Howell 2012).The purpose of this case report is to discuss the response of a 36-month-old male patient beginning treatment with melatonin after being diagnosed with sleep terror.Case ReportA 36-month-old male patient was brought to the child psychiatry clinic by his parents with complaints of a sleep disorder exhibited by the child waking up frequently at night. It was understood from the interview with his parents that the patient had had sleep problems since his birth; he slept well for 30 minutes to 1 hour during the daytime, and his parents rocked him to sleep at ∼10 pm. His parents stated that he shouted out agitatedly, screamed, and made gestures such as struggling ∼30 minutes after sleeping, had tachypnea, repeated such screams and actions four to five times at night, and then fell sleep again, and that he had a facial expression as if crying during moments of shouting, screaming, and struggling. According to the information obtained from the parents; the patient was an intended and planned baby, born after a stressful pregnancy, that he started to walk when he was 18 months old, started to talk when he was 24 months old, and had no health problem other than the sleep disorder.The mother described the patient as a warm-hearted child who shouted and insisted when he was angry. The patient had been taken care of by his babysitter during the daytime for the past 1.5 years; the 32-year-old university graduate mother described herself as a hot-tempered and intolerant person, and she stated that she received regular psychiatric support for manic-depressive disorder. The 32-year-old university graduate father had no psychiatric disorder, but had similar sleep problems when he was a child; the 8-year-old brother of the patient had short sleeping periods and had difficulty falling asleep.During the psychiatric evaluation, it was observed that the patient was dressed appropriately for his age and sociocultural level, and that his verbal and nonverbal communication was normal and his cognitive functions were consistent with his age. …

Examination of the Correlation Between Internet Addiction and Social Phobia in Adolescents

This was a descriptive and cross-sectional study conducted with adolescents to examine the correlation between Internet addiction and social phobia. The population of the study consisted of 24,260 students aged between 11 and 15 years. Sampling method was used from population with known number, and 1,450 students were calculated as sample of the study. In this study, 13.7% of the adolescents had an Internet addiction, and 4.2% spent more than 5 hr on the computer every day. There was a positive correlation between Internet addiction and social phobia. The form of time spent on Internet was examined in terms of addiction and social phobia; although Internet addiction was related to games, dating sites, and web surfing, social phobia was related to homework, games, and web surfing. It was hypothesized that adolescents with social phobia were Internet addicts, and the participants used the Internet to spend time rather than socialize.