Sabri Hergüner

Psychiatric disorders in individuals with high-functioning autism and Asperger's disorder: Similarities and differences

Abstract Objectives. To investigate and compare the rate and type of psychiatric co-morbidity in individuals with diagnosis of high functioning autism (HFA) and Aspergers disorder (AS). Methods. This study includes 30 children and adolescents with diagnosis of HFA and 30 with diagnosis of AS. Diagnoses of HFA and AS were made using strict DSM-IV criteria. Psychiatric co-morbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL-T). Results. The rate of comorbid psychiatric disorders was very high in both groups (93.3% in HFA and 100% in AS). The most common disorder in both groups was attention deficit hyperactivity disorder. There was no statistically significant difference between groups in the rate of associated psychiatric disorders, except for major depressive disorder (P = 0.029) and ADHD-combined type (P = 0.030). The AS group displayed greater comorbidity with depressive disorders and ADHD-CT. Conclusion. From a clinical perspective, it could be concluded that both disorders involve a high risk for developing psychiatric disorders, with AS patients at greater risk for depression. From a nosological perspective, the substantial similarities in terms of psychiatric comorbidity may support the idea that both disorders are on the same spectrum and differs in some aspects.

Autistic disorder and 22q11.2 duplication

Although several reports have described the co-occurrence of autism in subjects with chromosome 22 abnormalities including trisomy 22, translocation 20/22, 22q11.2 deletion, ring chromosome 22, and 22q13.3 deletion, there is no report with 22q11.2 duplication. We report a 9-year-old girl, referred to our department for her behavioural problems and language delay. She was diagnosed with autistic disorder according to DSM-IV criteria. Because of her dysmorphic characteristics comprising narrow face, narrow forehead, mandibular prognathism, synophrys, and operated cleft palate and cardiac problems, she had gone under cytogenetic analysis. Although she was ascertained as suspected velocardiofacial syndrome (VCFS), the duplication of 22q11.2 was detected by interphase fluorescence in situ hybridization. Previous reports on the psychiatric aspects of 22q11.2 duplication have shown the existence of hyperactivity, learning disability, speech problems, and aggressive behaviours but not autism. Moreover, the lack of reports of co-occurrence of autism and 22q11.2 duplication may be related to paucity as a result of technical problems.Although several reports have described the co-occurrence of autism in subjects with chromosome 22 abnormalities including trisomy 22, translocation 20/22, 22q11.2 deletion, ring chromosome 22, and 22q13.3 deletion, there is no report with 22q11.2 duplication. We report a 9-year-old girl, referred to our department for her behavioural problems and language delay. She was diagnosed with autistic disorder according to DSM-IV criteria. Because of her dysmorphic characteristics comprising narrow face, narrow forehead, mandibular prognathism, synophrys, and operated cleft palate and cardiac problems, she had gone under cytogenetic analysis. Although she was ascertained as suspected velocardiofacial syndrome (VCFS), the duplication of 22q11.2 was detected by interphase fluorescence in situ hybridization. Previous reports on the psychiatric aspects of 22q11.2 duplication have shown the existence of hyperactivity, learning disability, speech problems, and aggressive behaviours but not autism. Moreover, the lack o...

Autism and Williams syndrome: A case report

Williams syndrome (WS) is a neurodevelopmental disorder caused by a deletion in the 7q11.23 region which includes at least 17 genes. The presence of autistic features in WS is a controversial issue. While some authors describe WS as the opposite phenotype of autism, recent studies indicate that both share many common characteristics. We report a 12-year-old boy diagnosed as autistic disorder and WS with hemizygosity at the elastin locus and a karyotype of 46,XY,del(7)(q11.21q11.23). Molecular genetic studies have shown that deletion at the elastin gene may account for the cardiovascular abnormalities seen in WS, but autistic features are likely caused by other genes flanking elastin.Williams syndrome (WS) is a neurodevelopmental disorder caused by a deletion in the 7q11.23 region which includes at least 17 genes. The presence of autistic features in WS is a controversial issue. While some authors describe WS as the opposite phenotype of autism, recent studies indicate that both share many common characteristics. We report a 12-year-old boy diagnosed as autistic disorder and WS with hemizygosity at the elastin locus and a karyotype of 46,XY,del(7)(q11.21q11.23). Molecular genetic studies have shown that deletion at the elastin gene may account for the cardiovascular abnormalities seen in WS, but autistic features are likely caused by other genes flanking elastin.

Is Pica an eating disorder or an obsessive-compulsive spectrum disorder?

Pica is classified in Diagnostic and Statistical Manual of Mental Disorders (DSM) under the Feeding and Eating Disorders of Infancy and Early Childhood, and defined as the persistent eating of nonnutritive substances for a period of at least one month in a developmentally inappropriate and culturally unacceptable manner (APA, 1994). Although there is no clearly established etiology for Pica, its association with a number of conditions is reported; most commonly pregnancy, iron deficiency and psychosocial problems. It is also seen frequently in individuals with psychiatric disorders including psychosis, autism and intellectual disability. Moreover an association between Pica and obsessive–compulsive spectrum disorder (OCSD) is described by some authors (Bhatia and Gupta, 2007; Gundogar et al., 2003; Stein et al., 1996; Szabo et al., 1995). We here report a child who had Pica and treated with fluoxetine successfully.

Internet addiction is related to attention deficit but not hyperactivity in a sample of high school students.

Abstract Objective. To assess the effects of attention-deficit/hyperactivity disorder (ADHD) symptom dimensions on Internet addiction (IA) after controlling for Internet usage features among high school students. Methods. This study consisted of 640 students (331 females and 309 males) ranging from 14 to 19 years of age. The Internet Addiction Scale, the Conners-Wells’ Adolescent Self-Report Scale-Short Form, and a personal information form were completed by the participants. Statistical analyses were conducted for both sexes and the total sample. Results. According to the logistic regression analysis, attention deficit and playing online games were significant predictors of IA in both sexes. Other predictors of IA included behavioral problems for females, total weekly Internet usage time, and lifelong total Internet use for males. Hyperactivity and other Internet usage features did not predict IA. Conclusion. These results suggest that attention deficit and playing online games are important determinants of IA in this age group.

Attention deficit- hyperactivity disorder symptoms in women with polycystic ovary syndrome

Objectives Several studies suggest that androgens are involved in the etiology of attention deficit-hyperactivity disorder (ADHD). In this study, we investigated the ADHD symptoms in women with polycystic ovary syndrome (PCOS), a complex endocrine, hormonal, and metabolic condition associated with hyperandrogenism. Methods Forty women between the ages of 18 and 35 years with PCOS were recruited for the study group. For comparison, 40 healthy women who had regular menses were included. Current and childhood ADHD symptoms were assessed by using the Adult ADHD Self-Report Scale and Wender-Utah Rating Scale, respectively. Results Women with PCOS had higher total Adult ADHD Self-Report Scale and total Wender-Utah Rating Scale scores than controls. According to the Wender-Utah Rating Scale, the frequency of childhood ADHD was significantly higher in PCOS group than the control. Adult ADHD Self-Report Scale: Hyperactivity–Impulsivity and Wender-Utah Rating Scale: Behavioral Problems/Impulsivity scores were significantly higher in women with PCOS. However, there were no significant differences between groups in both current and childhood inattention scores. We found no correlations between ADHD symptoms and serum hormone levels including testosterone in women with PCOS. Conclusions These results suggest that women with PCOS have higher ADHD symptoms. Further studies are needed to investigate the association between PCOS and ADHD.

Doğum şeklinin doğum sonrası depresyon, algılanan sosyal destek ve maternal bağlanma ile ilişkisi

Association of delivery type with postpartum depression, perceived social support and maternal attachment Objective: There are contradictory findings in the literature about the effects of delivery type on postpartum depression and mother–infant interaction. The aim of this study was to investigate the relationship between delivery mode and postpartum depression, perceived social support, and maternal attachment. Method: Forty females, who had vaginal delivery (VD) and 40 females, who had cesarean delivery (CD) were recruited to participate in the study. Edinburgh Postpartum Depression Scale (EPDS) was used to screen depressive symptoms and Maternal Attachment Scale (MAS) was used to detect maternal attachment. Social support was assessed by using Multidimensional Scale of Perceived Social Support (MSPSS). Results: We found no significant differences in postpartum depression and perceived social support scores between the two groups. On the other hand, MAS scores were significantly lower in CD women. Discussion: Our findings support that delivery mode had no impact on the development of postpartum

Association between age at menarche and autistic traits in Turkish university students

The androgen theory of autism suggests that masculinizing effect of fetal androgens may play a role in the expression of autism. Recent evidence showed that excessive prenatal androgen exposure might delay age at menarche (AAM). The aim of this study was to investigate the relation between autistic traits and AAM in a sample of nonclinical female university students.

THE IMPACT OF ANXIETY SENSITIVITY ON SUICIDALITY IN ADOLESCENTS WITH MAJOR DEPRESSIVE DISORDER

BACKGROUND Few studies have examined the link between anxiety sensitivity (AS) and suicidality among adolescents with major depressive disorder; thus, there is a need to explore this relationship in order to fill the research gap. The aim of this cross-sectional study was to examine the association among AS and suicidal behaviour while taking into account the effects of potential third variables such as the presence of anxiety disorders and hopelessness in adolescents with major depressive disorder. SUBJECTS AND METHODS Participants (n=101) completed self-report measures of depressive symptoms, AS, hopelessness and suicidal ideation severity. The presence of anxiety disorders and suicide attempt history were determined with psychiatric interviews. The association between psychiatric variables was evaluated using structural equation modelling. RESULTS Results showed that AS cognitive concerns had a positive effect on suicidal ideation mediated by the severity of depression. AS physical concerns had a negative direct effect on suicidal ideation, but there was also a positive relationship among these variables through hopelessness, thus, the total effect of AS physical concerns was not significant. There were also positive relationships between hopelessness and suicidal ideation, and the presence of anxiety disorders to suicide attempt history. CONCLUSIONS The results of this study suggest that higher AS cognitive concerns may be a risk factor for suicidality through the severity of depression in adolescents who are diagnosed with major depressive disorder.

An adolescent with kleptomania and attention-deficit/hyperactivity disorder treated with methylphenidate.

According to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) (APA 1994) criteria, kleptomania is defined as the recurrent failure to resist impulses to steal objects that are not needed for personal use or monetary value. The impulse is accompanied by an increasing sense of tension immediately before committing the theft followed by a feeling of pleasure or relief at the time of committing it (APA 1994). Kleptomania differs from ordinary theft in that the act of stealing is performed for achieving symptomatic relief, not for personal gain. Individuals with kleptomania report that the objects stolen are usually of little value and affordable. Generally, the value of stolen items increases over the duration (Grant and Odlaug 2008). After stealing the items, the individual typically discard, hoard, secretly return, or give them away. Although a sense of pleasure, gratification, or relief is experienced at the time of the theft, individuals describe feelings of guilt, remorse, or depression afterward (Grant 2006). A number of case reports found various medications including tricyclic antidepressants, selective serotonin reuptake inhibitors, mood stabilizers (e.g., lithium, valproate), and naltrexone effective in the treatment of kleptomania (Grant 2006; Grant and Odlaug 2008). Additionally successful use of sertraline and methylphenidate combination in a child with attention-deficit/hyperactivity disorder (ADHD) and kleptomania had been reported (Feeney and Klykylo 1997). We describe an adolescent with kleptomania and ADHD, treated with methylphenidate.