Sebla Gökçe

Oxytocin system social function impacts in children with attention-deficit/hyperactivity disorder

To investigate relationships between the polymorphisms and social functioning of children with Attention Deficit/Hyperactivity Disorder (ADHD), according to the polymorphism of three oxytocin receptor (OXTR) genes (rs53576, rs13316193, and and rs2268493). A total of 198 children—studying in the same primary and secondary school and matched in terms of age and gender (99 ADHD, 99 control)—were included in this study. The Schedule for Affective Disorders and Schizophrenia for School‐Age Children‐Present and Lifetime Version was administered to establish the clinical diagnosis. The Social Reciprocity Scale (SRS) was applied to evaluate social functioning. The total genomic DNA was isolated from buccal mucosa samples. No significant differences were determined between the ADHD and control groups in terms of rs2268493, rs13316193, and rs53576 genotype distribution (P = 0.078, P = 0.330, and P = 0.149, respectively). However, the control group T allele frequency in the OXTR Single Nucleotide Polymorphism (SNP) rs2268493 was significantly higher than the ADHD group (P = 0.024). Compared to the control group, the ADHD group had a higher score on the SRS scale (SRS total; Z = −21,135, P < 0.001). No significant difference existed in the SRS scale scores between the children with the T/T genotype and the C allele in the ADHD group (SRS total; Z = −0.543, P = 0.587). The allele distribution of the OXTR gene SNP rs2268493 was significantly different in the ADHD group, compared to the control group. This observation is important in understanding the underlying biological infrastructure in ADHD and developing treatment modalities.

Disrupted latent decision processes in medication-free pediatric OCD patients

BACKGROUND Decision-making in Obsessive Compulsive Disorder has typically been investigated in the adult population. Computational approaches have recently started to get integrated into these studies. However, decision-making research in pediatric OCD populations is scarce. METHODS We investigated latent decision processes in 21 medication-free pediatric OCD patients and 23 healthy control participants. We hypothesized that OCD patients would be more cautious and less efficient in evidence accumulation than controls in a two alternative forced choice (2AFC) task. RESULTS Pediatric OCD patients were less efficient than controls in accumulating perceptual evidence and showed a tendency to be more cautious. In comparison to post-correct decisions, OCD patients increased decision thresholds after erroneous decisions, whereas healthy controls decreased decision thresholds. These changes were coupled with weaker evidence accumulation after errors in both groups. LIMITATIONS The small sample size limited the power of the study. CONCLUSIONS Our results demonstrate poorer decision-making performance in pediatric OCD patients at the level of latent processes, specifically in terms of evidence accumulation.

Psychometric properties of the DY-BOCS in a Turkish sample of children and adolescents

BACKGROUND Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) is a promising scale for assessing frequency and severity of symptom dimensions. The main objective of the study was to assess the psychometric properties of the DY-BOCS in a large sample of children and adolescents from Turkey. METHODS We studied 143 children and adolescents, 7-18years, with well characterized DSM-IV-R OCD, ascertained from seven collaborating university or state hospital sites. We compared the DY-BOCS scores with the Childrens Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), the Childrens Depression Inventory (CDI), the Yale Global Tic Severity Scale (YGTSS) and the Child Behavior Checklist 6-18years (CBCL 6-18). RESULTS The internal consistency of the DY-BOCS symptom dimensions and inter-rater agreement of component scores were excellent. The agreement between global DY-BOCS score and the total CY-BOCS score was highly significant (Pearsons r=0.55, p<0.0001). Severity scores for individual symptom dimensions were independent of one another, only modestly correlating with the global ratings, and were also differentially related to ratings of depression, anxiety and tic severity. CONCLUSION The DY-BOCS is a reliable and valid instrument for assessing multiple aspects of OCD symptom severity in children and adolescents from Turkey.

Outstanding Awards Brief Reports

Objective: Smith and Burger developed the Structured Inventory of Malingered Symptomatology (SIMS) in 1997 as a self-report measure for malingering of psychiatric symptoms. The SIMS consists of 75 dichotomous (True–False) items that form into five subscales Psychosis (P), Neurologic Impairment (NI), Affective Disorder (AF), Amnestic Disorders (AM), Low Intelligence (LI), with each subscale containing 15 items. In this study, we aimed to examine the reliability, validity, and factor structure of the SIMS in a Turkish forensic psychiatry sample. Methods: A sample of 103 forensic patients (9 female, 94 male), aged 18–75, undergoing an inpatient forensic evaluations for competency assessment for criminal responsibility were recruited from a large forensic hospital in Turkey. The study protocol was approved by the local ethics committee. Socio-demographic information of the participants was collected and the SIMS, Miller Forensic Assessment of Symptoms Test (M-FAST), the Scales of Psychological Well-being, 36-Item Short Form Survey (SF-36), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered. All statistical analyses were performed by using SPSS version 23.0 for Windows. Results: The Cronbach’s alpha coefficients for the Turkish SIMS were ranging from 0.42 to 0.87. The lowest alpha coefficient was observed for the Amnestic Disorders (0.46). For the whole scale, Cronbach’s alpha coefficient was found to be 0.93. The test–retest (at after 1 week) correlation coefficients for Psychosis (P), Neurologic Impairment (NI), Affective Disorder (AF), Amnestic Disorders (AM), Low Intelligence (LI), and whole scale were found to be 0.97, 0.97, 0.95, 0.91, and 0.96, respectively. A positive and statistically significant correlation was found between the Turkish SIMS and BDI (r = 0.593, p < .01), BAI (r = 0.578, r < 0.01), M-FAST subscale Reported versus Observed Symptoms (r = 0.660, p <.01), M-FAST subscale Extreme Symptomatology (r = 0.686, p <.01), M-FAST subscale Rare Combinations (r = 0.729, p <.01), M-FAST subscale Unusual Hallucinations (r = 0.698, p <.01), M-FAST subscale Unusual Symptom Course (r = 0.568, p <.01), M-FAST subscale Negative Image (r = 0.514, p <.01), M-FAST subscale Suggestibility (r = 0.426, p <.01), and M-FAST Total (r = 0.794, p <.01) scores. Principal axis factor analyses with promax rotation were performed and four-factor solution that accounted for 39.87% of the variance observed. Conclusions: Our preliminary findings suggested that Turkish SIMS was a valid and reliable tool with a robust factorial structure for further use in detecting malingering of forensic psychiatric cases in Turkey.

Effect of gender differences on impulsivity in adolescents with attention-deficit/hyperactivity disorder

Objective: Impulsiveness has been considered the core symptom of attention-deficit/hyperactivity disorder (ADHD). In this study, we aimed to assess effect of gender differences on impulsivity in adolescents diagnosed with ADHD. Methods: One hundred and fifty-six adolescents (91 males, 65 females) who were admitted to the Erenkoy Research and Training Hospital for Psychiatry and Neurology Child and Adolescent Clinic between 01.01.2016 and 01.05.2016 and diagnosed with ADHD were recruited to participate in this study. Adolescents filled out Barratt Impulsiveness Scale and parents completed the SNAP IV ADHD Scale. Results: Of the participants, 41.6% (n=65) were female and 58.3% (n=91) were male. The mean age of girls was 14.3±1.7 years, and the mean age of boys was 14.4±1.7 years. The Barratt impulsivity mean total scores, the Barratt attentive impulsivity subscale mean scores, and the Barratt motor impulsivity subscale mean scores were significantly higher in the female ADHD group than in the male ADHD group. In multiple linear regression analysis, gender was significantly correlated with the Barratt impulsivity total mean score, the Barratt attentive impulsivity mean score, and the Barratt motor impulsivity mean score. Conclusion: The finding of greatest interest in this analysis is that the adolescent girls who were diagnosed with ADHD had greater attentive and motor impulsivity scores than boys as measured by the BIS-11. Although, some previous research reported inconsistent findings of impulsivity levels by gender, our findings confirm prior reports of higher impulsivity in the female clinical population.

Factors related to diagnostic persistence of attention deficit/hyperactivity disorder in Turkish children and adolescents

Abstract Objective: Attention-deficit/hyperactivity disorder (ADHD) is one of the most frequently occurring mental disorders in children and adolescents. The purpose of this study was to determine diagnostic persistence three years after the first clinical evaluation and to investigate the factors relating to diagnostic persistence in children and adolescents with ADHD. Methods: The study included 183 children and adolescents who were evaluated in the first admission. Of 183 children and adolescents, 142 children and adolescents were evaluated in the second admission and only the data of 142 children and adolescents were analysed in the study. Diagnostic persistence was defined as having met the full criteria for ADHD on second evaluation. Symptom severity of ADHD was determined using the Turgay DSM-IV-based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form (T-DSM-IV-S). Intelligence level was assessed through the Wechsler Intelligence Scale for Children-Revised. Results: Of the children included in the study, 77.5% (n = 110) were determined to have ADHD diagnostic persistence. Low intelligence levels, younger age and higher T-DSM-IV-S inattention and conduct disorder scores were associated with diagnostic persistence. ADHD diagnosis in children and adolescents tends to continue at high rates. Conclusions: Determination of the risks related to ADHD diagnostic persistence may contribute to improved treatment planning and interventions.

The Interaction Between Attention Deficit Hyperactivity Disorder and Anxiety Symptoms

The interaction between attention deficit hyperactivity disorder and anxiety symptoms Objective: Attention deficit hyperactivity disorder (ADHD) and anxiety disorders are commonly seen in the field of child psychiatry. Childhood ADHD and anxiety disorders are comorbid with an estimated rate of 13% to 50%. In this study, it was aimed to research anxiety symptoms and its relation with ADHD symptoms in children with ADHD. Method: Fifty children with ADHD and 49 healthy controls (aged 8-15 years) who do not have any psychiatric diagnosis were included in study. We used socio-demographic information form, Conners’ Teacher Rating Scale (CTRS), Child Behavior Checklist for 4-18 years (CBCL), The Screen for Child Anxiety Related Emotional Disorders (SCARED) both parent and child report for assessing these children. The diagnosis were made with Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL). Results: The anxiety disorders comorbidity rate was 24% in ADHD group. The total scores of SCARED parent and children reports were higher in ADHD group. SCARED children report scores were higher than SCARED parent report scores in both groups. Discussion: Our results agree with the previously reported common anxiety comorbidity with ADHD and the association between attention deficit symptoms and anxiety symptoms. In our study, parents reported fewer anxiety symptoms in their children than children’s self reports. Clinicians should evaluate anxiety symptoms carefully in children with ADHD that could be unnoticed by their parents. The treatment should be determined according to the comorbidities.

Çocuk ve ergenlerde okul reddi davranışının nedenlerinin incelenmesi

Objectives: This study investigated the etiology of children and adolescents refusing to attend school and the psychopathologies of patients referred to the child and adolescent psychiatry outpatient clinic. Patients and Methods: Information of patients who had been referred to the Tekirdag State Hospital Child and Adolescent Psychiatry Clinic between 15.01.2011 and 15.01.2012 were reviewed retrospectively. The study was focused on sociodemographic characteristics and psychopathologies of the children and adolescents determined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSMIV) diagnostic criteria.Results: The mean age of the children (n:22) was 11.0 ± 4.5 (5.4 – 17.8). There was no statistically significant difference between the genders (45.5 % of girls, 54.5 % of boys) ( p> 0.05). The majority of girls (60 %) were in primary school and the boys (58.3 %) were in high school. Sixty-three point seven percent of the patients had anxiety disorder (n=14), 36.3 % had disruptive behaviour disorder (n=8), 13.6 % had mood disorder (n=3), 9 % had adjustment disorder (n=2).Conclusion: Refusing to attend school significantly affects the social and academic aspects of the child’s life. Managing of this problem is important for the family and the school staff. The factors underlying this behavior should be investigated in detail and existing psychopathology should be treated.

Symptoms of autism spectrum disorder in subtypes of attention-deficit/hyperactivity disorder

Abstract Background This study aimed to compare symptoms of autism spectrum disorder (ASD) in children according to attention-deficit/hyperactivity disorder (ADHD) subtypes and children without ADHD. Method The Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL), the Social Responsiveness Scale (SRS), the Childhood Behavior Checklist (CBCL), and the ADHD Rating Scale (ADHD-RS) were used to evaluate the children. Results ASD symptoms were significantly higher in all ADHD subtypes. After controlling for age, gender, and CBCL social withdrawal score, the difference in ASD symptoms between the 3 ADHD subtypes was not significant. Conclusions Children with ADHD, regardless of subtype, had a similar risk of ASD symptoms.