Şermin Yalın Sapmaz

Does working with child abuse cases affect professionals' parenting and the psychological well-being of their children?

Work in the field of sexual abuse is extremely stressful and may arouse negative personal reactions. Although these secondary trauma effects are well described on a personal level, there is not enough evidence to understand whether these professionals carry these effects to their homes, families, and offspring. This study aims to identify the effects of working with child abuse cases on the anxiety level and parenting styles of childhood trauma workers and on their children’s well-being. A total of 43 health and legal system workers who worked with abused children in any step of their process and who had children constituted the study group, and 50 control cases, each working in the same institution and having the same occupation as 1 of the participants from the study group and having children but not working directly with children and child abuse cases, were included in the study. Participants were asked to fill out a sociodemographic form, the Parental Attitude Research Instrument, the trait portion of the State-Trait Anxiety Inventory, and an age-appropriate form of the Child Behavior Checklist for each child they had. Professionals in the study working with child abuse cases demonstrated significantly higher democratic parenting attitudes. Law enforcement workers working with child abuse cases demonstrated stricter and more authoritarian parenting strategies, as well as more democratic attitudes, than their colleagues. There was not a statistically significant relationship between child abuse workers’ anxiety level and their children’s well-being among control subjects.

Immigration-related mental health disorders in refugees 5–18 years old living in Turkey

Purpose This study assessed early-onset psychiatric disorders and factors related to these disorders in a group of refugee children after immigration due to war. Materials and methods This study was conducted between January 2016 and June 2016. Clinical interviews were conducted with 89 children and their families, and were performed by native speakers of Arabic and Persian who had been primarily educated in these languages and were living in Turkey. A strengths and difficulties questionnaire (SDQ) that had Arabic and Persian validity and reliability was applied to both children and their families. Independent variables for cases with and without a psychiatric disorder were analyzed using the χ2 test for categorical variables, Student’s t-test for those that were normally distributed, and Mann–Whitney U-test for data that were not normally distributed. Data that showed significant differences between groups who had a psychiatric disorder and on common effects in emerging psychiatric disorders were analyzed through binary logistic regression analysis. Results A total of 89 children and adolescents were interviewed within the scope of the study. The mean age of cases was 9.96±3.98 years, and 56.2% (n=50) were girls, while 43.8% (n=39) were boys. Among these children, 47 (52.8%) had come from Syria, 27 (30.3%) from Iraq, 14 (15.7%) from Afghanistan, and 1 (1.1%) from Iran. A psychiatric disorder was found in 44 (49.4%) of the children. A total of 26 children were diagnosed with anxiety disorders, 12 with depressive disorders, 8 with trauma and related disorders, 5 with elimination disorders, 4 with attention deficit/hyperactivity disorder, and 3 with intellectual disabilities. It was determined that seeing a dead or injured person during war/emigration and the father’s unemployment increased the risk of psychopathology. The OR was 7.077 (95% CI 1.722–29.087) for having seen a dead or injured individual and 4.51 (95% GA 1.668–12.199) for father’s employment status. Conclusion Within the context of war and emigration, these children try to cope with the negative circumstances they experience prior to migration, as well as the despair they see their parents experience.

Validity and reliability of the Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale for children aged 11-17 years

Background/aim: This study aimed to assess the validity and reliability of the Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form. Materials and methods: The study sample consisted of 32 patients treated in a child psychiatry unit and diagnosed with generalized anxiety disorder and 98 healthy volunteers who were attending middle or high school during the study period. For the assessment, the Screen for Child Anxiety and Related Emotional Disorders (SCARED) was also used along with the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form. Results: Regarding reliability analyses, the Cronbach alpha internal consistency coefficient was calculated as 0.932. The test-retest correlation coefficient was calculated as r = 0.707. As for construct validity, one factor that could explain 62.6% of the variance was obtained and this was consistent with the original construct of the scale. As for concurrent validity, the scale showed a high correlation with SCARED. Conclusion: It was concluded that Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form could be utilized as a valid and reliable tool both in clinical practice and for research purposes.

Quickly diagnosed and treated prepubertal Type 1 narcolepsy case

ABSTRACT Excessive daytime sleepiness, cataplexy, sleep paralysis, and hypnagogic hallucination are the classic tetrad of narcolepsy. It has been shown that narcolepsy, a chronic and disabling disease, starts in childhood and adolescence rather than adulthood. The International Classification of Sleep Disorder (ICSD-3) classifies narcolepsy into Type 1 (narcolepsy with cataplexy) and Type 2 (narcolepsy without cataplexy). There is low awareness and knowledge of narcolepsy among the general public, primary care physicians, and sleep specialists. It has been shown that the lack of recognition of disease symptoms delayed the diagnosis of narcolepsy from 8.7 to 22.1 years. In this case report, we will discuss the case of Type 1 narcolepsy, which started in the prepubertal period and was diagnosed and treated in a short period of time.

Insulin Resistance is Related to Psychiatric Disorders Among Obese Children

Objective: The current study aimed to investigate psychiatric consequences of obesity and the relationship between componenets of the metabolic syndrome and psychiatric disorders in children. Our second aim was to elucidate which of the anthropometric parameters or metabolic components were most strongly associated with psychiatric disorders. Methods: The study included 88 obese and overweight children with a body mass index (BMI) greater than 85th percentile. The patients were evaluated for psychiatric disorders by a single child and adolescent psychiatrist. Forty patients diagnosed with psychiatric disorders and 48 patients with normal psychiatric evaluation were compared in terms of anthropometric and metabolic parameters. BMI, BMI-standard deviation score and BMI percentile, waist circumference, waist to hip ratio, blood pressure and pubertal stage of all patients were recorded. Fasting serum glucose, insulin, lipid profile and homeostatic model assessments of insulin resistance (HOMA-IR) were measured to evaluate the metabolic parameters. Serum and 24 hour urine cortisol levels were measured. Results: HOMA-IR in the group with psychiatric disorders was found to be significantly higher than in the group without psychiatric disorders (6.59±3.36 vs 5.21±2.67; p=0.035). Other anthropometric measurements and metabolic parameters were not significantly different between the two groups. Conclusion: An understanding of the relationships between obesity related medical comorbidities and psychiatric pathologies is important to encourage patients and their families to make successful healthy lifestyle changes and for weight management in terms of appropriate treatment.

The relationship between physical restraint and the diagnosis and drug use in the patients receiving inpatient treatment in a child and adolescent psychiatry clinic

Objective: The aim of this study is to evaluate the characteristics such as the diagnosis and medication of the physically restrained patients in our inpatient unit, which is one of the few inpatient units for children and adolescents in Turkey, and the effect of the physical restraint on the treatment of them. Methods: The medical records of 102 inpatients treated in our mental health hospital during the year 2016 had been retrospectively reviewed. Patients who were restrained at least once during the hospitalization period were compared with patients who were not, in terms of diagnosis, medication, presence of comorbidity, duration of hospitalization and the way of discharge Results: Comparing the groups that were restrained and not restrained, it was found that multiple drug use was more common in the restrained group. The use of antipsychotics, anxiolytics and mood stabilizer drugs and haloperidol-biperiden injections were found to be significantly higher in the restrained group. The rate of multiple psychiatric diagnoses was significantly higher and major depression, conduct disorder, bipolar disorder and self-injurious behaviors were more frequent in the restrained group. Although the duration of hospitalization for both groups was similar, discharge with the request of the family or caregivers before the end of treatment was more frequent in the restrained group. Clinical global improvement scores were lower in the restrained group. Discus-sion: There are many differences in terms of diagnosis, medication and the way of discharge between the re-strained and non-restrained groups. More strategies are needed to reduce the restriction rates.

Metabolic syndrome and features in children and adolescents diagnosed with mood disorders and psychotic disorders

Objective: Metabolic syndrome (METS) is described as cluster of risk factors including central obesity, hyperten-sion, low high-density lipoprotein (HDL), hypertriglyceridemia and hyperglycemia. The prevalence of METs has been associated with increased symptom severity and antidepressants utilization in many psychopathologies among adult population. We aimed to evaluate the effect of psychopathologies and antipsychotics in METs devel- opment, additionally to determine METs characteristics in children and adolescents diagnosed with bipolar and psychotic disorders. Methods: Thirty children and adolescents aged between 13-20 years old of whom were diag-nosed with bipolar mood disorders, schizophrenia, schizoaffective disorder and schizophreniform according to Diag-nostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TR) criteria were compared with a 30 healthy children and adolescents in present study. The anthropometric measurements including body weight, height, body mass index (BMI), waist circumference (WC) as well as blood pressure measurements were documented. In addition, total cholesterol, triglyceride (TG), HDL, low-density lipoprotein (LDL) and fasting blood glucose (FBG) levels were measured and METs assessed according to the IDF (International Diabetes Foundation) criteria in participants. Results: Overall the prevalence of METs was 20% (n=12) in our study. Among the METs patients, nine were (27%) in the case group, three were (10%) were in control group. The mean BMI, body weight, WC, serum TG and FBG values of the METs group were found to be statistically higher than the healthy control group. Moreover it was also found that utilization of mood-stabilizing drugs has a statistically significant effect on the development of METs. Conclusion: Psychopathologies and antipsychotic utilization have associated with an increased risk for the development of metabolic disorders and METs in the children and adolescents population. In this respect our findings may provide a new approach with the management of treatment strategies particularly in children and adolescents with high risk of METs.

Validity and reliability of the Turkish version of the DSM-5 Separation Anxiety Disorder Severity Scale–child form

ABSTRACT OBJECTIVE: This study aimed to assess the validity and reliability of the Turkish version of the DSM-5 Separation Anxiety Disorder Severity Scale–Child Form. METHODS: The scale was prepared by carrying out translation and back-translation of the DSM-5 Separation Anxiety Disorder Severity Scale–Child Form. The study group consisted of 41 patients who had been treated in a child psychiatry unit and diagnosed with separation anxiety disorder and 100 healthy volunteers who were attending middle or high school during the study period. For the assessment, Screen for Childhood Anxiety and Related Emotional Disorders (SCARED) was also used, along with the DSM-5 Separation Anxiety Disorder Severity Scale–Child Form. RESULTS: The Cronbach alpha internal consistency coefficient was calculated as 0.932, while the item–total score correlation coefficients were between 0.400 and 0.874. One factor that could explain 63% of the variance was obtained. The scale showed a medium correlation with SCARED. The area under the receiver operating characteristic curve was calculated as 0.898. CONCLUSION: It was concluded that the Turkish version of DSM-5 Separation Anxiety Disorder Severity Scale–Child Form could be used as a valid and reliable tool both in clinical practice and for research purposes.

Validity and reliability of the Turkish version of DSM-5 Level 2 Repetitive Thoughts and Behaviors Scale-Child Form

Objective: This study aimed to assess the validity and reliability of the Turkish version of DSM-5 Level 2 Repetitive Thoughts and Behaviors Scale-Child Form. Methods: The scale was prepared by carrying out the translation and back translation of DSM-5 Level 2 Repetitive Thoughts and Behaviors Scale -Child Form. Study group consisted of 37 patients that have been treated in a child psychiatry unit and diagnosed with obsessive-compulsive disorder and 32 healthy volunteers that were attending middle or high school during the study period. For reliability analyses, internal consistency coefficient and item-total score correlation analysis and for validity analyses, explanatory factor analysis was made and the discriminative quality of the scale regarding community and clinical samples were shown with ROC Curve. Results: Regarding reliability analyses, Cronbach’s alpha internal consistency coefficient was calculated as 0.910 while item-total score correlation coefficients were measured between 0.674 and 0.878. Test-retest correlation coefficient was calculated as r=0.928. As for construct validity, a factor that could explain 73.5% of the variance was obtained. In ROC analysis, area under ROC curve was calculated as 0.956. Conclusion: It was concluded that Turkish version of DSM-5 Level 2 Repetitive Thoughts and Behaviors Scale -Child Form could be utilized as a valid and reliable tool both in clinical practice and for research purposes.

Diagnostic and treatment process in a 12-year old adolescent with Kleine-Levin syndrome: a case presentation

Kleine-Levin Syndrome (KLS) is a rare and frequently misdiagnosed disorder with typical onset at adolescence and a male dominance that is presented with hypersomnia, hyperphagia, dysinhibitated behavior and perceptive abnormalities. Even though increasing number of researches have been conducted to shed a light on its etiology, no clear underlying mechanism have yet been identified. Similar to relatively small information about etiology of the disorder, no specific treatment technique has been identified to successfully eliminate the phenomenon; however treatment options that target symptom relief and decline in frequency of episodes have been present. This case report aimed to present the clinical course of a 12 year old adolescent with KLS who was successfully treated with a combination of carbamazepine and short- acting methylphenidate that was used during episodes, along with discussion of relevant literature.