Türkay Demir

Epidemiology of depression in an urban population of Turkish children and adolescents

BACKGROUND In Turkey, studies of childhood depression have been limited to those using only scales. METHODS This is a two-stage cross-sectional epidemiological study. Three schools in Fatih, Istanbul, Turkey were selected by cluster sampling. The study included 1482 students between the fourth and eighth grades. The Child Depression Inventory (CDI) was used for screening in the first stage. According to test results, 320 children were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version. Depressive disorders were diagnosed in 62 students, constituting the case group. The control group was matched to the case group on school, grade, age, gender, and socioeconomic status (SES). RESULTS The prevalence rate was 4.2% for some form of depressive disorder, 1.55% for major depressive disorder, 1.75% for dysthymic disorder, 0.26% for double depression, and 0.60% for depressive disorder-not otherwise specified. According to the logistic regression analysis, increasing age, having a working mother and low maternal education were all positively associated with CDI score. Low SES, perception of paternal health and relations with father as negatively, low popularity and behavior subscales of the Piers-Harris self-concept scale, and high trait anxiety were associated with the presence of a depressive disorder. LIMITATIONS Parents were not included in the diagnostic interviews. CONCLUSIONS Dysthymic disorder was the most common depressive disorder. Low maternal education, low SES, dysfunctional interaction with the father, anxiety, and low self-esteem, which were all associated with depression, may be the target of interventions for prevention and treatment of depression.

Psychiatric assessment of children with nonsyndromic cleft lip and palate

OBJECTIVE The aim of the study was to determine whether children with nonsyndromic cleft lip and palate (NSCLP) are more likely to be diagnosed with psychiatric disorders and whether cleft-related factors are related to psychopathology. METHOD Twenty children from 6 to 16 years of age with NSCLP, attending the Plastic, Reconstructive and Aesthetic Surgery Department of Cerrahpasa Medical Faculty between January and October 2010, were included as the case group. Forty healthy children who were matched on age and sex with the case group served as controls. Children were assessed by psychiatric interviews and scales. RESULTS Social anxiety disorder (SAD) (P=.003) and major depressive disorder (MDD) (P=.010) were more prevalent in children with NSCLP. The severity of dentofacial (P=.035) and cleft lip nose deformities (P=.002), appearance and competence of the lip (P=.008), dental alignment (P=.002), feeding (P=.044) and articulation problems (P<.001) were associated with clinical global functioning. CONCLUSIONS Children with NSCLP are at risk of developing psychopathology, especially SAD and MDD. The above cleft-related factors and articulation problems may be the target of interventions to prevent and treat psychiatric disorders in these children.

Recognition of emotional facial expressions and broad autism phenotype in parents of children diagnosed with autistic spectrum disorder

OBJECTIVE Research findings debate about features of broad autism phenotype. In this study, we tested whether parents of children with autism have problems recognizing emotional facial expression and the contribution of such an impairment to the broad phenotype of autism. METHOD Seventy-two parents of children with autistic spectrum disorder and 38 parents of control group participated in the study. Broad autism features was measured with Autism Quotient (AQ). Recognition of Emotional Face Expression Test was assessed with the Emotion Recognition Test, consisting a set of photographs from Ekman & Friesens. RESULTS In a two-tailed analysis of variance of AQ, there was a significant difference for social skills (F(1, 106)=6.095; p<.05). Analyses of variance revealed significant difference in the recognition of happy, surprised and neutral expressions (F(1, 106)=4.068, p=.046; F(1, 106)=4.068, p=.046; F(1, 106)=6.064, p=.016). CONCLUSION According to our findings, social impairment could be considered a characteristic feature of BAP. ASD parents had difficulty recognizing neutral expressions, suggesting that ASD parents may have impaired recognition of ambiguous expressions as do autistic children.

Maternal psychopathology and psychomotor development of children with GERD.

Objectives: The relation between gastroesophageal reflux disease (GERD) and maternal psychopathology as well as the role of impairments in mother–child interactions in the perpetuation of feeding problems in children with GERD was previously implicated but not confirmed. The present study aimed to study the relation between maternal psychopathology and feeding problems in children with GERD and the effects of GERD on the psychomotor development of children. Subjects and Methods: The case group included 39 children with GERD and their mothers and the comparison group included 39 healthy children and their mothers. The groups were matched for age, gestational age, socioeconomic status, and sex. Scales used for the psychiatric assessment of mothers were the Beck Anxiety Inventory, Hamilton Rating Scale for Depression, Eating Attitudes Test, and Experiences in Close Relationships-Revised. The childrens developmental levels were assessed by the Brunet-Lezine Revised test. Results: Maternal Beck Anxiety Inventory, Hamilton Rating Scale for Depression, Eating Attitudes Test, and Experiences in Close Relationships-Revised scores were significantly higher in the case group. Forced feeding and maternal thoughts of the childs feeding as insufficient were associated with a high level of maternal attachment-related anxiety and avoidance. Children with GERD had significantly lower Brunet-Lezine-Revised scores. Conclusions: Maternal psychopathology, especially insecure attachment, may play a role in the feeding problems in children with GERD. Children with GERD should be examined for maternal psychopathology and feeding problems so that maladaptive feeding behaviors can receive appropriate intervention before the development of negative reinforcement to feeding. The psychomotor development of children should be kept in mind.

The impact of migration and culture on suicide attempts of children and adolescents living in Istanbul.

Abstract Background. Suicidal attempts are steadily increasing in societies with rapid urbanisation and dramatic social changes in places like Istanbul. Stress related to internal migration may increase suicidal behaviour. Aim. We investigated the impact of internal migration and culture on suicide attempts among youth in Istanbul. Methods. We retrospectively analysed the records of 210 children and adolescents, aged 6–18 years, who presented at the Emergency Outpatient Clinic of the Department of Pediatrics at Cerrahpaşa Medical School in Istanbul because of suicide attempts between January 2008 and December 2010. Results. The majority of patients (78.95%, N = 165) had a background of internal migration, mostly (65%, N = 136) originating from regions with large cultural differences compared with that of Istanbul. Noticeably, more migrants than non-migrants (18.8% vs. 6.8%) and more patients originating from regions with large cultural differences chose high-risk methods for suicide attempts (20.7% vs. 8.1%). Conclusion. Internal migration can be considered a serious risk factor for suicidal behaviour. Furthermore, the degree of cultural differences between the area of origin and the new environment can be of vital importance. Healthcare measures should, therefore, focus on internal migration as a risk factor for youth suicidal behaviour and provide assistance for appropriate resettlement and integration in countries with increased mobility.

Prevalence and some psychosocial characteristics of social anxiety disorder in an urban population of Turkish children and adolescents.

PURPOSE To define the prevalence and some of the psychosocial characteristics of social anxiety disorder (SAD) in an urban population of Turkish children and adolescents. SUBJECTS AND METHODS This was a two-stage cross-sectional urban-based study conducted in Fatih, Istanbul, Turkey. The initial sample included 1,482 students between the 4th and 8th grades. The first stage involved screening using the Social Anxiety Scale for Children-Revised (SASC-R) and the Capa Social Phobia Scale for Children and Adolescents (CSPSCA). According to the test results, 324 children were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) in the second stage. RESULTS The SAD prevalence rate was 3.9%. According to the multiple regression analysis, low paternal education and trait anxiety were associated with SASC-R scores, whereas female gender and trait anxiety were associated with CSPSCA scores. According to logistic regression analysis, the anxiety subscale of the self-concept scale and trait anxiety were associated with SAD. CONCLUSION SAD is a relatively common disorder that is associated with lower self-concept in children and adolescents. Low paternal education, trait anxiety, and low self-concept may be the intervention targets for SAD prevention and treatment.

Use of social network sites among depressed adolescents

ABSTRACT Social network sites (SNSs) are relatively new phenomena, and the relationship between SNSs and psychopathology remains unclear. The purpose of this study was to evaluate the type of SNSs depressed adolescents use and the incidence of depressive disclosure on SNSs among them. The study was designed to be cross-sectional. The sample consisted of 53 adolescents diagnosed with depressive disorder, as confirmed by K-SADS-PL, and 55 non-depressed adolescents. The Children’s Depression Inventory, Social Anxiety Scale and Social Network Use Questionnaire were administered. The primary finding was that the amount of time spent on the Internet and on SNSs was significantly higher among depressed adolescents than non-depressed adolescents. Additionally, depressed adolescents reported significantly higher disclosure of anhedonia, worthlessness, guilt, loss of concentration, irritability and thoughts of suicide on SNSs. The intensity of the depression sharing was significantly higher in the depressed group. Depressed young people use social networks to express their symptoms. Adolescents’ disclosure on social networks may be able to guide relatives, friends and mental health professionals.

Serotonin-2a receptor and catechol-O-methyltransferase polymorphisms in panic disorder

Catechol-O-methyltransferase (COMT) and serotonin receptor 2A (5HTR2A) polymorphisms have been investigated for their possible role in panic disorder (PD). The aim of this study was to investigate the genotype distribution of the COMT val158met and 5HTR2A 102T/C polymorphisms in PD. COMT val158met is a polymorphism at codon 158 that results in variations in COMT enzymatic activity with high- (H) and low-activity (L) alleles. The 5HTR2A 102T/C polymorphism comprises a T-to-C mutation at position 102. The effects of symptom severity, gender, and age of onset were also investigated. The participants were 105 outpatients with PD and 130 controls. The severity of the symptoms of PD was assessed by the Panic and Agoraphobia Scale (PAS). Polymorphisms of the 5HTR2A and COMT genes were identified using polymerase chain reaction and restriction fragment length polymorphism analysis. A significant relationship was found between the COMT Val158Met polymorphism and PD. No significant differences were found in genotype distributions or allele frequencies of the 5HTR2A polymorphisms between the PD and control groups. There were no significant relationships between the COMT and 5HTR2A polymorphisms and age of onset, gender, presence of agoraphobia, or PAS scores in the PD group (p>0.05).

Doğuştan Görme Engeli Olan Çocuk ve Ergenlerde Bağlanma Özellikleri ve Davranışsal Sorunlar

INTRODUCTION This study aimed to assess the behavioral problems and the attachment characteristics of children and adolescents with congenital blindness (CB). METHOD Forty children and adolescents aged 11-14 years with CB were included as the case group. Forty healthy children and adolescents who were matched for age, gender, and socioeconomic status with the case group served as the comparison group. Behavioral problems were assessed by the Child Behavior Checklist for ages 4-18 (CBCL 4/18). Attachment characteristics were assessed via the Short Form of Inventory of Parent and Peer Attachment (s-IPPA). RESULTS The case group had lower CBCL total problems scores as well as anxiety/depression, withdrawal/depression, and attention problems subscales scores with respect to the comparison group. There were no significant differences between the two groups in s-IPPA scores. CONCLUSION Children and adolescents with CB did not differ from the comparison group in terms of attachment, whereas, they had lower scores on behavioral problems than the comparison group. Although previous studies indicate that children and adolescents with CB may be at the risk of insecure attachment, our study suggested that adaptive mechanisms of their families together with professional help from specialized teachers and services provided by schools for children and adolescents with CB may play compensatory roles.

Dokuz Tip Mizaç Ölçeği Ergen (DTMÖ-E) Formunun Geçerlik- Güvenirliği ve Ergenlerde Dikkat Eksikliği Hiperaktivite Bozukluğu İle Mizaç Tipleri Arasındaki İlişki

The purpose of this study is developing adolescent form (11-16 years old) of Nine Types Temperament Scale (NTTS) depending on Nine Types Temperament Model (Study 1) and evaluating and searching the relationship between Attention Deficit and Hyperactivity Disorder (ADHD) and Types of NTTM (Study 2). Sample of Study I consist of 1240 students who are between 11 and 16 years old. Pilot form of the Scale which consists of 90 items is tested with confirmatory factor analysis and with convergent and discriminant validity and the last version of the measure which consist of 82 items is prepared. Basic Personality Traits Inventory (BPTI) which depends on Fife Factor Model is used for Criterion-related validation. Results show that NTTS-A is valid and reliable measure for evaluating temperament types between 11-16 years adolescents. Their fit index is calculated as χ2 /df <3; SRMR, 0.06; RMSEA, 0.045; CFI, 0.909: TLI, 0901 supported to validity data. Sample of Study II consist of 56 adolescents who are diagnosed with ADHD according to DSM-IV diagnosis criteria and 56 students who does not get diagnosed with ADHD or mental retardation/medical disorder. Temperament types of participants are evaluated by the agency of Study-I and NTTS-A, which is developed appropriate for Turkish culture. Indication of the study shows that there are more NTT7 and NTT8 in NTTM types between adolescents with ADHD than the group, who are not diagnosed with ADHD. As a result, it is discussed that traits which belong to some temperament types could have a predisposing effect on emergence of ADHD, experiencing these traits extreme severely could cause a view similar to ADHD and ADHD which is a neurodevelopmental disease could interact with temperament traits of person, in that way it could illustrate ADHD clinic. Available findings support critics about that students are labelled as ADHD specially in the last years in education environment even if they have mostly not developmental problems and students are diagnosed easily with limited observations. However, it is asserted that diagnosis based on temperament, treatment and psychosocial support programmes could be formed and effects of ADHD, which is a factor interacting with temperament traits, on personality structure of adolescents on their development process, could be predicted. Our study has the feature of being the first measure developing study which is intended to evaluate temperament types of adolescents between 11-16 years old and also it is has the feature of being the first study which searches relationship between NTTM types and ADHD.