Ulku Akyol Ardic

Use of buspirone and fluoxetine for breathing problems in Rett syndrome.

Rett syndrome is a severe neurodevelopmental disease with a prevalence of 0.88 per 10,000 girls aged 5-18 years, and is often caused by mutations in methyl-cytosine-phosphate-guanine (CpG)-binding protein 2. Disorder of respiratory control is a prominent feature of Rett syndrome. Brainstem serotoninergic neurons are known to play an important role in the arrangement of breathing rhythm and pattern. We present a patient whose severe hyperventilation and apneic attacks resolved with the concomitant treatment of fluoxetine and buspirone. To our knowledge, we describe the first patient with Rett syndrome to receive fluoxetine for respiratory problems.

No Beneficial Effects of Adding Parent Training to Methylphenidate Treatment for ADHD + ODD/CD Children A 1-Year Prospective Follow-Up Study

Objective: The aim of this study was to compare the effect of methylphenidate (MPH) versus MPH + parent training in children with ADHD and oppositional defiant disorder/conduct disorder (ODD/CD) over a 12-month period. Method: After careful screening, 120 children diagnosed with ADHD + ODD/CD were included in the study. Treatment consisted of ongoing medication management for 12 months, with or without participation in a parent-training program beginning after the 1st month. Participants were not randomly assigned to treatment groups because of ethical, practical, and methodological reasons. Results: Data analyses revealed that mother–child relationship improvements and symptom severity did not benefit from parent training. Conclusion: The results of this study highlighted the positive role of MPH in ADHD. No significant effects were observed after the addition of parent training to MPH treatment. Clinicians should carefully follow patients’ improvements and titrate the MPH dosage during long-term treatment.

A Promising Preliminary Study of Aripiprazole for Treatment-Resistant Childhood Obsessive-Compulsive Disorder.

BACKGROUND Obsessive-compulsive disorder (OCD) is a relatively frequent disease in childhood, which is generally treated with selective serotonin reuptake inhibitors (SSRIs) and/or clomipramine and cognitive behavioral therapy (CBT). However, nearly half of the cases are treatment resistant. Aripiprazole was shown to be beneficial in augmentation therapy in treatment-refractory OCD. This study evaluated its effectiveness as a single agent in these cases. METHODS Sixteen children (nine girls, seven boys), who were nonresponders to treatment with at least two types of SSRIs and CBT, were administered 12 weeks of aripiprazole treatment with a mean dose of 4.75 mg/day (range: 2-7.5 mg/day). Treatment outcomes were evaluated by the Childhood Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and the Clinical Global Impressions-Severity and Improvement (CGI-S and CGI-I) scales. RESULTS Children with a mean age of 10.9±2.9 years had severe obsessive compulsive symptoms at baseline, and >80% of them had another comorbid psychiatric disease. Significant improvements in symptoms were achieved after 12 weeks of aripiprazole treatment, which were evaluated by significant decreases in symptom scores in the CY-BOCS, and improvements in CGI-I scores. CONCLUSIONS This very small study of aripiprazole, given to children with OCD resistant to at least 12 weeks treatment with at least two SSRIs and CBT, demonstrated striking improvement in CGI scores (all subsets, p≤0.002) for 13 of 16 children, and halved all CY-BOCS subscores after ∼12 weeks of treatment.

Psychiatric Comorbidity and Demographic Characteristics of 1,000 Children and Adolescents With ADHD in Turkey

Objective: The objective was to examine the frequency of comorbid disorders in children and adolescents with ADHD in Turkey and to evaluate the distribution of comorbidities according to the subtypes of ADHD and sociodemographic features. Method: The sample consisted of 1,000 children, 6 to 18 years of age, including 242 females and 758 males, from Ege University who were diagnosed with ADHD. Results: The overall prevalence rate of psychiatric comorbidity in the study was 56.3%. The most frequently observed comorbidity was oppositional defiant disorder with a rate of 37.4%. Conduct disorder, depressive disorder, obsessive-compulsive disorder, and anxiety disorder accompanied ADHD, respectively. The results revealed that 70.2% of the children with ADHD-Combine type had at least one psychiatric comorbidity. Oppositional defiant disorder, conduct disorder, depressive disorder, and obsessive-compulsive disorder accompanied ADHD-Combine type in 54.6%, 12.6%, 8.1%, and 8.8% of the participants, respectively. Conclusion: These findings provide valuable information about the comorbid disorders in children and adolescents with a very large clinical sample of ADHD children.

Effect of methylphenidate on neurocognitive test battery: an evaluation according to the diagnostic and statistical manual of mental disorders, fourth edition, subtypes.

Abstract The aims of this study were to evaluate the neuropsychological characteristics of the restrictive (R) subtype according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the attention-deficit/hyperactivity disorder (ADHD) combined (CB) type and predominantly inattentive (PI) type subtypes and to evaluate whether methylphenidate (MPH) affects neurocognitive test battery scores according to these subtypes. This study included 360 children and adolescents (277 boys, 83 girls) between 7 and 15 years of age who had been diagnosed with ADHD and compared the neuropsychological characteristics and MPH treatment responses of patients with the R subtype—which has been suggested for inclusion among the ADHD subtypes in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition—with those of patients with the PI and CB subtypes. They did not differ from the control subjects in the complex attention domain, which includes Continuous Performance Test, Stroop test, and Shifting Attention Test, which suggests that the R subtype displayed a lower level of deterioration in these domains compared with the PI and CB subtypes. The patients with the CB and PI subtypes did not differ from the control subjects in the Continuous Performance Test correct response domain, whereas those with the R subtype presented a poorer performance than the control subjects. The R subtype requires a more detailed evaluation because it presented similar results in the remaining neuropsychological evaluations and MPH responses.

Predicting aggression in children with ADHD

ObjectiveThe present study uses structural equation modeling of latent traits to examine the extent to which family factors, cognitive factors and perceptions of rejection in mother-child relations differentially correlate with aggression at home and at school.MethodsData were collected from 476 school-age (7–15 years old) children with a diagnosis of ADHD who had previously shown different types of aggressive behavior, as well as from their parents and teachers. Structural equation modeling was used to examine the differential relationships between maternal rejection, family, cognitive factors and aggression in home and school settings.ResultsFamily factors influenced aggression reported at home (.68) and at school (.44); maternal rejection seems to be related to aggression at home (.21). Cognitive factors influenced aggression reported at school (.-05) and at home (-.12).ConclusionsBoth genetic and environmental factors contribute to the development of aggressive behavior in ADHD. Identifying key risk factors will advance the development of appropriate clinical interventions and prevention strategies and will provide information to guide the targeting of resources to those children at highest risk.

Successful Treatment Response with Aripiprazole Augmentation of SSRIs in Refractory Obsessive–Compulsive Disorder in Childhood

The aim of this study is to evaluate the aripiprazole augmentation of selective seratonine reuptake inhibitors (SSRIs) in children and adolescents with treatment-resistant OCD. Forty-eight children and adolescents (14 girls, 34 boys), who are non-responders to treatment with at least two types of SSRIs and CBT, were administered a 12-week of augmentation. Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and Clinical Global Impression-Severity and Improvement (CGI-S and CGI-I) sub-scales were used for evaluation of the treatment outcomes. The results showed that total CY-BOCS scores were decreased from 33.3 ± 7.5 to 11.7 ± 9.3 (p < 0.001), CGI-S scores decreased from 6.3 ± 0.9 to 2.7 ± 1.6 (p < 0.001), and CGI-I scores improved from 4.3 ± 0.6 to 2.2 ± 1.1 (p < 0.001). Sensitivity analyses in 29 patients without SSRI dose escalation along with aripiprazole augmentation have also revealed that improvement effect was still significant, and CY-BOCS scores were improved from 34.2 ± 7.9 to 13 ± 10.3, CGI-S improved from 6.4 ± 1.0 to 3.0 ± 1.7, and CGI-I improved from 4.4 ± 1.0 to 2.3 ± 1.1 (p < 0.001 for all). Analyses revealed that a significant clinical improvement has been observed with aripiprazole augmentation. Aripiprazole augmentation of SSRIs is a promising strategy in the management of treatment-refractory OCD children and adolescents.

Altered structural connectivity is related to attention deficit/hyperactivity subtypes: A DTI study

This study aimed to provide novel insights into the white matter (WM) microstructural properties of Attention Deficit/Hyperactivity Disorder (ADHD) subtypes by recruiting a relatively large sample of stimulant-naïve children and adolescents who had no comorbidity other than Oppositional Defiant Disorder and were homogenous according to the DAT1 gene polymorphism. A sample of 72 ADHD subjects and 24 controls aged 8-15 years were enrolled in the study. We applied tract-based spatial statistics to the DTI measures for obtaining fractional anisotropy (FA) and axial, radial diffusivity (AD, RD) measures to explore ADHD type-related differences in WM for the whole brain. Comparing ADHD-Combined group (ADHD-C) with the ADHD predominantly inattentive group (ADHD-I) we detected increased RD in several bilateral brain area and increased AD mostly in left side of the brain, including the body and splenium of the corpus callosum; the anterior and posteriors limbs of the internal capsule; the superior, anterior and posterior corona radiata; the posterior thalamic radiation; and the superior longitudinal fasciculus. Likewise, mostly in the overlapping brain areas, the ADHD-C group presented increased AD values than ADHD-RI. Significant differences among ADHD types could be a preliminary evidence that they have distinct microstructural properties. There were no significant differences in diffusivity between controls and both the ADHD group as whole or any ADHD subgroups.

Aripiprazole use in children and adolescents: a case series

3 OZET: Cocuk ve genclerde aripiprazol kullan›m›: Olgu serisi Cocuk ve genclerde atipik antipsikotikler sald›rganl›k, duy- gudurumda deiflkenlik ve psikoz tedavisinde yayg›n ola- rak kullan›lmaktad›r. Aripiprazolun flizofreni, yayg›n geli- flimsel bozukluk ve bipolar bozukluu olan cocuk ve genc- lerde kullan›m›na iliflkin ilgi artmaktad›r. Farkl› psikiyatrik bozukluu olan 11-17 yafl aras›ndaki befli erkek 7 cocuk ve genc aripiprazol ile tedavi edilmifltir. Hastalar›n tumune da- ha once farkl› psikiyatrik ilaclar ile tedavi uygulanm›flt›r. Ari- piprazol gunluk 2.5 ya da 5 mg dozda bafllanm›flt›r ve opti- mal doz gunde 5 ile 10 mg aras›nda deiflmektedir. Yedi hastan›n alt›s›n›n aripiprazol tedavisinden yararland›¤› go- rulmufltur. Ekstrapiramidal yan etki ya da ajitasyon gozlen- memifltir. Aripiprazol hastalar›m›zda iyi tolere edilmifltir ve cocuk ve genclerde guvenilir ve etkin bir secenek gibi go- runmektedir. Ancak randomize kontrollu ileriye donuk kli- nik cal›flmalar›n yap›lmas› gerekmektedir. Klinik Psikofarmakoloji Bulteni 2010;20:84-93 ABSTRACT: Aripiprazole use in children and adolescents: a case series In children and adolescents, atypical antipsychotics have been largely used to treat aggression, mood instability, and psychosis. There is a growing interest in the use of aripiprazole in children and adolescents with schizophrenia, pervasive developmental disorders, and bipolar disorders. A series of 7 children and adolescents (ages 11-17 years, 5 males) were treated with aripiprazole for different psychiatric disorders. All patients had been treated previously with several psychotropic drugs. Aripiprazole was initiated at a starting dose of 2.5 or 5 mg daily and optimal dosages ranged from 5 to 10 mg daily. Six of the 7 patients appeared to benefit from aripiprazole. Neither extrapyramidal side effects nor agitation was observed in any case. Aripiprazole was well tolerated and effective in our cases and appears to be a safe and efficacious alternative in the child and adolescents. However, prospective clinical trials with a randomized placebo controlled design are needed.

Effect of Methylphenidate on Emotional Dysregulation in Children With Attention-deficit/hyperactivity Disorder + Oppositional Defiant Disorder/conduct Disorder

Background and Aim Emotional dysregulation (ED) is a frequent feature of attention-deficit/hyperactivity disorder (ADHD). It can be observed as a dysregulation profile or a deficient emotional self-regulation (DESR) profile. Oppositional defiant disorder/conduct disorder (ODD/CD) comorbidity is prevalent in ADHD and known to be related with ED. The first-line treatment of ADHD includes psychostimulants, but their effects on ED are not well studied. This study aimed to evaluate the outcomes of methylphenidate (MPH) treatment on ED in ADHD + ODD/CD cases. Methods A total of 118 ADHD + ODD/CD patients with a mean age of 9.0 ± 1.9 years were treated with MPH for 1 year. Also, parents of cases were recruited for a parent-training program, which initiated after first month of MPH treatment. Symptom severity was assessed at baseline and 12th month by Turgay Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition–Based Child and Adolescent Behavior Disorders Screening and Rating Scale–Parent Form, Children Depression Inventory, Child Behavior Checklist 4–18 years, and Parental Acceptance and Rejection Questionnaire–Mother Form. Results Emotional dysregulation (DESR + DP) was present in 85.6% of cases. Conduct disorder was significantly higher in patients with DP, whereas ODD was significantly higher in the DESR and non-ED groups (P < 0.0001). Symptoms of ADHD and ED were significantly improved with 1-year of MPH treatment (P < 0.05). The improvement in ED was independent of improvement in ADHD symptoms and parent training (P < 0.05). Conclusions Emotional dysregulation is highly prevalent in disruptive behavioral disorders as ODD and CD, which are comorbid with ADHD. The MPH treatment is effective on ED independently from other clinical determinants.