Veysi Ceri

Posttraumatic stress and depression in Yazidi refugees

Aim The aim of this investigation was to determine the frequency of mental pathologies in children and adolescents of the Yazidi minority group who immigrated to Turkey from Iraq. The refugees were asked about preventive and risk factors that occurred before and after their immigration. Subjects and methods The sample comprised 55 children and adolescents (30 males and 25 females) who were Yazidi refugees and had settled in the Uçkuyular, Oğuz, Onbaşı, and Uğurca villages of Batman, Turkey. The study was conducted 9 months after the refugees had immigrated. The participants were evaluated in their native language through a semistructured interview titled “Reliability and Validity of Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version – Turkish Version”. A sociodemographic form was prepared so that investigators could understand their traumatic experiences before and after the migration and their current social conditions. All the interviews were conducted in the participants’ native language without the help of translators. The investigators filled out the sociodemographic forms. Results Posttraumatic stress disorder (PTSD) was detected in 20 children (36.4%), depression in 18 (32.7%), nocturnal enuresis in six (10.9%), and anxiety in four (7.3%). The following factors were found to be associated with depression: witnessing violence and/or death, being a girl, having older parents, being the elder child, and having multiple siblings (P<0.05). Risk factors for PTSD, depression, and comorbid conditions included witnessing violence and/or death (P<0.05). Four participants were observed to have both PTSD and depression (7.3%). Conclusion Most of the refugee children had experienced serious traumatic events in their home country. PTSD, depression, and comorbid mental problems are frequently seen in refugee children.

Psychometric properties of the Turkish version of the Revised Child Anxiety and Depression Scale – Child Version in a clinical sample

ABSTRACT Objective: The shortage of cross-culturally validated instruments limits the study and treatment of psychopathology in countries other than English-speaking ones. The Revised Child Anxiety and Depression Scale – Child Version (RCADS-CV) is a self-report questionnaire that assesses dimensions of DSM anxiety and depressive disorders in youths. In this present study, we aimed to examine the psychometric properties of the Turkish version of the RCADS-CV in a clinical sample of children in Turkey. Method: The participants were 483 children aged 8–17 years old. Subjects were recruited from the following centers: Bezmialem University Hospital (55.7%), Kütahya Regional Hospital (17.4%), Istanbul Medical Faculty Hospital of the Istanbul University (16.7%), and Sakarya University Hospital (12.2%). A semi-structured diagnostic interview was carried out and the following measures were used: Children’s Depression Inventory, Screen for Child Anxiety-Related Emotional Disorders (SCARED), and Strengths and Difficulties Questionnaire (SDQ). Results: Inter-scale reliability was strong/excellent with a Cronbach’s α of .95 and coefficients for the RCADS-CV subscales ranging from .75 to .86, demonstrating good internal consistency. Convergent and discriminant validity tests against both a semi-structured clinical interview and self-report measures suggested favorable properties. Confirmatory factor analysis supported the original six-factor model. RCADS-CV showed greater correspondence to specific diagnoses in comparative tests with the existing measures of anxiety and depression. Conclusion: Overall, the study provides satisfactory evidence that the Turkish RCADS-CV yields valid scores for clinical purposes among Turkish children.

Mental health problems of second generation children and adolescents with migration background

Abstract Objective: Despite the growing number of young second-generation immigrant (SGI) children and adolescents, studies about their mental health are rare. The objective of this study was to investigate the mental health problems of SGI children and adolescents in Istanbul, Turkey. Methods: In a clinical sample the mental health of 54 SGIs and 50 native children and adolescents were examined using the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) and Children’s Global Assessment Scale. The assessments were carried out by a blinded rater. Results: SGI children had higher rates of psychiatric disorders such as depression (p = 0.001), post-traumatic stress disorder (PTSD) (p = 0.011) and anxiety disorders (p = 0.013), more comorbid disorders and lower functionality scores compared to their native counterparts (p = 0.001). Conclusions: SGI children seem to have higher rates of psychiatric disorders most probably due to migration-induced burdens. The professionals treating SGI children should have more awareness for these problems to be able to approach them in a culture and language sensitive way.

Capgras syndrome after use of synthetic cannabinoids: an adolescent case

Capgras syndrome after use of synthetic cannabinoids: an adolescent case Anxiety, agitation, irritability, confusion, hallucinations and delusions are among common psychoactive effects of synthetic cannabinoids, which are referred as “bonsai” and “jamaica” in Turkey. Cases of psychotic disorder induced by synthetic cannabinoid use are becoming increasingly more reported. Capgras syndrome is a psychotic disorder characterized by a delusion that a specific person or object has been replaced by an identical one. It has been reported to occur rarely in pure form, but generally accompanying schizophrenia or organic psychosis. Herein we aim to report an adolescent case presenting with Capgras syndrome developed after use of synthetic cannabinoids and to draw attention to psychotic symptoms and to this uncommon psychotic syndrome which may occur after synthetic cannabinoid use. Seventeen years old male, who reported using “bonzai” for about 10 days, was brought to the emergency room by his family. Capgras syndrome, defined with delusion that his mother and father have been changed and replaced by others, has been detected. In adolescents who admit with psychotic symptoms, synthetic cannabinoid use should be considered and detailed history should be taken, even laboratory tests were negative. Adolescents, as a vulnerable population, should be informed about negative effects of synthetic cannabinoids which are easily accessible and distributed as “herbal”, “natural” and “legal”, as well as their parents and institutions such as schools which may guide them. Thus, it might be possible to prevent psychotic disorders which will be induced by this substances.

Determinants of psychiatric disorders in children refugees in Turkey’s Yazidi refugee camp

ABSTRACT Objective: To examine the mental health states of a sample of Yazidi refugee children and adolescents who migrated from war-torn Iraq’s Sinjar region and to determine the risk and protective factors for psychiatric disorders among the refugee children and adolescents. Method: The participants of this research were children and adolescents between ages 6 and 17 who live in a refugee camp in Turkey. Their parents/guardians provided written informed consents for the research. The research was approved by the Ethics Council of Sakarya University. Participants with intellectual disabilities and autism spectrum disorders were excluded from the study. Two child and adolescent psychiatrists speaking their native language interviewed and evaluated each of the participants. Collected data included socio-demographic information about previous and current living situations, Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime – Turkish Version (K-SADS-PL). Results: One hundred and thirty-six children and adolescents (76 boys, 63 girls; mean age = 11.05 ± 3.11 (SD)). At the time of the assessment, 43.4% had posttraumatic stress disorder (PTSD) (n = 59), 27.9% depression (n = 38), 10.3% nocturnal enuresis (n = 14), 9.6% behavioural problems (n = 7), and 5.1% anxiety disorders (n = 13). Conclusions: Many of the refugee children and adolescents had developed psychiatric disorders, or are at risk for PTSD and depression. Also, the ongoing ambiguity regarding their living conditions, interruption of their education, a lack of hope for the future and anxiety regarding the ones they left behind are considered to be risk factors for the development of psychiatric and social problems in the future. Living with family members and not having losses from the immediate family are protective factors.

Psychometric Properties of the Parent Version of the Revised Child Anxiety and Depression Scale in a Clinical Sample of Turkish Children and Adolescents

The Revised Child Anxiety and Depression Scale-Parent version (RCADS-P) is a self-report questionnaire that assesses dimensions of DSM-based anxiety and depressive disorders in children and adolescents. The present study examined the psychometric properties of the Turkish version in a clinical sample of 483 children and adolescents. The child and parent versions of the RCADS, parent versions of the Screen for Child Anxiety Related Emotional Disorders, the Strengths and Difficulties Questionnaire and Adolescent Symptom Inventory-Depression Scale were administered. Current psychiatric diagnoses were assessed via the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present Version. The RCADS-P demonstrated high internal consistency and test–retest reliability, and good convergent, divergent, and discriminant validity. Confirmatory factor analysis supported the DSM-related six-factor structure. With its demonstrated favorable psychometric properties, the Turkish RCADS-P is currently the only validated parent-report instrument that assesses DSM-based anxiety and depressive disorders in children and adolescents in Turkey.

The number of war-related traumatic events is associated with increased behavioural but not emotional problems among Syrian refugee children years after resettlement

Background: Turkey is the leading refugee-hosting country in the world. However, there are few studies which investigate mental wellbeing of refugee children in Turkey. Objective: The paper aims to examine the prevalence of emotional and behavioural problems and associated risk factors among Syrian refugee minors in Turkey. Methods: The research involved 85 students from 2th to 8th grades. We investigated emotional and behavioural problems with parent-reported Arabic form of Strength and Difficulties Questionnaire (SDQ). Socio-demographical findings and children’s war-related experiences were also examined. Results: The study sample consisted of 49 (63.6%) girls, and 28 (36.4%) boys (total 77) from age 7 to 17. Average time after resettlement was 29.8 ± 11.2 (5 to 50 months) months. 66 (85.7%) children reported to had lost at least one familiar person due to the war. The mean experienced war-related traumatic events were calculated as 2.92 ± 1.86. Total difficulty scores of 30 (39.0%) children were above the cut off values. The rates of children whose SDQ problem scores exceeded the cut-off values were as high as 45.5% (35) for Emotional problems, 64.9% (50) for Peer, 27.3% (21) for conduct and 19.5% (15) for Hyperactivity problems. Discussion: Results indicate high prevalence rates of severe traumatic experiences and possible psychiatric disorders among child survivors of Syrian war which in its seventh year now. Çeri V, Nasirog6lu S / Arch Clin Psychiatry. 2018;45(4):100-5

Psychiatric Morbidity Among a School Sample of Syrian Refugee Children in Turkey: A Cross-Sectional, Semistructured, Standardized Interview-Based Study

Now in its eighth year, the Syrian civil war has caused displacement of more than half the population before the war and is viewed as the single largest contributing factor to many of the worsening global trends of children living in areas affected by conflict.1.

How should Child Psychiatrists Get Dressed? Children's Perspective

Abstract Objectives. The aim of the present study was to investigate the patients’ preference regarding psychiatrists’ attire and whether attire styles were important for patients in child and adolescent mental health services. It was additionally sought to examine the influence of doctors’ attire on patients’ confidence in their psychiatrists. Methods. Sixty-four participants between the ages of six and eighteen were recruited from a child and adolescent mental health service within Turkey. Participants were asked to report their preferences for five types of doctor attires (white coat, formal, semi-formal, casual wear and relaxed attire) in both male and female psychiatrists. Participants were additionally asked whether they considered psychiatrist dress important and whether their psychiatrists’ attire influenced their confidence. Results. A large proportion of our sample (N=49) reported doctors’ attire as important. For both male and female psychiatrists, white coat was determined to be the most preferred style of attire, whereas relaxed attire was the least preferred attire in children’s psychiatrists. Around 67% of our respondents reported that doctors’ attire has an influence on the confidence and trustwortiness they will hold for their psychiatrists. Conclusions. The present study confirms that psychiatrists’ attire is considered as important by the children and adolescent patients, and white coat is the most preffered type of attire by children and adolescents. Psychiatrists’ attires can additionally be suggested as influencial on children and young people’s confidence in their doctors.

Factitious disorder in adolescence.

To the Editor, Factitious disorder (FD) is defined as a condition in which a person voluntarily produces symptoms or illness and acts as if they are ill without an external gain (1). In the Psychiatric Disorders Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), it is divided into three types as “Factitious disorders with predominantly psychological signs and symptoms”, “Factitious disorders with predominantly physical signs and symptoms” and “Factitious disorders with combined psychological and physical signs and symptoms”. FD of the caregiver is classified under the title of “unidentified FD” (2). In the literature, mostly FD of the caregiver is emphasized and it is noted that awareness about the symptoms produced by pediatric patients themselves is low (3–6). In the study of Libow (3), in which pediatric and adolescent patients who produced disease symptoms themselves were reviewed, it was reported that 42 cases were reported in the literature. In our country, there is a small number of pediatric case reports of FD (7, 8). We wanted to emphasize that FD should be considered in the differential diagnosis in the childhood age group by presenting an adolescent patient with FD who presented with different physical and psychological signs and symptoms in this letter. A 15-year old male patient was found by police officers in the street and transported to another hospital where he was admitted because of epileptic seizure. Afterwards, he was referred to our hospital and internalized with the prediagnoses of epilepsy, mental retardation and atypical psychosis. On the first interview he stated that he had epilepsy. On the phone call performed with his grandmother, it was learned that he had faintings for 1–2 years, he was referred to many physicians and his faintings continued, although he used his drugs regularly and blood came out of his mouth occasionally. On psychiatric examination, it was found that he had delusions of persecution and delusions of reference that he was being followed and he will be murdered, auditory hallucinations as speaking sounds which said “come here” and visual halluciantions as “soldiers”. Other psychiatric examination findings were found to be normal. Physical and neurological examinations were found to be normal. Detailed laboratory tests were found to be normal. Electroencephalogram and brain magnetic resonance imaging findings were found to be normal. The blood levels of valproic acid were found to be in the efficient range. On the phone call performed with the grandmother, it was learned that he was adopted at the age of 1,5 years, he was sick from his childhood, he was always naughty and escaped from home. The family reported that they could not care for the patient. It was observed that the family did not call for the patient or visited him during his hospitalization. Treatment was started with 20 mg/day olanzapine in addition to 1 000 mg/day valproic acid which was stated to be used previously. Olanzapine was tapered and discontinued on the third day. Risperidon 2 mg/day was added and the patient was followed up with this treatment. During his hospitalization, he had complaints including fainting, cough, blood coming from the mouth, abdominal pain, crying, rocking the head, hitting the head to wall and moving all the time. Finally, he stated that he ingested screw and ate liquid soap. No pathology was found on consultations of urgent medicine, general surgery, pulmonology and neurology performed at different times. It was notable that the patient generally fainted in the presence of healthcare workers, lay down on the corridor or in front of the nurse’s deck, got up from the ground after fainting and lay down on another place. It was observed that the patient tried to draw attention by continuously explaining his complaints to healthcare workers, other patients and their relatives and demanded continuously. It was recognized that he had no distress or concern about his complaints. In contrast, he was very comfortable and willing during recurrent tests performed and was considerably happy to be in the hospital. During an interview when these behaviors were discussed, he stated that he intentionally fainted to stay in the hospital, he actually ingested no screw, he bit his cheek so that blood came from his mouth and lied about the sounds he heard. Thereupon, the patient’s symptoms, diagnostic and therapeutic process were evaluated and his diagnosis was reviewed. “Factitious disorder” was considered. It was targeted not to perform unnecessary medical investigations and consultations and new therapeutical approaches directed to the psychopathology of the patient were planned. Approximately one month after his hospitalization, the patient stated again that he ingested screw. On direct abdominal graphy in the standing position taken during urgent surgery consultation, two screws were observed. Colonoscopy was planned, but the patient leaved the hospital without permission and could not be found, although he was looked for around the hospital. FD which is a chronic disease with a high mortality leads to multiple hospitalizations and medical interventions, self-harming behavior and marked disruption in functionality (1). It has been reported that these symptoms generally start in adolescence, but the diagnosis of FD is made years later (3, 6, 9). Early diagnosis prevents unnecessary investigations and interventions and decreases the risk of self-harm (1, 7). Psychiatric assessment has an important role in the diagnosis (8). In treatment, it has been reported that confrontation does not lead acceptance of the patient that he/she artificially produces symptoms and may cause the patient to discontinue treatment. Therefore, it is recommended that confrontation should be postponed as much as possible, a supportive and emphatic approach should be displayed and the behaviors directed to produce illness should be tried to be changed in time (9, 10). Conclusively, FD should be considered in patients who have multiple hospital admissions with various physical and psychological symptoms and signs, who display a frequently changing clinical picture, who do not improve despite appropriate treatment and who has incompatibilities in history, examination and laboratory findings. We would also like to remind that considering FD in adolescent patients in the differential diagnosis will provide early diagnosis and treatment and will be beneficial in terms of preventing unnecessary investigations and therapies which may have a risk of harming the patient.