Kategori: Çocuk ve Ergen Psikiyatristi

AIM:

Many psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD), disruptive behavioral disorders, autism spectrum disorders, and some psychiatric characteristics, such as poor empathizing, are regarded to be related to elevated levels of androgens or androgen sensitivity. Thus, numerous studies have investigated the potential association between androgen-related physical diseases and these psychiatric conditions. Idiopathic hirsutism (IH) is a disease characterized by an increased sensitivity of the pilosebaceous unit to circulating androgens in women. The purpose of this study was to examine whether IH has a relationship with androgen-related psychiatric conditions.

MATERIALS AND METHODS:

Totally 37 females with IH and 33 healthy female controls were included in this study. Childhood and present ADHD symptoms of the participants were assessed using the Wender Utah Rating Scale (WURS) and the Adult ADHD Self-Report Scale, respectively. The Autism-spectrum quotient and the interpersonal reactivity index were used to assess autistic traits and different aspects of empathy. Hirsutism severity was measured using the Ferriman-Gallwey scoring system.

RESULTS:

No significant difference was found between the patients and controls on psychiatric questionnaire scores, except for a trend for subjects with IH to show higher levels of the school-associated problems than controls according to WURS. The severity of hirsutism was strongly correlated with the WURS irritability and behavioral problems/impulsivity subscores and WURS total score, and moderately correlated with the WURS attentional deficit subscore.

CONCLUSIONS:

This study provides preliminary evidence that common etiological factors may be involved in both the severity of IH, ADHD, and coexisting disruptive behavioral problems.

OBJECTIVE:

This study aimed to assess the relationships of depression, anxiety, anxiety sensitivity, and perceived social support with conversion symptoms in adolescents with conversion disorder (CD).

METHODS:

Fifty outpatients, aged 8-18 years, who had been diagnosed with CD and members of a control group were assessed using the psychological questionnaires.

RESULTS:

Compared with controls, adolescents with CD scored higher on the Child Depression Inventory (CDI), Screen for Child Anxiety-related Emotional Disorders (SCARED), Childhood Anxiety Sensitivity Index (CASI) total, CASI physical and cognitive subscales, and Multidimensional Scale of Perceived Social Support family subscale. Multiple regression analysis showed that CDI, CASI total, and CASI cognitive scores predicted the Somatoform Dissociation Questionnaire (SDQ) scores and that CDI and CASI total scores predicted the Children’s Somatization Inventory (CSI) scores of subjects.

CONCLUSIONS:

This study suggest that adolescents with CD had poor psychosocial well-being, and depression, global anxiety sensitivity and anxiety sensitivity cognitive concerns are related to conversion symptoms.

BACKGROUND:

The aim of this study was to assess depression, anxiety, and quality of life (QOL) in a cohort of children and adolescents with end-stage renal disease (ESRD), to compare these findings with healthy controls, and to evaluate the association between these psychological symptoms, QOL, and clinical variables related to ESRD.

METHODS:

Thirty-two children and adolescents 8-18 years of age were enrolled in the study. The sociodemographic data were evaluated. Questionnaires were used to evaluate the psychological status and QOL of the patients and healthy controls.

RESULTS:

There was a significant difference in mean depression score, which was significantly higher for the ESRD patients. Mean state anxiety score was significantly lower for ESRD patients than for controls. Regarding QOL score, there were significant differences between the ESRD patients and control groups for both child-rated and parent-rated QOL scores, which were significantly lower for ESRD patients. Trait anxiety was a negative predictor of all subscales of the Pediatric Quality of Life Inventory 4.

CONCLUSIONS:

End-stage renal disease was related to significant morbidity and poorer QOL. The assessment and enhancement of QOL and comorbid psychiatric disorders in ESRD should be a part of disease management.

BACKGROUND:

There is limited data concerning the relationship between psychosocial problems of psoriasis patients and the function of their hypothalamic-pituitary-adrenal (HPA) axis and immunologic markers. This study aimed to determine serum levels of basal cortisol and adrenocorticotropic hormone (ACTH) and circulating levels of various cytokines and chemokines and their association with psychological measures in psoriasis patients.

METHODS:

Serum concentrations of endocrinological and immunological variables were quantified, and psychiatric questionnaires were completed.

RESULTS:

In psoriasis patients, serum levels of ACTH, TNF-a, IL-6, IL-23, CCL-17, CCL-27, CCL-20 and CXCL-9, current psychiatric symptoms and childhood neglect scores were all higher than in controls. In addition, in psoriasis patients, physical neglect scores were related to lower basal cortisol, whereas recent stressful life events were related to higher IL-6, IL-23 and CCL-20 levels.

CONCLUSIONS:

The exposure to stressful life events in childhood and just before a flare-up of psoriasis may be related to altered function of the HPA axis and an immune dysregulation in psoriasis.

INTRODUCTION:

Cerebral palsy (CP) interferes with the quality of life (QOL) of children with CP, and given that parents report having to often guide their children’s decision making, it is important to understand the psychosocial factors that have a potential influence on parent-proxy reports. The purpose of this study was to investigate the impact of maternal anxiety and depression symptoms on parent proxy-reported health-related QOL (HRQOL) for children with CP, while controlling other clinical and demographical variables that may have affect HRQOL.

METHODS:

The HRQOL scores of 97 outpatients with CP, aged 7-18 years, were assessed using the Pediatric QOL Inventory, Parent version (PedsQL-P). Each patient’s type of CP, gross and fine motor function levels, severity of intellectual disability (ID), and other clinical variables were recorded. The levels of depression symptoms in each mother were assessed using the Beck Depression Inventory (BDI), and the levels of anxiety symptoms were assessed with the Beck Anxiety Inventory (BAI).

RESULTS:

According to regression analyses, male gender, severity of ID, and higher mothers’ BAI scores had negative effects on the PedsQL-P physical scores, and severity of ID and higher mothers’ BDI scores had negative effects on the PedsQL-P psychosocial scores. Regarding the determinants of total HRQOL, severity of ID, GMFCS score, and higher mothers’ BDI scores negatively impacted the PedsQL-P total scores.

CONCLUSION:

Our findings show significant predictor effects of the mothers’ anxiety and depressive symptoms, independent from other clinical variables, on the mother-rated HRQOL scores in children with CP.

Attention-deficit hyperactivity disorder (ADHD) is often comorbid with anxiety disorders and previous studies observed that anxiety could have an impact on the clinical course of ADHD and comorbid disruptive behavioral disorders (conduct disorders and oppositional-defiant disorders). Anxiety sensitivity (AS) is a different concept from anxiety per se and it is believed to represent the constitutionally based sensitivity of individuals to anxiety and anxiety symptoms. We aimed to assess the associations between anxiety, AS and symptoms of disruptive behavioral disorders (DBD) in a clinical sample of children and adolescents with ADHD. The sample consisted of 274 treatment naive children with ADHD aged 8-17 years. The severity of ADHD symptoms and comorbid DBD were assessed via parent rated Turgay DSM-IV-Based Child and Adolescent Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S), Conners’ Parent Rating Scale (CPRS), and Conners’ Teacher Rating Scale (CTRS). AS and severity of anxiety symptoms of children were evaluated by self-report inventories. The association between anxiety, AS, and DBD was evaluated using structural equation modeling. Analyses revealed that AS social subscale scores negatively predicted symptoms of conduct disorder (CD) reported in T-DSM-IV-S. On the other hand, CD symptoms positively predicted severity of anxiety. No direct relationships were detected between anxiety, AS and oppositional-defiant behavior scores in any scales. These results may suggest a protective effect of AS social area on the development of conduct disorder in the presence of a diagnosis of ADHD, while the presence of symptoms of CD may be a vulnerability factor for the development of anxiety symptoms in children and adolescents with ADHD.

OBJECTIVES:

Although encopresis shows a high rate of comorbidity in patients with attention-deficit/hyperactivity disorder (ADHD), the etiologic origin of this relationship and the effect of ADHD drugs on encopresis are unclear. In this chart review, we explored the effect of OROS long-acting methylphenidate (MPH) treatment on encopresis in children with ADHD. We also evaluated the relationship between the clinical variables of ADHD and encopresis.

METHODS:

The sample consisted of 21 children and adolescents (20 boys and 1 girl) with encopresis and coexisting ADHD 7-15 years of age. Their clinical characteristics and baseline (visit 1) and end of the second months’ (visit 2) Conners’ Parent Rating Scale (CPRS) subscores were recorded. Retrospective clinician determinations were made using the Clinical Global Impressions-Severity subscale (CGI-S) for encopresis severity and the Clinical Global Impressions-Improvement subscale (CGI-I) for encopresis response.

RESULTS:

According to the CGI-I, 14 subjects (71.4 %) showed much or very much improvement in their encopresis at the second visit. All of the CPRS scores showed a significant reduction during the second visit. No association was found between the CGI-I score and the changes in any of the CPRS scores. Baseline oppositional defiant disorder (ODD) and conduct disorder (CD) scores were correlated with the CGI-S score; however, no association was found between core ADHD symptom severity and the CGI-S score. With regard to the encopresis outcome, the baseline CD score was negatively correlated with the CGI-I score, and the baseline ODD score was prone to show a negative correlation with the CGI-I score.

CONCLUSIONS:

These results suggest that coexisting behavioral problems may be a vulnerability factor based on the severity of encopresis, and that MPH treatment may have a positive effect on encopresis in children and adolescents with ADHD.

OBJECTIVE:

Recent studies showed that attention deficit hyperactivity disorder (ADHD) is a lifelong disorder which may be seen in adults as well as children. However, information about the relationship between ADHD and general medical conditions in adulthood is limited. This case-control study aims to determine whether ADHD symptoms are associated with extremity fractures and their clinical characteristics.

METHODS:

Forty patients (25 male and 15 female; aged 18-50 years) who were seen due to extremity fractures and 40 control subjects were enrolled. Childhood and present ADHD symptoms of the participants were assessed using Wender Utah Rating Scale (WURS) and Adult ADHD Self-Report Scale (ASRS), respectively. Trauma type, reason of the trauma, fracture localization, hospitalization requirement, treatment type, and history of previous fracture(s) of the patients were recorded.

RESULTS:

Total score and all subscale scores of WURS were higher in the fracture groups compared with controls. Patients also had higher ASRS total score and ASRS hyperactivity-impulsivity subscore than the controls did. WURS irritability, inattentiveness, and behavioral problems/impulsiveness subscore and total score were positively correlated with the history of previous fracture. The patients in whom the reason for the fracture was fighting were also showed higher WURS irritability subscore.

CONCLUSIONS:

Our results suggest that extremity fractures are associated with ADHD symptoms in adults. These findings may provide an insight into better understanding the lifelong negative impact of ADHD on the physical health of its sufferer.