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Aim: The aim of this study was to compare inpatient and outpatient cases diagnosed with autism spectrum disorder (ASD) and to show which factors were more associated with hospitalization in children and adolescents. Materials and Methods: We included 85 outpatient and 34 inpatient children and adolescents with ASD. Psychiatric diagnoses were assessed with the K-SADS-PL. Factors relevant to the hospitalization of ASD cases were evaluated with a logistic regression model. Results: The Childhood Autism Rating Scale scores (p=0.002), comorbid psychopathology (p=0.04), multiple psychotropic medication (p=0.001), and psychopathology of the parents (p

Aim:This study aimed to understand how the pandemic has affected the mental health of adolescents with a previous psychiatric diagnosis.Materials and Methods:Fifty-nine patients aged 12-18 years who had been previously followed up in the adolescent mental health unit were included in this study. The participants were interviewed via telephone between June-July, 2020 and December, 2020-January 2021. Their socio-demographic data, psychiatric diagnoses and the previous Clinical Global Impression (CGI) scores were obtained from the patient files. The clinical global follow-up scale was scored by the interviewing physician.Results:Past CGI scores before the pandemic were significantly greater for those participants with more than one psychiatric condition (p=0.024). For those participants with more than one psychiatric condition, the difference between the CGI scores prior to the pandemic and during the early stages of the pandemic were significant (p=0.004). The total satisfaction scores for telepsychiatry services assessed via the telemedicine evaluation form were statistically higher for those participants with a single psychiatric disorder (p=0.023). The past and early pandemic CGI scores were found to be inversely correlated with the telemedicine evaluation form with r=-0.338, p=0.019, r=-0.353 p=0.014, respectively.Conclusion:The present study offers a perspective for adolescent mental health during the pandemic, underlining the importance and caveats of healthcare delivery to the youth with mental health problems during lockdown.

Objective: Hypospadias is defined as incomplete closure of the penile structures during embryogenesis. Surgical correction induces various complications, including urethrocutaneous fistula (UCF). The aim of this study was to determine the risk factors for the occurrence of UCF in children undergoing hypospadias repair under caudal anesthesia. Method: The medical records of children undergoing hypospadias repair between January 2013 and July 2018 were included. Data on patients’ age, body weight, height, type of repair procedure, type of hypospadias, duration of surgery, and hospitalization, and postoperative complications were analyzed. Results: The mean age of the 122 patients was 4.8±3.7 years. The type of surgery performed was tubularized incised plate urethroplasty (Snodgrass) in 90 (73.8%) and meatal advancement and glanuloplasty (MAGPI) in 32 (26.2%) children. Sixteen (13.1%) children had postoperative complications, all of which were UCF. No statistical association was found between postoperative UCF and patient variables. The most common complication of hypospadias repair is UCF, which occurs mostly in the immediate postoperative period. Conclusion: Hypospadias repair can result in complications. UCF remains a significant problem in the postoperative period. All patients underwent caudal block and despite the previous literature, we experienced lower rates of penile engorgement and postoperative UCF. These results showed that there was no cause-and-effect relationship between the caudal block and UCF. We think that the development of a urethrocutaneous fistula is mostly related to surgical causes and well-designed, prospective, and controlled studies are required to elucidate this issue.

(1) Background: Schroth exercise can reduce the deformity of the spine and improve the life quality and the body image of patients with adolescent idiopathic scoliosis (AIS). (2) Methods: The study began with 49 participants, aged 10–16 years old, who were diagnosed with AIS. At the end of the study, 37 patients were randomly assigned to either the Supervised (n = 19) or Home-Based Schroth Exercise Group (n = 18) and completed the study. Both groups were treated for seven days a week over twelve weeks. For all patients, body rotation measurements were performed with a scoliometer, surface asymmetry analysis was carried out using an Artec Eva 3D scanner, health-related quality of life was evaluated by the Scoliosis Research Society-22 (SRS-22) questionnaire, and the perception of the cosmetic deformity was assessed by the Walter Reed Visual Assessment Scale (WRVAS). All the measurements were repeated before and after the 12-week treatment. (3) Results: Post-treatment scoliometric measurements showed a significant decrease in body rotation in both groups (p < 0.05). Similarly, both groups observed significant positive changes in SRS-22 and WRVAS scores (p < 005). RMS values were statistically significant in both groups; the difference was only statistically significant in the thoracic anterior arm subparameter (p < 0.05). (4) Conclusion: The Schroth exercise for both groups with AIS improved body symmetry, quality of life, and body image.

Objective: Coronavirus disease-2019 (COVID-19) changed the status-quo in psychiatric interview with the advent of telemental health practices, save for a select group of patients; forensic psychiatric interviews among them. The present study aimed to identify the predictors of completing forensic psychiatric evaluations mandated by the judicial authorities in the hospital setting during the COVID-19 outbreak. Method: Twenty-six patients who had completed an initial forensic psychiatric assessment and were required to complete a child and adolescent forensic psychiatry board interview during the height of the COVID-19 pandemic were recruited. Their records were retrospectively examined, sociodemographic data, Beck Depression Inventory (BDI), the Screen For Child Anxiety Related Disorders (SCARED), and Wecshler Intelligence Scale for Childrenrevised scores were recorded and analyzed. Results: Statistical analysis revealed an association between conduct disorder and concomitant substance use with missed appointments, and maternal employment and completed interviews. BDI and SCARED total scores showed no difference between the patients who missed or completed their mandatory forensic psychiatry board assessment. BDI individual items of loss of pleasure (item 4), suicidality (item 9), and loss of interest (item 12) were associated with missed appointments. Conclusion: The results of this study support the established relationship between conduct problems and depressive symptoms, and this demographic group may be among the most affected by the limitation of access to mental health services during the COVID-19 pandemic, as they are already less likely to seek help overall.

Background. The aim of this study was to investigate the frequency of sleep problems in adolescents with epilepsy and their caregivers. We also examined the behavioural difficulties in adolescents with epilepsy and compared these behaviors with healthy controls. Methods. This observational case-control study included 37 adolescents with epilepsy and their caregivers, and 43 healthy age-matched adolescents and their caregivers. The Children`s Sleep Habits Questionnaire (CSHQ), DSM-5 Level 2 Sleep Disorders Scale for Children, and Strengths & Difficulties Questionnaire (SDQ) were used to evaluate sleep habits, sleep problems, and behavioural difficulties in adolescents. The DSM-5 sleep disorder scale for adults was used to evaluate the caregivers` sleep problems. Results. Adolescents with epilepsy had higher sleep problem scores such as daytime sleepiness and overall sleep problems compared with healthy controls. The psychopathological symptoms such as conduct problems, hyperactivity/inattention, and total behavior were also more frequent in adolescents with epilepsy. There was a nonsignificant increase in DSM-5 sleep disturbance score in caregivers of adolescents with epilepsy. Sleep onset delay had a significant negative correlation with total behavioral difficulties (r = -0.44, p < 0.01), and emotional problems (r = -0.47, p < 0.05) in adolescents with epilepsy. Sleep duration was negatively correlated with conduct problems (r = -0.33, p < 0.05), but positively correlated with prosocial score (r = 0.46, p < 0.01) in adolescents with epilepsy. Night waking was positively correlated with total behavioral difficulties (r = 0.35, p < 0.05) and hyperactivity score (r = 0.38, p < 0.05) in adolescents with epilepsy. Conclusions. Adolescents with epilepsy have more frequent sleep disturbances and maladaptive behaviors such as hyperactivity/inattention, and conduct problems compared with healthy controls, and their caregivers are more vulnerable to sleep problems. Moreover, we also demonstrated a strong association between sleep disturbances and behavioral problems in adolescents with epilepsy.

Objective: The aim of the presented study is to evaluate the adaptive process and psychiatric symptoms in the 7-12 age group followed-up with telemedicine interviews during the height of the pandemic. Method: Patients between the ages of 7-12 who were followed up in our outpatient clinic were called by telemedicine service at the appointment date. The questionnaire prepared by the researchers in order to investigate the adaptation process to the pandemic was administered, the answers provided by the patients and their families were recorded in the case data form together with Clinical Global Impression (CGI) Scale score appraised by the interviewing psychiatrist. Medical records pertaining to each patient were also reviewed, their psychiatric diagnoses, according to DSM 5 criteria and CGI scores recorded in their last face-to-face interviews during the pandemic period, were included in the case data form. Results: Fifty patients were included in the study. The mean age of the participants was 9.14+-1.61 years. Attention deficit hyperactivity disorder (60%) was the most common psychiatric diagnosis detected in the participants before the pandemic, followed closely by anxiety and related disorders (20%) and specific learning difficulty (16%). The CGI scores of the cases before, and during the pandemic were 2.72+-0.75, and 2.92+-0.94, respectively. The difference between the mean scores was statistically significant (p=0.024). Conclusion: Our study emphasizes the importance of follow-up by telemental health practices in cases where face-to-face psychiatric interviews are not applicable, i.e., due to the risk of transmission of COVID-19 disease during the current pandemic.

Narcolepsy is a childhood and adolescence disorder, that until recently remained unidentified until adulthood, with a reported time from onset to diagnosis of around a decade. This disorder affects approximately 0.05% of the population and starts in childhood and adolescence about half of the time. The main symptom of hypersomnia is excessive daytime sleepiness or prolonged night-time sleep that has occurred for at least 3 months prior to diagnosis. Patients with narcolepsy also exhibit hallucinations and delusions, however the differential diagnosis between the disorders is often unclear. Case presented in our study is an example of atypical narcolepsy with coexistence of psychotic symptoms. In our case upon the set-off of the second attack of excessive daytime sleepiness, the differential diagnosis of recurrent hypersomnia was not considered. This is due to the fact that the first attack of narcolepsy with hallucinatory component of the patient could have been misdiagnosed as acute transient psychotic attack. Hallucinations and delusions sometimes appear in patients with narcolepsy. The differential diagnosis between the disorders is not always simple. In our study we present the case which illustrate this overlap. Child and adolescent patients, which demonstrate psychotic symptoms and excessive daytime sleepiness component, should be concidered in case of evaluation for a diagnosis of primary hypersomnia following a multidisciplinary cooperation of neurologists, paediatricians and psychiatrists.

Aim:The aim of this study was to evaluate the place of clinical symptoms and findings, and radiological imaging in the diagnosis of foreign body aspiration (FBA) in children, and to investigate the validity of existing diagnostic algorithms.Materials and Methods:The medical records of 120 children with a diagnosis of FBA who underwent rigid bronchoscopy were examined. The sensitivity and specificity of the parameters used in the diagnosis of FBA and their predictive values were calculated.Results:78.9% of the patients were younger than 3 years and 63.8% were male. The peak incidence was 18 months. The rate of negative bronchoscopy was 30.8% and 87.3% of these patients were younger than 3 years. It was observed that the value with the highest diagnostical sensitivity and diagnostic accuracy (DA) rate (sensitivity; 92.54% and DA; 85.7%) had positivity for any of the radiological findings, and among these, there was the detection of one-sided excessive ventilation on chest X-ray (sensitivity; 70.0% and DA; 70.01%). Patients with positivity of any of the radiological findings who additionally had wheezing together with cyanosis or dyspnea had 100% specificity.Conclusion:Particularly male children under the age of 3 years have an increased risk of FBA. Neither clinical symptoms nor radiological findings alone are sufficiently specific and sensitive in the diagnosis of FBA. The most important factor in the decision to perform bronchoscopy is the evaluation of radiological findings together with physical examination and history.

Background. Twin-to-twin transfusion syndrome (TTTS) is a significant cause of perinatal morbidity and mortality. Fetoscopic laser photocoagulation (FLP) is the optimal treatment option for twin-to-twin transfusion syndrome; but can cause central nervous system, extremity and intestinal system injury. Case. We report the case report of ileal atresia and severe cerebral infarction co-occurrence after fetoscopic laser photocoagulation treatment. It is uncertain as to whether ileal atresia occurred due to ischemia associated with TTTS, the treatment with FLP, or a combination of both. Conclusions. Cases with prenatal ultrasonographic abnormalities after FLP should have a close assessment to detect bowel complications. Despite many developments in its management, TTTS remains an important risk factor for cerebral injury.

Background and Objectives. Acute disseminated encephalomyelitis (ADEM) is an immune-mediated, inflammatory and demyelinating disorder of the central nervous system. There have been a few studies in recent years on the fact that these cases have neurocognitive impairment. The purpose of this study is to evaluate the neurocognitive outcome and quality of life in cases with ADEM. Methods. Eleven cases who were on follow-up between 2008 and 2017 were included in the study, systemic, neurological and psychiatric examinations were done. All magnetic resonance images were re-evaluated. The neuropsychiatric evaluation was performed by clinical examination and psychometric scales; (1) The Pediatric Quality of Life Inventory 4.0, (2) Child Behavior Checklist, (3) Children`s Depression Inventory, (4) The Wechsler Intelligence Scale for Children-Revised and (5) Continuous Performance Test. The cases in our study underwent neuropsychiatric evaluation 3-42 months after the diagnosis of ADEM had been established. Results. Nine cases (81.8%) fully recovered without neurologic deficit. One case (9.1%) had a psychiatric disorder. During follow-up, cognitive and psychiatric problems were encountered in half of the cases (54.5%). Most of the cases with basal ganglia involvement (80%) displayed attention deficit and cognitive problems. Conclusion. In particular, cases with basal ganglia involvement should be followed carefully in terms of attention and cognitive problems.

Attention deficit hyperactivity disorder (ADHD), while characterized by attention problems, hyperactivity and impulsivity, essentially is a phenotypically heterogenous disorder. Social cognition disorders are important in ADHD, particularly in children due to their role in difficulties in social relations. Social cognition is crucial for the individual to build relations with others and through such relations inform social behavior. It has been suggested that sub-units of social cognition such as facial recognition and empathy are related to oxytocin. It is thought that individuals diagnosed with ADHD, for whom such skills are less readily available, have difficulties communicating on a social scale. PubMed medical search engine was used to identify the studies and review articles on oxytocin and ADHD. While the oxytocin gene and the oxytocin receptor gene are extensively studied in autism spectrum disorders, data on ADHD is scarce. Oxytocin, known as a mediator of social behavior, also affects the phenotype of ADHD, a disease subject to genetic and environmental influences determining its phenotype and individual case differences.

Aim: To evaluate the value of vagal nerve stimulation (VNS) in improving the quality of life, seizure frequency and mood in children with pharmacoresistant epilepsy. Materials and Methods: Eleven pharmacoresistant epileptic children implanted with the VNS therapy device between 2010-2014 were included in this prospective longitudinal study. Clinical assessment for the Diagnostic and Statistical Manual of Mental Disorders-IV psychiatric disorders, schedule for affective disorders, and schizophrenia for school children were applied. Childhood Depression Inventory (CDI), Beck Depression Inventory (BDI) were filled. Child Behavior Checklist (CBCL) and the Pediatric Quality of Life Inventory (PedsQL) were filled in by parents before the implantation. All of these tests were repeated in the first and second year of implantation. Results: Mean age at the first implantation of the VNS therapy device was 11.5 (2.5-16). Mean age was 13.9 (2.5-18) years. Mean duration of epilepsy prior to VNS implantation was 6.6 years, and VNS usage period was 30.4 months (10-96). International League Against Epilepsy classification of predominant seizure type was partial in seven, and generalized in four patients. Decrease in the number of seizures was 42% and 43% in the first and the second year respectively. While four of 11 patients had no psychopathology, different problems were determined in seven patients. There was no statistically significant difference between the scores of CDI/BDI, scores of CBCL and PedsQL prior to implantation, and also did not differ 1 year and 2 years after implantation. Conclusion: VNS is partially effective in controlling drug-resistant epilepsy. Although a positive effect on depression and quality of life is reported in literature, the results of this study were not statistically significant. We think that the scores of depression inventory should gradually decrease in years as it is reported for seizure frequency.

Aim: Callous and unemotional traits such as the inability to make emotional communication, and the lack of feelings of guilt and empathy are frequently found in the young with antisocial manners, who are at increased risk for violent behavior in the future. We aimed to identify the psychometric properties of the Turkish version of the “Inventory of Callous-Unemotional Traits-Youth Form” (ICU-TR). Materials and Methods: The ICU-TR was administered to 301 students, and only 250 completely filled out forms have been included in the study. One hundred students filled out the ICU-TR 3 weeks later for test-retest reliability. The factor structure of the scale has been studied with principle component analysis, and reliability measured with Cronbach’s alpha. Pearson correlation is used for criterion-related validity and test-retest reliability. Results: The mean age of the cases was 14.38, with 68% male and 32% female. Factor analysis supported a two factorial structure. The first factor (callousness) had 12 items (Eigen value=4.8; r=0.58, p

Eating disorders are a growing health problem among adolescents and have increasingly become the focus of studies due to their prevalence. Both obesity and anorexia nervosa are associated maladaptive eating behaviours that may be relevant to development. With this case report, it is intended to discuss the diagnosis and management of a female adolescent patient, diagnosed with obesity and attention deficit-hyperactivity disorder (ADHD). A 16-year-old, female, obese adolescent was referred to our in-patient clinic due to maladaptive eating styles, depressive symptoms and ADHD symptoms. Her early course of illness, diagnostic process, treatment and short-term outcome are described. At the time of discharge, the patient’s Clinical Global Impression (CGI) scale severity item score was 2 (borderline mentally ill) and CGI improvement item score was 2 (much improved). We report the present case with the purpose of establishing a pediatric approach to obesity, a disease not included in Diagnostic and Statistical Manual-5 under eating disorders, yet we believe it shares common underlying genetic and environmental causes.

Neuroleptic malignant syndrome (NMS) is an uncommon but potentially fatal idiosyncratic reaction to neuroleptics and characterized by a distinctive clinical syndrome of mental status change, rigidity, fever, and dysautonomia. Cotard’s syndrome is characterized by the appearance of nihilistic delusions concerning one’s own body or life. By presenting this case, we aim to discuss the differential diagnosis and treatment plan of a patient with catatonia and Cotard’s syndrome, which were noted after NMS, in light of the literature.

Simultaneous diagnosis of intussusception and appendicitis in the same patient have rarely been described in the pediatric population. We reported a small bowel intussusception case together with acute suppurative appendicitis. A 9 years old boy had abdominal colic pain and he had vomit frequently. On physical examination, he was awake, active and uncomfortable. Abdominal ultrasound (US) suggested ileoileocolic intussusception. Laparotomy was performed and an ileoileocolic intussusception was visualized. Ileoileocolic intussusception was reducted manually. After reduction appendix was visualized and it was acute suppurative appendicitis. Appendectomy was performed. Neither medical nor surgical problem occurred during long term follow-up. In conclusion, we though that it is important to examine the other pathologic conditions such as leading points, bowel complications and even appendicitis in case of intussusception.