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Studies have shown that theory of mind, emotion regulation and pragmatic abilities are negatively affected in people with OCD. We aimed to investigate ToM abilities, social responsiveness, pragmatic language, and emotion regulation skills in children with OCD, comparing them to healthy controls. This study was designed as a single-center, cross-sectional, case-control study. The participants were assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL) implemented by blinded professionals [32]. All participants fulfilled tests evaluating their ToM abilities via “Reading the Mind in the Eyes Test” (RMET), “Faces Test”, “Faux-Pas Test”, “Comprehension Test” and “Unexpected Outcomes Test”, Social Responsiveness Scale (SRS), Children’s Communication Checklist- Second Edition (CCC-2), Difficulties in Emotion Regulation Scale (DERS) and Yale-Brown Obsession Compulsion Scale (YBOCS). Within the study period, we enrolled 85 adolescents (42 with OCD and 43 controls). The CCC-2 scores except for CCC-2 coherence subscaleand SRS-2 scale total were found to be statistically significantly elevated in the OCD group than healthy controls (p

Risk factors associated with antidepressant treatment-emergent mania(ATEM) are poorly characterized in child and adolescent populations. To identify better biomarkers, we aimed to explore whether thyroid autoimmunity is associated with ATEM in pediatric mood disorders. We enrolled two groups of pediatric mood disorders, those with ATEM+ (n = 29) and those with ATEM- controls (n = 31). All diagnoses were made according to structured interviews by the clinicians. Autoimmune thyroiditis (anti-thyroid peroxidase antibodies [TPO-abs] and thyroid function (thyroid-stimulating hormone [TSH] and free thyroxin [FT4]) were assessed. Logistic regression was used to explore the relationship between TPO-abs seroprevalence and ATEM+ while controlling for covariates. Group comparisons showed that the patient with ATEM+ had significantly higher seroprevalence and titer of TPO-abs compared to ATEM- controls. In logistic regression analysis adjusting for age, gender, Tanner stage, body mass index, antipsychotic treatments, smoking status and family history of thyroid disorder, the seroprevalence of TPO-abs (>60 U/mL) was significantly associated with ATEM+ (OR = 3.67, 95% confidence interval [CI] = 1.2-11.1, p = 0.022). Our findings demonstrated that seroprevalence and titer of TPO-abs in pediatric mood disorders are associated with ATEM+ status. TPO-abs could potentially serve as a biomarker when assessing the risk of ATEM in the child and adolescent population.

Studies have shown that elevated empathic abilities and impaired theory of mind (ToM) tasks may be associated with social anxiety disorder (SAD). Adolescence is a critical period for the onset of SAD which may cause impairment in various domains of functioning. We aimed to investigate the association of ToM and empathy characteristics in adolescents diagnosed as having SAD. Forty-one drug-naive adolescents (between 12 and 18 years), who were diagnosed as having SAD without comorbidities were enrolled in the patient group. Forty adolescents in the same age range without any psychiatric disorders were matched as the healthy control group. The sample was evaluated via the Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version. The severity of the SAD symptoms was evaluated using the Social Anxiety Scale for Adolescents. ToM was evaluated with the Reading the Mind in the Eyes Test and emotion recognition was assessed by Faces Test. The KA-SI Empathic Tendency Scale was used to assess empathic abilities. The average age was 14.36 +/- 1.41 years in the SAD group and 14.30 +/- 1.04 years in the control group. Twenty-eight adolescents were female in the SAD and control groups. SAD and healthy controls did not differ in terms of sociodemographic data. There were higher scores in the KA-SI cognitive and affective empathic subscales (p < .001 in all scales) in the SAD group compared with the healthy controls. Adolescents with SAD have more difficulties both in Reading the Mind in the Eyes Test and Faces Test. The results of this study may indicate that although adolescents with SAD may be impaired in decoding aspects of ToM they may evaluate themselves as more empathic in self-report tests. The discrepancy between objective tests of ToM decoding and subjective reports of empathy may play an important role in the etiology and treatment of SAD in adolescents.

Binge eating disorder (BED) is characterized by frequent and persistent overeating episodes of binge eating without compensatory behaviors. The aim was to evaluate regional gray matter volume (GMV) abnormalities and appetite-regulating hormone levels (NPY and Leptin) in obese subjects either with or without BED compared to healthy controls (HC). Twenty-six obese patients with BED, 25 obese patients without BED and 27 healthy subjects as an age-matched control group with neuroimaging and appetite-regulating hormone levels were found eligible for regional GMV abnormalities. A structural magnetic resonance scan and timely blood samples were drawn to assess the appetite-regulating hormone levels. The BED obese patients had a greater GMVs of the right medial orbitofrontal cortex (OFC) and the left medial OFC compared to the non-BED obese patients. BED patients were characterized by greater GMV of the left medial OFC than HCs. Relative to the HCs, higher serum NPY levels were found in BED obese and non-BED obese groups. Serum leptin levels (pg/mL) had positively correlations with GMV in right medial OFC, left medial OFC, right lateral OFC, and left anterior cingulate cortex. Among the reward processing network, which is largely associated with feeding behaviours in individuals with obesity and binge eating disorder, the OFC volumes was correlated with serum leptin concentrations. The results of our study may provide a rationale for exploring the link between regional grey matter volumes and appetite-related hormone levels in people with BED. Level III, case–control analytic study.

Attention Deficit and Hyperactivity Disorder (ADHD) is associated with significant pragmatic language impairment and theory of mind deficits, but there are only a handful of studies have investigated the relationship between them in these conditions. This study aimed that investigate two different aspects of Theory of Mind (ToM) (ToM decoding and reasoning), pragmatic language impairment, and emotion regulation in patients with ADHD. Seventy adolescents with ADHD were compared to matched 64 healthy controls. We administered Social Responsiveness Scale-2 (SRS-2), Difficulties in Emotion Regulation Scale (DERS), Kiddie-SADS, Conners Parent Rating Scale, Children���s Communication Checklist-2 (CCC-2), Faux Pas, Comprehension Test, and Reading Mind in the Eyes Test (RMET) to all study participants. The CCC-2 scores were found to be statistically significantly higher in the ADHD group than in healthy controls. ADHD group had lower performance in the Faces Test and RMET compared to healthy controls, which did not survive from false discovery rate correction. We also found that CCC-2 performance and Conners scores were significant predictors of social responsiveness. Our results point to widespread impairment in pragmatic language use and communication from many perspectives. These results might be important to understand the difficulties in social functioning and interpersonal relationship in adolescents with ADHD.Key pointsADHD is associated with significant impairment in pragmatic language use and social cognitive functions.ToM-Decoding (RMET) is impaired much more than ToM-Reasoning (Faux Pas) in ADHD.Pragmatic language skills and severity of ADHD may be significant predictors of social responsiveness.Emotion regulation problems may affect communication and pragmatic language use. ADHD is associated with significant impairment in pragmatic language use and social cognitive functions. ToM-Decoding (RMET) is impaired much more than ToM-Reasoning (Faux Pas) in ADHD. Pragmatic language skills and severity of ADHD may be significant predictors of social responsiveness. Emotion regulation problems may affect communication and pragmatic language use.

Objective Major depressive disorder (MDD) in adolescence is a prevalent mental health problem with a complex etiology and a rising incidence. The aim of the study investigated functioning of family, attitudes of parents, and peer victimization in adolescents with MDD and to compare those with healthy adolescents. Methods The study was designed as a multi-center, cross-sectional, case-control study. 98 adolescents diagnosed with MDD and 99 healthy controls were recruited for the study. Beck depression inventory, parental attitude research instrument (PARI) tool, family assessment device (FAD), and multidimensional peer victimization scale (MPVS) were applied to all participants. Descriptive, correlational, and bivariate group comparisons were used in analyses. Results The average ages of adolescents with MDD and control adolescents were 14.7 (S.D.=1.5) and 15.0 (S.D.=1.6) years, respectively. Females formed 74.5% of youth with MDD (vs. 70.3% of controls). The groups were similar in terms of socio-demographic features (all p>0.05). Adolescents with MDD had significantly elevated scores in FAD subscales except problem solving, PARI rejection of homemaking, marital conflict, and authoritarian subscales, and all MPVS subscales. Adolescents with MDD also displayed significant positive correlations between all MPVS subscales and FAD subscales except FAD problem-solving. Conclusion This cross-sectional, multi-center study suggests that family dysfunction and peer victimization may be higher in youth with MDD. Although cross-sectional design precludes evaluation of causality, it may be prudent to evaluate family functions as well as peer victimization of depressed youth.

This study aimed to investigate the effects of drug holidays during summer vacations among children with attention deficit/hyperactivity disorder (ADHD) who were treated with methylphenidate in terms of ADHD symptoms and executive functions.The study was a prospective cohort study that includes pre-treatment, post-treatment and post-drug holiday evaluations. ADHD symptom severity was evaluated with the Clinical Global Impression Scale (CGI), the Conners' Parental Rating Scale-Short Form (CPRS) and the Conners' Teacher Rating Scale- Short Form (CTRS). The Stroop Color Word Test- TBAG Form (SCWT) was used to evaluate executive functions. Fifty-one patients participated in the study according to the inclusion and exclusion criteria. Methylphenidate (MPH) was started at 0.5 mg/kg/day and titrated weekly to a maximum of 1.2 mg/kg/day. During the follow-up period, 22 (43.0%) of the patients stopped treatment.Completion times for all SCWT subtests were significantly reduced after treatment (Our results suggest that psychomotor speed and resistance to interference improved in children with ADHD receiving methylphenidate treatment. Drug holidays did not affect psychomotor speed while beneficial effects on resistance to interference were reduced with drug holidays.

Objective: The pathophysiological mechanisms underlying the effects of psychostimulants (methylphenidate) treatment on growth still remain controversial. We examined the long term effects of methylphenidate on height, weight and body mass index in Turkish children and adolescents with attention deficit hyperactivity disorder (ADHD). Methods: Participants (6-18 years, 330 boys, 103 girls) diagnosed with ADHD who received treatment with methylphenidate for at least 1 year at the Department of Child and Adolescent Psychiatry at Dokuz Eylul University Medical School were included in a retrospective study. Weight, height, and BMI z scores were converted to age- and gender-corrected z scores using norms from the Turkish population at baseline and last follow-up. Results: Height and weight standard deviation score (SDS) were reduced by treatment (baseline height-SDS (SDS]: 0.74 +/- 1.43, followup height-SDS [SDS]: -0.67 +/- 4.35, t-test p

Introduction: Studies have suggested that attachment styles are associated with social anxiety disorder (SAD). Recent studies found that individuals with a diagnosis of SAD were significantly impaired relative to healthy controls on tasks of theory of mind (ToM). We aimed to investigate the association of ToM and attachment styles in adolescents diagnosed with SAD in this study. Methods: Drug-naïve 42 adolescents diagnosed with SAD and aged between 12 to 18, without psychiatric comorbidity were enrolled in the patient group. Forty-two adolescents in the same age range without any psychiatric disorders were matched as the healthy control group. The diagnosis was made by experienced clinicians using the Kiddie and Young Adult Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version and diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. The severity of SAD symptoms was evaluated with the Social Anxiety Scale for Adolescents. ToM was evaluated with Reading the Mind in the Eyes task and faces test. Parent and Peer Attachment Inventory was used for assessing attachment properties. Results: Adolescents with SAD compared to healthy control groups have more difficulties both in Reading the Mind in the Eyes task and faces test. We found a statistically significant decrease in peer and parent attachment scores when compared with SAD and healthy controls (p

Sleep has marked effects on learning, neurocognitive functions, integration of information, and quality of life during childhood. Many pediatric diseases may impair both quality of sleep and quality of life of children.. Diseases with chronic or progressive nature, requiring regular drug use or long term follow-up, causing somatic complaints like pain may effect sleep qualitatively or quantitatively. A better understanding of the effects of these diseases on sleep will have a positive effect on the neurocognitive and physical development of patients. Sleep disorders could be an etiologic factor for cardiovascular, neurocognitive and endocrinological disorders as well. Diabetes, childhood cancers, diseases with chronic pain, neurological diseases and airway pathologies may cause sleep disorders in childhood. Further understanding and better treatment of sleep disorders may contribute to the general well-being of the patients.

WOS: 000436416800034 #REF! Aim: To examine theeffects on the brain of 2-month treatment withamethylphenidate extended-release formulation (OROS-MPH) using [Tc-(99m)] TRODAT-1SPECT in a sample of treatment-naive adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). In addition, to assess whether risk alleles (homozygosity for 10-repeat allele at the DAT1 gene were associated with alterations in striatal DAT availability. Methods: Twenty adolescents with ADHD underwent brain single-photon emission computed tomography (SPECT) scans with [Tc-(99m)] TRODAT-1 at baseline and two months after starting OROS-MPH treatment with dosages up to 1 mg/kg/day. Severity of illness was estimated using the Clinical Global Impression Scale (CGI-S) and DuPaul ADHD Rating Scale-Clinician version (ARS) before treatment,1 month and 2 months after initiating OROS-MPH treatment. Results: Decreased DAT availability was found in both the right caudate (pretreatment DAT binding: 224.76 +/- 33.77, post-treatment DAT binding: 208.86 +/- 28.75, p = 0.02) and right putamen (pre-treatment DAT binding: 314.41 +/- 55.24, post-treatment DAT binding: 285.66 +/- 39.20, p = 0.05) in adolescents with ADHD receiving OROS-MPH treatment. Adolescents with ADHD who showed a robust response to OROS-MPH (n = 7) had significantly greater reduction of DAT density in the right putamen than adolescents who showed less robust response to OROS-MPH (n = 13) (p = 0.02). However, between-group differences by treatment responses were not related with DAT density in the right caudate. Risk alleles (homozygosity for the 10-repeat allele of DAT1 gene) in the DAT1 gene were not associated with alterations in striatal DAT availability. Conclusion: Two months of OROS-MPH treatment decreased DAT availability in both the right caudate and putamen. Adolescents with ADHD who showed a robust response to OROS-MPH had greater reduction of DAT density in the right putamen. However,our findings did not support an association between homozygosity for a 10-repeat allele in the DAT1 gene and DAT density, assessedusing[Tc-(99m)] TRODAT-1SPECT. Dokuz Eylul University Research CommitteeDokuz Eylul University [2008132]; Fogarty MH/DD program; Institute of Nuclear Energy Research (INER-Taipei, Taiwan) This study was partially supported by Dokuz Eylul University Research Committee (2008132), Fogarty MH/DD program and the Institute of Nuclear Energy Research (INER-Taipei, Taiwan).

Background: We aimed to examine the long-term effects of atomoxetine on height, weight, and body mass index in Turkish children and adolescents with attention deficit hyperactivity disorder (ADHD). Methods: Participants (6–18 years, 146 boys, 52 girls) with ADHD who used atomoxetine for at least 1 year were included in a retrospective study. Weight, height, and BMI z scores were converted to age- and gender- corrected z scores at baseline and last follow-up. Results: Atomoxetine treatment was associated with a notional reduction in height and weight standard deviation scores (SDS). There were no differences in BMI-SDS before and after atomoxetine treatment. Results of multiple linear regression analysis assess the possible contribution of the different treatment-related factors, age starting treatment, and duration of treatment predicted final height. And also, only the duration of treatment predicted final weight, not final height and BMI. Conclusions: We conclude that atomoxetine shows a negative effect on height and weight in children. This study demonstrated that these findings obtained at the end of the study might be helpful in assessing the growth parameters that may facilitate the course of the ADHD.

WOS:000481832500014 OBJECTIVE: The aim of this study was to examine the relationship between executive functions and suicidality in terms of impulsivity and depression severity. METHODS: Depressed adolescents who have made a suicide attempt in the last year (n = 32), depressed adolescents without a suicide attempt (n = 30), and healthy controls (n = 30) participated in the study in Dokuz Eylul University Faculty of Medicine, Department of Child and Adolescent Psychiatry. Clinical diagnoses were made according to the DSM-IV by applying Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL). Data were collected by using a sociodemographic data form, the Beck Depression Inventory (BDI), Barratt Impulsiveness Scale, and the Children's Depression Rating Scale - Revised (CDRS-R). To evaluate all participants' intelligence scores, the Wechsler Intelligence Scale for Children (WISC-R) was applied for adolescents aged under 16 years, and the Wechsler Adult Intelligence Scale (WAIS) was applied to adolescents aged 16-18 years. To determine the performance-based executive functions, Wisconsin Card Sorting Test and Stroop Test were applied to all participants. RESULTS: In this study, the participants who had made a suicide attempt displayed lower performance in the Stroop Test, especially in part 1 and part 4 compared with the controls (p = .04 and p = .011). Depressive patients also exhibited lower performance in the Stroop Test in part 3 compared with the controls (p = .049). Impulsivity was found more severe in depressive patients compared with controls (p < .001). There were no statistically significant differences between depressive patients with or without suicide attempt in terms of depression severity. CONCLUSION: Executive dysfunction appears to be associated with suicidal behaviour in adolescents with the major depressive disorder. This findings need to be replicated with a larger sample size in the future.

Objective: The purpose of this study is to compare health related quality of life of children and adolescents with attention deficit hyperactivity disorder (ADHD) both with health related quality of life of type 1 diabetes mellitus (T1DM) and healthy control groups. Methods: Sixty ADHD newly diagnosed cases with no treatment, age and gender matched two control groups; 60 T1DM and 60 healthy control groups aged between 8 and 16 years were enrolled in this study. The diagnostic assessments and exclusion criteria of psychiatric disorders of all subjects were made according to the DSM-IV criteria and the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and the Lifetime (K-SADS PL). Sociodemographic Form, Pediatric Quality of Life Scale for Children (PedsQL 4.0 TM) were applied to all of participants and their parents. DSM-IV based Turgay ADHD and Distruptive Behavior Disorders Screening Scale, ADHD Rating Scale-IV and Clinical Global Impression Scale were additionally administered to ADHD group. HbA1c levels were used in terms of T1DM disease severity. Results: Children and adolescents diagnosed ADHD reported lower self-concept in emotional functioning and psychosocial health summary scores than children and adolescents with T1DM. Compared with healthy controls, children and adolescents diagnosed ADHD reported lower self-concept in all subscales and total scores of PedsQL except physical health summary. Parent of ADHD children reported lower concept in all scores of quality of life than parents of healthy controls. Conclusions: Life quality in terms of psychosocial health were found to be impaired in newly diagnosed ADHD subjects more than T1DM and healthy controls. Evaluation of quality of life during diagnosis and treatment stages of ADHD may help to identify and manage the overall impact of the disorder. © 2019, Cukurova University, Faculty of Medicine. All rights reserved. 2-s2.0-85073413012

Depression is a common mental health problem in adolescence. In this study it was aimed to investigate attachment properties, emotion regulation skills and anger expression patterns in adolescents diagnosed with major depressive disorder (MDD) and to compare the results with healthy controls' findings. Effects of having comorbid anxiety disorder (AD) to these psychological properties were also evaluated. The study was planned as three-centered, single-disciplinary, a cross-sectional study with a control group in Turkey. Depression group was consisted of 97 adolescents while control group was 101 adolescents. All participants were administered Beck Depression Inventory (BDI), Inventory of Parent and Peer Attachment (IPPA), Difficulties in Emotion Regulation Scale (DERS), and State-Trait Anger Expression Inventory (STAXI). Depression group had statistically lower scores in peer attachment and parent attachment, and higher scores in all subscales of DERS compared to the controls. Due to STAXI, it was observed that depression group obtained statistically significant higher scores in trait anger, repression of anger, expression of anger and statistically lower scores in control of anger, compared the controls. There was no difference in state anger between groups. In depression group, there were no significant differences for any promising psychiatric properties between adolescents with MDD and those with MDD + AD. The findings of this study supported that anger expression and emotional regulation difficulties were related with depression and that this relationship was also associated by attachment security. These findings are important for clinical practice to increase understanding of the association between attachment security, emotion regulation, anger expression and depression.

Brain-derived neurotrophic factor (BDNF) is an important neurotrophin in the brain that modulates dopaminergic neurons. In this study, we aimed to investigate the changes in serum BDNF levels of children with attention-deficit/hyperactivity disorder (ADHD) in response to OROS methylphenidate treatment. We also aimed to determine whether there were any pre-post-differences between ADHD subtypes and comorbid psychiatric disorders in serum BDNF levels. Fifty male children with ADHD and 50 male healthy controls within the age range of 6-12 years were recruited to the study. The psychiatric diagnoses were determined by applying a structured interview with Kiddie schedule for affective disorders and schizophrenia for school-age children-present and lifetime version. The symptom severity of ADHD was measured using the Clinical Global Impression ADHD Severity Scale (CGI-S). Physicians completed Du Paul ADHD questionnaires. The levels of serum BDNF were assessed before and after 8 weeks of treatment with effective dosages of OROS methylphenidate. In the present study, the mean serum BDNF levels of boys with ADHD and of the healthy controls were 2626.33 +/- 1528.05 and 2989.11 +/- 1420.08 pg/mL, respectively. Although there were no statistically significant difference between the ADHD group and healthy controls at baseline (p = 0.22), the increase of serum BDNF was statistically significant from baseline to endpoint in the ADHD group (p = 0.04). The mean serum BDNF levels at baseline and endpoint of the ADHD group were 2626.33 +/- 1528.05 and 3255.80 +/- 1908.79 pg/mL, respectively. The serum BDNF levels of ADHD-inattentive subtype were significantly lower at baseline (p = 0.02), whereas BDNF levels post-treatment showed no significant difference. The increase of serum BDNF levels with methylphenidate treatment after 8 weeks was significantly higher in the inattentive group (p = 0.005). The increase of serum BDNF levels with methylphenidate treatment after 8 weeks in boys with ADHD may support the potential role of BDNF in the pathophysiology of ADHD. The role of BDNF in ADHD subtypes in particular should be evaluated with further, larger studies.

OBJECTIVES: In this study, it was aimed to analyse the relationship between clinical improvement in adolescents with attention deficit/hyperactivity disorder (ADHD) and the presence of allele frequencies of dopamine D4 receptor (DRD4), and Val158Met polymorphism of catechol-O-methyltransferase (COMT) genes. METHODS: Thirty-four adolescents (age range, 13–18 years) with ADHD participated in this study. Thirty-two patients were males and two were females. Du Paul ADHD Rating Scale-Clinician version (ARS) and Clinical Global Impression-severity of impairment (CGI-S) were used for the evaluation of symptom severity. Fifty healthy age-matched adolescents were recruited as controls. RESULTS: When the groups with (n = 9) and without (n = 25) 7-repeat alleles for DRD4 were considered, there was a statistically significant decrease of DuPaul ARS total and hyperactivity scores in those treated with OROS-methylphenidate. When the Val/Met allele-positive group for COMT gene (n = 17) was compared with the Val/Val allele-positive group (n = 13) and Met/Met allele-positive group (n = 4), there was a statistically significant decrease of ARS total scores, ARS attention scores, and CGI scores in adolescents with ADHD treated with OROS-MPH. CONCLUSIONS: Specific data from further studies with a larger sample sizes would provide more insights to replicate the current findings.

WOS:000446303100012 PubMed: 30110079 BACKGROUND: Studies have shown that children with anxiety disorders (ADs) present impaired family functioning and quality of life. We aimed to evaluate family functioning and quality of life among children with AD and healthy controls. DESIGN AND SETTING: Cross-sectional study (survey) at two centers in Turkey. METHODS: The study group comprised 42 children diagnosed with AD and 55 controls. The Screen for Child Anxiety-Related Emotional Disorders (SCARED) questionnaire was filled out by their parents to measure the severity of anxiety symptoms. Family functioning among the children was assessed using the Family Assessment Device (FAD) and Parental Attitude Research Instrument (PARI). The children's quality of life was assessed through the Pediatric Quality of Life Inventory (PedsQL). RESULTS: The children's average age was 10.00 +/- 0.21 years in the AD group and 9.98 +/- 1.53 years among the controls. There were higher scores on all FAD subscales in the AD group (2.15 +/- 0.52; 2.29 +/- 0.44; 2.44 +/- 0.55; 2.10 +/- 0.61; 2.56 +/- 0.40; 2.32 +/- 0.33; and 2.29 +/- 0.47). On PARI subscales, there were significant differences favoring the AD group (p < 0.05), except for democratic attitude. All PedsQL subscales differed significantly between the groups, favoring the AD group. A statistically significant relationship was found between all PedsQL subscales and SCARED scores in the AD group. CONCLUSION: We found that both family functioning and quality of life among children with AD were negatively affected. However, further studies with larger sample sizes are required to reach stronger conclusions.

To examine theeffects on the brain of 2-month treatment withamethylphenidate extended-release formulation (OROS-MPH) using [Tc-Twenty adolescents with ADHD underwent brain single-photon emission computed tomography (SPECT) scans with [Tc-Decreased DAT availability was found in both the right caudate (pretreatment DAT binding: 224.76 ± 33.77, post-treatment DAT binding: 208.86 ± 28.75, p = 0.02) and right putamen (pre-treatment DAT binding: 314.41 ± 55.24, post-treatment DAT binding: 285.66 ± 39.20, p = 0.05) in adolescents with ADHD receiving OROS-MPH treatment. Adolescents with ADHD who showed a robust response to OROS-MPH (n = 7) had significantly greater reduction of DAT density in the right putamen than adolescents who showed less robust response to OROS-MPH (n = 13) (p = 0.02). However, between-group differences by treatment responses were not related with DAT density in the right caudate. Risk alleles (homozygosity for the 10-repeat allele of DAT1 gene) in the DAT1 gene were not associated with alterations in striatal DAT availability.Two months of OROS-MPH treatment decreased DAT availability in both the right caudate and putamen. Adolescents with ADHD who showed a robust response to OROS-MPH had greater reduction of DAT density in the right putamen. However,our findings did not support an association between homozygosity for a 10-repeat allele in the DAT1 gene and DAT density, assessedusing[Tc

Objective The goal of this study was to investigate depression and anxiety levels of mothers whose child (7–11 years) and adolescent (12–18 years) offspring had obesity, as well as those mothers’ attitudes toward their children and their family relationships. Method This is a cross-sectional, case–control study of 100 dyads. All mothers completed the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Parental Attitude Research Instrument, and the Family Assessment Device. Results Maternal state anxiety in the group with obesity was significantly higher than controls ( p = 0.03). As measured by Family Assessment Device, affective involvement ( p = 0.05) and behavior control ( p = 0.00) scores were significantly higher for those with obesity. Obesity and adolescence have independent effects on maternal state anxiety; affective involvement domain of family function is affected by both obesity and its interaction with adolescence, while behavior control domain is singularly affected by obesity. Conclusions Our results may demonstrate that, for the mothers of children who have obesity, this condition may have an adverse effect on their lives and their family relationships. Pediatric obesity and developmental stage of offspring may have different effects on maternally reported psychometric variables. Cross-sectional design may hinder causal explanations. Further studies with longitudinal designs are needed.

Introduction: The information about the etiology of anxiety disorders are still limited however anxiety disorders are prevalent disorders in childhood. In this study it is aimed to evaluate the relation of emotion regulation and anxiety level of children diagnosed with anxiety disorder with attachment and emotion regulation in the children’s mother and it is also aimed to compare the results with healthy controls. Methods: The study group consisted of 64 children (8-12 years old) diagnosed with anxiety disorder and their mothers. The control group (78 children and mothers) comprised patients of other clinics at hospital and was matched for gender and age to the anxious patients. We evaluated disorder severity at the time of assessment using the Screen for Child Anxiety Related Emotional Disorders (SCARED). Emotional Regulation Checklist (ERC) was used to examine children emotional regulation. Difficulties in Emotion Regulation Scale (DERS) was used to indicate maternal emotional dysregulation status, Anxiety Sensitivity Index-3 (ASI-3) was used for anxiety sensitivity in mothers and Experiences in Close Relationship Scale-II was used to evaluate attachment properties in mothers. Results: SCARED child and parent form scores were compared with anxiety sensitivity index, ERC subscales, DERS and ASI with Pearson’s correlation analysis. Positive correlation was found between SCARED child, parent form scores and ERC emotional lability scores, social, physical, cognitive anxiety scores of ASI, maternal anxious attachment and DERS scores and negative correlation was found between SCARED child, parent form scores and ERC emotional regulation scores. There was no relation between SCARED child, parent form scores and maternal avoidant attachment. Conclusion: This is the first study which evaluated the relationship of emotion regulation difficulties of children, who are diagnosed with anxiety disorder, and maternal attachment properties and maternal emotion regulation. The anxiety symptoms may decrease with using cognitive behavioral methods in emotion regulation difficulties of children diagnosed with anxiety disorder.

Objective: Problematic internet use and poor sleep quality are widespread problems in adolescents. The aim of this study is to investigate the relationship between problematic internet use, sleep quality and impulsivity in adoles- cents diagnosed with major depressive disorder and to compare the findings with those of healthy controls. Meth- ods: The study was planned as a single-disciplinary, three-centered, cross-sectional study with a control group. All participants were assessed using the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Life- time Version (K-SADS-PL). Beck Depression Inventory (BDI), Barratt Impulsiveness Scale (BIS-11), Pittsburgh Sleep Quality Index (PSQI) and Young’s Internet Addiction Test (IAT) were administered to all participants. Results: It was determined that the total scores of BIS-11 scale, PSQI and IAT were statistically and significantly higher in the depression group than controls. In addition, a positive correlation was found between IAT and BIS-11 score and between IAT and PSQI. A positive correlation was also found between BIS-11 and PSQI. Conclusion: According to the findings of our study, it is suggested that there may be multiple and complex interactions between problematic internet use, low sleep quality, impulsivity and depressive symptoms. (Anatolian Journal of Psychiatry 2019; 20(5):491-498) Amaç: Problemli internet kullanımı ve düşük uyku kalitesi ergenlerde sık rastlanan sorunlardır. Bu çalışmanın amacı majör depresif bozukluk tanısı konan ergenlerde problemli internet kullanımı, uyku kalitesi ve dürtüsellik arasındaki ilişkiyi araştırmak ve saptanan bulguları sağlıklı kontrol grubunun bulgularıyla karşılaştırmaktır. Yöntem: Çalışma, olgu ve kontrol grubu ile üç merkezli, tek disipliner, kesitsel bir çalışma olarak planlanmıştır. Tüm katılımcılar Okul Çağı Çocukları için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi - Şimdi ve Yaşam Boyu Versiyonu kullanılarak değerlendirmeye alınmıştır. Tüm katılımcılar Beck Depresyon Ölçeği (BDÖ), Barratt Dürtüsellik Ölçeği (BIS-11), Pittsburgh Uyku Kalitesi Ölçeği (PUKÖ) ve Young İnternet Bağımlılık Testi (YİBT) ile değerlendirilmiştir. Bulgular: BIS-11, PUKÖ ve YİBT ölçeklerinin toplam puanlarının depresyon grubunda kontrol grubuna göre istatis- tiksel olarak anlamlı düzeyde daha yüksek olduğu saptanmıştır. YİBT ve BIS-11 puanları arasında ve YİBT ve PUKÖ puanları arasında pozitif bir korelasyon bulunmuştur. Ayrıca BIS-11 ve PUKÖ puanları arasında da pozitif bir korelasyon saptanmıştır. Sonuç: Çalışmamızın bulguları problemli internet kullanımı, düşük uyku kalitesi, dürtü- sellik ve depresif belirtiler arasında çok yönlü ve karmaşık etkileşimlerin olabileceğini destekler niteliktedir. (Ana- dolu Psikiyatri Derg 2019; 20(5):491-498) ________________________________________

Summary Objective The goal of this study was to investigate how the disease and treatment of epilepsy affected the psychological profile (depression and anxiety) of mothers whose children had epilepsy, as well as these mothers' attitudes towards their children and their family relationships. Methods Both the case and control groups consisted of 50 children and their mothers. All mothers were asked to complete the Beck Depression Inventory, State-Trait Anxiety Inventory, Parental Attitude Research Instrument and Family Assessment Device. Results Mothers whose children had epilepsy scored significantly higher in depression and state anxiety compared to the mothers of the control group. The mothers of children diagnosed with epilepsy also failed to develop supportive and friendly relationships with their children. In addition, these mothers scored significantly higher in the Attitude of Hostility and Rejection, Marital Discordance and Authoritarian Attitude as compared to the mothers of the control group. Conclusion This cross-sectional study demonstrated that, for the mothers of children who had epilepsy, the illness might have an adverse effect on their lives and their family relationships.

The authors evaluated basic sleep architecture and non–rapid eye movement (NREM) sleep alterations in drug-naïve attention-deficit/hyperactivity disorder (ADHD) children without psychiatric or other comorbidities. This cross-sectional case-control study included 28 drug-naïve children with ADHD and 15 healthy controls. This subjective studies revealed that children with ADHD had a worse sleep quality and increased daytime sleepiness. Polysomnography data showed that the sleep macrostructure was not significantly different in children with ADHD. Sleep microstructure was altered in ADHD children by means of reduced total cyclic alternating pattern rate and duration of cyclic alternating pattern sequences. This reduction was associated with a selective decrease of A1 index during stage 2 NREM. SpO2 in total sleep was slightly decreased; however, the incidence of sleep disordered breathing showed no significant difference. The authors suggest that cyclic alternating pattern scoring would provide a further insight to obtain a better understanding of the sleep structure in children with ADHD.

ABS TRACT: Plasma norepinephrine and dopamine levels in prepubertal male children with attention-deficit hyperactivity disorder do not change with 8 weeks of methylphenidate treatment Objectives: The aim of this study was to determine plasma norepinephrine and dopamine levels at baseline and after 8 weeks of stimulant treatment in pre-pubertal male children with ADHD. Methods: The study group consisted of 50 children (6-12 years old) diagnosed with ADHD. The control group comprised students from a primary school within the epidemiological catchment area of the clinic and was matched for class and age to the ADHD patients. The Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) was used to diagnose ADHD and allowed comorbidities. Mental retardation was ruled out with the Wechsler Intelligence Scale for Children-Revised (WISC-R) and impaired functioning. We evaluated disorder severity at the time of assessment using the Clinic Global Impression Scale (CGI). The DuPaul ADHD Rating Scale-IV (ARS) was also used. All patients were treatment-naive. The parents were advised to use OROS methylphenidate daily with no drug holidays during weekends. No rescue medications (immediate-release methylphenidate) were allowed. The dose started at 18 mg and was titrated to 54 mg in 4 weeks to yield average doses of 1 mg/kg/ day. Baseline and endpoint plasma DA and NE were measured. Results: Baseline plasma NE and DA levels had no statistically significant differences between ADHD patients `and controls (232.0±67.3 versus 232.2±65.3 pg/mL and 169.3±48.4 versus 186.9±40.5 pg/mL). Plasma NE levels in all ADHD subgroups decreased with 8 weeks of stimulant treatment, while changes in DA levels were more complex. Plasma DA levels decreased with treatment in the ADHD-inattentive subgroup but were elevated in the hyperactive/impulsive and combined subgroups. There were no statistically significant differences between ADHD subgroups for these variables. Endpoint NE levels were correlated with endpoint DA levels. There were no statistically significant differences between ADHD subgroups. Plasma NE levels were not related to symptom severity or treatment response. In contrast, baseline DA levels were negatively correlated with ARS total scores. Conclusions: We found no statistically significant differences between plasma levels of NE and DA in a prepubertal male sample with ADHD and controls. Plasma DA and NE levels were correlated at both baseline and the endpoint. Although there was a signal that baseline DA levels may correlate with ADHD symptoms as evaluated via ARS, this was not true for endpoint analyses. Because this negative correlation disappeared after treatment, this finding about baseline DA levels may also be evaluated as an early treatment neuromarker. The negative results could also be explained by our focus on plasma. The recent consensus is that urinary levels of NE and DA may be more informative in patients with ADHD and that concurrent evaluation of multiple neurotransmitter systems (i.e., neuropeptide Y and NE) may be more informative. Further studies may benefit from concurrent measurements of plasma and urinary levels of catecholamines and their metabolites.

WOS: 000404458100004, PubMed ID: 27556551, This study evaluated the dental anxiety levels of preschool children at a kindergarten and at a dental clinic. The anxiety levels of ninety 4-6-year-old (4.99 +/- 0.81) preschool children were evaluated according to pulse rates, the facial image scale (FIS), the Venham picture test (VPT), and the Frankl behavior rating scale. The children's mothers were asked to complete the state-trait anxiety inventory (STAI) forms 1 and 2 (STAI 2 and STAI 2). The sample t-test, Mann-Whitney U test, and Pearson's correlation test were used. A statistically significant difference was observed between the children's pulse rates when measured at the dental clinic and those when measured at the kindergarten (p < 0.001). Although the results were not statistically significant, more negative facial expressions were observed in the children at the dental clinic than in those at the kindergarten when assessed using FIS and VPT (p = 0.090 and p = 0.108, respectively). There was a statistically significant correlation between the transient anxiety levels (STAI 1) of mothers and the VPT scores of their children evaluated at the dental clinic (r = 0.506, p < 0.001). The continuous anxiety level of the mothers of males was found to be significantly higher (p = 0.033) than that of the mothers of females (STAI 2). Although the children had been informed about dentistry and were introduced to a dentist at the kindergarten, their anxiety levels seemingly increased as they arrived at the dental clinic. The significant increase observed in the children's pulse rates was a physical indicator that their anxiety levels had increased. It can be concluded that the children felt more anxious at the dental clinic that at the kindergarten.

Aynur Pekcanlar Akay,1 Gamze Capa Kaya,2,3 Burak Baykara,1 Yusuf Demir,2,3 Handan Özek,1 Sevay Alsen,1 Mine Sencan Eren,2,3 Neslihan Inal Emiroglu,1 Turkan Ertay,2,3 Yesim Ozturk,4 Suha Miral,1 Hatice Durak,2,3 Evren Tufan4 1Department of Child and Adolescent Psychiatry, 2Department of Nuclear Medicine, 3Department of Pediatrics, Dokuz Eylul University Medical Faculty, Izmir, 4Department of Child and Adolescent Psychiatry, AbantÄ°zzet Baysal University, Bolu, Turkey Abstract: Attention deficit/hyperactivity disorder is one of the most common neurodevelopmental disorders. The pathophysiology is thought to involve noradrenaline and dopamine. The role of dopamine transporter (DAT) was evaluated in imaging studies using mostly dopamine reuptake inhibitors. Atomoxetine is a selective noradrenaline reuptake inhibitor. Here we report the results of a pilot study conducted to evaluate changes in striatal DAT after 8 weeks of atomoxetine treatment. Our results suggest that 8 weeks of atomoxetine treatment may change striatal DAT bioavailability as measured via SPECT but that change was not correlated with genotype or clinical improvement. Keywords: neuroimaging, dopamine, noradrenaline, SLC6A3 protein, human, pragmatic clinical trial, pilot study

Objective: Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood neurodevelopmental disorder. Difficulties in the areas of emotion regulation and empathy were found in prior studies. Mother-child attachment is important in the development of emotion regulation and empathy. We aimed to examine the relation emotional regulation and empathy skills in children with ADHD and emotion regulation and attachment properties in their mothers and to compare with healthy controls. Methods: The study group consisted of 61 children (8-12 years old) diagnosed with ADHD. The control group (87 children) comprised patients of other clinics at hospital and was matched for gender and age to the ADHD patients. The Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) was used to diagnose ADHD and allowed comorbidities. We evaluated disorder severity at the time of assessment using the DuPaul Attention Deficit and Hyperactivity Disorder Rating Scale. All patients were treatment-naive. Emotional Regulation Checklist (ERC) and KA-SI empathy scale were used to examine children emotional regulation and empathy. Difficulties in Emotion Regulation Scale (DERS) was used to indicate maternal emotional dysregulation status and Experiences in Close Relationship Scale-II was used to evaluate attachment properties in mothers. Results: Children with ADHD had statistical significant lower scores in the areas of affective empathy, cognitive empathy, total empathy score and emotion regulation and cases had statistical significant higher scores in emotion lability. Mothers of children with ADHD had higher scores in anxious and avoidant attachment styles and all subscales of DERS. The correlation between, ADHD symptoms, KA-SI Empathy, ERC, Attachment Scale, and DERS was evaluated by Pearson’s correlation analysis. Negative correlation was found between both attention deficit and hyperactivity scores of Du Paul scale and affective, cognitive empathy scores of KA-SI Emphatic Tendency Scale and emotion regulation scores of ERC; a positive correlation was determined between attention deficit and hyperactivity scores of Du Paul scale, mothers’ anxious and avoidant attachment and DERS total scores, and emotional lability scores of ERC. Discussion: Mother-child attachment and maternal emotion regulation skills have important roles in the emotion regulation and empathy skills of children. Better understanding of neuropsychologic development process of attachment, empathy and emotion regulation skills and their relations with each other may contribute to the treatment of children with ADHD.

Attention Deficit and Hyperactivity Disorder (ADHD) children has been shown to affect the quality of sleep. In this study it is aimed to evaluate sleep habits and sleep problems between the cases who are diagnosed with ADHD and healthy controls. The study group consisted of 61 children (8-12 years old) with ADHD; the control group (87 children) comprised patients of other clinics at hospital. The Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) and DuPaul ADHD Rating Scale vere used. Children's sleep habits and sleep problems were assessed with the Children's Sleep Habits Questionnaire. ADHD group compared to healthy controls; statistical significant difference was found in bedtime resistance, the sleep onset delay, the sleep duration, the sleep anxiety, the night wakings, the parasomnias and the daytime sleepiness but statistical significant difference wasnt found the sleep disordered breathing. In our study, problems in the sleep habits evaluated by parents ADHD are more than campared with healty controls likewise literature. However, further studies with larger sample size and objective measures such as actigraphy and polysomnography may allow us to have more knowledge in this area. [JCBPR 2017; 6(3.000): 108-114]

Objectives: The aim of the present study was to assess differences and correlations between the hippocampal volumes (HCVs), serum nerve growth factor (NGF), and brain-derived neurotrophic factor (BDNF) levels in adolescents with bipolar disorder (BP) compared to healthy controls. Methods: Using structural magnetic resonance imaging, we compared HCVs of 30 patients with euthymic BP who were already enrolled in a naturalistic clinical follow-up. For comparison, we enrolled 23 healthy controls between the ages of 13 and 19. The boundaries of the hippocampus were outlined manually. The BDNF and NGF serum levels were measured with the sandwich ELISA. Results: The groups did not differ in the right or left HCVs or in the NGF or BDNF serum levels. However, negative correlations were found between the right HCVs and the duration of the disorder and medication and positive correlations were found between the duration of the medications and the NGF and BDNF levels in the patient group. Additionally, positive correlations were found between the follow-up period and left normalized HCVs in both the BP and lithium-treated groups. Conclusions: The right HCVs may vary with illness duration and the medication used to treat BP; NGF and BDNF levels may be affected by long-term usage. Further research is needed to determine whether these variables and their structural correlates are associated with clinical or functional differences between adolescents with BP and healthy controls.

Background The amygdala is repeatedly implicated as a critical component of the neurocircuitry regulating emotional valence. Studies have frequently reported reduced amygdala volumes in children and adolescents with bipolar disorder (BD). Brain derived neurotrophic factor (BDNF) and nerve growth factor (NGF) play critical roles in growth, differentiation, maintenance, and synaptic plasticity of neuronal systems in adolescent brain development. The aim of the present study was to assess amygdala volumesand its correlation with serum levels of NGF and BDNF in euthymic adolescents with BD and healthy controls. Methods Using structural MRI, we compared the amygdala volumes of 30 euthymic subjects with BD with 23 healthy control subjects aged between 13 and 19 years during a naturalistic clinical follow-up. The boundaries of the amygdala were outlined manually. Serum BDNF and NGF levels were measured using sandwich-ELISA and compared between the study groups. Results The right or left amygdala volume did not differ between the study groups.The right and left amygdala volumes were highly correlated with levels of BDNF in the combined BD group and the valproate-treated group.Both R and L amygdala volumes were correlated with BDNF levels in healthy controls. The left amygdala volumes were correlated with BDNF levels in the lithium-treated group. Limitations This cross-sectional study cannot inform longitudinal changes in brain structure. Further studies with larger sample sizes are needed to improve reliability. Conclusions The correlations between amygdala volumes and BDNF levels might be an early neuromarker for diagnosis and/or treatment response in adolescents with BD.

The study aimed to ascertain the prevalence of mood and disruptive behavior disorders and symptoms in 35 children of 29 adult outpatients with a DSM-IV diagnosis of bipolar I disorder, compared with 33 children of 29 healthy adults, matched with patients on age, socioeconomic status and education. The offspring of bipolar patients had a 9.48 fold higher risk of receiving a psychiatric diagnosis. While only two children of patients with bipolar disorder were diagnosed with a mood disorder, 30.9% displayed mild depressed mood, compared with 8.8% of the controls, a statistically significant difference. The bipolar offspring also scored significantly higher on the hyperactivity and conduct problems subscales as well as the ADHD index of the Conners' Teacher Rating Scale. The disruptive behavior and mood symptoms observed in early life in the offspring of bipolar patients may indicate the need for early psychosocial intervention.

The neurologic dysfunctions caused by treatment may affect health and quality of life in survivors of childhood leukemia. The objective of this study was to identify the neuropsychological late effects of leukemia treatment to provide an assessment about the degree and incidence of these late effects. Neurological and ophtalmological examination, cranial magnetic resonance imaging (MRI), auditory and neurocognitive tests, and questionnaires of quality of life were performed to 44 acute leukemia survivors at least 5 years after diagnosis. Median time since completion of chemotherapy was 7.5 years (2-18) and median age at the time of the study was 16.4 years (8-31). At least one or more late effects detected by physical examination (PE), neurological tests, or neurocognitive tests encountered in 80% of the patients, and 64% of the patients specified at least one complaint in the quality of life questionnaire. MRI revealed pathological findings in 18% and electroencephalogram (EEG) abnormalities were present in 9% of the patients. Evaluation of total intelligence scores revealed that 30% of patients' IQ scores were 6 years at the time of diagnosis were found to have more psychological problems and higher rates of smoking and alcohol consumption. The most frequent complaint was headache and the most common problem in school was denoted as difficulty in concentration. Our study demonstrated that most of the survivors of childhood leukemia are at risk of developing neuropsycological late effects.

Objectives: This prospective, observational, non-randomized study aimed to describe the relationship between treatment regimen prescribed and the quality of life (QoL) of ADHD patients in countries of Central and Eastern Europe (CEE) and Eastern Asia over 12 months. Methods: 977 Male and female patients aged 6-17 years seeking treatment for symptoms of ADHD were assessed using the Child and Adolescent Symptom Inventory-4 Parent Checklists, and the Clinical Global Impressions-ADHD-Severity scale. QoL was assessed using the Child Health and Illness Profile-Child Edition parent report form. Patients were grouped according to whether they were prescribed psycho-and/or pharmacotherapy (treatment) or not (no/'other' treatment). Results: No statistically significant differences were observed between cohorts (treatment vs. no/'other' treatment) in terms of change in QoL, although there was improvement over 12 months, with a greater improvement experienced by patients in the treatment cohort in both study regions (CEE and Eastern Asia). Psychoeducation/counselling and methylphenidate were the predominant ADHD treatments prescribed. Conclusions: Although both treatment and no/'other' treatment cohorts showed improvements in mean QoL over 12 months, the difference was small and not statistically significant. A major limitation was the higher than anticipated number of patients switching treatments, predominantly from the no/'other' treatment cohort. (J. of Att. Dis. 2012; 16(1) 44-59)

Background Although abnormalities in the regional cerebral blood flow (rCBF) responses to methylphenidate (MPH) treatment have been reported in children with attention deficit hyperactivity disorder (ADHD), there are few prospective longitudinal studies assessing the long-term effects of MPH and discontinuation effects after chronic treatment. Methods The authors studied ten drug-naive children (2 girls, 8 boys, mean age ± S.D. = 9.60 ± 1.96) diagnosed with ADHD by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria, using 99m Tc-HMPAO-single photon emission computed tomography (SPECT). Patients were studied at baseline (visit 1), after 2 months of MPH treatment (visit 2) and after a drug-free period of 2 months following 12 months of MPH treatment (visit 3) at doses of 1 mg/kg/day. We evaluated SPECT data visually and semi-quantitatively. Results Two months of chronic MPH treatment resulted in visually detectable improvement in hypoperfusion in the right frontal cortex and all areas of temporal cortex with the exception of left lateral temporal cortex. This improvement was still detectable on visual evaluations of SPECT data after 2 months of treatment discontinuation. The treatment effects that were detected visually were not statistically significant in semi-quantitative analyses. Conclusions Treatment effects of chronic MPH treatment may persist long after the discontinuation of the treatment.

Neurologic symptoms such as headache, vertigo, dizziness, and fainting can create a diagnostic problem in pediatric neurology practice because they are also the most common presenting symptoms of psychiatric disorders. Children, especially adolescents, who are often admitted with such autonomic symptoms, are frequently misdiagnosed. In this study, we aimed to investigate the psychiatric morbidity and comorbidity rate in children and adolescents presenting with neurologic symptoms such as headache, vertigo, and syncope. We investigated 31 children who presented with these symptoms. All children were evaluated for their medical history and had a physical and neurologic examination. We attempted to rule out a possible organic etiology. All patients received a complete laboratory examination (blood count, electroencephalography), pediatric cardiology and otorhinolaryngology consultations, and a caloric test. All patients were assessed according to Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) criteria. The majority of the patients (93.5%) received a psychiatric diagnosis according to the DSM-IV criteria. Most of these patients were adolescents and female. Psychosocial stressors such as academic problems, familial dysfunction, parental psychopathology, and child sexual abuse were associated with somatic symptoms. The results of this study demonstrated the importance of differential diagnosis and psychiatric comorbidity in a pediatric neurologic outpatient population. Treatment should be directed at biopsychosocial integrity, and a multidisciplinary treatment approach should be applied. (J Child Neurol 2004;19:332-336).

We aimed to evaluate the effect of chronic hepatitis B virus infection on the psychological state of children. Children who were carriers of hepatitis B virus (n:20) and those with chronic hepatitis B virus infection (n:20) for at least one year formed study Groups 1 and 2, respectively. Healthy children with similar demographic characteristics (n:43) were enrolled as the control group. The "Children's Depression Inventory" and "State-Trait Anxiety Inventory for Children" were used for the assessment of the extent of depression and anxiety, respectively. Then, mean depression and anxiety scores of the study and control groups were compared. In addition, the children in each group were further evaluated for depression and anxiety with respect to gender and age as prepubertal and postpubertal. The mean depression and anxiety scores of study Groups 1 and 2 and of the control group were 8.35 +/- 5.6, 8.22 +/- 6.85, 9.12 +/- 5.2 (depression scores) and 32.7 +/- 6.85, 33.4 +/- 10 and 34 +/- 6.5 (anxiety scores), respectively. These three groups did not differ significantly from each other with respect to anxiety and depression scores (p0.05). Athough there was no child with overt depression (with a depression score over 19) in study Group 2, two children in study Group 1 and one child in the control group were determined to be in overt depression. Children with chronic hepatitis B virus infection were not different with respect to depression and anxiety from children who were carriers of hepatitis B virus nor from the healthy controls.

Aim The aim of this study was to investigate the frequency of depressive symptoms in psoriasis vulgaris and lichen planus and to evaluate the relationship between the Beck depression scores and the Psoriasis Area and Severity Index (PASI) scores of subjects with psoriasis vulgaris. Subjects The study involved 120 subjects attending the dermatology clinic of Izmir Ataturk Training Hospital (Izmir, Turkey) and comprised 50 subjects with psoriasis vulgaris, 30 with lichen planus and 40 healthy control subjects. Results Subjects with psoriasis vulgaris, lichen planus and controls had depression scores of 58%, 53% and 20%, respectively. The Beck depression scores of patients with psoriasis vulgaris were significantly higher than those of the control group. The PASI scores showed a correlation with Beck depression scores. Smoking and drinking were very common in subjects with psoriasis vulgaris. There was no correlation between the duration of illness and depressive symptoms. Conclusions This study confirms the importance of depressive symptoms in two common dermatological diseases. It is important to recognize this association as it affects both clinical outlook and response to treatment.

clinical diagnosis of the study participants. In a formal de-blinding session the SD-BERA diagnoses were compared with the clinical DSM-IV diagnoses (SCID-I). The sensitivity of the method for schizophrenia vs. no-diagnosis controls was 82.7%, for ADHD vs. no-diagnosis controls 87.5%, and the specificity vs. no-diagnosis controls was 92.7 and 93.1%, respectively. The SD-BERA test indicated ADHD in 1/29 patients with clinical schizophrenia, and schizophrenia in 1/24 patients with clinical ADHD. The present study suggests that the SD-BERA method might provide useful biomarkers to support the clinical diagnoses of schizophrenia and adult ADHD. The findings also indicate variability in the neuronal organization of the brain stem with characteristics that differentiates the two neuropsychiatric disorders from each other and from no-diagnosis controls. Further studies of the SD-BERA method are in progress.

To the editor: Juvenile idiopathic arthritis (JIA) is the most common chronic pediatric rheumatic disease. In JIA, as in other chronic pediatric illnesses, a child’s illness affects the daily activities and functioning of the entire family. Families must deal with illness-related stressors such as the need for frequent medical visits, demands of the multicomponent treatment regimen, and unpredictable illness course. Adjustment problems were reported among mothers of children with JIA. Fifty percent of the mothers reported psychiatric distress [1]. We investigated the psychological profile of mothers of children with JIA, their attitudes to their children and their family functioning. In addition, parameters such as severity and duration of JIA, and pain that could affect the status of mothers were evaluated. Twenty-seven children with JIA, 29 healthy controls, and their mothers were evaluated in our outpatient clinic. Childhood Health Assessment Questionnaire, Beck Depression Inventory, State-Trait Anxiety Inventory, Parental Attitude Research Instrument, and Family Assessment Device were used for assessment parameters. The three criteria of the core set of outcome variables [2] such as physician’s global assessment, number of joints with active arthritis, and erythrocyte sedimentation rate (ESR) were selected as severity parameters. The duration and severity of JIA, and pain were correlated with mothers’ psychological well-being, attitudes, and functioning. There were statistically significant correlations between ESR in JIA cases and state anxiety (r=0.416, P=0.034), and between pain assessment-visual analog scale in JIA cases and attitude of maternal hostility and rejection (r=0.466, P=0.016) and marital discordance (r=0.418, P=0.034) in mother’s scales who have children with JIA. There was a significant positive correlation between the duration of JIA and behavior control (r=0.441, P=0.024) in mothers’ scales who had children with JIA. In addition, statistically significant negative correlation was found between the duration of JIA and state anxiety between the duration of JIA and state anxiety (r= 0.445, P=0.02). We showed increased duration of JIA-caused problems in the behavioral control of mothers of children with JIA. It was indicated that state anxiety of the mothers, which is defined as a transient momentary emotional status that results from situational stress that fluctuates in time and intensity, was associated with increased ESR in children with JIA in the present study. The ESR is an objective parameter in monitoring the disease activity of children with JIA. In addition, the sudden increase in ESR levels could be easily recognized by the mothers of children with chronic arthritis. This condition might have contributed to the mothers’ awareness, leading to anxiety. Because of this reason the mothers might be overprotective and behave in a more controlling manner toward their child. As in our findings, Scharloo et al. [3] indicated that a strong illness identity, passive coping, long illness duration, and unfavorable score on medical variables were associated with worse outcome on disease-specific measures of functioning in mothers. There was a positive correlation between pain in JIA cases and hostility and rejection of maternal role and marital discordance in mothers’ scales who have children with JIA. Williamson et al. [4] suggested that the A. P. Akay (&) AE A. Ozbek AE B. Baykara Department of Child and Adolescent Psychiatry, Dokuz Eylul University Faculty of Medicine, Inciralti, Izmir, Turkey E-mail: pekcanlara@yahoo.com Tel.: +90-232-4123559 Fax: +902322776686