Objectives: This study aimed to determine the impact of maternal attachment styles on the oxygen saturation level of infants in relation to the health behavior. Methods: The data for the current study was collected from mothers who were being treated in Newborn Intensive Care by dividing their newborns into two groups in accordance with their changed oxygen levels to determine an effective health behavior for treating them and achieving the required health outcomes. In this regard, the health behavior of the mothers, focusing on their psychological and physical well-being, was also taken into consideration. Psychometric measures were evaluated by instruments like State-Trait Anxiety Inventory, Hamilton Rating Scale for Depression, Hamilton Anxiety Rating Scale, Experiences in Close Relationships, and Relationship Scales Questionnaire. Results: Sixty-nine newborns and their mothers were included in the study. It was discovered that mothers of infants whose oxygen levels increased after contact had significantly higher rates of secure attachment, due to effective health behavior practices, than those with fearful and dismissing attachment styles. Infants′ oxygen saturation level whose mothers had higher rates on the HAM-A somatic subscale did not change or worsened significantly after physical contact (46.7%, 23.5%, p = 0.050, respectively). Conclusions: It was found that the change in an infant's oxygen saturation level after physical contact may be associated with the maternal attachment patterns which are highly influenced by mothers′ health behavior.

Background: Vitamin D has been found to be associated with the pathogenesis of attention deficit hyperactivity disorder (ADHD). However, the potential role of parathyroid hormone (PTH) is still unclear. Aim: We aimed to investigate the association between calcium metabolism and ADHD symptomatology. Methods: We included 106 participants aged between 7 and 13 years old (51 ADHD patients, mean age: 9.54 ± 1.77, 55 healthy controls mean age: 9.97 ± 0.94) to this study. K-SADS-PL and Conners' Parent/Teacher Rating Scales, Stroop Test were performed. Blood samples to measure serum levels of Vitamin D, PTH, calcium (Ca), magnesium (Mg), phosphorus (P), and alkaline phosphatase (ALP) were collected in the spring (March–April–May) to prevent seasonal variability. Results: PTH, P, and ALP values were significantly lower and Vitamin D, Ca, and Mg values were significantly higher in the ADHD group (P < 0.05, for all). Both groups had Vitamin D deficiency. Control group has lower Vitamin D levels than the ADHD group (respectively; 17.66 ± 9.07, 21.99 ± 10.99, P < 0.05). There was a negative correlation between PTH and CTRS hyperactivity, CGI-RI and CGI-EL sub-scores, CGI-Total, DSM-IV-Inattention, DSM-IV Hyperactivity/Impulsivity, DSM-IV-Total scores (P < 0.05, for all). Conclusions: We found lower PTH levels in ADHD patients and a strong and negative correlation between PTH and symptom severity. Future studies are needed to clarify if these findings are due to the key role of PTH in ADHD pathology or PTH's function in activating vitamin D.

This study aims to examine 167 adolescents who were referred by courts between 2008 and 2016 to prepare medical–legal reports on their suitability for marriage. Most were illiterate or graduates of primary/secondary school; only 17 (10.2%) were still at high school. A total of 95 girls (56.9%) had a religious marriage without a civil certificate, 63 girls (37.7%) were pregnant, and 15 (9%) had a child. According to medical reports, 91 of the girls were considered unsuitable for marriage; 76 girls who were pregnant and/or had a child were also considered unsuitable, so it was necessary to let the judge decide.

Ayşegül Yolga Tahiroğlu1, Gonca Gül Çelik2, Ayse Avci1, Canan Kuygun Karcı3 1Prof., 2Assis. Prof., Çukurova University Medical Faculty Child And Adolescent Psychiatry, Adana, Turkey https://orcid.org/0000-0002-3039-2864-https://orcid.org/0000-0001-6101-0796-https://orcid.org/0000-0001-5450-4659 3M.D., Dr. Ekrem Tok Psychiatry Hospital, Child And Adolescent Psychiatry, Adana, Turkey https://orcid.org/0000-0002-9355-9449

Objective: In recent years the use of antipsychotics (APs) for neurodevelopmental, behavioral and psychiatric disorders in children and adolescents has significantly increased while the age of prescription has decreased. To the best of our knowledge, there is very limited data about the use of APs in the clinical practice in Turkish children and adolescents with different psychiatric disorders. The aim of this retrospective study was to analyze the relationship between the use of different APs and clinical factors in a child and adolescent outpatient clinic in Turkey. Methods: Medical records of 4623 patients referred to the Children and Adolescent Psychiatry outpatient clinic between May 2013 and September 2014 were reviewed retrospectively. Results: The analyses included 304 (6.6%) patients who were prescribed APs medications. The sample was predominantly male (61.5%) and mean age was 11.4±4.3 years. The most commonly prescribed APs were risperidone, aripiprazole, haloperidol and olanzapine, respectively. Diagnoses upon admission to clinic in descending order of frequency are disruptive behavior disorders (DBD), mental retardation (MR), bipolar disorder (BPD), posttraumatic stress disorder, autism spectrum disorder (ASD) and psychotic disorder. Risperidone was the most preferred drug in all diagnosis groups. Approximately 30% of the patients have comorbid medical conditions. The rate of Aripiprazole was more in females than males (p=0.003), and risperidone was more used in male than in female patients (p=0.001). It was detected that risperidone was more selected with the diagnosis of mental MR/ASD and DBD, olanzapine was more chosen for the diagnosis of psychotic disorder/BPD, aripiprazole was preferred for the diagnosis of anxiety disorders and psychotic/BPD than other diagnoses (in all comparison; p<0.05). Conclusion: Previous studies in outpatients are mainly prescription studies, which stated that APs are mainly used off-label. Specifically, risperidone was the most prescribed SGA in almost all studies on the prevalence of prescriptions in children and adolescents as well as in an adolescent inpatient setting with the exception of one study performed in Italy. Consistent with the literature, the most common diagnostic category for which APs were used in patients was DBD. Effectiveness of risperidone on autism-related aggression/irritability and conduct disorder has been shown. Consistent with the literature, we have detected that risperidone was preferred with the diagnosis of MR/ASD and DPD. Effectiveness of aripiprazole for psychosis and BPD has been shown. Consistent with the literature, we have detected that aripiprazole was more prescribed with the diagnosis of psychosis and BPD. Furthermore in our study aripiprazole was preferred for the diagnosis of anxiety disorders. However, there is insufficient evidence in child and adolescent anxiety disorders. The upward trends in the use of APs have not been matched by advances in the understanding of AP safety profiles in this group of patients. It is therefore crucial to produce up-to-date syntheses of the evidence and clinical guidelines for the use and monitoring of these treatments in pediatric populations.

We aim to explore the importance of early differential diagnosis of an organic etiology such as intestinal malrotation and psychiatric disorder. We present a child with an intestinal malrotation, who had no symptoms until she was 4 year old. The child presented with sudden cessation of oral food intake and constipation. The diagnosis was missed at another center, as there were many accompanying psychiatric symptoms. The child improved after surgery, and the severity of the psychiatric symptoms decreased. This case emphasizes that an organic disorder can be confused with a mental disorder. Many patients with intestinal malrotation present with abdominal discomfort since childhood, while others present with relatively sudden onset of symptoms. The clinician should consider all symptoms to avoid missing that important and treatable condition.

Objective: Gender assignment in infants and children with disorders of sex development (DSD) is a stressful situation for both patient/families and medical professionals. Methods: The purpose of this study was to investigate the results of gender assignment recommendations in children with DSD in our clinic from 1999 through 2019. Results: The mean age of the 226 patients with DSD at the time of first admission were 3.05±4.70 years. 50.9% of patients were 46,XY DSD, 42.9% were 46,XX DSD and 6.2% were sex chromosome DSD. Congenital adrenal hyperplasia (majority of patients had 21-hydroxylase deficiency) was the most common etiological cause of 46,XX DSD. In 46,XX patients, 87 of 99 (89.7%) were recommended to be supported as a female, 6 as a male, and 4 were followed up. In 46,XY patients, 40 of 115 (34.8%) were recommended to be supported as a female, and 70 as male (60.9%), and 5 were followed up. In sex chromosome DSD patients, 3 of 14 were recommended to be supported as a female, 9 as a male. The greatest difficulty in making gender assignment recommendations were in the 46,XY DSD group. Conclusion: In DSD gender assignment recommendations, the etiologic diagnosis, psychiatric gender orientation, expectation of the family, phallus length and Prader stage were effective in the gender assignment in DSD cases, especially the first two criteria. It is important to share these experiences among the medical professionals who are routinely charged with this difficult task in multidisciplinary councils.

Purpose: This study aims to examine the relationship of the pre-school childhood masturbation with the parental attitude as well as the relation of the same with the comorbidity and related stammering, tic disorders, nail biting, nocturnal enuresis (NE) and encopresis. Materials and Methods: In this study, parents of 105 preschool children (between the ages of 3 - 6) were interviewed. 50 out the 105 interviewed parents’ children had have been with childhood masturbation (CM) and they are receiving professional consultancy or support services and these parents constitute the case group of this study. The control group was formed with the parents of 55 children. Research data were obtained by of the Personal Information Form filled by the parents, Parental Attitude Scale (PAS) and Comorbid Problems Determination Form prepared by the researcher. Results: Authoritarion parental attitude is discovered to be statistically higher than the case group with CM compared to the control group without such disorder. It has been detected that nail biting, NE and encopresis comorbidity is significantly higher in the case group with CM compared to the control group. Conclusion: There was a direct relationship between authoritarian parental attitudes and the CM that emerged in pre-school childhood. Along with CM the rate of frequency of nail biting, NE and encopresis are higher than the control group.

Amaç: Bu çalışmada okul öncesi dönemde çocukluk çağı masturbasyon bozukluğunun ebeveyn tutumları ile ilişkisinin ve kekemelik, tik bozukluğu, tırnak yeme, enürezis noktürna, enkoprezis ile komorbiditesinin incelenmesi amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada 105 okul öncesi çocuğun (3-6 yaş) ebeveynleri ile görüşülmüştür. Görüşülen 105 ebeveynin 50’si çocuklarına Çocukluk çağı masturbayon (ÇÇM) bozukluğu tanısı konulan ve profesyonel danışmanlık veya destek hizmeti alan kişilerdir ve bu ebeveynler çalışmanın olgu grubunu oluşturmaktadır. Kontrol grubu 55 çocuğun ebeveynleri ile oluşturulmuştur. Araştırma verileri, ebeveynlerin doldurduğu Kişisel Bilgi Formu, Ebeveyn Tutum Ölçeği ve araştırmacı tarafından hazırlanan Alışkı Sorunları Belirleme Bilgi Formu kullanılarak elde edilmiştir. Bulgular: Otoriter ebeveyn tutumu ÇÇM bozukluğu olan olgu gurubunda, bu bozukluğun olmadığı kontrol grubuna göre istatistiksel olarak yüksek bulunmuştur. ÇÇM bozukluğu olan olgu grubunda, kontrol grubuna göre anlamlı düzeyde yüksek tırnak yeme, enürezis noktürna, enkoprezis komorbiditesi saptanmıştır. Sonuç: Otoriter ebeveyn tutumu ile okul öncesi çocukluk döneminde ortaya çıkan ÇÇM arasında doğrudan bir ilişki olduğu görülmüştür. ÇÇM ile birlikte tırnak yeme, enürezis noktürna, enkoprezis görülme sıklığı kontrol grubuna göre daha yüksektir.

Background: We sought to investigate the changes in hypothalamic-pituitary-adrenal (HPA) axis after methylphenidate (MPH) treatment, and their association with attention deficit hyperactivity disorder (ADHD) symptomatology. Methods: We included 86 children with ADHD and 58 healthy controls in this study. Morning cortisol was measured at baseline, 1st, 3rd, 6th month of MPH treatment. K-SADS-PL and Conners' Parent/Teacher Rating Scales (CTRS and CPRS) were collected at each visit. Results: There was an increase with borderline significance (p=0.054) in cortisol levels measured before and after the 6th month of MPH treatment. However, there was no significant change in control group (p > 0.05). In gender subgroups there was a significant change in boys (p = 0.008), whereas no similar increase was found in girls (p > 0.05).While there was a significant increase in cortisol levels of ADHD combined (ADHD-C) type, no significant change was found in ADHD inattentive (ADHD-I) type. Boys had higher rates of improvement in most of the subscales. While there was a significant decrease in all subscale scores of CTRS and CPRS in ADHD-C group, there was no significant difference in most subscales in ADHD-I group. Conclusions: Change in plasma cortisol levels may be useful in predicting the long-term treatment response, especially in the male gender and ADHD-C subgroup.

Amac: Bu calismada okul oncesi donemde cocukluk cagi masturbasyon bozuklugunun ebeveyn tutumlari ile iliskisinin ve kekemelik, tik bozuklugu, tirnak yeme, enurezis nokturna, enkoprezis ile komorbiditesinin incelenmesi amaclanmistir.  Gerec ve Yontem: Arastirma icin Adana ilinde yasayan 105 okul oncesi cocugun (3-6 yas) ebeveynleri ile gorusulmustur. Gorusulen 105 ebeveynin 50’si cocuklarina Cocukluk cagi masturbayon (CCM) bozuklugu tanisi konulan ve profesyonel danismanlik veya destek hizmeti alan kisilerdir ve bu ebeveynler calismanin olgu grubunu olusturmaktadir. Kontrol grubu, okul oncesi egitim kurumlarinda egitim almis ve masturbasyon aliskanligi problemi yasamamis ancak diger davranis problemleri nedeniyle psikolojik danisma merkezine basvuran 55 cocugun ebeveynleri ile olusturulmustur. Arastirma verileri, ebeveynlerin doldurdugu Kisisel Bilgi Formu, Ebeveyn Tutum Olcegi ve arastirmaci tarafindan hazirlanan Aliski Sorunlari Belirleme Bilgi Formu kullanilarak elde edilmistir.  Bulgular: Otoriter ebeveyn tutumu CCM bozuklugu olan olgu gurubunda, bu bozuklugun olmadigi kontrol grubuna gore istatistiksel olarak yuksek bulunmustur (p=0,032). Asiri koruyucu ebeveyn tutumu ise olgu grubunda, kontrol grubuna gore istatistiksel olarak daha dusuk bulunmustur (p=0,012). CCM bozuklugu olan olgu grubunda, kontrol grubuna gore anlamli duzeyde yuksek tirnak yeme, enurezis nokturna, enkoprezis komorbiditesi saptanmistir (pu003c0,05).  Sonuc: Arastirma sonucunda otoriter ebeveyn tutumu ile okul oncesi cocukluk doneminde ortaya cikan CCM arasinda dogrudan bir iliski oldugu gorulmustur. CCM ile birlikte tirnak yeme, enurezis nokturna, enkoprezis gorulme sikligi kontrol grubuna gore daha yuksektir.

Purpose: In this study, we aimed to investigate the sociodemographic and clinical characteristics of children and adolescents diagnosed with tic disorders.Materials and Methods: The study population included 187 children with tic disorders, aged between 4 and 18 years. The data were obtained by using Yale Global Tic Severity Scale (YGTSS), Screen for Child Anxiety and Related Disorders, Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL). The demographic information, history of familial diseases were recorded.Results: The study included 37 girls (mean 10.9 +/- 2.5 years) and 150 boys (mean 10.9 +/- 2.7 years) with a mean age of 10.9 +/- 2.6 years. Of all cases, 135 were classified as Tourette Syndrome (n=135; 72,2%), 50 as motor tics (n=50; 26,7 %) and 2 as others tic disorders (n=2; 1,1%) according to the diagnostic tic disorders subtype. There was no significant difference between the two groups in terms of mean age and first symptom age according to the subtype of tic disorder. In 91% of the cases, the age of onset of tics was 12 years or younger. The rate of having at least one comorbidity, mean number of comorbidities and comorbid ADHD rates were significantly higher among boys than girls. The most common comorbid diagnoses were ADHD (n=142, 75.9%), OCD (n= 08, 57.8%) and anxiety disorder (n=57, 30.4%).Conclusion: In our study, male cases, early onset and multiple comorbid diagnoses were found to be significantly higher in childhood tic disorders.

Amaç: Bu çalışmada, tik bozukluğu tanısı alan çocuk ve ergenlerin sosyodemografik verileri, klinik özellikleri ve eşlik eden diğer ruhsal bozuklukların araştırılması amaçlanmıştır. Gereç ve Yöntem: Çalışmaya, Tik Bozukluğu tanısı olan 4-18 yaş aralığında 187 olgu alındı. Ruhsal belirtilerin taranması amacı ile Okul Çağı Çocukları İçin Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi-Şimdi ve Yaşam boyu Şekli Türkçe uyarlaması ÇDŞG-ŞY (K-SADS-PL), Tik belirti şiddeti için, Yale Genel Tik Ağırlığını Derecelendirme Ölçeği (YGTDÖ) kullanıldı. Olguların demografik bilgileri ve ailesel hastalık öyküleri kaydedildi. Bulgular: Çalışmaya, ortalama yaşı 10,9±2,6 yaş olan, 37 kız (ortalama 10,9±2,5 yaş) ve 150 erkek (ortalama 10,9±2,7 yaş) olgu alındı. Tik Bozukluğu alt tipine göre olguların 135’i (%72,2) Tourette Sendromu, %26,7’si (n=50) motor tik bozukluğu, 2’si (%1,1) bunların dışında bir tik bozukluğu tanısı aldı. Tik Bozukluğu alt tipine göre olguların ortalama yaşı, ilk belirti yaşı açısından iki grup arasında anlamlı fark yoktu. Olguların % 91’inde tiklerin başlangıç yaşı, 12 yaş ve altında idi. Kızlara göre erkekler arasında en az bir eş tanıya sahip olma oranı, ortalama eş tanı sayısı ve dikkat eksikliği hiperaktivite bozukluğu (DEHB) eş tanı oranı anlamlı biçimde daha fazlaydı. En sık görülen eş tanılar, DEHB (n=142, %75,9), obsesif kompulsif bozukluk (OKB) (n=108, %57,8) ve anksiyete bozukluğu (n=57, %30,4) idi. Sonuç: Çalışmamızda, çocukluk çağı tik bozukluklarında erkek olgu, erken başlangıç ve çoklu eş tanıların belirgin düzeyde yüksek olduğu bulunmuştur.

Choking phobia is characterized by the extreme fear about swallowing and avoidance of eating, swallowing solids and/or liquids1. During childhood, vomiting and painful traumatic experiences can cause maladaptive eating behavior. These patients reject eating solid foods as a result of this they may lose weight 2. Here, we report a pediatric patient whose eating refusal occurred after death of her grandfather, and was treated successfully with haloperidol and behavioral intervention.

Introduction: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), a subgroup of obsessive-compulsive disorder (OCD), has received much attention even though the specific underlying mechanisms remain unknown. Mannose-binding lectin (MBL) is a key factor in the innate immune response. The aim of this study was to investigate the role of MBL2 gene polymorphisms in pediatric OCD patients diagnosed as PANDAS, PANDAS-Variant and non-PANDAS. Methods: The study included 102 pediatric OCD patients (59 [57.8% ] PANDAS, 20 [19.6%] non-PANDAS, and 23 [22.5%]PANDAS-Variant) and 60 healthy controls. Polymorphisms at codon 52, 54 and 57 of the MBL2 gene were investigated. Results: Codon 54 polymorphism and any variant of MBL2 gene were significantly more frequent in the OCD group than in the control group (OR=2.97, 95% CI: 1.26-6.97; and OR=2.66, 95% CI: 1.32-5.38, respectively). According to regression analysis, the presence of any variant of MBL2 gene was found in 14.50-fold increased frequency in the PANDAS subgroup compared with the non-PANDAS subgroup (95% CI: 2.49-84.19). Conclusions: Our findings support an association between MBL2 genotypes and pediatric OCD, particularly PANDAS-OCD.

Amaç: Obsesif-Kompulsif Bozukluğun (OKB) bir alt grubu olan PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections), altta yatan spesifik mekanizmaları bilinmemesine rağmen, çok dikkat çekmeye başlamıştır. MBL (mannoz bağlayıcı lektin), doğal bağışıklık yanıtta anahtar bir faktördür. Bu çalışmanın amacı, PANDAS, Variant-PANDAS ve Non-PANDAS tanılı pediatrik OKB’li hastalarda MBL-2 gen polimorfizminin rolünü araştırmaktır.

10th International Congress on Psychopharmacology & 6th International Symposium on Child and Adolescent Psychopharmacology[Abstract:0110] [Addiction]Cessation of cigarette smoking in adolescents: s...

Background: Disclosing the sexual abuse may be related on many individual and/or environmental factors in all age groups. The sociocultural context is the most influential factor of the disclosing process especially for those living in patriarchal cultural values. This study compares the impacts of sexual abuse and other sociodemographic variables between recanting and non-recanting victimized groups in Adana city from Turkey.Methods: The samples attending our department were divided into two groups: group 1 comprised victims who recanted their first abuse disclosure, and group 2 comprised victims who insisted on the veracity of their first report at further evaluations. The characteristics of the child, family, and abuser were compared between recanting victims and non-recanting victims by retrospective data.Results: Each group included 27 children, for a total of 54 subjects. All adverse social reactions after the sexual abuse, including keeping secrets and a repressive family attitude, were higher among group 1 victims than group 2 victims (p<0.0001).Conclusions: Although they are victimized by protecting family integrity, victims may show a tendency to keep secrets and to not immediately disclose an abuse event.

Grief mania that is evaluated as psychogenic mania in the literature is related to manic episode that emerges after the loss of a loved one. There are not many cases that associate causality of beginning of mania and mourning in the literature. It is known that mania is induced by traumatic events but the cases that do not suit stages of development of grief process are evaluated as pathological grief. In this case, the woman who experienced manic episode after her son’s death is presented. This case is prepared because mania should be considered as possible grief reaction. Case presentation: A patient who is 40 years old, married, mother of 4 children is brought by relatives because of aggressiveness, tension, insomnia for 4 days, fast and talk a lot and nonsense laughing attacks. She was presented to hospital for stressful life events 2 years ago and started to be on medication (escitalopram 10 mg) because of depression and fibromiyaliji diagnosis. She used medication for 1.5 years and she did not use any medication for the last 6months. There is no history for mental disorder in her family. Psychological examination: her interest for the environment was increased, self-care ability got better, her temperament was cheerful, her sociability was respectful, amount of talking and tone of voice increased, mimic and gesture was appropriate for her temperament, sleeping decreased, thought flow increased and achieved goal of conversation late. Moreover, there were grandiose delusions and hypervigilance, affect was close to euphoria, her psychomotor behaviours increased and social functioning decreased. According to biochemical and radiological workup, there was no pathological situation. The client started to use Lithium 900 mg/day and Olanzapin 10 mg/day because of the bipolar disorder diagnosis. The patient’s blood lithium level was 0.8mEq/L and lithium was used 1200 mg/day and then 10 days later the patient’s blood lithium level was 0.72 mEq/L. According to clinical observations, the patient’s manic symptoms remained. Furthermore, the patient started to cry occasionally after 1 month and her grandiosity disappeared. The patient was discharged from the hospital after 45 days. The patient met the criteria for manic episode in DSM 5. The patient did not take any medication for last 6 months. Thus, it is considered that this situation was not induced by medication. It puts the patient into risk group because she was treated for depression before but it is not considered as bipolar depression because there were psychiatric history in the family and depression that experienced 2 years ago was related to stressful life events. It is considered that this case experienced grief/funeral mania because there was contiguity between loss of her son and manic episode, the patient did not react this way to previous challenging life events and the patient was outside of the ordinary 5 stages of grief process.