AIM:The aim of this study was to compare the clinical characteristics of childhood-onset schizophrenia (COS) and early-onset schizophrenia (EOS) during the first- episode psychosis and the stable period, to examine psychopharmacological treatment approaches, and to investigate potential predictive factors for prognosis. METHODS:Demographic, clinical, and psychopharmacological therapy data for 31 patients diagnosed with COS and 66 with EOS were retrieved from the file records in this multicenter study. Symptom distribution and disease severity and course were evaluated twice, in the acute psychotic stage and in the latest stable phase, during follow-up using the positive and negative syndrome scale (PANSS) and clinical global impression (CGI) scales. RESULTS:A statistically significant difference was observed between the groups' CGI improvement rates and median last stable stage PANSS positive, negative, and general psychopathology symptom scores (p = .005, p = .031, p = .005, and p = .012, respectively). Premorbid neurodevelopmental disorder and obsessive-compulsive disorder and comorbidities were more common in the COS group (p = .025 and p = .030, respectively), and treatment required greater multiple antipsychotic use in that group (p = .013). When the independent variables affecting the difference between pre- and post-treatment PANSS scores were examined using linear regression analysis, the model established was found to be statistically significant (F = 5.393; p = .001), and the group variable (p = .024), initial disease severity (p = .001), and socioeconomic level (p = .022; p = .007) emerged as predictive factors for the disease course. CONCLUSION:Although early diagnosis and treatment is an important factor in improving prognosis in schizophrenia, more specific predictors for schizophrenia need to be identified. Additionally, preventive programs and pharmacological methods need to be developed in children with neurodevelopmental problems, particularly those from low socioeconomic status families.

The etiology of tic disorders (TDs) is not precisely known, although several lines of evidence suggest involvement of the immune system in pathogenesis. Here, we aimed to determine the expression levels of pro-inflammatory and anti-inflammatory cytokines in children with TD and compare them with those of healthy controls. Furthermore, we also evaluated their association with clinical variables in the TD group. Within the study period, 88 children with tic disorders and 111 healthy control children were enrolled. Most children with tic disorders were diagnosed with Tourette’s disorder (n = 47, 53.4%) or persistent motor tic disorder (n = 39, 44.3%), while the remainder (n = 2, 2.3%) were diagnosed with persistent vocal tic disorder. We found that children with tic disorders had significantly elevated levels of IL-1β, TNF-α, IL-6 and IL-4 expression, while we detected lower expression levels of IL-17 in children with tic disorders. Our findings provide a molecular landscape of cytokine expression in children with TD, which may suggest a proinflammatory state not affected by the presence of comorbidity and symptom severity. Delineating the contribution of alterations in the immune system to the pathogenesis of tic disorders may pave the way for better therapeutic interventions.

Introduction: USP9X has been associated with neurodevelopmental disorders due to its role in synaptic development and neural function. This study aimed to compare USP9X and TGF-(3 levels in children with autism and healthy controls, and explore their relationship with autism severity. Methods: Serum USP9X and TGF-(3 levels were measured in 41 healthy control children (aged 3-12 years) and 41 children with autism. Results: Our study revealed a significant increase in USP9X levels (p=0.001) among children with autism compared to controls. However, TGF-(3 levels showed no significant difference between the two groups. Furthermore, we observed a positive correlation between difficulty in making eye contact subscale and blood levels of both USP9X and TGF-(3. Conclusions: This study is the first to compare serum USP9X levels in children with autism to healthy controls. Our findings suggest USP9X's potential role in autism development, emphasizing the need for further research on its involvement in neurodevelopmental processes.

The aim of this study was to compare the levels of thyroid hormones in children with ADHD and ADHD-NOS and to assess the relationship between ADHD symptom severity, anxiety symptom severity and thyroid hormone levels. The study was planned as a cross-sectional, retrospective study. The records of patients who applied to the study center in between January 2012 and January 2013 were screened and 205 ADHD and ADHD-NOS cases' records were evaluated. Both groups were compared according to thyroid hormon levels. The diagnosis of 205 patients' records and their comorbid psychiatric disorders was made clinically. ADHD symptom severity was assessed by Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S). Anxiety symptom severity was assessed by The Screen for Anxiety Related Emotional Disorders (SCARED). Groups were compared with parametric or non-parametric methods according to assumptions of normality. P was set at 0.05 (two-tailed). Among the whole sample, 99 (48.3 %) patients were ADHD, and 106 (51.7 %) patients were ADHD- NOS. The average age of the children in the ADHD group was 10.88 ± 3.02 years, and the average age of the children in the NOS-ADHD group 9.93 ± 2.49 years. Thyroid hormone levels were detected in 81 of 205 patients participating in the study. We found statistically significantly higher T4 levels in the ADHD group compared to the ADHD-NOS group (p=0.006). A statistically significant negative correlation between the total number of diagnoses and T4 level was noted (p=0.001). TSH levels correlated significantly with T-DSM-IV-S total score and symptom counts in the Hyperactivity subscale of this measure. Thyroid hormone levels may be affected in children with impairing ADHD symptoms and increased comorbidities. Our results should be supported with future studies.

OBJECTIVE:The aim of this study is to investigate whether there may be differences in the measurements of the orbital region between healthy children and children with attention deficit hyperactivity disorder (ADHD).METHODS:In this study, the orbital region measurements of 310 children, including 130 ADHD children and 180 healthy children aged 7 to 11 years, were analyzed. For this analysis, anterior view photographs of these individuals were used. For both sides, endocanthion (en), exocanthion (ex), and pupil (p) were determined in these photographs. A total of 5 distances (ex-ex, en-en, ex-en for the right side, ex-en for the left side and p-p) were analyzed using these points.RESULTS:In both sexes, no statistically significant difference was observed between the 2 groups in all 6 parameters analyzed.CONCLUSION:Although it was concluded that there was no difference in orbital measurements between healthy children and children with ADHD in this study, it was thought that a definite conclusion could not be reached because the cases examined belonged to a single center. Therefore, it is thought that multicenter studies in which more individuals are evaluated are needed.

OBJECTIVE:To compare psychiatric emergencies and self-harm at emergency departments (EDs) 1 year into the pandemic, to early pandemic and pre-pandemic, and to examine the changes in the characteristics of self-harm presentations.METHOD:This retrospective cohort study expanded on the Pandemic-Related Emergency Psychiatric Presentations (PREP-kids) study. Routine record data in March to April of 2019, 2020, and 2021 from 62 EDs in 25 countries were included. ED presentations made by children and adolescents for any mental health reasons were analyzed.RESULTS:Altogether, 8,174 psychiatric presentations were recorded (63.5% female; mean [SD] age, 14.3 [2.6] years), 3,742 of which were self-harm presentations. Rate of psychiatric ED presentations in March to April 2021 was twice as high as in March to April 2020 (incidence rate ratio [IRR], 1.93; 95% CI, 1.60-2.33), and 50% higher than in March to April 2019 (IRR, 1.51; 95% CI, 1.25-1.81). Rate of self-harm presentations doubled between March to April 2020 and March to April 2021 (IRR, 1.98; 95% CI, 1.68-2.34), and was overall 1.7 times higher than in March to April 2019 (IRR, 1.70; 95% CI, 1.44-2.00). Comparing self-harm characteristics in March to April 2021 with March to April 2019, self-harm contributed to a higher proportion of all psychiatric presentations (odds ratio [OR], 1.30; 95% CI, 1.05-1.62), whereas female representation in self-harm presentations doubled (OR, 1.98; 95% CI, 1.45-2.72) and follow-up appointments were offered 4 times as often (OR, 4.46; 95% CI, 2.32-8.58).CONCLUSION:Increased pediatric ED visits for both self-harm and psychiatric reasons were observed, suggesting potential deterioration in child mental health. Self-harm in girls possibly increased and needs to be prioritized. Clinical services should continue using follow-up appointments to support discharge from EDs.DIVERSITY & INCLUSION STATEMENT:One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

The aim of this study is to determine the functioning of adults with autism spectrum disorders (ASDs) diagnosed in childhood and depression and burnout levels among their parents. A total of 261 adults with ASDs and their parents were recruited for the study. Both parents completed the Beck Depression and Maslach Burnout Inventories and reported the functioning of their adult offspring with ASDs. Only 5.4 % of our sample reported "good" or "very good" outcomes. The most common psychiatric comorbidities were intellectual disabilities and attention-deficit/ hyperactivity disorder. Maternal burnout and depression scores were significantly elevated compared to those of fathers. There is an undeniable urgent need for more research to identify the needs of adults and families suffering from ASD. Modifications for those with ASD may have to be made for support in workplaces, achieving driving licenses, using public transportation and attendance at tertiary education.

Objectives: There is a diagnostic overlap between the symptom clusters of Disruptive Mood Dysregulation Disorder (DMDD) and Oppositional Defiant Disorder (ODD).In this study we aim to compare behavior problems in these two disorders as quantified by the Conners' Parent Rating Scale scores. Materials and Methods:In a sample of 96 children between the ages of 8-12 who presented to Gaziantep University, Department of Child and Adolescent Psychiatry, Gaziantep, Turkey with irritability or anger outbursts and were diagnosed with either DMDD or ODD, we conducted a semi-structured clinical interview to assess comorbidities and we obtained Conners' Parent Rating Scale Scores.Results: All those diagnosed with DMDD had comorbidities, and DMDD was associated with a higher frequency of comorbidities than ODD.The most common lifetime comorbidity was Attention Deficit and Hyperactivity Disorder with 96.0%.96.0% of the cases diagnosed with DMDD also met the diagnostic criteria for ODD.Conners' Scale results showed that there was a statistically significant difference between the two groups in terms of mean total score (p<0.05), which was 47.4±18.3 in the ODD group and 64.3±20.1 in the DMDD group.Regarding the subscale scores, these was a statistically significant difference among the groups in the Conduct Problems and Anxiety Subscales (p<0.05), which were higher in the DMDD group, whereas there was not a statistically significant in the other subscale scores (p>0.05).Amaç: Yıkıcı Duygudurum Düzenleyememe Bozukluğu (YDDB) ve Karşıt Karşı Gelme Bozukluğu (KOKGB) belirti kümeleri arasında tanısal bir örtüşme vardır.Bu çalışmada bu iki tanı grubu arasında Conners Ebeveyn Derecelendirme Ölçeği puanlarıyla ölçülen problemleri davranışlarla ile ilişkili belirtileri karşılaştırmayı amaçladık. Gereç ve Yöntem:

Recent studies show that oxidative stress has an important role in the etiology of autism. In our study, Nrf2, which is the main regulator of cellular antioxidant response, and Keap1 and Gsk-3β, which are the main proteins that regulate this pathway, were compared between children with autism and healthy controls. To the best of our knowledge, our study is the first in which Nrf2, Keap1 and Gsk-3β levels were evaluated together in children with ASD. In our study, Nrf2 level was found to be lower and Keap1 level higher in children with autism. Although GSK-3β is increased in many psychiatric and neurodegenerative diseases, it was found to be low in the autistic group in accordance with the literature. In conclusion, considering the versatile modulation of the Nrf2 pathway, this article does not provide any mechanistic insight into the pathway, but it suggests that Nrf2, Keap1 and Gsk-3β, which have central roles in oxidative stress, may play a role in the pathophysiology of autism.

Giriş ve Amaç: Otizm Spektrum Bozukluğunun etiyolojisini saptamaya yönelik çalışmalarda kesin bir sebep bulunamamış olmakla birlikte literatürde artan kanıtlar, oksidatif stresin otizmin gelişimi ve klinik tezahüründe rol oynadığını düşündürmektedir. Çalışmamız oksidatif stres ile otizm spektrum bozukluğu arasındaki ilişkinin değerlendirilmesinde güçlü bir oksidan olan peroksinitritin destekleyici biyokimyasal belirteç olarak kullanılıp kullanılamayacağını araştırmak için tasarlanmıştır ve bildiğimiz kadarıyla peroksinitritin otizmli çocukların serumlarında çalışıldığı ilk çalışmadır. Yöntemler: Araştırmamızda 3-12 yaş aralığındaki 40 otizmli çocuk ile aynı yaş grubundaki 40 sağlıklı kontrol çocuğun serum peroksinitrit düzeyleri ölçülmüş ve peroksinitrit düzeyi ile otizm şiddeti arasındaki ilişki araştırılmıştır. Otizm semptomlarının şiddeti, Childhood Autism Rating Scale puanlarına göre değerlendirildi. Bulgular: Çalışmamızda vaka ve kontrol grupları arasında peroksinitrit değerleri açısından istatistiksel olarak anlamlı farklılık belirlenmiştir (p=0,010). Verilerimiz Peroksinitrit düzeyleri ile otizm şiddeti arasında ise anlamlı ilişki olmadığını göstermektedir (p=0,527). Sonuç: Bulgularımız otizmde oksidatif stresin arttığına dair artan kanıtlarla tutarlı olarak peroksinitrit düzeylerinin otizm tanısı olan grupta daha yüksek olduğunu göstermekte ve oksidatif stresin otizm patofizyolojisindeki rolüne işaret etmektedir. Peroksinitrit gibi güçlü oksidanlar ve bu yolaktaki farklı biyobelirteçlerin kombinasyonlarının dikkate alınarak tasarlandığı çalışmaların Otizm Spektrum Bozukluğu fizyopatolojisinin daha iyi anlaşılmasını sağlayabileceği ve potansiyel tedaviler için yol gösterici olabileceği düşünülmektedir.

Objective: ADHD is associated with increased sleep problems and circadian rhythm disturbances. This study aimed to examine ADHD patients and healthy controls in terms of chronotypic features and expression levels of CLOCK, PER1, lncRNA HULC, lncRNA UCA1. Method: Eighty-three children were included (43 ADHD). Conner’s Parent Rating Scale-Revised Short Form, Childhood Chronotype Questionnaire, Children’s Sleep Disorders Scale were administered. Gene expression levels were studied from peripheral blood. Results: Evening chronotype, sleep initiation/maintenance disorder, sleep-wake transition disorder, excessive sleepiness disorder were higher in the ADHD group compared to the controls in the scales reported by the parents. Expression levels of all examined genes were statistically significantly higher in the ADHD group. There was no significant relationship between genes and sleep parameters in the ADHD group. Conclusion: Our study provides the first evidence that lncRNA HULC and lncRNA UCA1 might have a role in the etiology of ADHD.

Objective: Although no definite reason has been found in studies to determine the etiology of Autism Spectrum Disorder, increasing evidence in the literature suggests that oxidative stress plays a role in the development and clinical manifestation of autism. Our study was designed to investigate whether peroxynitrite, a powerful oxidant, can be used as a supportive biochemical marker in the evaluation of the relationship between oxidative stress and autism, and as far as we have researched, it is the first study to measure serum peroxynitrite levels in children with autism. Methods: In our study, serum peroxynitrite levels of 40 children with autism between the ages of 3-12 and 40 healthy controls in the same age group were measured. In addition, the relationship between peroxynitrite level and autism severity was evaluated. The severity of autism symptoms was evaluated according to Childhood Autism Rating Scale scores. Results: In our study, a statistically significant difference was found between children with autism and control groups in terms of eroxynitrite values (p=0,010). Our data show that there is no significant relationship between peroxynitrite levels and autism severity (p=0,527). Conclusion: Our findings show that peroxynitrite levels are higher in the group with autism, consistent with the growing evidence that oxidative stress is increased in autism, pointing to the role of oxidative stress in the pathophysiology of autism. It is thought that studies designed by considering strong oxidants such as peroxynitrite and combinations of different biomarkers in this pathway may provide a better understanding of the pathophysiology of Autism Spectrum Disorder and may guide potential treatments.

Otizm Spektrum Bozukluğu (OSB) etyolojisinde birden fazla faktörün rol aldığı nörogelişimsel bir bozukluktur. OSB tanılı çocukların ebeveynleri geleneksel tıbbi tedavilerden yeterince fayda sağlayamadıkları gerekçesiyle sıklıkla tamamlayıcı ve alternatif tedavilere (TAT) yönelebilmektedir. Bu gözden geçirme yazısında TAT kavramının tanımı, kullanım yaygınlığı, OSB’de kullanılan TAT yöntemleri ve etkinliklerinin incelenmesi ve ülkemizde OSB’li çocuklarda TAT kullanımı ile ilgili çalışmaların gözden geçirilmesi amaçlanmıştır. TAT uygulamalarının OSB’de etkinliklerine dair güncel veriler sınırlı olmakla birlikte kullanım oranları göz önüne alındığında hekimlerin TAT yöntemleri hakkında bilgi sahibi olmaları, ailelerle TAT kullanımını açık bir şekilde sormaları ve bilgi paylaşımında bulunmaları gerekmektedir.

Objectives:In this study, it was aimed to examine the relationship between anxiety, depression and negative automatic thoughts and quality of life of adolescents with primary headache.Materials and Methods:Eighty-six adolescents, who applied to the Ministry of Health Ordu University Training and Research Hospital Pediatric Neurology Outpatient Clinic with chronic headache, were included in the study. In this study, Visual pain scale, KIDDO-KINDL quality of life, state-trait anxiety scale (SAS), child depression scale (CDS), and children’s automatic thoughts (CAT) scales were evaluated.Results:The mean age of the adolescents in the study was 13.7 years [standard deviation SD: 2.0]. 72.1% (n=62) of the cases were female and 27.9% (n=24) were male. While the mean headache duration was 5.6 (SD=6.7) hours, the mean pain intensity was 6.8 according to the visual pain scale (SD=1.7). Headache severity reported by girls was significantly higher than that reported by boys (p=0.035). SAS and CDS scores were significantly correlated with quality of life (QoL) scores (rho=-0.623, p=0.001; rho=-0.690, p=0.001). A moderate negative correlation was observed between CAT and QoL (rho=0.584, p=0.002). In linear regression analysis, the variables of gender, pain duration, pain intensity, SAS, CDI and CAT explained 53.2% of the variance in KIDDO-KINDL scores. The regression equation was statistically significant, but none of the variables reached a significant level individually [F (6,12)=4.4; p=0.014].Conclusion:Anxiety, depression levels and automatic thoughts seem to be associated with quality of life in adolescents with primary headache.