Blood Count Parameters as Inflammation Indicators in Children and Adolescents Diagnosed with Depressive Disorder

Aim

There is increasing evidence that immunological and inflammatory dysfunctions play an essential role in the initiation and progression of major psychiatric disorders. Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume can be used as markers of systemic inflammation in different diseases. We aimed to investigate these blood count parameters in children and adolescents diagnosed with major depressive disorder.

Methods

Designed as a case-control study, our sample consisted of patients aged 9-16 years referred to Child and Adolescent Psychiatry and pediatrics outpatient clinics for the first time and diagnosed with major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, 5th edition diagnostic criteria, and healthy children and adolescents matched at a ratio of 1 to 2. Data of 58 cases and 90 healthy controls evaluated between 01.07.2019 and 01.07.2020 were included.

Results

Platelet-to-lymphocyte ratio values were significantly higher in the case group. No significant difference was found between patient and control groups regarding other blood count parameters. When depression group was compared in terms of all parameters as those who committed suicide and those did not, significant difference was found between the 3 groups in terms of platelet-to-lymphocyte ratio values. The intergroup difference in platelet-to-lymphocyte ratio was found between the depression group without suicide and the control group. No significant relationship was found between other parameters and Children's Depression Inventory Scale scores. We determined a cut-off value of 112.5 for platelet-to-lymphocyte ratio (with sensitivity of 70% and specificity of 63%).

Conclusion

Platelet-to-lymphocyte ratio might be an important parameter in the clinical follow-up of major depressive disorder.

Delayed-Onset Toxicity in an Adolescent Case Following Attempted Suicide with an Overdose of Paliperidone Intake

Paliperidone is a relatively novel atypical antipsychotic drug that is currently used to treat schizophrenia in adolescents and adults. The drug was generated by combining the active metabolite of risperidone, 9-hydroxyrisperidone, with osmotic controlled-release oral administration system (OROS) technology. Due to its specific design, the drug has been identified as a different form, albeit an active metabolite of risperidone. Such distinction mainly manifests itself during pharmacokinetic processes, because paliperidone is not affected by CYP2D6 metabolism. On the other hand, this drug is regularly released for a period of 24 hours. Even though it is possible to reach relevant literature on the efficacy and safety of paliperidone use in detail, limited data regarding its toxicity exists. A review of the literature in that sense, has revealed a scarce number of case reports and a retrospective study existing. Bearing in mind the specific form and design of the drug, we have hypothesized its toxicity might cause diverse clinical presentations, in the face of overdose or poisoning. This might in turn, prompt us to switch our usual evaluation and intervention practices. With this case report, we have aimed to discuss delayed onset toxicity with paliperidone overdose in an adolescent case, due to a suicide attempt with excessive intake of the medication.

DSM-5 Level 2 Sleep Disorders Scale Validity and Reliability of Turkish Form (Form for Children Aged 11-17 Years and Parent Form for Children Aged 6-17 Years)

Introduction

This study aimed to assess the validity and reliability of Turkish version of DSM-5 Level 2 Sleep Disorders Scale.

Method

The scale was prepared by translation and back translation of DSM-5 Level 2 Sleep Disorders Scale. Study groups consisted of a clinical sample that contained cases that had sleep related problems and treated in a child and adolescent psychiatry unit and also a community sample. In the assessment process, child and parent forms of DSM-5 Level 2 Sleep Disorders Scale and also Children's Sleep Habits Questionnaire-Turkish version (CSHQ) and Pittsburgh Sleep Quality Index (PSQI) were used. As for reliability analyses, internal consistency coefficient and item-total score correlation analysis, test-retest reliability; and for validity analyses, explanatory factor analysis and for concurrent validity, correlation analyses with Children's Sleep Habits Questionnaire-Turkish version (CSHQ) and Pittsburgh Sleep Quality Index (PSQI) were made.

Results

In reliability analyses, Cronbach's alpha internal consistency coefficient values were found to be very highly reliable regarding child and parent forms. Item-total score correlation coefficients were high for child form while medium and high for parent form; indicating a statistical significance. As for construct validity, two factors were maintained that would count for 74.1% of the variance in child form and 66.9% of the variance in parent form. It was seen that positive and negative statements weighed on two different factors. As for concurrent validity, child and parent form of the scale showed significant correlation with Children's Sleep Habits Questionnaire-Turkish version (CSHQ) and Pittsburgh Sleep Quality Index (PSQI).

Conclusion

It was found that Turkish version of DSM-5 Level 2 Sleep Disorders Scale could be utilized as a valid and reliable tool both in clinical practice and for research purposes.

Genetic imaging study with [Tc-99m] TRODAT-1 SPECT in adolescents with ADHD using OROS-methylphenidate

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-naïve 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.

Validity and Reliability of the Turkish Version of DSM-5 Level 2 Anxiety Scale (Child Form for 11-17 Years and Parent Form for 6-17 Years)

Introduction

This study aimed to assess the validity and reliability of the Turkish Version of DSM-5 Level 2 Anxiety Scale's child and parent forms.

Methods

The scale was constructed by carrying out the translation and back translation of DSM-5 Level 2 Anxiety Scale. The study group consisted of a community and clinical sample. The scale was applied to 148 parents and 189 adolescents that represented the clinical and community sample. During the assessment process, Screen for Childhood Anxiety Related Emotional Disorders and Strengths and Difficulties Questionnaire - Parent Form were also used.

Results

Reliability analyses indicated a high internal consistency regarding Level 2 Anxiety Scales, both for child and parent forms (0.915/0.933). In the meantime, it was shown that child form for Level 2 Anxiety Scale was significantly correlated with Screen for Childhood Anxiety Related Emotional Disorders (r=0.758, p<0.0001) while the parent form was significantly correlated with Strengths and Difficulties Questionnaire - Parent Form (r=0.717, p<0.0001). As for the content validity, one factor was obtained for both forms, and it was observed to be consistent with the original construct of the scale.

Conclusion

It was concluded that Turkish version of DSM-5 Level 2 Anxiety Scale was a valid and reliable tool to be utilized both for clinical practice, and research purposes.

Validity and reliability of the Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale for children aged 11–17 years

Background/aim: This study aimed to assess the validity and reliability of the Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form. Materials and methods: The study sample consisted of 32 patients treated in a child psychiatry unit and diagnosed with generalized anxiety disorder and 98 healthy volunteers who were attending middle or high school during the study period. For the assessment, the Screen for Child Anxiety and Related Emotional Disorders (SCARED) was also used along with the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form. Results: Regarding reliability analyses, the Cronbach alpha internal consistency coefficient was calculated as 0.932. The test-retest correlation coefficient was calculated as r = 0.707. As for construct validity, one factor that could explain 62.6% of the variance was obtained and this was consistent with the original construct of the scale. As for concurrent validity, the scale showed a high correlation with SCARED. Conclusion: It was concluded that Turkish version of the DSM-5 Generalized Anxiety Disorder Severity Scale - Child Form could be utilized as a valid and reliable tool both in clinical practice and for research purposes.

Validity and Reliability of the Turkish version of DSM-5 Social Anxiety Disorder Severity Scale- Child Form

Introduction

This study aimed to assess the validity and reliability of the Turkish version of the Diagnostic and statistical manual of Mental Disorders. (5^th ed.) (DSM-5) Social Anxiety Disorder Severity Scale- Child Form.

Method

The scale was prepared by carrying out the translation and back translation of the DSM-5 Social Anxiety Disorder Severity Scale - Child Form. The study group consisted of 31 patients that had been treated in a child psychiatry unit and diagnosed with social anxiety disorder and 99 healthy volunteers that were attending middle or high school during the study period. For the assessment, the Screen for Child Anxiety and Related Emotional Disorders (SCARED) was also used along with the DSM-5 Social Anxiety Disorder Severity Scale - Child Form.

Results

Regarding reliability analyses, Cronbach's alpha internal consistency coefficient was calculated as 0.941, while item-total score correlation coefficients were measured between 0.566 and 0.866. A test-retest correlation coefficient was calculated as r=0.711. As for construct validity, one factor that could explain 66.0 % of the variance was obtained. As for concurrent validity, the scale showed a high correlation with the SCARED.

Conclusion

It was concluded that the Turkish version of the DSM-5 Social Anxiety Disorder Severity Scale - Child Form could be utilized as a valid and reliable tool both in clinical practice and for research purposes.

Validity and Reliability of the Turkish Version for DSM-5 Level 2 Anger Scale (Child Form for Children Aged 11-17 Years and Parent Form for Children Aged 6-17 Years)

Introduction

This study aimed to assess the validity and reliability of the Turkish version of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Level 2 Anger Scale.

Methods

The scale was prepared by translation and back translation of DSM-5 Level 2 Anger Scale. Study groups consisted of a clinical sample of cases diagnosed with depressive disorder and treated in a child and adolescent psychiatry unit and a community sample. The study was continued with 218 children and 160 parents. In the assessment process, child and parent forms of DSM-5 Level 2 Anger Scale and Children's Depression Inventory and Strengths and Difficulties Questionnaire-Parent Form were used.

Results

In the reliability analyses, the Cronbach alpha internal consistency coefficient values were found very high regarding child and parent forms. Item-total score correlation coefficients were high and very high, respectively, for child and parent forms indicating a statistical significance. As for construct validity, one factor was maintained for each form and was found to be consistent with the original form of the scale. As for concurrent validity, the child form of the scale showed significant correlation with Children's Depression Inventory, while the parent form showed significant correlation with Strengths and Difficulties Questionnaire-Parent Form.

Conclusion

It was found that the Turkish version of DSM-5 Level 2 Anger Scale could be utilized as a valid and reliable tool both in clinical practice and for research purposes.

Serum brain-derived neurotrophic factor levels in treatment-naïve boys with attention-deficit/hyperactivity disorder treated with methylphenidate: an 8-week, observational pretest-posttest study

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.

Validity and Reliability of the Turkish Version of the DSM-5 Posttraumatic Stress Symptom Severity Scale-Child Form

INTRODUCTION

This study assessed the validity and reliability of the Turkish version of the DSM-5 Posttraumatic Stress Symptom Severity Scale-Child Form for use among the Turkish population.

METHODS

The study group consisted of 30 patients that had been treated in a child psychiatry unit and diagnosed with posttraumatic stress disorder and 83 healthy volunteers that were attending middle or high school during the study period. For reliability analyses, the internal consistency coefficient and the test-retest correlation coefficient were measured. For validity analyses, the exploratory factor analysis and correlation analysis with the Child Posttraumatic Stress Reaction Index for concurrent validity were measured.

RESULTS

The Cronbach's alpha (the internal consistency coefficient) of the scale was 0.909, and the test-retest correlation coefficient was 0.663. One factor that could explain 58.5% of the variance was obtained and was congruent with the original construct of the scale. As for concurrent validity, the scale showed high correlation with the Child Posttraumatic Stress Reaction Index.

CONCLUSION

It was concluded that the Turkish version of the DSM-5 Posttraumatic Stress Symptom Severity Scale-Child Form can be used as a valid and reliable tool.

Validity and reliability of the Turkish version of the DSM-5 Dissociative Symptoms Severity Scale-Child Form

The goal of this study was to assess the validity and reliability of the Turkish version of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) Dissociative Symptoms Severity Scale-Child Form. The scale was prepared by translating and then back-translating the DSM-5 Dissociative Symptoms Severity Scale. The study groups included one group of 30 patients diagnosed with posttraumatic stress disorder who were treated in a child and adolescent psychiatry unit and another group of 83 healthy volunteers from middle and high schools in the community. For assessment, the Adolescent Dissociative Experiences Scale (ADES) was used in addition to the DSM-5 Dissociative Symptoms Severity Scale. Regarding the reliability of the DSM-5 Dissociative Symptoms Severity Scale, Cronbach's alpha was .824 and item-total score correlation coefficients were between .464 and .648. The test-retest correlation coefficient was calculated to be r = .784. In terms of construct validity, one factor accounted for 45.2% of the variance. Furthermore, in terms of concurrent validity, the scale showed a high correlation with the ADES. In conclusion, the Turkish version of the DSM-5 Dissociative Symptoms Severity Scale-Child Form is a valid and reliable tool for both clinical practice and research.

Treating an Adolescent with Long QT Syndrome for Bipolar Disorder: A Case Presentation

OBJECTIVES

Long QT syndrome (LQTS) is described as the development of sudden syncope attacks or death as a result of ventricular tachycardia (VT) episodes that might be observed as elongated QT interval in electrocardiography (ECG). Implantable Cardioverter Defibrillator (ICD) is recommended as first-line treatment for the condition in guidelines. We aimed to present an adolescent recently diagnosed with Bipolar Disorder (BD) who had LQTS that was treated with ICD, discussing her follow up and treatment along with relevant literature.

METHODS

Psychiatric assessment of the case that applied to our child psychiatry unit due to manic symptoms were carried out by using Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) criteria. Symptom severity was monitored via Young Mania Rating Scale scores (YMRSS).

RESULTS

The case met criteria for Bipolar Disorder Type I (BD-I). She had improvement in her mood symptoms with treatment regimen as risperidone 3 mg/day, valproate 1000 mg/day and lorazepam 1 mg/dayi after her 2-week follow up as well as no reported ICD activity, reflecting fine cardiac functions and rhythm.

CONCLUSIONS

LQTS is a serious health issue for children and adolescents diagnosed with BD. This condition should be kept in mind especially in cases where familial risk factors are present and precautions need to be maintained upon required assessments. These cases need to be closely monitored due to risk factors related to both BD and LQTS, in a multidisciplinary fashion, involving both psychiatry and cardiology divisions.