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Objective:Pediatric bipolar disorder (BD) is a highly morbid disorder which is associated with impairments in social, academic, and family functioning. Despite its great impact on public health, the literature is scarce regarding the studies examining the clinical phenomenology of BD in children and adolescents.Methods:A retrospective chart review of 113 children and adolescents’ files (ages 13-18 years) who were consecutively admitted to our inpatient clinic between March 2012 and November 2014 and diagnosed as having BD type I or BD type II was made. The diagnoses were based on DSM-IV-TR criteria. A sociodemographic and clinical data form was created by the authors and was filled out for each patient by the authors themselves.Results:Totally 113 adolescents (71 male, 42 female) were included in the study. Mean age of the sample was 16.054±1.23 (range=13-18) years. Mean age of onset of BD was 15.04±1.74 (range=9-17) years. The first mood episode was manic in 60% of patients, depressive in 27.3%, mixed in 10.9% and hypomanic in 1.8% of patients. Of the patients, 23.4% had a suicide attempt history, 48.2% had a previous referral to a psychiatry clinic before the onset of BD. History of substance/alcohol use was present in 27.4% of the patients. Of the patients, 84.9% were using combination treatments.Conclusion:High rates of suicide attempt, substance use and significant functional impairment found in our study sample indicate that early recognition and intervention of BD, specialized educational programs and occupational support for these children and adolescents seem indispensable.

ABS TRACT: Insignificant effects of atomoxetine on thyroid functions in children and adolescents with attention deficit and hyperactivity disorder in short term Objective: In this study, we aimed to explore the effects of atomoxetine on thyroid functions in children and adolescents with attention deficit hyperactivity disorder. Methods: A retrospective chart review was done to evaluate the thyroid function tests of patients diagnosed with attention deficit hyperactivity disorder and treated with only atomoxetine. The thyroid function tests of 38 subjects, from both before atomoxetine was started and during an effective dose of atomoxetine treatment, were found from the patient charts and compared statistically. Results: There were no statistically significant differences between the baselines levels of thyroidstimulating hormone (TSH), free T4, and free T3 values and those during an effective dose of atomoxetine treatment. In one subject, four weeks after atomoxetine was started and titrated to the effective dose, an insignificant increase in TSH was observed, which decreased to the normal range after the discontinuation of the atomoxetine treatment. Conclusion: Therapeutic doses of atomoxetine do not seem to change thyroid functions in children and adolescents with attention deficit hyperactivity disorder.

Objective To investigate the relationship between brain masculinization and retinal thickness in children with congenital adrenal hyperplasia (CAH). Methods Forty-five patients with CAH aged between 4 and 18 years and 30 age-matched healthy controls were included in this prospective study. Macular area was examined with optical coherence tomography (OCT); central subfield thickness (CST), cube volume (CV) and macular retinal thickness (MT) were measured in each subject. A gender identity questionnaire (GIQ) was used for the evaluation of gender happiness index. Results Girls with CAH had a higher CV (p = 0.002) and MT (p = 0.003) than healthy girls. No significant difference was found between boys with CAH and healthy boys regarding the retinal thickness measurements. Mean CST, CV and MT were significantly higher in boys than in girls in the control group (p = 0.013, p Conclusions As retina is part of the brain, our finding appears to be a morphological evidence of the excess androgen exposure on brain structures in girls with CAH. In addition, we suggest using retinal thickness measurements as a marker of prenatal excess androgen exposure in future studies.

ObjectivesThe aims of this cross-sectional study were to assess the prevalence of Internet addiction (IA) in a clinical sample of adolescents with attention-deficit hyperactivity disorder (ADHD) and to detect the moderating effects of co-occurring oppositional defiant disorder/conduct disorder (ODD/CD) on the association between ADHD and IA.MethodsThe study group comprised 119 adolescent subjects who were consecutively referred to our outpatient clinic with a diagnosis of ADHD. The Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S) was completed by parents, and subjects were asked to complete the Internet Addiction Scale (IAS).ResultsThe IAS results indicated that 63.9% of the participants (n = 76) fell into the IA group. Degree of IA was correlated with hyperactivity/impulsivity symptoms but not with inattention symptoms. As compared to the ADHD-only group (without comorbid ODD/CD), ADHD + ODD/CD subjects returned significantly higher scores on the IAS.ConclusionsAs adolescents with ADHD are at high risk of developing IA, early IA detection and intervention is of great importance for this group. In addition, adolescents with ADHD + ODD/CD may be more vulnerable to IA than those in the ADHD-only group and may need to be more carefully assessed for IA.

Background The aim of this study was to examine the effects of atomoxetine on heart rhythm using 12-lead electrocardiography (ECG) and 24 h Holter monitoring. Methods Children and adolescents who were diagnosed with attention deficit–hyperactivity disorder according to DSM-IV-TR were referred to a pediatric cardiology clinic for cardiologic examination before and after 4 or 5 weeks of atomoxetine treatment. Cardiac examination, complete blood count, biochemistry, thyroid function tests, 12-lead ECG and 24 h Holter monitoring were performed routinely in all patients. Each subject underwent 24 h Holter ECG monitoring before atomoxetine was started and after 4 or 5 weeks of effective dose atomoxetine treatment. Results Forty-one patients were included in this prospective study. No statistically significant change was found in QT, QTc or QT interval dispersion or blood pressure before and after 4 or 5 weeks of atomoxetine treatment. There was a statistically significant increase in heart rate (both during the day and at night) and QRS duration, and a statistically significant decrease in P wave dispersion. Three patients had rhythm disturbances. All of these three patients were asymptomatic and none of these arrhythmias reached clinical significance. Conclusion Atomoxetine did not cause significant changes in ECG or Holter variables. In two patients, who had undiagnosed subclinical extrasystoles, extra beats were increased after 4th week of treatment, but still remained clinically insignificant. Before and after atomoxetine treatment, listening to the heart sounds for a longer time, may help clinicians to notice an extra beat. If an extra beat is identified then 24 Holter monitoring is recommended.

Catatonia and differential diagnosis in adolescence: a case report Catatonia is a motor dysregulation syndrome with main symptoms and signs such as mutism, posturing, stupor, motor rigidity, hyperalertness, refusal to eat or drink, and hypokinesis. Recognizing catatonia in children and making a differential diagnosis is important in terms of investigations required as well as for determining the treatment protocol. The present paper discusses the differential diagnosis of catatonia presentation and the clinical characteristics of a 17-year-old male case who was initially followed as inpatient in our clinic for catatonia presentation, though his diagnosis did not become definite within this period. Approximately one year later, he was readmitted to our clinic being pre-diagnosed with bipolar disorder-manic attack because of symptoms such as talking excessively, hyperactivity, irritability, and insomnia.

Many obsessive-compulsive disorder (OCD) patients experience sensory phenomena, such as bodily sensations and "just-right" perceptions accompanying compulsions. We studied tactile processing in OCD by psychophysical experiments targeting the somatosensory cortex. Thirty-two children and adolescents with OCD (8 tic-related, 19 with sensory phenomena (SP)) and their sex- and age-matched controls participated in the study. After clinical assessments, two questionnaires were completed for sensory problems (Sensory Profile and Touch Inventory for Elementary-School-Aged Children). The psychophysical experiments consisted of five tasks: simple reaction time, choice reaction time, dynamic (detection) threshold, amplitude discrimination, and amplitude discrimination with single-site adaptation. The tactile stimuli were sinusoidal mechanical vibrations (frequency: 25 Hz) applied on the fingertips. Just-noticeable differences (JNDs) were found in amplitude discrimination tasks. There was no difference between the OCD group and controls in detection thresholds. However, the OCD group (especially young males) had worse amplitude discrimination (i.e., higher JNDs) than controls. Young OCD participants had reduced adaptation than young controls. Tic-related OCD participants and those with SP had higher detection thresholds than those without. Additionally, the OCD group reported more problems than controls in the Emotional/Social subset of the Sensory Profile questionnaire. The discrimination results show altered tactile processing in OCD at suprathreshold levels. This can be explained by a scaling factor modifying the sensory signal with decreasing slope at higher input levels to achieve normal Weber fractions internally. Quadratic discriminant analysis gave the best positive (76%) and negative (60%) predictive values for classifying individuals (into "OCD" or "control" groups) based on psychophysical data alone.

Background: Obsessive-compulsive disorder (OCD) is a heterogeneous disorder; therefore, there is a need for identifying more homogeneous subtypes. This study aimed to examine the clinical characteristics and comorbidity pattern of a large sample of pediatric OCD subjects, and to examine the impact of gender, age at onset, and lifetime tic disorders on the clinical presentation and comorbidity pattern. Methods: A total of 110 children and adolescents diagnosed with OCD were assessed using the Kiddle Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) for psychiatric comorbidity, and a clinical data form was filled out. The cutoff for differentiating prepubertal from adolescent onset was 11 years of age. Results: A total of 83.6% of the subjects had at least one comorbid psychiatric disorder. Oppositional defiant disorder and contamination/somatic obsessions were significantly higher in males (p=0.036 and p=0.03, respectively) than in females. Depressive disorders and religious obsessions were significantly higher in the adolescent-onset group (p=0.02, p=0.05, respectively) whereas disruptive behavior disorders were higher in the prepubertal-onset group (p=0.037). Disruptive behavior disorders were significantly more frequent in the tic (+) group than in tic (-) group (p=0.021). Conclusions: There were differences in the comorbidity pattern and clinical expression between genders and between prepubertal and adolescent-onset cases. Findings of this study supported the introduction of tic-related OCD as a specifier in Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5), and the necessity of a detailed assessment of other psychiatric disorders in youth with OCD.

WOS: 000359611700003 Objective: In this study we aimed to examine the trends and gender differences in substance use behaviors and treatment seeking patterns of children and adolescents who were admitted to an addiction treatment center in Turkey. Method: Participants were 2718 children and adolescents who had been consecutively admitted to the 'Children and Adolescent Alcohol and Drug Dependency Treatment Center' in Istanbul between January 2011 and December 2013. A detailed drug use questionnaire was completed by all participants, and substance use characteristics were analyzed in terms of gender and substance types. The data regarding age of first use, age at referral, referral pattern, and type of the substances used were compared between three years (2011, 2012, and 2013) and between genders. Results: There was a statistically significant increase in the number of females (p

Objective: Androgen exposure is hypothesized to play a role in the development of autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and disruptive behavior disorders/DBDs (oppositional defiant disorder/ODD and conduct disorder/CD). The aim of this cross-sectional study was to investigate ASD, ADHD, and DBD (ODD and CD) traits in children and adolescents with congenital adrenal hyperplasia (CAH), a natural cause of prenatal androgen excess in females. Methods: Forty-five children and adolescents (27 girls, mean age 11.1±3; 18 boys, mean age 10.8±3.6) with CAH and their unaffected siblings (16 girls, mean age 11.4±3.9; 14 boys, mean age 12.6±4.2) were included in the study. Parents completed the Social Communication Questionnaire, to measure ASD symptoms; and the Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale to assess ADHD and DBD traits. Results: In this study, boys but not girls with CAH showed higher autistic traits. There was no significant difference between either girls or boys with CAH and their unaffected counterparts with respect to inattention or hyperactivity symptoms. Boys with CAH showed more ODD symptoms than the unaffected boys. There was a trend for boys to have more CD symptoms compared to unaffected boys. Conclusions: Our study does not support the hypothesis that prenatal androgen exposure is associated with ASD, ADHD or DBDs. Postnatal/circulating androgen levels, higher testosterone/cortisol ratio, lower basal cortisol or dysregulation in HPA axis might be related to higher autistic traits or increased DBDs symptoms found in boys with CAH. Further investigations with larger groups are needed to clarify these associations.

WOS: 000388118400007 PubMed: 26771824 Objective: The aim of this retrospective study is to examine the clinical outcomes and safety of clozapine in children and adolescents with schizophrenia or other psychotic disorders/autism spectrum disorder (ASD) or affective disorders. Methods: The inpatient and outpatient files of all children and adolescents treated with clozapine over a period of 34 months (from October 2011 to July 2014) were reviewed. Demographic and clinical data were examined to describe clinical and metabolic findings, dosing, and tolerability of clozapine treatment in youth with schizophrenia, other psychotic disorders, ASD, or bipolar disorder. Results: The 37 pediatric patients included 26 patients with schizophrenia or other psychotic disorders, 7 patients with ASD complicated by schizophrenia or other psychotic disorders or affective disorders, and 4 patients with ASD only. In all groups (n = 37) there was a significant reduction (p < 0.001) in Brief Psychiatric Rating Scale (BPRS) points after clozapine treatment during the inpatient period (38.78 +/- 27.75 days). In patients with schizophrenia or other psychotic disorders co-occurring with ASD or not (n = 31), there was a significant improvement in psychotic symptoms according to Positive and Negative Syndrome Scale (PANSS) total scores and subscores (p < 0.001). Of the 26 patients with schizophrenia or other psychotic disorders, 8 (30.8%) showed a positive response (>30% symptom reduction on BPRS). In patients with ASD complicated by schizophrenia or other psychotic disorders or bipolar disorders (n = 7), there was a significant reduction (p = 0.017) in BPRS scores after clozapine treatment. The discontinuation rate for clozapine was 10.8%, and the most frequently observed side effect was hypersalivation (54.1%). Neutropenia associated with clozapine was observed in only one patient (2.7%). Conclusions: Clozapine seems to be effective and safe in children and adolescents with schizophrenia or other psychotic disorders co-occuring with ASD or not. There is a need for further studies for determining the efficacy of clozapine in children and adolescents with bipolar affective disorder or ASD.

Objective: In this study, we aimed to investigate internet addiction and the effects of some variables like age, gender, parental age and education, number of siblings, existence of internet connection at home, existence of computer in the adolescent’s room, time spent on internet, adolescent’s cigarette use, depression inventory score on internet addiction inventory scores in a group of high school students. Method: The study group consisted of students of a high school in Ankara city center who volenteered to participate in the study. Data was collected by a socio-demographic information form, Beck Depression Inventory (BDI) and Internet Addiction Inventory (IAI). A probability level of p

Many children with autistic spectrum disorders have unusual reactions to certain sensory stimuli. These reactions vary along a hyper- to hypo-responsivity continuum. For example, some children overreact to weak sensory input, but others do not respond negatively to even strong stimuli. It is typically assumed that this deviant responsivity is linked to sensitivity, although the particular stage of sensory processing affected is not known. Psychophysical vibrotactile thresholds of six male children (age: 8-12) who were diagnosed to have autistic spectrum disorders and six normal male children (age: 7-11) were measured by using a two-alternative forced-choice task. The tactile stimuli were sinusoidal displacements and they were applied on the terminal phalanx of the left middle finger of each subject. By using a forward-masking paradigm, 40- and 250-Hz thresholds of the Pacinian tactile channel and 40-Hz threshold of the Non-Pacinian I tactile channel were determined. There was no significant difference between the thresholds of autistic and normal children, and the autistic children had the same detection and masking mechanisms as the normal children. The sensory responsivity of each subject was tested by clinical questionnaires, which showed again no difference between the two subject groups. Furthermore, no significant correlations could be found between the questionnaire data and the psychophysical thresholds. However, there was a high correlation between the data from the tactile and emotional subsets of the questionnaires. These results support the hypothesis that the hyper- and hypo-responsivity to touch, which is sometimes observed in autistic spectrum disorders, is not a perceptual sensory problem, but may probably be emotional in origin.

Pica is defined as persistent eating of substances that have no nutritive value for at least one month in a developmentally inappropriate manner and the behavior should not be part of a culturally appropriate action. Although the etiological factors have not been clearly described, several psychiatric conditions including mental retardation, developmental disorders, dementia, schizophrenia, autism spectrum disorder, major depressive disorder, obsessive compulsive disorder (OCD), and attention deficit hyperactivity disorder (ADHD) have been reported in association with pica 1-3 . In this report, we present a

Patients with cardiomyopathy have a higher incidence of mood and anxiety disorders, resulting in greater probability for hospitalisation and increased risk for arrhythmia and death. We report a case of a 16-year-old boy with Danon disease, Wolff–Parkinson–White syndrome, and hypertrophic cardiomyopathy, who later developed depression and significant weight loss. The patient was successfully treated for his anxiety and depression with mirtazapine without any adverse cardiac effects.

[Author Affiliation]Hatice Gunes. Bakirkoy Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.Canan Tanidir. Bakirkoy Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.Ayten Erdogan. Bakirkoy Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey.Address correspondence to: Hatice Gunes, Child and Adolescent Psychiatry Clinic, Bakirkoy Training and Research Hospital for Psychiatric and Neurological Diseases, Zuhuratbaba, Bakirkoy, Istanbul 34147, Turkey, E-mail: dr_haticegunes@yahoo.comTo The Editor:Irritability and disruptive behaviors are frequent associated symptoms of autism spectrum disorder (ASD) that interfere with adaptive functioning and lead to distress in affected individuals and their caregivers. Atypical antipsychotics are first-line psychotropic agents for the treatment of irritability and disruptive behaviors in children with ASD, although only risperidone and aripiprazole have proven to be tolerable and effective with multisite, randomized, controlled trials (Politte and McDougle 2014). However, there is still a group of patients who do not respond to common treatment strategies. Clozapine has been suggested to be an effective alternative for treatment-resistant disruptive behaviors in patients with ASD (Beherec et al. 2011). However, to the best of our knowledge, adding aripiprazole to clozapine in patients with ASD has never been reported before. Here, we describe a clozapine-treated adolescent with ASD, and show the beneficial effects of aripiprazole augmentation.Case ReportA 13-year-old boy admitted to our outpatient clinic with complaints of severe temper tantrums, destroying household objects, and being aggressive toward his mother. He also had compulsive symptoms such as cleaning and ordering. He had been diagnosed with autism when he was 3 years old. For the last 3 years he had received mirtazapine (max 15 mg/day), fluoxetine (max 40 mg/day), sodium valproate (max 1000 mg/day), risperidone (max 3 mg/day), quetiapine (max 600 mg/day), olanzapine (max 5 mg/day), aripiprazole (max 10 mg/day), haloperidol (max 15 mg/day), chlorpromazine (max 150 mg/day), clonazepam (max 4mg/day), carbamazepine (max 400 mg/day), and oxcarbazepine (max 150 mg/day) either alone or in combination for his disruptive behaviors, with no significant effect. After obtaining his legal guardian's consent and completing routine neurological and cardiac examination, blood screen, and liver and kidney function tests, he was started on clozapine and the dose was gradually increased to 300 mg/day, and 500 mg/day sodium valproate was combined for potential seizures. His aggressiveness and disruptive behaviors markedly improved within 2 weeks after the target dose for clozapine (300 mg/day) was reached. His global improvement rating on Clinical Global Impressions-Improvement Scale (CGI-I) was 2 (much improved). Drawing blood was not troublesome, and white blood cell (WBC) counts were obtained weekly at the beginning of the treatment and monthly thereafter. Clozapine was well tolerated by the patient with no hematological, neurological, cardiac, or metabolic side effects, except for a slight increase in his compulsive behaviors. At the end of the 1st year, his cleaning and ordering compulsions were exacerbated and caused significant distress for his parents. Because his spoken language was limited to a few words, we could not assess whether his compulsive behaviors were accompanied by obsessive thoughts. Aripiprazole was started at 5 mg/day and increased to 7.5 mg/day because of its well-known effects on clozapine-associated obsessive compulsive symptoms (Englisch et al. 2009) and aggressive behaviors in patients with ASD (Politte and McDougle 2014). At the end of the 1st month, his compulsive behaviors ceased, and further improvement was seen in his disruptive behaviors. …

[Author Affiliation]Canan Tanidir. 1 Child and Adolescent Psychiatry Clinic, Bakirkoy State Hospital for Mental Health and Neurological Disorders, Istanbul, Turkey.Sabri Herguner. 2 Department of Child and Adolescent Psychiatry, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.Address correspondence to: Sabri Herguner, Meram Tip Fakultesi, Cocuk ve Ergen Psikiyatrisi AD, 42090, Konya, Turkey, E-mail: herguners@yahoo.comTo The Editor:Choking phobia, also known as posttraumatic eating disorder or phagophobia, is characterized by the excessive fear and avoidance of eating, chewing, or swallowing solids and/or liquids without an underlying physiological cause (Lopes et al. 2014). Although it was defined as a "specific phobia" in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV), DSM-5 included chocking phobia in the diagnostic category of "avoidant/restrictive food intake disorder" (ARFID) (American Psychiatric Association 1994, 2013).The onset of choking phobia is typically sudden, following an incident of choking. The children refuse to either drink liquids or eat any solid food, and in severe cases, refuse all oral feeding. It may cause weight loss, avoidance of public eating, social withdrawal, and anxiety and family distress during mealtimes. Choking phobia is more common in girls than in boys, and high comorbidity with other anxiety disorders, including separation anxiety disorder and obsessive-compulsive disorder (OCD) is reported (Okada et al. 2007; Lopes et al. 2014).A standard treatment for choking phobia has not been described in the literature. Behavioral interventions, including systemic desensitization, are found as effective in a number of case studies (Okada et al. 2007; Lopes et al., 2014). There are several reports about the psychopharmacological treatment of choking phobia, including selective serotonin reuptake inhibitors (SSRIs) (Banerjee et al. 2005; Celik et al. 2007), risperidone (Berger-Gross et al. 2004), and benzodiazepines (Kardas et al. 2014). Here, we report a pediatric patient who began refusing food after a choking experience, and was treated successfully with mirtazapine.Case ReportA 10-year-old girl was referred to the child and adolescent psychiatry outpatient clinic from the pediatric gastroenterology department because of her refusal to eat any solid foods. Her symptoms began after she had choked on her mother's ring when she was 4 years old. After this event, she became fearful and started refusing to consume and swallow any solid foods. During mealtimes she experienced great anxiety and distress. Because she was willing to eat only strained foods and liquids, her mother was liquidizing solid foods. On admission, the patient's weight was 26 kg and her weight-for-stature was below the 10th percentile. Although she had undergone repeated physical examinations and several diagnostic tests, they were all unremarkable.At her psychiatric assessment, she was diagnosed with OCD and ARFID, and she had a past history of separation anxiety disorder according to DSM-5 criteria (American Psychiatric Association 2013). Family history was positive for OCD in her mother and grandmother. Initially, a behavioral approach (gradual desensitization) was introduced, but the patient did not respond because of her high anxiety level. Then we decided to try psychopharmacological treatment. Because of her difficulty swallowing pills, liquid preparation of fluoxetine 10 mg/day was initiated and the dose was increased up to 30 mg/day, gradually. There was no significant improvement in her symptoms during a 2 month period; moreover, her appetite decreased. We stopped fluoxetine, and a liquid form of mirtazapine 15 mg/day was introduced. The response was dramatic; within the first week she began eating solid foods, including toast, beef, and crackers. At her follow-up visit 2 weeks later, she reported feeling less anxious during mealtimes and was consuming entire meals without difficulty. …

Liver enzymes and bilirubin levels during atomoxetine treatment in children and adolescents Objective: Atomoxetine is the first non stimulant medication approved by FDA for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). The objective of this study was to investigate the changes in the liver enzymes levels associated with one month atomoxetine treatment in children with ADHD. Methods: A retrospective chart review was done to evaluate patients treated with only atomoxetine in Bakirkoy Prof. Dr. Mazhar Osman Research and Training Hospital for Psychiatry and Neurological Disease, Child and Adolescent Psychiatry Clinic outpatient unit between September 2010 and December 2010. A total of 62 patients between 6-15 years of age were eligible for the study. Patients' baseline and one month follow-up hepatobiliary function tests including alanine aminotransferase (ALT) and aspartat aminotransferase (AST), gamma glutamyl transferase (GGT), alkaline phosphatase (ALP) and total serum bilirubin levels were noted. Results: No case of jaundice or hepatic failure was seen during the one month treatment period. ALT levels in the first month were significantly lower than baseline. The mean levels of other liver enzymes and bilirubin levels of the patients at the first month were not significantly different than baseline. Clinically nonsignificant elevation of liver enzymes and bilirubin from the defined normal levels were observed in 8 (12.9%) patients. Conclusion: Taking into account the limitations of a retrospective chart review in nonrandomized samples, it appears that atomoxetine treatment in short term does not lead to abnormal liver function changes at therapeutic doses in children and adolescents. Prospective studies are needed to assess liver function tests abnormalities in youth population using atomoxetine.

Objectives: To investigate the most frequent reasons for referral, the most common special interests, age at first referral to a mental health service, and the age of diagnosis in children and adolescents with Asperger syndrome living in Turkey. Methods: This study includes 61 children and adolescents diagnosed with Asperger syndrome using strict DSM-IV criteria. Results: The mean age at first referral was 7.9 whereas the mean age when Asperger syndrome was diagnosed was 9.9, which is compatible with other studies. The most frequent reasons for the first referral were attention deficits, hyperactivity, and academic failure, and the most common special interest area was “electronic devicess, computer, and technical interests.” Conclusions: The types of special interests and referral reasons in our Asperger syndrome sample are very similar to the interest areas and referral reasons of individuals with Asperger syndrome from developed western countries indicating the universality of symptoms. It could be concluded that children and adolescents with Asperger syndrome may refer to mental health services with a variety of symptoms; therefore, it is important to make a detailed assessment of social difficulties especially in school-age children and adolescents for the differential diagnosis of Asperger syndrome.

Williams syndrome (WS) is a genetic disorder caused by the hemizygous microdeletion in chromosome 7q11.23. It is characterized by dysmorphic face, cardiovascular disease, idiopathic hypercalcemia, mental retardation, and an uneven profile of cognitive-linguistic abilities and deficits. The presence of autistic features in individuals with WS is a controversial issue. While there are reports that describe them as overly friendly with excessive sociability and good empathic skills, some recent studies focus more on the qualitative impairment of their social abilities. Here, we report the clinical presentation and follow-up of an eight-year-old boy with WS and clear problems in his social interaction, non-verbal communication and circumscribed interests. To our knowledge, this is the first case report on the coexistence of WS and Asperger's disorder. It also differs from previous papers on the comorbidity of WS and autism spectrum disorders, by depicting a highly verbal, nonretarded child followed for seven years through adolescence.

To investigate and compare the rate and type of psychiatric co-morbidity in individuals with diagnosis of high functioning autism (HFA) and Asperger's disorder (AS).This study includes 30 children and adolescents with diagnosis of HFA and 30 with diagnosis of AS. Diagnoses of HFA and AS were made using strict DSM-IV criteria. Psychiatric co-morbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL-T).The rate of comorbid psychiatric disorders was very high in both groups (93.3% in HFA and 100% in AS). The most common disorder in both groups was attention deficit hyperactivity disorder. There was no statistically significant difference between groups in the rate of associated psychiatric disorders, except for major depressive disorder (P = 0.029) and ADHD-combined type (P = 0.030). The AS group displayed greater comorbidity with depressive disorders and ADHD-CT.From a clinical perspective, it could be concluded that both disorders involve a high risk for developing psychiatric disorders, with AS patients at greater risk for depression. From a nosological perspective, the substantial similarities in terms of psychiatric comorbidity may support the idea that both disorders are on the same spectrum and differs in some aspects.

Objective: In this study we aimed to investigate the properties and strong and weak parts of the psychodrama group therapy techniques in adolescents with social anxiety disorder and tried to create a psychodrama group therapy model for adolescents. Methods: The group consists of adolescents aged 16-18 years old who were diagnosed with social anxiety disorder in the child and adolescent psychiatry outpatient clinic of a research hospital for psychiatric and neurologic disorders in Istanbul and who were volunteer to join the group. The adolescents with a psychotic disorder, autism spectrum disorder or mental retardation were not included in the study. The group was started when the number of volunteer adolescents have reached ten and group meetings were planned as once a week lasting 1.5-2 hours. Results: In this group therapy program using psychodrama techniques, totally 14 sessions were done. The total time of sessions have changed between 70 and 150 minutes according to the needs of the group and the related topic. Minimum 2 group members and maximum 8 group members attended to the group sessions. We observed in the meetings with low attendance, co-therapists’ acting and taking roles as group members maintained the group permanency and increased the assertiveness of the inhibited group members. Also we observed that spontaneity and creativity increased if the co-therapists joined the group games. Using symbolic items like toys facilitated the expression of emotions in this group for the adolescents. Discussion: While using psychodrama with adolescents with social anxiety disorder in order to minimize the problems of low attendance and warrant the group permanency it is useful to conduct the group with at least two co-therapists and to begin with more than ten or twelve group members at the beginning. Groups should be conducted weekly and interest areas of adolescents should be taken into account while preparing group games and symbolic items should be used often

Objective: Trichotillomania (TTM) is characterized by the repetitive pulling out of one-s own hair from the scalp, eyebrows, eyelashes, or other areas of the body and is often associated with other psychiatric disorders. In this study we aimed to investigate the clinical and sociodemographic characteristics and comorbid psychiatric disorders in children with TTM. Methods: Twenty-three children and adolescents (15 females and 8 males, median age: 12, range: 6-18 years), who were followed at our outpatient clinic with the diagnosis of TTM, were included in the study. The Turkish version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version was used to detect the comorbid psychiatric disorders. Depression and anxiety levels were measured by Childhood Depression Inventory (CDI) and State-Trait Anxiety Inventory for Children, respectively. Results: The most commonly affected areas were; the scalp (n=13). Nine cases have been affected more than two areas. Median duration of the symptoms were 7 +/- 20.01 months (range: 7 days-72 months) at admission. 65.2% of the cases reported precipitating stress factors before the beginning of TTM symptoms. Nineteen (82.6%) subjects suffered from at least one psychiatric disorder and 14 (60.8%) from at least two psychiatric disorders. The most common comorbid disorders were anxiety disorders (n=15), disruptive behavioral disorders (n=6), tic disorder (n=3) and enuresis nocturna (n=3). The mean score in the CDI was 13.25 +/- 8.45. Mean state and trait anxiety scores were 37.19 +/- 8.01 and 37.62 +/- 7.61, respectively. There was a significant relationship between the time passed until admission to a psychiatry clinic and having multiple comorbid psychiatric disorders. Conclusion: High rates of comorbid psychiatric disorders were found in children and adolescents with TTM. Delay in psychiatric help-seeking seems to be associated with other psychiatric disorders. Early intervention may decrease comorbid psychiatric disorders, which may affect treatment options and prognosis.

Amaç: Temel olarak agresif ve yıkıcı davranışsal belirtiler ile başvuran okul öncesi çağdaki çocuklarda risperidon kullanım yaygınlığı ve özelliklerini araştırmayı amaçladık. Yöntem: Bu geriye dönük dosya tarama çalışmasında, hastaların tıbbi kayıtları yaş, cinsiyet, birincil ve eş tanılar, risperidon dozu ve tedavi süresi açısından gözden geçirildi. Risperidon dozu ve tedavi süresi birincil tanılar arasında karşılaştırıldı. Bulgular: Risperidonun 2790 çocukta kullanım yaygınlığı %18.5ti (s516). Ortalama yaş 4.861.12 yıl idi. Bu hastaların %74.4ünde bir yıkıcı davranış bozukluğu (YDB) birincil tanısı vardı. Risperidon ortalama başlangıç dozu 0.35 mg/gün ve ortalama idame dozu 0.52 mg/gün idi. Tedavinin ortalama süresi 4.9 ay idi. Zeka geriliği (ZG) olan hastalarda, YDB olan hastalara göre, başlangıç ve sürdürme dozları anlamlı olarak daha yüksek ve tedavi süresi anlamlı olarak daha uzundu. Tartışma: Okul öncesi çocuklarda, risperidon MR olan hastalarda daha yüksek dozlarla ve daha uzun süreli tedavi ile azaltılabilen agresif ve yıkıcı davranışsal belirtilerini kontrol etmek için sıklıkla kullanılır Agresif ve yıkıcı davranışları olan çocuklar için kanıta dayalı tedavi yöntemlerinin geliştirilmesi kontrollü çalışmalara ve onların klinik pratiğe uygunluğunun onayını gerektirir. Objective: We aimed to investigate the prevalence and mode of risperidone use in preschool aged children admitted with a chief complaint of aggressive and destructive behavioral symptoms. Methods: In this retrospective chart review study, medical records of the patients were reviewed for age, gender, primary and comorbid diagnoses, dosage and duration of risperidone treatment. Dosage and duration of risperidone treatment were compared among primary diagnoses. Results: In 2790 children prevalence of risperidone use was 18.5% (n516). Mean age was 4.86±1.12 years. Of these patients, %74.4 had primary diagnosis of a disruptive behavior disorder (DBD). Mean starting dosage of risperidone was 0.35 mg/day and mean maintenance dosage was 0.52 mg/day. The mean length of treatment was 4.9 months. Starting and maintenance doses were significantly higher and treatment duration was longer in patients with mental retardation (MR) than in those with DBDs. Conclusion: In preschoolers, risperidone is frequently used to control aggressive and destructive behavioral symptoms which may improve with higher doses and longer treatment in those with MR. The development of evidence-based treatment modalities for children with aggressive and destructive behaviors necessitates controlled studies and confirmation of their pertinence to clinical practice.

Most of mood stabilizers and antipsychotic agents are commonly used for early-onset bipolar disorder in clinical settings although there is limited number of randomized controlled trials with youths. Also, there are few prospective studies for the treatment of depressive episodes in bipolar disorder and maintenance therapy in children and adolescents. Here we report a 16 years-old adolescent with rapid cycling bipolar disorder who responded well to olanzapine monotherapy both at the acute manic phase and during the maintenance treatment. Olanzapine seems to be an effective choice during both acute phase and maintenance treatment of bipolar disorder in adolescents. Also, improvement in manic symptoms appears in the early days of treatment.