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Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by limitations in mutual communication and social interaction as well as restricted, repetitive patterns of behaviors, interests, or activities. A number of biological abnormalities have been reported in ASD. Therefore the possible role of biological abnormalities in etiopathogenesis arouses research interest in this area. This is a case-control design study evaluating epithelial barrier function by comparing serum concentrations of occludin and zonulin in children with ASD (n = 60) and controls (n = 30). The Childhood Autism Rating Scale (CARS) was used to evaluate autistic symptom levels of all children. Serum occludin and zonulin levels were analyzed using an enzyme-linked immunosorbent assay. Serum occludin was significantly lower in children with ASD than in control subjects. In children with ASD, a decrease in occludin level was significantly associated with the disorder symptom levels item mean score (CARS total scores). Our findings showed that children with ASD had alterations in epithelial barrier function compared to the control group. The investigation of the mechanism underlying the different levels of occludin between ASD and controls may be of importance in clarifying the etiopathogenesis of ASD, as well as its follow-up and treatment.

Dissociation is defined as impairment and / or interruption in the integration of consciousness, memory, identity, emotion, perception, body representation, motor control and behavior. Dissociation is evaluated in a spectrum ranging from a natural response that can occur in response to small tensions to dissociative disorders (DB) that can cause severe impairment in functionality. Although the underlying cause of CD development is often childhood trauma, attachment disorder is also an important factor. In the studies conducted, it was stated that internal working models formed through traumatic relational experiences experienced in childhood and internalized by repetition may lead to insecure attachment and disrupt the functional regulation of emotions. There are many studies in the literature that indicate a strong relationship between attachment style, emotional neglect, and dissociative symptoms. However, dissociative symptoms are not discussed in detail by clinicians within the framework of attachment pathology. In this case report, it is aimed to present a 14-year-old girl who applied to our clinic due to dissociative symptoms in the light of literature findings.

\n Otizm spektrum bozuklugu, sosyal etkilesim ve iletisim bozuklugu ile kisitli ve tekrarlayici davranislarla karakterize norogelisimsel bozukluklardan biridir. Otizm yaklasik 68 cocukta 1 gorulmektedir. Son yillarda yapilan calismalarda gorulme sikliginin arttigi bildirilmekte olup bu artisin bilgi ve farkindaligin artmasi ve tani olcutlerinin degismesinden kaynaklandigi iddia edilmekle birlikte yapilan calismalarda cevresel faktorler ve bunlarin henuz bilinmeyen genetik bir takim etkenlerle iliskisinin de bu artisa katki sagladigi dusunulmektedir. Norogelisimsel olarak onemli ve kirilgan bir donem olan prenatal donemde cocugun maruz kaldigi cevresel faktorlerin otizm spektrum bozuklugu gelismesi acisindan risk etkeni olup olmadiginin degerlendirilmesi onemlidir. Gebelik doneminde ozellikle valproik asit, terbutalin, selektif serotonin geri alim inhibitorleri gibi ilaclarla otizm spektrum bozuklugu arasinda bir iliski oldugu, bu donemde agir metal ve pestisite maruz kalmanin otizm spektrum bozuklugu riskini arttirdigi, yogun sigara, alkol ve madde kullaniminin norogelisimsel sureci sekteye ugrattigi, gebelik doneminde gecirilen gestasyonel diyabet, otoimmun hastaliklar, enfeksiyonlar ve uzamis atesin inflamatuar surecler araciligiyla otizm spektrum bozuklugu riskini artirabilecegi bildirilmektedir. Goc, mevsimler ve gebelik doneminde maruz kalinan hava kirliligininde risk artisina etkisi oldugu bildirilmis ve daha fazla epidemiyolojik calismaya ihtiyac oldugu vurgulanmistir. otizm spektrum bozuklugu ile iliskili cevresel etkenlerin taninmasi, anne adaylarinin bu risk etkenleri ile ilgili bilgilendirilmesinin saglanarak bu etkenlerden uzak durmalari veya bu etkenlerin elimine edilmesi ile otizm spektrum bozuklugu riskinin azaltilmasina yardimci olabileceginden bu alanda yapilan calismalarin derlenmesi ve risklerin ortaya konulmasi ozellikle onemlidir. Bu gozden gecirmede son donemde sayisi artan prenatal etkenler ile ilgili yapilan calismalarin derlenerek butuncul olarak ele almasinin kolaylastirilmasi hedeflemektedir. \n

Aim To evaluate the impact of the COVID‐19 lockdown on adolescents with eating disorders (ED) and identify factors predicting ED behaviour. Method This study took place during an age‐stratified lockdown for those under 20 years in Turkey. Participants completed a survey developed to evaluate the effects of the lockdown on ED behaviour, well‐being and quality of life (QoL) and additionally the eating disorder examination questionnaire (EDE‐Q), and scales for depression, anxiety and obsessive‐compulsive behaviour. The relationship between the EDE‐Q‐global score and other variables related to ED was examined. Linear regression analysis was performed to examine the predictive power of these variables on ED behaviour. Results Thirty‐eight ED patients with a mean age of 15.12 ± 1.56 years were included in the study. Of participants, 42.1% reported feeling an improvement in ED symptomatology, 71.0% reported none or rare conflict with parents due to eating, 39.5% reported often or always complying with their meal plan. Of participants, 92.0% agreed to ‘understanding the value of being healthy’ and stated realizing that ‘they were in control’ due to the pandemic. Of participants 36.9% scored ‘bad’ for both overall and ED related QoL. In the stepwise regression analysis depression score had the highest predictive value for ED behaviour. Conclusion Almost half of the participants felt an improvement in their ED and a majority reported rare parental conflict. However, less than half reported meal plan compliance. As depression had the highest positive predictive value for ED behaviour additional screening for depression during the pandemic maybe warranted in ED patients.

To compare vitamin B12, homocysteine, and anti-parietal cell antibody (APCA) levels between children with ASD and controls, paired in terms of age, sex, and socioeconomic level.The research group consisted of 69 children, 36 with ASD and 33 controls. The severity of ASD was determined using the Childhood Autism Rating Scale (CARS). Serum vitamin B12, homocysteine and human anti-parietal cell levels were analysed using enzyme-linked immunosorbent assay.The serum vitamin B12 and homocysteine levels in children with ASD were lower than in the control group, but there was no significant difference in terms of APCA levels.Deficiencies in micronutrients, such as B12, may play a role in the pathogenesis and clinical symptoms of autism. However, it is believed that these parameters should be analysed in a wider population to clarify their effect on the aetiology of ASD.KEY POINTWe hypothesised that low levels of vitamin B12 and homocysteine levels reported in previous studies might be associated with APCA levels.The homocysteine and B12 levels were found to be significantly lower in children with ASD. There was no significant difference in serum APCA levels.No significant relationship was found between B12 levels and APCA.Given all these findings, it can be stated that vitamin B12 deficiency is not associated with an absorption-related mechanism due to the presence of APCA.Deficiencies in micronutrients, such as B12, may play a role in the pathogenesis and clinical symptoms of autism.In future studies, it will be beneficial to investigate other mechanisms that may cause vitamin B12 deficiency.

Introduction: It is known that patients with anorexia nervosa (AN) display social difficulties like social responsiveness and high levels of autistic behaviors such as rigidity, narrow interests of food and weight; however it is not clear whether they have comorbid Autism Spectrum Disorders (ASD) or it is about acute phase of illness. In this study it is aimed to investigate autistic traits and social responsiveness in adolescents with AN. Methods: Study group was consisted of 39 female AN patients aged between 12-18 years. Control group was consisted of 34 female adolescents who did not have any psychiatric disorder. K-SADS-PL was applied to all participants in order to detect the psychiatric disorders. Autism traits and social responsiveness were evaluated using Social Responsiveness Scale. All adolescents of the study were administered The Eating Attitude Test, Beck Depression Inventory, Screen for Child Anxiety and Related Disorders, Maudsley Obsesive Compulsive Inventory. Results: Results of the study indicated that adolescents with AN had higher symptoms of depression, anxiety and autism-like symptom clusters; and lower social responsiveness. Psychiatric comorbidities were not associated with these difficulties. Conclusion: The results show that AN patients have an impairment of social responsiveness, the impairment seems to be associated with AN regardless of psychiatric comorbidities. Despite these two disorders are considered unrelated, they have several traits in common. These results suggest that there may be a common pathogenesis between ASD and AN.

To investigate the possible relationship between relaxin-3 and autism spectrum disorder (ASD).Serum relaxin-3 was measured in 80 children (50 children diagnosed with ASD and 30 controls). Symptom severity in the ASD group was evaluated by the Childhood Autism Rating Scale (CARS). Behavioral and nutritional problems in the groups were evaluated using the Abnormal Behavior Checklist (ABC) and the Children's Eating Behavior Questionnaire (CEBQ).Our findings showed that serum relaxin-3 levels were higher in children with ASD than in the controls. The listening response sub-scale score of the CARS scale was found to decrease as the level of relaxin-3 increased. However, as relaxin-3 levels increased in children with ASD, it was found that the speech problem sub-scale score on the ABC scale and the desire to drink score on the CEBQ scale increased, but the satiety responsiveness and food fussiness scores decreased.This study the first to investigate serum levels of relaxin-3, which has a role in regulating social behavior and nutritional behavior in children with ASD.

EgeUn###, Aim: The aim of this study was to determine the prevalence of childhood psychopathologies in Turkey. Method: A nation-wide, randomly selected, representative population of 5830 children (6-13 years-old) enrolled as a 2nd,3rd or 4th grade student in 30 cities were evaluated for presence of a psychiatric or mental disorder by a Sociodemographic Form, Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and DSM-IV-Based Screening Scale for Disruptive Behavior Disorders in Children and Adolescents scales. Impairment criterion was assessed via a 3 point-Likert scale by the parent and the teacher independently. Results: Overall prevalence of any psychopathology was 37.6% without impairment criterion, and 17.1% with impairment criterion. Attention-deficit hyperactivity disorder was the most frequent diagnosis, followed by anxiety (19.5% and 16.7% without impairment, 12.4% and 5.3% with impairment, respectively). Lower education level and presence of a physical or psychiatric problem of the parents were independent predictors of any psychopathology of the offspring. Conclusion: This is the largest and most comprehensive epidemiological study to determine the prevalence of psychopathologies in children and adolescents in Turkey. Our results partly higher than, and partly comparable to previous national and international studies. It also contributes to the literature by determining the independent predictors of psychopathologies in this age group.

Objective The aim of this study was to compare the attachment security and perceived expressed emotion of female adolescents diagnosed with anorexia nervosa and those without any psychiatric disorder and to compare the expressed emotion of their parents. We also aimed to investigate the relationships between these variables and the effects of depression and anxiety symptoms of the adolescents on attachment security, perceived expressed emotion and expressed emotion of the parents. Method The study enrolled 43 female adolescents aged 12-18 years diagnosed with anorexia nervosa and an age and economic statusmatched control group of 37 healthy female adolescents. Both groups completed the Eating Attitudes Test-40 (EAT-40), the Perceived Expressed Emotion Scale (PEES), the Short Form of Inventory of Parentand Peer Attachment (IPPA), the Beck Depression Inventory (BDI) and the Screenfor Child Anxietyand Related Disorders (SCARED). Parents were assessed with the Expressed Emotion Scale (EES). Results As compared to the control group, the female adolescents with anorexia nervosa had lower attachment security and higher perception of parental expression of criticism and hostility. Presence of depression and anxiety symptoms did not affect these results. The security of maternal attachment in the adolescents with anorexia nervosa predicted their perception of criticism and hostility in their mothers. Conclusion The results of this study indicate the importance of assessing attachment security and perceived expressed emotion in adolescents with anorexia nervosa and the requirement of parental inclusion in the therapeutic process during follow up for implementation of appropriate interventions.

Emotional functions may play an important role in anorexia nervosa (AN). The onset of the disorder generally occurs during adolescence, which is a critical period of emotional development. However, most studies that evaluated emotional functions in AN were conducted in adult patients. The aim of this study was to evaluate emotion regulation, emotion recognition, and empathy skills in adolescent girls with AN by controlling for the effects of depression and anxiety symptoms, childhood traumatic experiences, and attachment security on emotional functions. Thirty-two adolescent girls with AN and 32 healthy counterparts completed the Difficulties in Emotion Regulation Scale, the Reading the Mind in the Eyes Test, Toronto Alexithymia Scale-20, and the Child and Adolescent KA-SI Empathic Tendency Scale-Adolescent Form. The results revealed that adolescents with AN were found to have more difficulties in emotion regulation, higher alexithymic tendencies, and lower empathy skills compared with the control group. However, emotion recognition was not found to be significantly different between the two groups. These results were the same when controlling for the effects of depression and anxiety symptoms, childhood traumatic experiences, and attachment security except for empathy skills. Alexithymia and depressive symptoms were significantly related to emotion regulation difficulties in adolescents with AN. Considering the results, it seems that emotion regulation and alexithymia may play a crucial role in the development and maintenance of AN. Accordingly, it is necessary to focus on the improvement of these skills during the treatment of AN. Furthermore, interventions promoting these skills during adolescence may be preventive. Level III, case–control study.

GOKCEN, CEM/0000-0003-3824-5890; Topal, Zehra/0000-0001-8397-5636; Tural, Umit/0000-0002-1593-2180; Unal, Fatih/0000-0001-8386-9884; Acikel, Burak/0000-0002-8964-9513; Erden, Semih/0000-0002-7723-9584; Kilic, Birim Gunay/0000-0002-4566-2564; Ucar, Halit Necmi/0000-0002-2706-7454; CELIK, GONCA/0000-0001-6101-0796; Gunes, Serkan/0000-0002-8247-2145; Isik, Umit/0000-0001-6006-3247; Coskun, Murat/0000-0002-4808-5870; Tufan, ALI EVREN/0000-0001-5207-6240; Donmez, Yunus Emre/0000-0002-7785-2805; Ceri, Veysi/0000-0001-6152-0227; Uzun, Necati/0000-0003-3381-2331; Hesapcioglu, Selma Tural/0000-0002-4816-0228; Kandemir, Hasan/0000-0002-1138-4973; Gormez, Vahdet/0000-0002-2704-9520 WOS: 000439557000070 PubMed: 29936389 Aim: To determine the prevalence of affective disorders in Turkey among a representative sample of Turkish population. Methods: This study was conducted as a part of the "The Epidemiology of Childhood Psychopathology in Turkey" (EPICPAT-T) Study, which was designed by the Turkish Association of Child and Adolescent Mental Health. The inclusion criterion was being a student between the second and fourth grades in the schools assigned as study centers. The assessment tools used were the K-SADS-PL, and a sociodemographic form that was designed by the authors. Impairment was assessed via a 3 point-Likert type scale independently rated by a parent and a teacher. Results: A total of 5842 participants were included in the analyses. The prevalence of affective disorders was 2.5 % without considering impairment and 1.6 % when impairment was taken into account. In our sample, the diagnosis of bipolar disorder was lacking, thus depressive disorders constituted all the cases. Among depressive disorders with impairment, major depressive disorder (MDD) (prevalence of 1.06%) was the most common, followed by dysthymia (prevalence of 0.2%), adjustment disorder with depressive features (prevalence of 0.17%), and depressive disorder-NOS (prevalence of 0.14%). There were no statistically significant gender differences for depression. Maternal psychopathology and paternal physical illness were predictors of affective disorders with pervasive impairment. Conclusion: MDD was the most common depressive disorder among Turkish children in this nationwide epidemiological study. This highlights the severe nature of depression and the importance of early interventions. Populations with maternal psychopathology and paternal physical illness may be the most appropriate targets for interventions to prevent and treat depression in children and adolescents.

In the literature self-esteem is found to be lower in clinically referred adolescents compared to adolescents without any psychiatric disorder. The aim of this study is to examine self-esteem and associated socio-demographical and psychological factors in clinically referred adolescents in Turkey. Three hundred forty-nine adolescents aged between 12 and 18 years admitted to the Department of Child and Adolescent Psychiatry with a psychiatric complaint were enrolled. Rosenberg Self-Esteem Scale (RSES), Brief Symptom Inventory (BSI), Parenting Style Scale (PSS) and Sense of Identity Assessment Form (SIAF) were used for the evaluation. Self-esteem was lower in: girls, adolescents without siblings, living in non-nuclear families, with a past suicide attempt, and with history of a non-suicidal self-injurious behavior (NSSI). Self-esteem was negatively correlated with identity confusion on SIAF and positively correlated with acceptance/involvement on PSS. Significant predictors of self-esteem were gender, presence of a sibling, history of a NSSI and SIAF scores. Interactions between self-esteem and gender, psychiatric symptoms, parenting and identity development are complex in clinically referred adolescents. Further elucidation of the mechanisms through which these characteristics modify self-esteem will be necessary to guide families and clinicians to help adolescents to maintain high self-esteem levels.