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Opioid use disorder (OUD) is a chronic disorder with a considerable amount of morbidity and mortality. Despite remarkable improvement achieved by maintenance programs, an array of treatment goals were still unmet. Mounting evidence suggests that transcranial Direct Current Stimulation (tDCS) improves decision making and cognitive functions in addictive disorders. tDCS paired with a decision making task was depicted to diminish impulsivity as well. The present study aimed to assess the effect of tDCS combined with cognitive training (CT) in OUD for the first time. In this triple-blind randomized sham-controlled pilot study, 38 individuals with OUD from the Buprenorphine-Naloxone Maintenance Therapy program were administered 20-minutes of 2 mA active/sham tDCS over the dorsolateral prefrontal cortex with concomitant cognitive training. A selected test battery evaluating decision making under risk and ambiguity as well as executive functions, verbal fluency and working memory was utilized before and after the intervention. Greater improvements were observed in decision making under ambiguity (p = 0.016), set shifting ability and alternating fluency while no improvements were observed in decision making under risk in the active group, compared to sham. Deficits of decision making and executive functions have a pivotal role in the perpetuation and the relapse of the OUD. Alleviation of these impairments brought tDCS/CT forth as an expedient neuroscientifically-grounded treatment option that merits further exploration in OUD, Trial registration: NCT05568251. [ABSTRACT FROM AUTHOR]

Aim: Emerging evidence suggests that transcranial direct current stimulation (tDCS) has anxiolytic effects and may enhance emotional processing of threat and reduce threat‐related attentional bias. Panic disorder (PD) is considered to be a fear network disorder along with prefrontal activity alterations. We aim to assess the effect of tDCS on clinical and physiological parameters in PD for the first time. Methods: In this triple‐blind randomized sham‐controlled pilot study, 30 individuals with PD were allocated into active and sham groups to receive 10 sessions of tDCS targeting the dorsolateral prefrontal cortex bilaterally at 2 mA for 20‐min duration over 2 weeks. The clinical severity, threat‐related attentional bias, interoceptive accuracy, and emotional recognition were assessed before, immediately after, and 1 month after tDCS. Results: Active tDCS, in comparison to sham, did not elicit more favorable clinical and neuropsychological/physiological outcomes in PD. Conclusion: The present study provides the first clinical and neurobehavioral results of prefrontal tDCS in PD and indicates that prefrontal tDCS was not superior to sham in PD. [ABSTRACT FROM AUTHOR]

Decision making and cognitive flexibility are two components of cognitive control that play a critical role in the emergence, persistence, and relapse of gambling disorder. Transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) has been reported to enhance decision making and cognitive flexibility in healthy volunteers and individuals with addictive disorders. In this triple-blind randomized sham-controlled parallel study, we aimed to determine whether tDCS over DLPFC would modulate decision making and cognitive flexibility in individuals with gambling disorder. Twenty participants with gambling disorder were administered Iowa Gambling Task (IGT) and Wisconsin Card Sorting Test (WCST). Subsequently, participants were administered three every other day sessions of active right anodal /left cathodal tDCS (20 min, 2 mA) or sham stimulation over bilateral DLPFC. WCST and IGT were readministered following the last session. Baseline clinical severity, depression, impulsivity levels, and cognitive performance were similar between groups. TDCS over the DLPFC resulted in more advantageous decision making (F1,16 = 8.128, p = 0.01, ɳp2 =0.33) and better cognitive flexibility (F1,16 =8.782, p = 0.009, ɳp2 = 0.35), representing large effect sizes. The results suggest for the first time that tDCS enhanced decision making and cognitive flexibility in gambling disorder. Therefore, tDCS may be a promising neuromodulation-based therapeutic approach in gambling disorder. Trial registration: Clinicaltrials.gov NCT03477799. [ABSTRACT FROM AUTHOR]

Few studies have investigated the relationship between obsessive-compulsive symptoms (OCS) and clinical variables, and cognition in individuals at ultra high-risk (UHR) for psychosis. The aim of this study was to evaluate the frequency of OCS and their relationship with clinical variables and cognitive functions in individuals at UHR. Eighty-four individuals at UHR for psychosis were administered the Brief Psychiatric Rating Scale, the Yale-Brown Obsession Compulsion Symptom Check List and, the Calgary Depression Scale for Schizophrenia. A cognitive test battery was also applied. We compared the clinical, functional, and cognitive parameters of individuals at UHR with and without OCS and healthy controls. Thirty-five percent of the UHR sample had at least two obsessions/compulsions. The duration of subthreshold psychotic symptoms was longer in individuals with OCS. Those who can work/study before first presentation were more frequent in OCS-positive group. CDSS scores were higher in those with OCS. Compared to controls, OCS-negative group's performance was worse in 8 cognitive test items, while OCS-positive group performed worse in only one cognitive test item. Our findings suggest that OCS are common in the UHR group. OCS might be related to higher level of depression, but better work/study performance, and less cognitive deficits in UHR group. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to provide clinical data regarding comorbidity of psychiatric disorders in individuals with dissociative disorders (DD). Methods: The study included 60 consecutive patients (8 male, 52 female, mean age: 15.6+/-1.8 years) diagnosed with DD in Istanbul Faculty of Medicine, Department of Child and Adolescent Psychiatry. The patients were diagnosed according to the DSM-IV criteria and the psychiatric comorbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime Version. The patients also filled in a questionnaire to gather information about types of trauma, suicide attempts and self-mutilative behaviors. Adolescent Dissociative Experiences Scale (ADES) and Posttraumatic Stress Reaction Index (PSRI) were also administered. Results: The mean age at first admission and diagnosis were 14.3 and 15.6 years, respectively. The types of trauma reported were emotional abuse (66.7%), physical abuse (63.3%), emotional neglect (56.7%), sexual abuse (50%), and incest (20%). Seventy-one percent of the sample reported multiple traumas. The frequency of suicide attempts and self-mutilative behaviors were 66.7% and 88.3%, while 46% reported multiple suicide attempts. Fifty-eight percent of the sample were diagnosed with Dissociative Identity Disorder and 42% with Dissociative Disorder Not Otherwise Specified. All patients reported at least one comorbidity. The mean number of psychiatric comorbidities was 3.8 and the most common ones were as follows: 88% major depressive disorder (MDD), 45% posttraumatic stress disorder (PTSD), 38% conversion disorder, 36% attention deficit hyperactivity disorder, 35% separation anxiety disorder, 33% social anxiety disorder, 30% conduct disorder, 25% anxiety disorder not otherwise specified, 23% obsessive compulsive disorder, 23% generalized anxiety disorder. Alcohol, tobacco and illicit drug abuse were described in 16%, 45% and 8% of the sample. The ADES and PSRI scores were higher in the depressive group. The number of comorbidities was higher in PTSD group. The number of comorbidities correlated with ADES (p:0.01, r:0.317) and the PSRI (p:0.001, r:0.408) scores. The ADES scores also correlated with the PSRI scores (p:0.0001, r:0.46). Conclusion: DD is one of the most common disorders associated with traumatic experiences in the pediatric population. A recent study with 25 adolescents with DD from our clinic revealed that the most common comorbidities were MDD and PTSD. Our results support these findings with a bigger sample. In conclusion, DD is an important clinical diagnosis, which usually presents with high rates of psychiatric comorbidity in the adolescent age. The diagnosis of DD may be overshadowed by these comorbid conditions, which may be associated with late diagnosis. [ABSTRACT FROM AUTHOR]

Objective: Gambling disorder is the new term for"pathological gambling" in the DSM-5. It is an emerging mental health concern with easier access and increasing opportunities via internet lately. However, treatment seeking is low and data the in Turkish population are limited to a single study. Therefore, we assessed sociodemographic and clinical features in a treatment-seeking male population. Methods: Charts of patients presenting with gambling disorder to the addiction unit of Istanbul University between 2000 and 2014 were reviewed. Manic or psychotic patients were excluded. Results: Forty-one patients had presented primarily due to compulsive gambling. 70% (n=29) of the sample were married, 85% (n=35) were employed. Mean age at admission was 38.9±9.11 (min=18, max=61). Mean duration of compulsive gambling was 8 years. Sixtythree percent of the patients were self-motivated for therapy while others came due to family pressure. 58.5 % (n=24) of the sample had histories of unsuccessful attempts to quit gambling. The gambling types were as follows: 48% horse races, 48% football bet, 4.9% stock exchange, 34.1% card games, 24.4% dice games, 19.7% online bet sites. Frequency of gambling behaviors were as follows: 61% every day, 34% three times a week, 2.4% once a week, 2.4% less than four times in a month in the last month before admission. Mean followup duration in our unit was 3.9 months (min=one visit, max=48 months). 51% (n=21) had major depressive disorder at admission. 43.9% (n=18) had thoughts about death. 9.8% (n=4) reported a history of suicide attempt. 5% (n=2) were hospitalized at first admission due to active suicidal ideation. 27% of the sample had reported alcohol, 12% had cannabis, 7% had designer drugs, 2.4% had cocaine, and 2.4% had heroine abuse. During follow-up 28.9% of the sample stopped gambling and 10.5% had reduced gambling frequency. Patients that were hospitalized had higher follow-up duration. Self-motivated patients had higher depression rates, ideation of dying rates and higher follow-up duration. Conclusion: The main finding is the high early drop-out rate of the patients with gambling disorder despite treatment seeking behavior. Another finding was the long interval of compulsive gambling without treatment seeking. Notably, none of the efforts to quit gambling was made during psychiatric follow-up. Stigma and lack of knowledge may explain these situations. Besides, depression and suicidality seems to be an important factor for treatment seeking. Gambling should be assessed and targeted specifically in depressive patients. To conclude, new treatment models are urgently needed to increase admission and attendance to treatment and studies to be conducted in the general population or risky populations are required. [ABSTRACT FROM AUTHOR]

Abstract Association of cognitive deficits and diabetic peripheral neuropathy (DPN) is frequent. Working memory (WM) deficits result in impairment of daily activities, diminished functionality, and treatment compliance. Mounting evidence suggests that transcranial Direct Current Stimulation (tDCS) with concurrent working memory training (WMT) ameliorates cognitive deficits. Emboldening results of tDCS were shown in DPN. The study aimed to evaluate the efficacy of anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC) coupled with cathodal right DLPFC with concurrent WMT in DPN for the first time. The present randomized triple-blind parallel-group sham-controlled study evaluated the efficacy of 5 sessions of tDCS over the DLPFC concurrent with WMT in 28 individuals with painful DPN on cognitive (primary) and pain-related, psychiatric outcome measures before, immediately after, and 1-month after treatment protocol. tDCS enhanced the efficacy of WMT on working memory and yielded lower anxiety levels than sham tDCS but efficacy was not superior to sham on other cognitive domains, pain severity, quality of life, and depression. tDCS with concurrent WMT enhanced WM and ameliorated anxiety in DPN without affecting other cognitive and pain-related outcomes. Further research scrutinizing the short/long-term efficacy with larger samples is accredited. [ABSTRACT FROM AUTHOR]

Background: Parkinson's disease-mild cognitive impairment (PD-MCI) is garnering attention as a key interventional period for cognitive impairment. Currently, there are no approved treatments for PD-MCI and encouraging results of transcranial direct current stimulation (tDCS) combined with other interventions have been proposed, though the efficacy and neural mechanisms of tDCS alone have not been studied in PD-MCI yet.Objectives: The present double-blind, randomized, sham-controlled study assessed the effects of tDCS over the dorsolateral prefrontal cortex on cognitive functions via neuropsychological and electrophysiological evaluations in individuals with PD-MCI for the first time.Method: Twenty-six individuals with PD-MCI were administered 10 sessions of active (n = 13) or sham (n = 13) prefrontal tDCS twice a day, for 5 days. Changes were tested through a comprehensive neuropsychological battery and event-related potential recordings, which were performed before, immediately, and 1 month after the administrations.Results: Neuropsychological assessment showed an improvement in delayed recall and executive functions in the active group. N1 amplitudes in response to targets in the oddball test-likely indexing attention and discriminability and NoGo N2 amplitudes in the continuous performance test-likely indexing cognitive control and conflict monitoring increased in the active group. Active stimulation elicited higher benefits 1 month after the administrations.Conclusion: The present findings substantiate the efficacy of tDCS on cognitive control and episodic memory, along with the neural underpinnings of cognitive control, highlighting its potential for therapeutic utility in PD-MCI.Trial Registration: NCT 04,171,804. Date of registration: 21/11/2019. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 15-year-old boy with Henoch-Schönlein purpura (HSP). Topics discussed include association of the patient with fluoxetine treatment, involvement of the leukocytoclastic vasculitis with selective serotonin reuptake inhibitors (SSRI), description of Paroxetine relation with leukocytoclastic vasculitis treatment process, illustration of symptoms related to HSP such as abdominal pain and utilization of fluoxetine in treatment as its causative factor property.

• The London Tower Test performance was enhanced after active tDCS in adults with ADHD. • The backward digit span improved after active tDCS. • No improvements were observed in the Continuous Performance Test and Stroop Test after active tDCS. Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects up to 2.8% of the adult population. Albeit pharmacological and behavioral therapies alleviate some core symptoms of ADHD, they do not avail cognitive dysfunction adequately. Executive dysfunction has been considered to have a principal role in ADHD and has previously been linked to activity alterations in the prefrontal cortex. Transcranial Direct Current Stimulation (tDCS) is a noninvasive brain stimulation technique that may modulate prefrontal cortex activity and induce neuroplasticity, with preliminary results in ADHD. The aim of the present study is to assess the effect of repeated tDCS on measures of executive functions in adults with ADHD. In this randomized double-blind sham-controlled study, 22 adults with ADHD were allocated into two groups and were administered five consecutive sessions of 2 mA active/sham tDCS over the dorsolateral prefrontal cortex (right anodal/left cathodal). A neuropsychological test battery was administered before the first session and immediately after the last session. The maximum number of digits and the total number of correct trials in the Digit Span Backward test increased in the active group (p = 0.017). The total move score in the Tower of London test decreased (p = 0.033), suggesting better planning ability. However, no significant differences were observed on Stroop Test and Trail Making Test after tDCS. The present study corroborates the modulating effects of tDCS on planning and working memory in a small group of adults with ADHD. Our results highlighted that cognitive functions are modulable using tDCS in adults with ADHD. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the frequencies of psychiatric comorbidities in children and adolescents with chronic idiopathic urticaria (CIU) and compare these findings with the normal population. Methods: Fifty-six patients (31 boys, 25 girls) participated in the study. All of them were being followed up at the outpatient clinic for at least 6 months and diagnosed as having CIU after excluding any possible causes of urticaria. Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) were administered to assess psychiatric comorbidities. Results: The mean age was 10.37±2.75 years. The frequency of any psychiatric disorder was 69.6%, and 17.9 % of the patients had more than one psychiatric disorder. Psychiatric comorbidity was higher in girls than boys (76% vs. 35.4%). The psychiatric comorbidities were as follows: social phobia (30.4%), attention deficit hyperactivity disorder (19.6%), separation anxiety, (10.7 %), anxiety disorder not otherwise specified (10.7%), major depressive disorder (7.1%), generalized anxiety disorder (5.4%), obsessive compulsive disorder (1.8%), and oppositional defiant disorder (1.8%). Conclusion: Recent studies show that both adults and children with CIU frequently exhibit psychiatric comorbidity, most commonly depression and anxiety disorders consistent with our findings. Psychiatric comorbidities were registered in 60% of the CIU adult population and 70% of CIU pediatric population (versus 30% of controls); while depression was the most common diagnosis in adults, anxiety disorders were more frequent in children. The most common diagnoses included social anxiety disorder, separation anxiety disorder, and specific phobias. The present study confirms these findings in a Turkish population. In conclusion, CIU is a psychosomatic disorder and usually accompanied by a psychiatric disorder. The high frequency of psychiatric comorbidity must be kept in mind while evaluating these patients. [ABSTRACT FROM AUTHOR]

Objective: Psychogenic and habit cough are the common terms to refer to a chronic dry cough without evidence of organic base that does not respond to antitussive pharmacotherapy. It has been reported that children with psychogenic cough may have an underlying psychiatric disorder, most commonly conversion disorder (21.9%), followed by mixed anxiety and depressive disorder (12.2%). We aim to investigate underlying psychiatric disorders in patients with psychogenic cough. Methods: Thirty-eight patients with psychogenic cough (23 males, 15 females, minimum age6, maximum age15, mean age: 9.4±2.9 years) were included in the study. To exclude other medical etiologies, physical examination, blood tests with complete blood count, erythrocyte sedimentation rate, blood chemistry, liver function tests, throat swab culture, pulmonary function tests, allergic profile, and chest X-ray were performed. Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) was administered to assess psychiatric comorbidities. Results: The most common psychiatric disorder was tic disorder with a frequency of 23.7%, followed by conversion disorder with the frequency of 21.1%. Other common diagnoses were as follows: separation anxiety disorder (13.2%), anxiety disorder not otherwise specified (13.2%), generalized anxiety disorder (10.5%). Conclusion: Psychogenic cough was the second-most common cause of chronic cough in children aged 6 to 16 years, which may be due to a high frequency of tic disorders in childhood. Tic disorders were the most common diagnosis in our group, followed by conversion disorder and separation anxiety disorder. Some studies also report psychiatric comorbidities in patients with psychogenic cough. Bhatia et al. reported a 62% rate of psychiatric comorbidity; the most common diagnoses were conversion disorder (22%), mixed anxiety and depressive disorder (12%), and generalized anxiety disorder (10%). Anbar and Hall reported that conversion disorder was diagnosed in 11% and anxiety disorder in 2 % of patients with psychogenic cough. Consistent with these findings, conversion disorder was the second-most common diagnosis in our sample. As a result, differential diagnosis between psychogenic and organic etiology of cough is very important in order to provide psychiatric help and avoid unnecessary medical procedures. Therefore, psychiatric evaluation should be performed for children with chronic cough. [ABSTRACT FROM AUTHOR]

Dystonic reactions are complication of medications that act on dopaminergic pathways. Dystonic reactions occur often as a side effect following administration of medications that block dopamine receptors like antipsychotics. But rarely, drugs that increase dopaminergic activity like methylphenidate may also cause dystonic reactions. This has been previously reported only in patients who took dopamine antagonists or, less commonly, in children with developmental abnormalities. There is also a case report about a patient, who is only under methylphenidate treatment and has dyskinesia. We report here on a child treated with methylphenidate, who experienced an acute dystonic reaction. H.S. is a 15-years-old female with ADHD. She had been received 27 mg extended-release methylphenidate for nine days. She complained for spasmodic muscular contractions of extensor side of his right hand and wrist. The parents of the child also observed the same. She was admitted to emergency service with involuntary extensor contraction, tension and severe pain. She was diagnosed as acute dystonic reaction in assessment by psychiatrist. The patient was treated with biperiden 2 mg oral tablet and intramuscular 5 mg diazepam. In psychiatric history, the patient disclosed that this adverse effect had occurred on one occasion previously when she had taken short-acting methylphenidate several years ago. She told that the muscular contractions had occurred in her feet and toes. She had no preexisting movement disorder, central nervous system injury, developmental abnormalities or any other previously reported risk factors for this side effect. In examination the patient had normal general and neurological features. Also the cranial MRI and EEG were normal. Detailed assessment showed her to be within the normal range for gross motor, fine motor, social, and language development. Family members had no movement or psychiatric disorders.Methylphenidate is a commonly used agent effective in the treatment of attention-deficit hyperactivity disorder (ADHD). There has been one case report about dyskinesia during methylphenidate treatment, so far. There are a few case reports of extrapyramidal side effects during methylphenidate treatment in patients who has been on concomitant antipsychotic medication or having neurodevelopmental abnormalities. There are also case reports of patients, who used aripiprazole and methylphenidate combined and had dyskinesia after cessation of methylphenidate. The mechanism of this side effect is unclear. We think that our case is the first dystonia that occurred during methylphenidate treatment, so we came up with the idea that, shifts in dopamine by methylphenidate might rarely cause childhoodonset movement disorders like dystonia or dyskinesias as a side affect. [ABSTRACT FROM AUTHOR]