Sezen Kose - Academia.edu (original) (raw)

Papers by Sezen Kose

The International journal of eating disorders, Aug 1, 2016

Deficits in theory of mind (ToM), ability to infer mental states of others, can play a significan... more Deficits in theory of mind (ToM), ability to infer mental states of others, can play a significant role in interpersonal difficulties and/or unawareness of illness observed in AN and other eating disorders including bulimia Nervosa (BN). Current meta-analysis aimed to summarize available evidence for deficits in ToM in AN and BN and examine the effects of number of study-level variables on observed findings. In this meta-analysis, 15 studies (22 samples with eating disorders) investigating ToM performances of 677 individuals with AN or BN and 514 healthy controls were included. AN was associated with significant deficits in ToM (d = 0.59) which were more pronounced in the acute patients (d = 0.67). Small sized deficits in ToM were observed in BN (d = 0.34) and recovered AN (d = 0.35). Both cognitive perspective-taking (ToM-PT) (d = 0.99) and decoding mental states (ToM-decoding) (d = 0.61) aspects of ToM were impaired in acute AN. ToM-decoding impairment in BN was modest. There was ...

Health Related Quality of Life in children with Autism Spectrum Disorders: The clinical and demographic related factors in Turkey

Research in Autism Spectrum Disorders, 2013

This study examined the prevalence and chronicity of sleep problems in children who manifest prob... more This study examined the prevalence and chronicity of sleep problems in children who manifest problems believed to be typical of Autism Spectrum Disorders (ASD). Using data from a longitudinal total population study, symptoms of ASD, insomnia and potential explanatory factors were assessed at ages 7-9 and 11-13. Children were included in a group defined as having Autism Spectrum Problems (ASP) if they scored above a strict threshold on the Autism Spectrum Screening Questionnaire (ASSQ). Twenty-eight (0.8%) of 3700 children fulfilled the selected criteria for ASP at both waves, and the prevalence of chronic insomnia was more than ten times

This study examined the prevalence and chronicity of sleep problems in children who manifest prob... more This study examined the prevalence and chronicity of sleep problems in children who manifest problems believed to be typical of Autism Spectrum Disorders (ASD). Using data from a longitudinal total population study, symptoms of ASD, insomnia and potential explanatory factors were assessed at ages 7-9 and 11-13. Children were included in a group defined as having Autism Spectrum Problems (ASP) if they scored above a strict threshold on the Autism Spectrum Screening Questionnaire (ASSQ). Twenty-eight (0.8%) of 3700 children fulfilled the selected criteria for ASP at both waves, and the prevalence of chronic insomnia was more than ten times

Anadolu Psikiyatri Dergisi, 2011

Amaç: Çocukluk çağında yaşanan stres verici yaşantılar, özellikle cinsel istismar, çocuğun psikol... more Amaç: Çocukluk çağında yaşanan stres verici yaşantılar, özellikle cinsel istismar, çocuğun psikolojisine ve yaşam kalitesine zarar vermektedir. Adli psikiyatrik değerlendirme, mahkeme karar süreci için bilgi sağlama ve bilirkişiliği içerdiği gibi, çocuktaki olası psikiyatrik bozukluğun saptanması ve çocuğun korunabilmesi açısından da önemlidir. Bu nedenle polikliniğimize adli makamlarca rapor düzenlenmesi amacıyla yönlendirilen çocukların incelenmesi amaçlanmıştır. Yöntem: Adli makamlarca Ocak 2007-Aralık 2009 tarihleri arasında haklarında rapor düzenlenmesi amacıyla hastanemizin çocuk psikiyatrisi polikliniğine yönlendirilen 4-18 yaşları arasındaki 73 olgunun (45 kız, 28 erkek) dosya bilgileri geriye dönük olarak incelenmiştir. Sosyodemografik özellikler, psikopatoloji, zeka düzeyi, doğum yeri, adli istekler ve zanlının özellikleri her olgu için ayrı bir kayıt formu tutularak değerlendirilmiştir. Sonuçlar: Olguların 65'i (%89) cinsel istismar sonrası değerlendirilmek üzere gönderilmiştir. Olguların %61.6'sı, cinsel istismar grubunun %66.2'si kızdır. Mahkeme isteklerinin %86.3'ü çocuğun ruhsal durumunun değerlendirilmesidir. Cinsel istismara uğramış çocuklarda saptanan psikiyatrik tanılar travma sonrası stres bozukluğu (%32.3), uyum bozukluğu (%20), akut stres bozukluğu (%16.9), depresif bozukluklardır (%13.8). Olguların %16.9'unda aktif psikiyatrik bozukluk saptanmamıştır. Zeka düzeyi 42 (%64.6) olguda normaldir. Cinsel istismar zanlılarının %20.4'ü 18 yaşından küçük, %26.4'ü yabancı, %56.6'sı tanıdık (9 olgu ensest mağduru-%13.8) ve %17'si arkadaşlarının aracılığı ile tanışılan kişilerdir. Tartışma: Mahkemenin en sık isteği cinsel istismarın ardın-dan ruhsal durumun değerlendirilmesi olarak saptanmıştır. Cinsel istismar ardından değerlendirilen çocukların %83.1'inde aktif psikiyatrik bozukluk saptanmıştır. En sık saptanan tanı travma sonrası stres bozukluğudur ve bu bulgu literatür bilgileri ile tutarlıdır. Özellikle cinsel istismar gibi stres verici yaşam olaylarının çocukların ruh sağlığını olumsuz etkilediği açıktır. (Anadolu Psikiyatri Dergisi 2011; 12:221-225) Anahtar sözcükler: Çocukluk çağı cinsel istismarı, adli değerlendirme, psikiyatrik tanı The forensic cases applied to an education and research hospital's child psychiatry department ABSTRACT Objective: The stressful experiences, especially sexual abuse, damage the child's psychology, mental health and quality of life. Forensic psychiatric evaluation includes the expertness, provides information for judicial decision and also is important to diagnose the psychiatric disorder of the child and protect him. Because of these reasons we were aimed to examine the characteristics of children applied to our department for criminal report. Methods: The files of 73 cases aged 4-18 years have been examined retrospectively who referred to Erenkoy Psychiatry ______________________________________________________________________________________________________ 1 Uzm.Dr., Ege Üniversitesi Tıp Fakültesi, Çocuk ve Ergen Psikiyatrisi ABD, İzmir 2 Uzm.Dr., 4 Psikolog, Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk ve Ergen Psikiyatrisi, İstanbul 3 Uzm.Dr., Göztepe Eğitim ve Araştırma Hastanesi, Çocuk ve Ergen Psikiyatrisi, İstanbul 5 Doç.Dr., 6 Prof.Dr., Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul

Childhood sexual abuse and supportive factors

Pediatrics International, 2016

Childhood sexual abuse (CSA) can be a devastating life experience that produces higher incidences... more Childhood sexual abuse (CSA) can be a devastating life experience that produces higher incidences of mental disorders and suicide attempts. However, there are factors that may be found with a greater ratio in the vulnerable victims. We evaluated 181 Turkish children and adolescents with a history of CSA regarding their age, gender, suicide attempts, family relations and educational background. Abuse involving the insertion of an organ or foreign object into the individual's body was designated as a "Qualified Sexual Abuse" (QSA); other forms of sexual abuse were designated "Basic Sexual Abuse" (BSA). Suicide attempts were significantly higher in adolescent girls in the QSA subgroup; age, gender, family integrity, and school attendance did not associate with the risk of mental disorders in this group. Among BSA patients, family integrity statistically influenced suicide attempts. Suicide attempts were approximately 10 times higher (P = 0.005, 95%CI: 2.020-51.051, OR, 10.154) in the participants of children living in broken families. Family integrity and school attendance were also noted as weak protective factors against mental disorders in BSA patients. The incidence of mental disorders was 3.5 times higher in children who had not been attending school (P = 0.009, 95%CI: 1.379-9.211, OR, 3.564). We found that family integrity and school attendance weakly related with psychopathology (e.g., mental disorders or suicide attempts) for BSA survivors but not for QSA survivors. Female gender and puberty also increased the likelihood of a suicide attempt for QSA survivors. This article is protected by copyright. All rights reserved.

Çocukluk Çağı Kanserlerinde Ruhsal Sorunlar ve Antidepresan Kullanımı

Turkiye Klinikleri Journal of Pediatrics, 2013

The Psychometric Properties of Turkish Version of Autism Spectrum Screening Questionnaire in Children aged 6-18 years

Turkish Journal of Psychiatry, 2016

Risperidone, quetiapine and chlorpromazine may have induced priapism in an adolescent

Pediatrics International, 2015

Priapism is the prolonged, painful erection of penile tissue not accompanied by sexual arousal. P... more Priapism is the prolonged, painful erection of penile tissue not accompanied by sexual arousal. Priapism has been established as a rare adverse drug reaction to drugs such as antipsychotics, psychostimulants, antidepressants, and mood stabilizers. Immediate intervention is needed to prevent destructive and irreversible complications, such as erectile dysfunction, disfigurement, inability of the penis to stay erect, and related social/emotional problems. Antipsychotic-induced priapism may result from the alpha receptor occupancy property of those drugs. We report the case of a 13-year-old suffering from attention deficit-hyperactivity disorder plus conduct disorder with priapism related to antipsychotics. Episodes occurred with risperidone plus methylphenidate, quetiapine plus methylphenidate, and chlorpromazine alone.

The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry, Jan 30, 2015

Objectıves. Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) includes... more Objectıves. Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) includes stimulant and non-stimulant medications. Our purpose in this study is to investigate efficacy, safety and tolerability of combined methylphenidate and atomoxetine pharmacotherapy. We included 12 patients of the 824 patients with ADHD using methylphenidate and atomoxetine combined therapy between the years 2010 and 2014. Kiddie-SADS, Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale, Child Behavior Checklist, Clinic Global Impression Scale Severity and Impression (CGIS-S-I) scales were used. Patients were between the ages of 7 and 17 years. Before combined pharmacotherapy the CGIS-S score mean was 5.08. Mean CGIS-S score after the combined pharmacotherapy was 3.08 (P = 0.03; -2,980). The most common side effects were irritability (n = 5, 41.6%), appetite reduction (n = 3, 25%), palpitations (n = 2, 16.7%), headache (n = 1, 8.3%). Conclusıons. Nine of ...

Evaluation of the contribution of inpatient services and experiences on improvement in child and adolescent psychiatry practice

Anatolian Journal of Psychiatry, 2015

Bulletin of Clinical Psychopharmacology, 2015

The role and efficacy of clozapine treatment in early-onset and very early-onset schizophrenia ca... more The role and efficacy of clozapine treatment in early-onset and very early-onset schizophrenia cases: discussion of five cases Schizophrenia is a serious mental disorder emerging at an early age, characterized by significant breakdowns in thought, perception and behavioral processes and withdrawal from human relationships. Psychopharmacologic and psychosocial approaches should be combined for the treatment of schizophrenia. Although the effects and side effects of both typical and atypical antipsychotics have been studied in adult patients in detail, studies in child and adolescent age groups are inadequate. Clozapine is a prototype of atypical antipsychotics and the first antipsychotic to be defined as atypical. Clozapine is often effective in cases in which typical and other atypical antipsychotics fail, and is accepted as the "gold standard" in the treatment of schizophrenia. In this paper, the effects and side effects of clozapine in five adolescent cases diagnosed with schizophrenia are discussed. Four of these cases showed that clozapine is effective in adolescent schizophrenia. While the four cases showing good responses to the treatment tolerated clozapine well, the other case (case 4) showed an apparent decreasing trend in neutrophil count a short while after starting the treatment and his medication was stopped at the request of his parents.

Determination of the predictive factors that affect the sobriety of probationers with substance use disorders

Noro Psikiyatri Arsivi, 2015

Psychiatric Approaches for Disorders of Sex Development: Experience of a Multidisciplinary Team

Journal of Clinical Research in Pediatric Endocrinology, 2013

Disorders of sex development (DSD) are a group of congenital medical conditions that affect life ... more Disorders of sex development (DSD) are a group of congenital medical conditions that affect life as a whole. In this study, we aimed to reflect the experience of a multidisciplinary team in the clinical/psychiatric follow-up of a group of children and adolescents with DSD. The study group consisted of 51 patients diagnosed with DSD. The Kiddie-Schedule for Affective Disorders and Schizophrenia, Wechsler Intelligence Scale for Children-Revised, Draw a Person Test and Children's Apperception Test, and the Clinical Global Impression Scale (CGIS) were used for psychiatric evaluations. The mean age of the patients was 7.8 years (median: 7.8; min: 1.0; max: 18.0). Genetic evaluation showed 46,XX configuration in 15 patients (29.4%) and 46,XY in 35 (68.6%). One patient (2.0%) was diagnosed to have a sex chromosome disorder. Forty patients (78.4%) had no problems with their given gender identity and gender role. Thirty-four (66.7%) patients had normal intellectual capacity. Twenty-eight (54.9%) patients did not have any psychiatric problem. Depression, anxiety disorders, attention deficit/hyperactivity disorder, and adjustment disorders were the common diagnoses. The mean score of symptom severity on CGIS-severity-baseline was 6.15±0.68 and after one year, it was 1.46±0.51 (Z=-3.236 p=0.001). The mean score of CGI-Improvement was 1.23±0.44. It is important to identify and treat the psychiatric disorders encountered in patients with DSD. A psychiatrist needs to be included in the professional team following these patients. Examination and observation results need to be shared by holding periodic team meetings to establish a wholesome point of view for every unique child.

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry, 2014

Sosyal biliş, kişinin kendisi ve diğerleri arasındaki sosyal etkileşimle ilgili zihinsel süreçler... more Sosyal biliş, kişinin kendisi ve diğerleri arasındaki sosyal etkileşimle ilgili zihinsel süreçleri temsil eder. Son yıllarda yeme bozukluğu olgularının sosyal biliş becerilerine yönelik ilgi artmıştır. Anoreksiya nervosa, etiyolojisi çoklu etmenlerle ilişkili olan bir yeme bozukluğu tablosudur. Tedavisi halen tartışmalıdır. Yeme bozukluğu hastaları içinde en zor ilişki kurulan grubun anoreksiya nervosa tanılı gençler olduğu bilinmektedir. Çalışmalar çoğunlukla, anoreksiya nervosa olgularının sosyal bilişsel işlevlerinde güçlükler olduğuna işaret etmektedir. Bununla birlikte farklı sonuçların bildirildiği çalışmalar da mevcuttur. Görüldüğü kadarıyla, anoreksiya nervosa olgularında sosyal biliş işlevlerini değerlendiren çalışmaların büyük çoğunluğu, erişkin yaş grubu ile yapılmış çalışmalardır. Çocuk ve ergen yaş grubu ile yapılmış çalışmaların kısıtlı sayıda olduğu dikkati çekmektedir. Bu yazıda, literatürdeki, anoreksiya nervoza tanılı çocuk ve ergenlerin sosyal biliş becerileri ile ilgili çalışmaların incelenmesi ve genel özelliklerinin sunulması amaçlanmıştır.

Motor Tics Related to Atomoxetine Use: A Case Report

Bulletin of Clinical Psychopharmacology, 2011

ABSTRACT Motor tics due to atomoxetine use: a case report The comorbidity ratio of attention defi... more ABSTRACT Motor tics due to atomoxetine use: a case report The comorbidity ratio of attention deficit and hyperactivity disorder (ADHD) and tic disorders (TD) or Tourette's syndrome (TS) is very high. It is also known that, psychostimulant use in the treatment of ADHD can increase existing tics or cause new tics. Therefore, a selective noradrenaline reuptake inhibitor, atomoxetine, which is effective in the treatment of tics and ADHD symptoms, was introduced into clinical practice as a treatment choice in patients with ADHD and TD/TS comorbidity. However, recently there have been reports about reverse effects of atomoxetine on tics. In this report, we discuss a clinical case that had an increase in existing tic severity and developed new tics during atomoxetine treatment.

Treatment duration of children with attention deficit hyperactivity disorder is related to functioning and prognosis

Bulletin of Clinical Psychopharmacology, 2012

Effectiveness and Tolerability of Aripiprazole in a Real-World Outpatient Population of Youth

Bulletin of Clinical Psychopharmacology, 2012

ABSTRACT Effectiveness and tolerability of aripiprazole in a real-world outpatient population of ... more ABSTRACT Effectiveness and tolerability of aripiprazole in a real-world outpatient population of youth Objectives: To identify the pattern of initiation for off-label use of aripiprazole among adolescent outpatients; determine whether or not aripiprazole is effective and tolerable for the treatment of adolescents with a wide range of psychiatric symptoms and disorders or not. Methods: Medical charts were retrospectively reviewed for the effectiveness and tolerability of aripiprazole. The Clinical Global Impression Scale (CGI), the Brief Symptom Inventory (BSI), and the Extrapyramidal Symptom Rating Scale were used. Results: The data were available on 31 patients. The sample consisted of mostly females (87.1%). The mean age was 16.38 +/- 1.14 years, and the ages range was 15-19 years. Twenty-one patients (67.8%) had at least one comorbid disorder. The most common comorbid disorder was major depressive disorder. The mean initial dosage of aripiprazole was 4.83 +/- 3.59 mg (2.50 mg - 20.00 mg), and the mean endpoint dosage was 8.62 +/- 3.46 mg (2.50 mg - 15.00 mg). The mean duration of aripiprazole medication was 19.56 +/- 1.23 months (range: 4-48 months). Endpoint CGI-S scores were significantly lower compared with baseline CGI-S score (p<0.001). Similarly, the difference between depression severity (z=-3.232; p=0.001), anxiety severity (z=-3.004; p=0.003), hostility severity (z=-3.207; p=0.001), psychoticism severity (z=-1.973; p=0.049), and paranoid ideation severity (z=2.733; p=0.006) scores were statistically significant. The difference between the baseline and endpoint BSI Global Indices of distress scores were found to be statistically significant (The Global Severity Index: z=-2.987; p=0.003, the Positive Symptom Distress Index: z=-3.435; p=0.001, and the Positive Symptom Total: z=-3.023; p=0.003). Six cases (20.0%) discontinued the treatment. The most frequent adverse effects were asthenia (50.0%), somnolence (42.9%), and dizziness (39.30%). The most severe extrapyramidal symptoms were: impression of slowness or weakness, difficulty in carrying out routine tasks (11.5%), and tonic muscular contractions localized to one or several muscle groups, particularly in the throat, neck or back (11.5%). None of the cases had abnormal involuntary movements (dyskinesia) of the extremities or trunk. Conclusion: Aripiprazole was well tolerated and effective in our clinical practice and appears to be a safe and efficacious alternative in adolescents. However, a prospective clinical trial with a randomized controlled design is warranted.

Pediatric Transplantation, 2014

As there is still a shortage of pediatric donor hearts, several techniques have been used to assi... more As there is still a shortage of pediatric donor hearts, several techniques have been used to assist pediatric patients to survive until transplantation. VADs provide long-term support and ability of mobilization for children before a suitable heart becomes available. Several devices such as paracorporeal pumps have been used for this purpose, with acceptable morbidity and mortality rates. However, discharge is not possible, as there is no mobile drive unit for these small-sized pumps. The possible negative psychosocial impact of longterm hospitalization, away from home and school, may cause some adjustment problems in the future. In this case series, three pediatric patients that underwent intracorporeal LVAD implantation and returned to school are presented to share clinical experience and also to attract attention to the potential social and psychiatric implications.

Psychiatric Evaluation of Children and Adolescents With Left Ventricular Assist Devices

Psychosomatic Medicine, 2012

To evaluate the psychiatric symptoms of children equipped with a ventricular assist device (VAD) ... more To evaluate the psychiatric symptoms of children equipped with a ventricular assist device (VAD) and follow them up for 6 months. With the shortage of donor hearts available for the treatment of end-stage heart failure, VADs have been used to provide temporary treatment until a heart becomes available. VADs provide external sources of power for mechanical circulatory support and are capable of sustaining life over weeks and months. This study provides preliminary details about the psychiatric symptoms and disorders of the first eight children equipped with a VAD in Turkey. Eight pediatric patients who recently underwent VAD implantation, aged 1 to 16 years, were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia, Child Behavior Checklist, Children's Depression Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory for Children and followed up for 6 months. In the first evaluation, five participants had a psychiatric disorder diagnosis. Two patients had adjustment disorder with depressive and anxiety symptoms; one had anxiety disorder, not otherwise specified; and two had major depressive disorder. The anxiety and depressive symptom levels in questionnaires were consistent with psychiatric diagnoses. Two patients had heart transplantation during the follow-up period. To determine and treat psychiatric symptoms and disorders at an earlier stage, it is important for children and adolescents with a VAD and those who have undergone heart transplantation to be evaluated by a multidisciplinary consultation liaison team including psychiatrists, psychologists, consultant nurses, and counselors.

The International journal of eating disorders, Aug 1, 2016

Deficits in theory of mind (ToM), ability to infer mental states of others, can play a significan... more Deficits in theory of mind (ToM), ability to infer mental states of others, can play a significant role in interpersonal difficulties and/or unawareness of illness observed in AN and other eating disorders including bulimia Nervosa (BN). Current meta-analysis aimed to summarize available evidence for deficits in ToM in AN and BN and examine the effects of number of study-level variables on observed findings. In this meta-analysis, 15 studies (22 samples with eating disorders) investigating ToM performances of 677 individuals with AN or BN and 514 healthy controls were included. AN was associated with significant deficits in ToM (d = 0.59) which were more pronounced in the acute patients (d = 0.67). Small sized deficits in ToM were observed in BN (d = 0.34) and recovered AN (d = 0.35). Both cognitive perspective-taking (ToM-PT) (d = 0.99) and decoding mental states (ToM-decoding) (d = 0.61) aspects of ToM were impaired in acute AN. ToM-decoding impairment in BN was modest. There was ...

Health Related Quality of Life in children with Autism Spectrum Disorders: The clinical and demographic related factors in Turkey

Research in Autism Spectrum Disorders, 2013

This study examined the prevalence and chronicity of sleep problems in children who manifest prob... more This study examined the prevalence and chronicity of sleep problems in children who manifest problems believed to be typical of Autism Spectrum Disorders (ASD). Using data from a longitudinal total population study, symptoms of ASD, insomnia and potential explanatory factors were assessed at ages 7-9 and 11-13. Children were included in a group defined as having Autism Spectrum Problems (ASP) if they scored above a strict threshold on the Autism Spectrum Screening Questionnaire (ASSQ). Twenty-eight (0.8%) of 3700 children fulfilled the selected criteria for ASP at both waves, and the prevalence of chronic insomnia was more than ten times

This study examined the prevalence and chronicity of sleep problems in children who manifest prob... more This study examined the prevalence and chronicity of sleep problems in children who manifest problems believed to be typical of Autism Spectrum Disorders (ASD). Using data from a longitudinal total population study, symptoms of ASD, insomnia and potential explanatory factors were assessed at ages 7-9 and 11-13. Children were included in a group defined as having Autism Spectrum Problems (ASP) if they scored above a strict threshold on the Autism Spectrum Screening Questionnaire (ASSQ). Twenty-eight (0.8%) of 3700 children fulfilled the selected criteria for ASP at both waves, and the prevalence of chronic insomnia was more than ten times

Anadolu Psikiyatri Dergisi, 2011

Amaç: Çocukluk çağında yaşanan stres verici yaşantılar, özellikle cinsel istismar, çocuğun psikol... more Amaç: Çocukluk çağında yaşanan stres verici yaşantılar, özellikle cinsel istismar, çocuğun psikolojisine ve yaşam kalitesine zarar vermektedir. Adli psikiyatrik değerlendirme, mahkeme karar süreci için bilgi sağlama ve bilirkişiliği içerdiği gibi, çocuktaki olası psikiyatrik bozukluğun saptanması ve çocuğun korunabilmesi açısından da önemlidir. Bu nedenle polikliniğimize adli makamlarca rapor düzenlenmesi amacıyla yönlendirilen çocukların incelenmesi amaçlanmıştır. Yöntem: Adli makamlarca Ocak 2007-Aralık 2009 tarihleri arasında haklarında rapor düzenlenmesi amacıyla hastanemizin çocuk psikiyatrisi polikliniğine yönlendirilen 4-18 yaşları arasındaki 73 olgunun (45 kız, 28 erkek) dosya bilgileri geriye dönük olarak incelenmiştir. Sosyodemografik özellikler, psikopatoloji, zeka düzeyi, doğum yeri, adli istekler ve zanlının özellikleri her olgu için ayrı bir kayıt formu tutularak değerlendirilmiştir. Sonuçlar: Olguların 65'i (%89) cinsel istismar sonrası değerlendirilmek üzere gönderilmiştir. Olguların %61.6'sı, cinsel istismar grubunun %66.2'si kızdır. Mahkeme isteklerinin %86.3'ü çocuğun ruhsal durumunun değerlendirilmesidir. Cinsel istismara uğramış çocuklarda saptanan psikiyatrik tanılar travma sonrası stres bozukluğu (%32.3), uyum bozukluğu (%20), akut stres bozukluğu (%16.9), depresif bozukluklardır (%13.8). Olguların %16.9'unda aktif psikiyatrik bozukluk saptanmamıştır. Zeka düzeyi 42 (%64.6) olguda normaldir. Cinsel istismar zanlılarının %20.4'ü 18 yaşından küçük, %26.4'ü yabancı, %56.6'sı tanıdık (9 olgu ensest mağduru-%13.8) ve %17'si arkadaşlarının aracılığı ile tanışılan kişilerdir. Tartışma: Mahkemenin en sık isteği cinsel istismarın ardın-dan ruhsal durumun değerlendirilmesi olarak saptanmıştır. Cinsel istismar ardından değerlendirilen çocukların %83.1'inde aktif psikiyatrik bozukluk saptanmıştır. En sık saptanan tanı travma sonrası stres bozukluğudur ve bu bulgu literatür bilgileri ile tutarlıdır. Özellikle cinsel istismar gibi stres verici yaşam olaylarının çocukların ruh sağlığını olumsuz etkilediği açıktır. (Anadolu Psikiyatri Dergisi 2011; 12:221-225) Anahtar sözcükler: Çocukluk çağı cinsel istismarı, adli değerlendirme, psikiyatrik tanı The forensic cases applied to an education and research hospital's child psychiatry department ABSTRACT Objective: The stressful experiences, especially sexual abuse, damage the child's psychology, mental health and quality of life. Forensic psychiatric evaluation includes the expertness, provides information for judicial decision and also is important to diagnose the psychiatric disorder of the child and protect him. Because of these reasons we were aimed to examine the characteristics of children applied to our department for criminal report. Methods: The files of 73 cases aged 4-18 years have been examined retrospectively who referred to Erenkoy Psychiatry ______________________________________________________________________________________________________ 1 Uzm.Dr., Ege Üniversitesi Tıp Fakültesi, Çocuk ve Ergen Psikiyatrisi ABD, İzmir 2 Uzm.Dr., 4 Psikolog, Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, Çocuk ve Ergen Psikiyatrisi, İstanbul 3 Uzm.Dr., Göztepe Eğitim ve Araştırma Hastanesi, Çocuk ve Ergen Psikiyatrisi, İstanbul 5 Doç.Dr., 6 Prof.Dr., Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul

Childhood sexual abuse and supportive factors

Pediatrics International, 2016

Childhood sexual abuse (CSA) can be a devastating life experience that produces higher incidences... more Childhood sexual abuse (CSA) can be a devastating life experience that produces higher incidences of mental disorders and suicide attempts. However, there are factors that may be found with a greater ratio in the vulnerable victims. We evaluated 181 Turkish children and adolescents with a history of CSA regarding their age, gender, suicide attempts, family relations and educational background. Abuse involving the insertion of an organ or foreign object into the individual's body was designated as a "Qualified Sexual Abuse" (QSA); other forms of sexual abuse were designated "Basic Sexual Abuse" (BSA). Suicide attempts were significantly higher in adolescent girls in the QSA subgroup; age, gender, family integrity, and school attendance did not associate with the risk of mental disorders in this group. Among BSA patients, family integrity statistically influenced suicide attempts. Suicide attempts were approximately 10 times higher (P = 0.005, 95%CI: 2.020-51.051, OR, 10.154) in the participants of children living in broken families. Family integrity and school attendance were also noted as weak protective factors against mental disorders in BSA patients. The incidence of mental disorders was 3.5 times higher in children who had not been attending school (P = 0.009, 95%CI: 1.379-9.211, OR, 3.564). We found that family integrity and school attendance weakly related with psychopathology (e.g., mental disorders or suicide attempts) for BSA survivors but not for QSA survivors. Female gender and puberty also increased the likelihood of a suicide attempt for QSA survivors. This article is protected by copyright. All rights reserved.

Çocukluk Çağı Kanserlerinde Ruhsal Sorunlar ve Antidepresan Kullanımı

Turkiye Klinikleri Journal of Pediatrics, 2013

The Psychometric Properties of Turkish Version of Autism Spectrum Screening Questionnaire in Children aged 6-18 years

Turkish Journal of Psychiatry, 2016

Risperidone, quetiapine and chlorpromazine may have induced priapism in an adolescent

Pediatrics International, 2015

Priapism is the prolonged, painful erection of penile tissue not accompanied by sexual arousal. P... more Priapism is the prolonged, painful erection of penile tissue not accompanied by sexual arousal. Priapism has been established as a rare adverse drug reaction to drugs such as antipsychotics, psychostimulants, antidepressants, and mood stabilizers. Immediate intervention is needed to prevent destructive and irreversible complications, such as erectile dysfunction, disfigurement, inability of the penis to stay erect, and related social/emotional problems. Antipsychotic-induced priapism may result from the alpha receptor occupancy property of those drugs. We report the case of a 13-year-old suffering from attention deficit-hyperactivity disorder plus conduct disorder with priapism related to antipsychotics. Episodes occurred with risperidone plus methylphenidate, quetiapine plus methylphenidate, and chlorpromazine alone.

The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry, Jan 30, 2015

Objectıves. Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) includes... more Objectıves. Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) includes stimulant and non-stimulant medications. Our purpose in this study is to investigate efficacy, safety and tolerability of combined methylphenidate and atomoxetine pharmacotherapy. We included 12 patients of the 824 patients with ADHD using methylphenidate and atomoxetine combined therapy between the years 2010 and 2014. Kiddie-SADS, Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale, Child Behavior Checklist, Clinic Global Impression Scale Severity and Impression (CGIS-S-I) scales were used. Patients were between the ages of 7 and 17 years. Before combined pharmacotherapy the CGIS-S score mean was 5.08. Mean CGIS-S score after the combined pharmacotherapy was 3.08 (P = 0.03; -2,980). The most common side effects were irritability (n = 5, 41.6%), appetite reduction (n = 3, 25%), palpitations (n = 2, 16.7%), headache (n = 1, 8.3%). Conclusıons. Nine of ...

Evaluation of the contribution of inpatient services and experiences on improvement in child and adolescent psychiatry practice

Anatolian Journal of Psychiatry, 2015

Bulletin of Clinical Psychopharmacology, 2015

The role and efficacy of clozapine treatment in early-onset and very early-onset schizophrenia ca... more The role and efficacy of clozapine treatment in early-onset and very early-onset schizophrenia cases: discussion of five cases Schizophrenia is a serious mental disorder emerging at an early age, characterized by significant breakdowns in thought, perception and behavioral processes and withdrawal from human relationships. Psychopharmacologic and psychosocial approaches should be combined for the treatment of schizophrenia. Although the effects and side effects of both typical and atypical antipsychotics have been studied in adult patients in detail, studies in child and adolescent age groups are inadequate. Clozapine is a prototype of atypical antipsychotics and the first antipsychotic to be defined as atypical. Clozapine is often effective in cases in which typical and other atypical antipsychotics fail, and is accepted as the "gold standard" in the treatment of schizophrenia. In this paper, the effects and side effects of clozapine in five adolescent cases diagnosed with schizophrenia are discussed. Four of these cases showed that clozapine is effective in adolescent schizophrenia. While the four cases showing good responses to the treatment tolerated clozapine well, the other case (case 4) showed an apparent decreasing trend in neutrophil count a short while after starting the treatment and his medication was stopped at the request of his parents.

Determination of the predictive factors that affect the sobriety of probationers with substance use disorders

Noro Psikiyatri Arsivi, 2015

Psychiatric Approaches for Disorders of Sex Development: Experience of a Multidisciplinary Team

Journal of Clinical Research in Pediatric Endocrinology, 2013

Disorders of sex development (DSD) are a group of congenital medical conditions that affect life ... more Disorders of sex development (DSD) are a group of congenital medical conditions that affect life as a whole. In this study, we aimed to reflect the experience of a multidisciplinary team in the clinical/psychiatric follow-up of a group of children and adolescents with DSD. The study group consisted of 51 patients diagnosed with DSD. The Kiddie-Schedule for Affective Disorders and Schizophrenia, Wechsler Intelligence Scale for Children-Revised, Draw a Person Test and Children's Apperception Test, and the Clinical Global Impression Scale (CGIS) were used for psychiatric evaluations. The mean age of the patients was 7.8 years (median: 7.8; min: 1.0; max: 18.0). Genetic evaluation showed 46,XX configuration in 15 patients (29.4%) and 46,XY in 35 (68.6%). One patient (2.0%) was diagnosed to have a sex chromosome disorder. Forty patients (78.4%) had no problems with their given gender identity and gender role. Thirty-four (66.7%) patients had normal intellectual capacity. Twenty-eight (54.9%) patients did not have any psychiatric problem. Depression, anxiety disorders, attention deficit/hyperactivity disorder, and adjustment disorders were the common diagnoses. The mean score of symptom severity on CGIS-severity-baseline was 6.15±0.68 and after one year, it was 1.46±0.51 (Z=-3.236 p=0.001). The mean score of CGI-Improvement was 1.23±0.44. It is important to identify and treat the psychiatric disorders encountered in patients with DSD. A psychiatrist needs to be included in the professional team following these patients. Examination and observation results need to be shared by holding periodic team meetings to establish a wholesome point of view for every unique child.

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry, 2014

Sosyal biliş, kişinin kendisi ve diğerleri arasındaki sosyal etkileşimle ilgili zihinsel süreçler... more Sosyal biliş, kişinin kendisi ve diğerleri arasındaki sosyal etkileşimle ilgili zihinsel süreçleri temsil eder. Son yıllarda yeme bozukluğu olgularının sosyal biliş becerilerine yönelik ilgi artmıştır. Anoreksiya nervosa, etiyolojisi çoklu etmenlerle ilişkili olan bir yeme bozukluğu tablosudur. Tedavisi halen tartışmalıdır. Yeme bozukluğu hastaları içinde en zor ilişki kurulan grubun anoreksiya nervosa tanılı gençler olduğu bilinmektedir. Çalışmalar çoğunlukla, anoreksiya nervosa olgularının sosyal bilişsel işlevlerinde güçlükler olduğuna işaret etmektedir. Bununla birlikte farklı sonuçların bildirildiği çalışmalar da mevcuttur. Görüldüğü kadarıyla, anoreksiya nervosa olgularında sosyal biliş işlevlerini değerlendiren çalışmaların büyük çoğunluğu, erişkin yaş grubu ile yapılmış çalışmalardır. Çocuk ve ergen yaş grubu ile yapılmış çalışmaların kısıtlı sayıda olduğu dikkati çekmektedir. Bu yazıda, literatürdeki, anoreksiya nervoza tanılı çocuk ve ergenlerin sosyal biliş becerileri ile ilgili çalışmaların incelenmesi ve genel özelliklerinin sunulması amaçlanmıştır.

Motor Tics Related to Atomoxetine Use: A Case Report

Bulletin of Clinical Psychopharmacology, 2011

ABSTRACT Motor tics due to atomoxetine use: a case report The comorbidity ratio of attention defi... more ABSTRACT Motor tics due to atomoxetine use: a case report The comorbidity ratio of attention deficit and hyperactivity disorder (ADHD) and tic disorders (TD) or Tourette's syndrome (TS) is very high. It is also known that, psychostimulant use in the treatment of ADHD can increase existing tics or cause new tics. Therefore, a selective noradrenaline reuptake inhibitor, atomoxetine, which is effective in the treatment of tics and ADHD symptoms, was introduced into clinical practice as a treatment choice in patients with ADHD and TD/TS comorbidity. However, recently there have been reports about reverse effects of atomoxetine on tics. In this report, we discuss a clinical case that had an increase in existing tic severity and developed new tics during atomoxetine treatment.

Treatment duration of children with attention deficit hyperactivity disorder is related to functioning and prognosis

Bulletin of Clinical Psychopharmacology, 2012

Effectiveness and Tolerability of Aripiprazole in a Real-World Outpatient Population of Youth

Bulletin of Clinical Psychopharmacology, 2012

ABSTRACT Effectiveness and tolerability of aripiprazole in a real-world outpatient population of ... more ABSTRACT Effectiveness and tolerability of aripiprazole in a real-world outpatient population of youth Objectives: To identify the pattern of initiation for off-label use of aripiprazole among adolescent outpatients; determine whether or not aripiprazole is effective and tolerable for the treatment of adolescents with a wide range of psychiatric symptoms and disorders or not. Methods: Medical charts were retrospectively reviewed for the effectiveness and tolerability of aripiprazole. The Clinical Global Impression Scale (CGI), the Brief Symptom Inventory (BSI), and the Extrapyramidal Symptom Rating Scale were used. Results: The data were available on 31 patients. The sample consisted of mostly females (87.1%). The mean age was 16.38 +/- 1.14 years, and the ages range was 15-19 years. Twenty-one patients (67.8%) had at least one comorbid disorder. The most common comorbid disorder was major depressive disorder. The mean initial dosage of aripiprazole was 4.83 +/- 3.59 mg (2.50 mg - 20.00 mg), and the mean endpoint dosage was 8.62 +/- 3.46 mg (2.50 mg - 15.00 mg). The mean duration of aripiprazole medication was 19.56 +/- 1.23 months (range: 4-48 months). Endpoint CGI-S scores were significantly lower compared with baseline CGI-S score (p<0.001). Similarly, the difference between depression severity (z=-3.232; p=0.001), anxiety severity (z=-3.004; p=0.003), hostility severity (z=-3.207; p=0.001), psychoticism severity (z=-1.973; p=0.049), and paranoid ideation severity (z=2.733; p=0.006) scores were statistically significant. The difference between the baseline and endpoint BSI Global Indices of distress scores were found to be statistically significant (The Global Severity Index: z=-2.987; p=0.003, the Positive Symptom Distress Index: z=-3.435; p=0.001, and the Positive Symptom Total: z=-3.023; p=0.003). Six cases (20.0%) discontinued the treatment. The most frequent adverse effects were asthenia (50.0%), somnolence (42.9%), and dizziness (39.30%). The most severe extrapyramidal symptoms were: impression of slowness or weakness, difficulty in carrying out routine tasks (11.5%), and tonic muscular contractions localized to one or several muscle groups, particularly in the throat, neck or back (11.5%). None of the cases had abnormal involuntary movements (dyskinesia) of the extremities or trunk. Conclusion: Aripiprazole was well tolerated and effective in our clinical practice and appears to be a safe and efficacious alternative in adolescents. However, a prospective clinical trial with a randomized controlled design is warranted.

Pediatric Transplantation, 2014

As there is still a shortage of pediatric donor hearts, several techniques have been used to assi... more As there is still a shortage of pediatric donor hearts, several techniques have been used to assist pediatric patients to survive until transplantation. VADs provide long-term support and ability of mobilization for children before a suitable heart becomes available. Several devices such as paracorporeal pumps have been used for this purpose, with acceptable morbidity and mortality rates. However, discharge is not possible, as there is no mobile drive unit for these small-sized pumps. The possible negative psychosocial impact of longterm hospitalization, away from home and school, may cause some adjustment problems in the future. In this case series, three pediatric patients that underwent intracorporeal LVAD implantation and returned to school are presented to share clinical experience and also to attract attention to the potential social and psychiatric implications.

Psychiatric Evaluation of Children and Adolescents With Left Ventricular Assist Devices

Psychosomatic Medicine, 2012

To evaluate the psychiatric symptoms of children equipped with a ventricular assist device (VAD) ... more To evaluate the psychiatric symptoms of children equipped with a ventricular assist device (VAD) and follow them up for 6 months. With the shortage of donor hearts available for the treatment of end-stage heart failure, VADs have been used to provide temporary treatment until a heart becomes available. VADs provide external sources of power for mechanical circulatory support and are capable of sustaining life over weeks and months. This study provides preliminary details about the psychiatric symptoms and disorders of the first eight children equipped with a VAD in Turkey. Eight pediatric patients who recently underwent VAD implantation, aged 1 to 16 years, were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia, Child Behavior Checklist, Children's Depression Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory for Children and followed up for 6 months. In the first evaluation, five participants had a psychiatric disorder diagnosis. Two patients had adjustment disorder with depressive and anxiety symptoms; one had anxiety disorder, not otherwise specified; and two had major depressive disorder. The anxiety and depressive symptom levels in questionnaires were consistent with psychiatric diagnoses. Two patients had heart transplantation during the follow-up period. To determine and treat psychiatric symptoms and disorders at an earlier stage, it is important for children and adolescents with a VAD and those who have undergone heart transplantation to be evaluated by a multidisciplinary consultation liaison team including psychiatrists, psychologists, consultant nurses, and counselors.