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Öğe Adjustment disorder after botulinum toxin injection in an adolescent palatal myoclonus case: the importance of informed consent in the treatment of neuropsychiatric disorders in children and adolescents(Elsevier Sci Ltd, 2018) Öztürk, Yusuf; Topal, Zehra; Demir, Nuran; Tufan, Ali EvrenInformed consent in clinical practice is a process in which a patient consents to participate or undergo the proposed procedures after being informed of its procedures, risks, and benefits. Ideally, the patient is expected to give his/her consent solely after fully understanding the information about the procedures, benefits, and risks involved in the practice. According to the doctrine, the necessary information should be given by the physician and he/she should also respect the decision of the patient which is based on this information.1 Although the importance of providinginformation about the proposed treatment’s effects and side effects to children and adolescents before treatment is accepted by physicians, this issue is given little importance in research and case presentations.2 In this case, it was aimed to discuss the importance of informed consent and multi-disciplinary approach in treatment by presenting an adolescent patient who was diagnosed with palatal myoclonus and treated with botulinum toxin. Although the neurological treatment was effective, the patient developed adjustment disorder (with depressive mood) due to dysphonia after the procedure.Öğe Angioedema probably related to fluoxetine in a preadolescent being followed up for major depressive disorder(Mary Ann Liebert, Inc, 2013) Tuman, Taha Can; Demir, Nuran; Topal, Zehra; Tuman, Bengü Altunay; Tufan, Evren AliÖğe Dikkat eksikliği/ hiperaktivite bozukluğu, öğrenme bozukluğu ve otistik spektrum bozukluğu tanılı çocukların yaş ve cinsiyet açısından eşlenmiş sağlıklı kardeşlerinde sözel olmayan iletişim becerileri, empati düzeyleri, çevresel belirteçleri ile ilişkilerinin araştırılması: kontrollü bir araştırma(Bolu Abant İzzet Baysal Üniversitesi, 2016) Demir, Nuran; Tufan, Ali EvrenÖZET: Amaç: Son yıllarda Dikkat Eksikliği Hiperaktivite Bozukluğu (DEHB) olgularında empati, sözel olmayan iletişim ve emosyon tanıma becerileri ve Öğrenme Bozukluğu (ÖB, Özgül öğrenme güçlüğü, ÖÖG) tanılı çocukların yaşayabilecekleri sosyal iletişim ve etkileşim sorunları araştırmalarda ilgi çekmektedir. Otistik Spektrum Bozukluğu( OSB) ise tanım gereği sözel olmayan iletişim becerilerinde sorunlarla karakterizedir. Klinik psikofizyoloji metodlarindan elektrodermal aktivite (EDA) ise otonomik, emosyonel ve bilişsel işlemleme ile yakından ilişkili olan ve sempatik sinir sistemi aktivitesinin duyarlı bir belirteci olarak yaygın olarak kullanılır. DEHB, OSB ve ÖÖG tanılı çocuklarda EDA üzerine yürütülmüş olan araştırmalar son zamanlarda giderek daha çok ilgi çekmeye başlamıştır. Erişkin ve çocuk örneklemlerle yürütülmüş olan araştırmalar emosyonel uyaranlara verilen EDA yanıtlarının empati ve sözel olmayan iletişim becerileri ile ilişkili olabileceğini düşündürmektedir. DEHB, ÖÖG ve OSB tanılı çocuklar ve akrabalarında toplumsal iletişim ve etkileşim zorluklarının saptanması nedeniyle DEHB ve OSB'nun altta yatan örtük bir genotipi paylaşabileceği, bu bozukluklardaki fenotipin ise genetik yapının farklı görünümleri olabileceği düşünülmektedir. Araştırmamızda DEHB, ÖÖG ve OSB tanılı çocukların sağlıklı kardeşlerinde sözel olmayan iletişim becerileri ve empati düzeylerinin ölçülmesi ve empati düzeyleri ile elektrodermal aktivite değişimlerinin ve elektrodermal aktivite değişiminin anksiyete duyarlılığı ile ilişkisinin saptanması amaçlanmıştır Yöntem: Daha önce araştırma merkezine başvuran DSM- IV' e göre DEHB, ÖÖG ve OSB tanılarını almış çocuk hastaların geriye dönük dosya taraması yapılmıştır. Yapılan taramalar sonucunda kliniğine başvuran ve DEHB, ÖÖG ve OSB tanılarından herhangi birisini karşılayan hastaların uygun yaş- sınıf aralığında (8-12 yaş, İO3-4-5) kardeşi bulunan ve dışlama ölçütlerini dışında kalan hastalar çalışmaya dahil edilmiştir. Tanı alan ve sağlıklı kardeş olan çocuklara K-SADS uygulanmıştır. Sonuçta çalışmaya DEHB grubu için 20, ÖÖG grubu için 23, OSB grubu için 6 çocuk, kontrol grubu için 24 olmak üzere toplamda 73 çocuk yer almıştır. Sağlıklı kardeşlerin sözel olmayan iletişim becerileri Sözel Olmayan İpuçlarını Algılama Becerileri Testi (SÖİAB testi) ile değerlendirilip, bu sırada Elektrodermal Aktivite (EDA) kayıt edilmiştir. Empatiyi değerlendirmek için çocuklara Gözlerden Zihin Okuma Testi ve KA-Sİ Empati ölçeği (KA-Sİ EEÖ-Çocuk formu) kullanılmıştır. Toplumsal iletişim ve etkileşim becerilerini özelliklerini değerlendirmek için Otizm Spektrum Anketi (OSA) ve Sosyal cevaplılık ölçeği (SCÖ) kullanılmıştır. Bulgular: KA-Sİ EEÖ- Çocuk Formu bilişsel Empati alt ölçeği için DEHB ve ÖÖG grupları kontrol grubundaki çocuklara göre anlamlı olarak daha düşük puan aldıkları görülmüştür. Sosyal Cevaplılık Ölçeği puanları gruplarda DEHB > ÖÖG> Kontrol > OSB biçiminde sıralandığı görülmektedir. Bilişsel empati testi olan Gözlerden Zihin Okuma Testi- Çocuk Versiyonu değerlendirmesinde kontrol grubunun en iyi performansı gösterdiği saptanmıştır. Babaların ve annelerin kendileri için doldurmuş oldukları Anksiyete Duyarlılığı İndeksi-3 değerlendirmesinde her iki ebeveyn için ADİ-3 -toplam puan ve alt testleri puan ortancalarının tanı grupları arasında anlamlı fark göstermediği saptanmıştır. SOİAB testinde DEHB ve ÖÖG tanılı bireylerin sağlıklı kardeşleri doğru cevaplandırmada kontrol grubuna göre daha kötü performans göstermiştir. SOİAB testi içerisinde yer alan resim, video, ses ve hikaye uyaranlarına yanıt latansları (saniye) için ortancaları bakımından grupların anlamlı fark göstermedikleri görülmüştür. SOİAB testi uygulaması emosyonel uyaranlara yanıt olarak gerçekleşen elektrodermal aktivite değişimi korelasyon göstermemiştir. Sonuç: Bu araştırmada DEHB ve ÖÖG tanılı bireylerin sağlıklı kardeşlerinin bilişsel empati testlerinde kontrollere göre daha kötü performans gösterdiği görülmüştür. SOİAB testinde DEHB ve ÖÖG grubundaki sağlıklı kardeşlerin sözel olmayan iletişim becerilerinde doğru yanıtlamada sorun yaşadığı, uyaranlara yanıt latansının farklı olmadığı, emosyonel uyaranlara yanıt olarak gerçekleşen elektrodermal aktivite değişimininde anlamlı farklılık olmadığı saptanmıştır. Bu araştırmanın tek merkezli bir çalışma olmasının sonuçları olumsuz etkilediği düşünülmekte olup çok merkezli çalışmalarda desteklenmesi gerekmektedir.Öğe Emotional and cognitive conflict resolution and disruptive mood dysregulation disorder in adolescent offspring of parents diagnosed with major depressive disorder, bipolar disorder, and matched healthy controls(Taylor and Francis Ltd., 2021) Topal, Zehra; Demir, Nuran; Tufan, Evren; Tuman, Taha Can; Semerci, BengiAims: Children of parents with mood disorders have an elevated risk for various psychopathologies. In this study rate of psychopathologies among adolescent offspring of parents with major depressive (MDDoff) and bipolar disorder (BDoff), including disruptive mood dysregulation disorder (DMDD) along with the offspring ability to resolve cognitive and emotional conflicts were evaluated. Method: 12–16 years old children of parents with MDD (n = 31, children= 36), BP (n = 20, children = 26) and controls (n = 25, children = 28) were enrolled. Children and parents were evaluated by using the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) and the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID); respectively. The parents completed the Child Behavior Checklist (CBCL)-dysregulation profile. The Stroop test-TBAG form and emotional Stroop test were given out to evaluate conflict resolution ability. Results: The most common diagnoses among the whole sample were attention deficit and hyperactivity, separation anxiety and oppositional defiant disorders. Five cases (5.5%) of lifetime DMDD were found (three from MDDoff, the rest from BDoff). Completion times for the Stroop test-TBAG form were ranked as: BDoff > MDDoff > Hoff. In the emotional Stroop test, the BDoff responded significantly later and had significantly reduced correct responses. Conclusion: Rates of lifetime DMDD were similar in the MDDoff and BDoff groups. BDoff may experience greater difficulties in resolving cognitive and emotional conflicts.Öğe Iron and ferritin levels of children and adolescents with attention deficit hyperactivity disorder and attention deficit hyperactivity disorder-not otherwise specified(Galenos Yayincilik, 2020) Öztürk, Yusuf; Topal, Zehra; Demir, Nuran; Tufan, Ali EvrenAim: The study aimed to compare the levels of iron and ferritin in children with Attention Deficit Hyperactivity Disorder (ADHD) and Attention-Deficit Hyperactivity Disorder-Not Otherwise Specified (ADHD-NOS) and to assess the relationship between ADHD symptom severity and anxiety symptom severity with iron and ferritin levels. Materials and Methods: This study was planned as a cross-sectional, retrospective study. The study was performed by scanning the records of patients who applied to our clinic between January 2012 and January 2013. Accordingly, 205 ADHD and ADHD-NOS case records were evaluated. Patients were diagnosed clinically according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) criteria. ADHD symptom severity was assessed by the Turgay DSM-IV-TR-Based Child and Adolescent Behavior Disorders Screening and Rating scale. Anxiety symptom severity was assessed by The Screen for Anxiety Related Emotional Disorders. Results: Among the whole sample, 99 (48.3%) patients had ADHD and 106 (51.7%) had ADHD-NOS. In the ADHD group, the average age of the children was 10.88 +/- 3.02 years, while that of the children in the ADHD-NOS group was 9.93 +/- 2.49 years. Iron and ferritin were measured in 81 of the 205 patients participating in the study. There was no statistically significant difference between the two groups in terms of iron or ferritin levels (p>0.05). Statistically significant negative correlations between ADHD hyperactivity symptom severity and iron levels, and ADHD attention deficit symptom severity and ferritin levels were found. Ferritin levels correlated statistically with the total number of psychiatric diagnoses in the children. Conclusion: Iron and ferritin levels may be differentially affected in children with ADHD. The results we obtained from our study should be supported by studies with larger samples.Öğe Possible exogenous growth hormone induced mood disorder with mixed features in a child(Mary Ann Liebert, Inc, 2015) Tuman, Taha Can; Topal, Zehra; Demir, Nuran; Arısoy, Özden; Taşkıran, Sarper; Tufan, Ali EvrenÖğe The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T)(Taylor & Francis Ltd, 2019) Ercan, Eyüp Sabri; Demirbaş Çakır, Emine; Cansız, Mehmet Akif; Topal, Zehra; Demir, NuranAim: 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.Öğe Rates of disruptive mood dysregulation disorder among adolecent offspring of parens with recurrent major depressive disorder versus those with bipolar disorder and matched healthy controls(Elsevier Science Inc, 2016) Topal, Zehra; Demir, Nuran; Tuman, Taha Can; Yıldırım, Osman; Tufan, EvrenObjectives: Offspring of parents with mood disorders have increased risk for irritability as well as psychopathologies. Disruptive Mood Dysregulation Disorder (DMDD) is characterized by severe, mpairing, temper outbursts along with irritability. Recent data suggest that episodic and chronic irritability in childhood may have different developmental trajectories. Here we aimed to determine the rates of DMDD, via DSM-5 criteria, in adolescent offspring of parents with recurrent depression and bipolar disorders (BP-I) and to compare those rates with matched healthy controls. A priori study hypothesis was: DMDD diagnosis would be significantly more common among mood disorder offspring.Öğe Relationships between vitamin b12, folate levels and clinical features in attention deficit hyperactivity disorder and attention deficit hyperactivity disorder-not otherwise specified(Galenos Yayincilik, 2020) Öztürk, Yusuf; Topal, Zehra; Demir, Nuran; Tufan, Ali EvrenAim: In this study, we aimed to compare the levels of vitamin 812 and folate in children with Attention Deficit and Hyperactivity Disorder (ADHD) and Attention Deficit and Hyperactivity Disorder-Not Otherwise Specified (ADHD-NOS). Materials and Methods: This study was planned as a cross-sectional, retrospective study. Patients were recruited between January 2012 and January 2013 and 205 case records were evaluated. The ADHD and ADHA-NOS groups were compared according to vitamin B12 and folate levels. Symptom severity was evaluated by the Turgay DSM-IV-Based Child and Adolescent Behavior Disorders Screening and Rating scale. Anxiety symptom severity was assessed by The Screen for Anxiety Related Emotional Disorders. Results: The average age of the children in the ADHD group was 10.88 +/- 3.02 (n=99) years, and the average age of the children in the ADHD-NOS group was 9.93 +/- 2.49 (n=106) years. There was no statistically significant difference between two groups in terms of Vitamin B12 level and folate level (p>0.05). A statistically significant negative correlation between the total number of diagnoses of a child and vitamin 812 levels was found. Folate levels correlated significantly with anxiety total scores generalized anxiety subscale. Conclusion: Vitamin B12 levels may be affected in children with impairing ADHD symptoms and increased comorbidities. The results of the study should be supported by future studies.Öğe Remission rates, time to remission, and related factors in adolescents with major depressive disorder(Aves, 2021) Topal, Zehra; Öztürk, Yusuf; Demir, Nuran; Adıgüzel, Öznur; Karadağ, Mehmet; Tufan, Ali EvrenObjective: Major depressive disorder (MDD) is a common disorder in children and adolescents that can cause serious morbidity and mortality. Although response rates to treatment are high, less than half of the adolescents with MDD achieve remission. The present study aims to evaluate remission rates, time to remission, and the predictors of remission in adolescents with MDD. Methods: This study included 34 adolescents with MDD who were followed-up for a minimum period of 120days. The adolescents were assessed with the Clinic Global Impression Scale, Beck Depression Inventory, Young Mania Rating Scale, Child Mania Rating Scale, and Screen for Child Anxiety-Related Emotional Disorders at the baseline and at weeks 4, 8, and 12. Results: 67.6% of the adolescents had at least one comorbid diagnosis. The remission rate at week 12 was 735%. The mean time to remission was 72.0days. The female adolescents achieved a significantly higher remission rate than the males. Conclusion: The majority of adolescents achieved remission following acute treatment, and that the time to remission for the female adolescents was shorter compared with the males. Remission time does seem neither to be related to the number of medications prescribed nor to the number of comorbid diagnoses.Öğe Retrospective analysis of patients with disruptive mood dysregulation disorder and psychopharmacologic treatment preferences(YERKURE TANITIM & YAYINCILIK HIZMETLERI A S, 2021) Topal, Zehra; Öztürk, Yusuf; Tufan, Ali Evren; Demir, Nuran; Semerci, BengiObjective: DMDD is a new diagnosis listed in the DSM-5. Here, we aimed to present a retrospective analysis of cases with probable DMDD and their psychopharmacological treatment characteristics. Methods: 200 patients complaining of irritability and temper tantrums were evaluated retrospectively. To differentiate those with probable DMDD; Young Mania Rating Scale, Children's Depression Inventory, Screen for Anxiety and Related Disorders, Atilla Turgay Scale for DSM-IV-TR Disruptive Behavior Disorders scores were used. Results: 99 patients were found to fulfill criteria for DMDD. 85 patients (88 %) were prescribed drugs. Most common drugs were risperidone, methylphenidate, atomoxetine, OROS methylphenidate, sertraline and fluoxetine in descending order. Females are more frequently prescribed SSRIs while males are prescribed other drugs. Conclusion: As a new diagnosis, the treatment guidelines for DMDD are still unclear. The preliminary results of this study suggest that clinicians tend to prescribe stimulants/atomoxetine, atypical antipsychotics, and SSRIs for this group of patients.Öğe Rett Sendromu'nun tanısı ve izleminde çok boyutlu yaklaşımın önemi: Bir olgu sunumu(2012) Topal, Zehra; Demir, Nuran; Alhan, Cafer; Tufan, EvrenRett Sendromu X’e bağlı baskın geçiş gösteren nörogelişimsel bir bozukluktur. Bu yazıda Rett Sendromu tanısı konulduğundan beri pediatrik nöroloji ve pediatri uzmanları tarafından izlenen ve çocuk ve ergen ruh sağlığı ve hastalıkları polikliniğine ancak ergenlik döneminde başvuran bir olgunun tedavi ve izlem sürecinin sunulması, olgu özelliklerinin ulusal yazında şimdiye kadar bildirilen olgularla karşılaştırılması ve çok boyutlu yaklaşımın öneminin vurgulanması amaçlanmıştır.Öğe Sociodemographic and clinical features of disruptive mood dysregulation disorder: a chart review(Mary Ann Liebert, Inc, 2016) Tufan, Evren; Topal, Zehra; Demir, Nuran; Taşkıran, Sarper; Savcı, Uğur; Cansız, Mehmet AkifObjective: Disruptive mood dysregulation disorder (DMDD) is a novel diagnosis listed in Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) to encompass chronic and impairing irritability in youth, and to help its differentiation from bipolar disorders. Because it is a new entity, treatment guidelines, as well as its sociodemographic and clinical features among diverse populations, are still not elucidated. Here, DMDD cases from three centers in Turkey are reported and the implications are discussed. Methods: The study was conducted at the Abant Izzet Baysal University Medical Faculty Department of Child and Adolescent Psychiatry (Bolu), and American Hospital and Bengi Semerci Institute (Istanbul) between August 2014 and October 2014. Records of patients were reviewed and features of patients who fulfilled criteria for DMDD were recorded. Data were analyzed with SPS Version 17.0 for Windows. Descriptive analyses, (2) test, and Mann-Whitney U test were used for analyses. Diagnostic consensus was determined via Cohen's constants. p was set at 0.01. Results: Thirty-six patients (77.8 % male) fulfilled criteria for DMDD. value for consensus between clinicians was 0.68 (p=0.00). Mean age of patients was 9.0 years (S.D.=2.5) whereas the mean age of onset for DMDD symptoms was 4.9 years (S.D.=2.2). Irritability, temper tantrums, verbal rages, and physical aggression toward family members were the most common presenting complaints. Conclusions: Diagnostic consensus could not be reached for almost one fourth of cases. Most common reasons for lack of consensus were problems in clarification of moods of patients in between episodes, problems in differentiation of normality and pathology (i.e., symptoms mainly reported in one setting vs. pervasiveness), and inability to fulfill frequency criterion for tantrums.
