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Öğe Long-Term Effects of Lithium Use on Children and Adolescents: A Retrospective Study from Turkey(Mary Ann Liebert, Inc, 2022) Gunes, Hatice; Tanidir, Canan; Doktur, Hilal; Karacetin, Gul; Kilicoglu, Ali Guven; Yalcin, Ozhan; Bahali, Mustafa KayhanBackground: The aim of this study was to evaluate the long-term effects of lithium treatment on white blood cell (WBC) count, serum creatinine, and thyroid-stimulating hormone (TSH) levels in children and adolescents with bipolar disorder (BD) and non-BD in a Turkish children and adolescent sample.Methods: The study is based on retrospective chart review. Children and adolescent patients with BD and non-BD prescribed lithium in a mental health and neurological disorders hospital between 2012 and 2017 were included in the study. Data were collected from the electronic medical files. Laboratory values for WBC count, serum creatinine, and TSH levels at baseline within the week before the onset of lithium, and at 1st, 3rd, 6(th), and 12th month of treatment were recorded.Results: A total of 143 patients (82 females, 61 males; 100 BD, 43 non-BD) aged 9-18 were included. Non-BD diagnoses were psychotic and schizoaffective disorders, unipolar depression, attention-deficit/hyperactivity disorder, conduct disorder, severe mood dysregulation syndrome, borderline personality disorder, and autism. Mean age of the participants were 15.90 +/- 1.16 years for the bipolar group and 14.88 +/- 1.79 years for the nonbipolar group. Patients with BD reported more adverse effects. There was a statistically significant increase in WBC counts and TSH levels at any time point. A statistically significant elevation in serum creatinine was found at 3rd and 12th month of treatment. During the course of lithium treatment, WBC counts exceeded 13,000 in 14 (9.8%) patients, and TSH levels exceeded 5.5 mU/L in 41 patients (28.6%). Twenty-one (14.68%) patients were started on thyroxin replacement. Basal TSH levels and duration of the lithium treatment were higher in the participants with TSH levels exceeding 5.5 mU/L. Lithium maximum dose, lithium blood level, basal TSH level, and duration of treatment were higher in the participants receiving thyroxin replacement. No patients had serum creatinine levels exceeding the normal reference values.Conclusion: Our study suggests that lithium is a generally safe and tolerable agent for children and adolescents with BD and non-BD; however, close monitoring of thyroid functions particularly in patients with a higher basal TSH level and longer duration of lithium use is important.Öğe Prenatal androgens and autistic, attention deficit hyperactivity disorder, and disruptive behavior disorders traits(CUMHURIYET UNIV TIP FAK PSIKIYATRI ANABILIM DALI, CUMHURIYET UNIV TIP FAK PSIKIYATRI ABD, SIVAS, 58140, TURKEY, 2020) Güneş, Hatice; Tanıdır, Canan; Doktur, Hilal; Önal, Zerrin; Kutlu, Esra; Önal, Hasan; Münir, KerimObjective: Androgen exposure is hypothesized to play a role in the development of autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and disruptive behavior disorders/DBDs (oppositional defiant disorder/ODD and conduct disorder/CD). The aim of this cross-sectional study was to investigate ASD, ADHD, and DBD (ODD and CD) traits in children and adolescents with congenital adrenal hyperplasia (CAH), a natural cause of prenatal androgen excess in females. Methods: Forty-five children and adolescents (27 girls, mean age 11.1 +/- 3; 18 boys, mean age 10.8 +/- 3.6) with CAH and their unaffected siblings (16 girls, mean age 11.4 +/- 3.9; 14 boys, mean age 12.6 +/- 4.2) were included in the study. Parents completed the Social Communication Questionnaire, to measure ASD symptoms; and the Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale to assess ADHD and DBD traits. Results: In this study, boys but not girls with CAH showed higher autistic traits. There was no significant difference between either girls or boys with CAH and their unaffected counterparts with respect to inattention or hyperactivity symptoms. Boys with CAH showed more ODD symptoms than the unaffected boys. There was a trend for boys to have more CD symptoms compared to unaffected boys. Conclusions: Our study does not support the hypothesis that prenatal androgen exposure is associated with ASD, ADHD or DBDs. Postnatal/circulating androgen levels, higher testosterone/cortisol ratio, lower basal cortisol or dysregulation in HPA axis might be related to higher autistic traits or increased DBDs symptoms found in boys with CAH. Further investigations with larger groups are needed to clarify these associations.Öğe Prenatal, perinatal, postnatal risk factors, and excess screen time in autism spectrum disorder(WILEY, 111 RIVER ST, HOBOKEN 07030-5774, NJ, 2023) Güneş, Hatice; Tanıdır, Canan; Doktur, Hilal; Yılmaz, Seheryeli; Yıldız, Deniz; Özbek, Fatih; Bozbey, Sema; Özşirin, GülşahBackground: The aim of this study was to investigate pre-, peri-, and postnatal factors, screen time in a group of patients with autism spectrum disorder (ASD) and age and sex-matched clinical controls to evaluate risk factors specific to ASD. Methods: The study included 211 ASD patients (177 boys, 34 girls; mean age 44.3±13.0months) and 241 (190 boys, 51 girls; mean age 44.6±14.1months) age and sex group matched clinical controls. Non-ASD diagnoses were expressive language disorder (n = 135, 56.0%), intellectual disability (n = 15, 6.2%), attention deficithyperactivity disorder (n = 6, 2.4%), oppositional disorder (n = 6, 2.4%), and other behavioral or emotional problems (no diagnosis; n = 79, 32.8%). A sociodemographic data form was used to collect data regarding pre-, peri-, and postnatal factors and total daily screen exposure. Results: According to our findings, maternal severe psychological stress and depression during pregnancy, and maternal postpartum depression were more frequent in the ASD group (p =0.005, p =0.035, and p =0.001 respectively). There was a statistically significant difference between groups with regards to maternal any medication use during pregnancy (p =0.004). The mean duration of daily screen exposure was higher in the ASD group (9.90±5.10h) compared to non-ASD children (4.46±3.40 h; p <0.001). A ROC curve showed that 8.5h and above total daily screen exposure (AUC = 0.808 [95% CI: 0.769–0.848], p <0.001; 55% sensitivity, 90.5% specificity) is likely to be associated with increased risk for ASD. Conclusion: Our study suggests that prenatal maternal psychological stress, prenatal and postpartum depression, and excess exposure to screen might be related to an increased risk for ASD.Öğe Socio-demographic and Clinical Characteristics of 113 Adolescents with Bipolar Disorder: An Inpatient Sample from Turkey(GALENOS PUBL HOUSE, Kaçamak Sokak 21/1, ISTANBUL, Fındıkzade 34093, TURKEY, 2020) Güneş, Hatice; Tanıdır, Canan; Doktur, Hilal; Kılıçoğlu, Ali Güven; Üneri, Özden ŞükranObjective: Pediatric bipolar disorder (BD) is a highly morbid disorder which is associated with impairments in social, academic, and family functioning. Despite its great impact on public health, the literature is scarce regarding the studies examining the clinical phenomenology of BD in children and adolescents. Methods: A retrospective chart review of 113 children and adolescents’ files (ages 13-18 years) who were consecutively admitted to our inpatient clinic between March 2012 and November 2014 and diagnosed as having BD type I or BD type II was made. The diagnoses were based on DSM-IV-TR criteria. A sociodemographic and clinical data form was created by the authors and was filled out for each patient by the authors themselves. Results: Totally 113 adolescents (71 male, 42 female) were included in the study. Mean age of the sample was 16.054±1.23 (range=13-18) years. Mean age of onset of BD was 15.04±1.74 (range=9-17) years. The first mood episode was manic in 60% of patients, depressive in 27.3%, mixed in 10.9% and hypomanic in 1.8% of patients. Of the patients, 23.4% had a suicide attempt history, 48.2% had a previous referral to a psychiatry clinic before the onset of BD. History of substance/alcohol use was present in 27.4% of the patients. Of the patients, 84.9% were using combination treatments. Conclusion: High rates of suicide attempt, substance use and significant functional impairment found in our study sample indicate that early recognition and intervention of BD, specialized educational programs and occupational support for these children and adolescents seem indispensable.
