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Öğe Evaluating clonidine response in children and adolescents with attention-deficit/hyperactivity disorder(Amer Inst Mathematical Sciences-Aims, 2018) Kütük, Meryem Özlem; Güler, Gülen; Tufan, Ali Evren; Sungur, Mehmet Ali; Topal, Zehra; Kütük, ÖzgürAttention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood, which is generally treated with stimulant and non-stimulant medications. However, 10-30% of patients in clinical setting do not present with adequate response to initial stimulant treatment. Thereby, clonidine may be considered for those patients who have failed to respond to psychostimulant/atomoxetine monotherapy or as an augmentation for inadequate response/comorbidity. This observational study evaluated its effectiveness as a single drug in ADHD cases unresponsive to previous treatment trials. Seventeen ADHD cases that were non-responders to stimulant, non-stimulant and combination therapy for the primary symptoms of ADHD were included in the study. Four cases dropped out before follow up, leaving thirteen cases who were administered immediate release clonidine treatment alone with a mean dose of 0.2 +/- 0.05 mg/day at baseline. The trial lasted for 12 weeks, and treatment outcomes were evaluated by the Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale (T-DSM-IV-S) and the Clinical Global Impressions-Severity (CGI-S) and Improvement (CGI-I) scales. Mean age of the sample was 12.5 years (SD = 3.0) and eleven of the subjects had another comorbid psychopathology. Only two cases were evaluated as "very much improved", while another patient was judged to be "minimally improved" after 12 weeks of clonidine treatment. Attrition during follow-up was associated with higher median scores on the hyperactivity and impulsivity subscales (Mann-Whitney U test, p = 0.02). According to the T-DSM-IV-S, CGI-S, and CGI-I scales, clonidine treatment by itself had minimal benefits in this sample of treatment of refractory cases with ADHD evaluated at the study center. Clonidine is not available in Turkey pharmaceutical marketing system and patients' access to drug is limited. Our results provide first data regarding the use of clonidine in Turkish ADHD patients.Öğe Novel inflammatory targets for immunotherapies in pediatric patients with trichotillomania(Elsevier GmbH, 2020) Kütük, Meryem Özlem; Tufan, Ali Evren; Kılıçaslan, Fethiye; Mutluer, Tuba; Gökçen, Cem; Karadağ, Mehmet; Kütük, ÖzgürImmune dysregulation may be important in the etiology of obsessive-compulsive and related disordersandbody-focusedrepetitivebehaviors, such as Trichotillomania (TTM). The role of inflammation and inflammatory markers in TTM has received relatively little attention. This study was aimed to determine the expression levels of inflammatory markers (i.e. IL-1?, IL-1?, IL-4, IL-6, IL-17, TNF-? and TGF-?) in peripheral blood mononuclear cells of children with TTM and healthy controls and to evaluate their association with clinical variables. Seventy-seven patients with TTM and 107 healthy controls were enrolled in the study. Peripheral blood was collected in standardized conditions. The mean age of patients and controls did not differ significantly (10.8 ± 4.4 and 12.0 ± 3.2 years; respectively). The majority of patients with TTM and controls were females (n = 55, 71.4 % and n = 55, 51.4 %; respectively); with a greater preponderance of females among TTM. Patients with TTM had significantly elevated expression levels of TNF-?, IL-6 and IL-17 compared to controls. However, the expression level of IL-4 was significantly reduced in TTM patients compared to controls. Accordingly, we found a pro-inflammatory state in TTM and those findings may suggest novel treatment options for TTM and further, cross-disciplinary studies focusing on neuro- inflammation in TTM conducted on larger samples are needed. © 2020 Elsevier GmbHÖğe Predictors of Severe and Permanent Disability in Children Evaluated in Health Boards: A Single-Center Study(2020) Yıldırım, Didem Derici; Biçer, Ali; Kütük, Meryem Özlem; Toros, Fevziye; Tufan, Ali Evren; Aksu, Gülen Güler; Dağ, PelinAim: The aim of this study is to determine the severe and permanent disability of the childrenevaluated in the disabled health boards and to evaluate the predictors of severe and permanentdisability.Material and Methods: Records of 1482 children who were referred to a university hospitalhealth board for disability between the years 2013-2018 were screened retrospectively.Results: More than half (52.2%) of the children had a single psychopathology. 83.5% of thecases were severely disabled and 66.5% were permanently disabled. Severely disabled childrenwere significantly more likely to have psychiatric, pediatric, neurological, orthopedic andotorhinolaringologic disorders. Permanent disability was significantly more frequent amongpatients with pediatric, ophthalmologic and cardiac disorders while children withpsychopathologies were significantly less likely to have permanent disability. Mentalretardation/intellectual developmental disorder levels differed in rates of permanent disabilitywith pair-wise comparisons revealing that severe mental retardation/intellectualdevelopmental disorder was the main factor. Severe disability was significantly more commonamong children younger than 8 years while permanent disability was more common amongchildren >3 years. Children with psychopathology were 4.1 times more likely to have severedisability and this further increased to 15.3 for those with mental retardation/intellectualdevelopmental disorder.Conclusion: This is the first study to evaluate the factors that affecting the decisions ofpermanent and severe disabilities in disability health boards. Comprehensive results have beenachieved despite low generalizability. To provide consistent reports, further and multicenterstudies on factors associated with severe and permanent disabilities in children are needed.Öğe Suça Sürüklenen Çocukların Klinik ve Sosyodemografik Özelliklerinin Değerlendirilmesi(2018) Güler, Gülen; Sungur, Mehmet Ali; Kütük, Meryem ÖzlemGiriş: Suça sürüklenen çocukların ruhsal değerlendirmesinde çocuğu suça sürükleyen risk faktörleri detaylı incelenmelidir. Bu çalışmada birincil amaç suça sürüklenen 12-15 yaş arası çocukların sosyodemografik ve klinik özelliklerinin değerlendirilmesi, ikincil amaç ise klinisyenin ceza sorumluluğu değerlendirmesinde göz önünde bulundurduğu özelliklerin incelenmesidir.Gereç ve Yöntem: 12-15 yaş arası suça sürüklenen çocukların tıbbi kayıtları retrospektif değerlendirildi. Olguların ve ebeveynlerinin sosyodemografik özellikleri, suç türü, suç öyküsü, ailede suç öyküsü ve rapor sonucu bilgileri çalışmada yer aldı.Bulgular: Olguların çoğunluğu (%87.1) erkekti. %31.7'si okulu bırakmıştı. Olguların %55.4'ünün işlediği iddia edilen suçun hukuki anlam ve sonuçlarını algılayabildiği ve davranışlarını yönlendirebildiği saptandı. %43.6'sında bir ruhsal rahatsızlık mevcuttu ve en sık görülen Dikkat eksikliği hiperaktivite bozukluğuydu. En sık suç türü kasten yaralamaydı. %32.7'sinde tekrarlayan suç öyküsü vardı. Hem suçun hukuki anlam ve sonuçlarını algılama ve davranışlarını yönlendirme yeteneği gelişmiş grupta hem de tekrarlayıcı suç öyküsü olan grupta istatistiksel anlamlı düzeyde okul başarısızlığı, ebeveyn akrabalığı, ailede birinci derece akrabalarda suç öyküsü, sigara/alkol/madde kullanımı ve ruhsal rahatsızlık saptandı. Beck depresyon ve sürekli kaygı ölçeği (STAI-2) puanları tekrarlayıcı suç öyküsü olan grupta daha yüksekti. Hırsızlık (p0.012) ve darp suçları (p0.046) daha çok tekrarlama eğilimindeydi.Sonuç: Hem ceza sorumluluğu olan hem de tekrarlayan suç işleyen grupta öne çıkan risk faktörleri okul başarısızlığı, ebeveyn akrabalığı, akrabalarda suç öyküsü, sigara/alkol/madde kullanımı ve ruhsal rahatsızlıklardır. Bu risk faktörlerinin genetik bir zemini olabileceği bilinmekle birlikte birçoğunun koruyucu, destekleyici çalışmalar ile önlenebilecek özellikler olması dikkat çekicidir. Topluma ciddi yükü olan çocuk suçluluğunu önleyici toplumsal projelerin geliştirilmesi gerekmektedir.Öğe The Self-Concept, Family Functioning, Psychological and Emotional Symptoms, in Children and Adolescents with Neurofibromatosis Type 1(Düzce Üniversitesi, 2024) Güler Aksu, Gülen; Tezol, Özlem; Kütük, Meryem Özlem; Kayar, Ozan; Tufan, Ali Evren; Kargın, İrem; Dağ, PelinAim: This study aimed to examine the self-concept and related psychological factors in children and adolescents with neurofibromatosis type 1 (NF1).Material and Methods: A total of 71 participants (35 patients and 36 controls) were included in this study. As measurement tools the Piers-Harris children’s self-concept scale (PHSCS), family assessment device (FAD), Turgay DSM-IV-based screening and rating scale for disruptive behavior disorders (T-DSM-IV-S), children's depression inventory (CDI), Beck depression inventory (BDI), state-trait anxiety inventory (STAI), children’s sleep habits questionnaire (CSHQ), and autism spectrum quotient-adolescent (AQ-adolescent) were used.Results: NF1 patients had lower intellectual functioning/academic achievement (p=0.002) and popularity/social appreciation (p
