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Generalized structural equation modeling:Symptom heterogeneity in attention-deficit/hyperactivity disorder leading to poor treatment efficacy

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World Journal of psychiatry 2022年第6期12卷 787-800页

作者： Ruu-Fen Tzang Yue-Cune Chang department of Child and adolescent psychiatry Mackay Memorial HospitalTaipei 104Taiwan department of childhood Care and Education Mackay Junior College of MedicineNursingand ManagementNew Taipei City 112Taiwan department of Mathematics Tamkang UniversityNew Taipei City 251Taiwan

BACKGROUND Treatment efficacy for attention-deficit/hyperactivity disorder(ADHD)is reported to be poor,possibly due to heterogeneity of ADHD symptoms.Little is known about poor treatment efficacy owing to ADHD heterogeneity.AIM To use generalized structural equation modeling(GSEM)to show how the heterogeneous nature of hyperactivity/impulsivity(H/I)symptoms in ADHD,irritable oppositional defiant disorder(ODD),and the presentation of aggression in children interferes with treatment responses in ADHD.METHODS A total of 231 children and adolescents completed ADHD inattention and H/I tests.ODD scores from the Swanson,Nolan,and Pelham,version IV scale were obtained.The child behavior checklist(CBCL)and parent’s satisfaction questionnaire were completed.The relationships were analyzed by GSEM.RESULTS GSEM revealed that the chance of ADHD remission was lower in children with a combination of H/I symptoms of ADHD,ODD symptoms,and childhood aggressive behavior.ODD directly mediated ADHD symptom severity.The chance of reaching remission based on H/I symptoms of ADHD was reduced by 13.494%[=exp(2.602)]in children with comorbid ADHD and ODD[odds ratio(OR)=2.602,95%confidence interval(CI):1.832-3.373,P=0.000]after adjusting for the effects of other factors.childhood aggression mediated ODD symptom severity.The chance of reaching remission based on ODD symptoms was lowered by 11.000%[=1-exp(-0.117)]in children with more severe baseline symptoms of aggression based on the CBCL score at study entry[OR=-0.117,95%CI:(-0.190)-(-0.044),P=0.002].CONCLUSION Mediation through ODD symptoms and aggression may influence treatment effects in ADHD after adjusting for the effects of baseline ADHD symptom severity.More attention could be directed to the early recognition of risks leading to ineffective ADHD treatment,e.g.,symptoms of ODD and the presentation of aggressive or delinquent behaviors and thought problems in children with ADHD.

关键词： Attention-deficit/hyperactivity disorder Oppositional defiant disorder Aggression Remission Generalized structural equation modeling

Diagnostic accuracy and clinical utility of non-English versions of Edinburgh Post-Natal Depression Scale for screening post-natal depression in India:A meta-analysis

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World Journal of psychiatry 2020年第4期10卷 71-80页

作者： Paul Swamidhas Sudhakar Russell Swetha Madhuri Chikkala Richa Earnest Shonima Aynipully Viswanathan Sushila Russell Priya Mary Mammen Child and adolescent psychiatry Unit Department of PsychiatryChristian Medical CollegeVellore 632002India

BACKGROUND The prevalence of post-natal depression(PND)is high in India,as it is in many other low to middle income countries.There is an urgent need to identify PND and treat the mother as early as possible.Among the many paper and pencil tests available to identify PND,the Edinburgh Postnatal Depression Scale(EPDS)is a widely used and validated measure in India.However,the summary diagnostic accuracy and clinical utility data are not available for this measure.AIM To establish summary data for the global diagnostic accuracy parameter as well as the clinical utility of the non-English versions of the EPDS in India.METHODS Two researchers independently searched the PubMed,EMBASE,MEDKNOW and IndMED databases for published papers,governmental publications,conference proceedings and grey literature from 2000-2018.Seven studies that evaluated the diagnostic accuracy of EPDS in five Indian languages against DSM/ICD were included in the final analysis.Two other investigators extracted the Participants’details,Index measures,Comparative reference measures,and Outcomes of diagnostic accuracy data,and appraised the study quality using QUADS-2.Deek’s plots were used to evaluate publication bias.We used the area under the curve of the hierarchical summary area under the receiver operating characteristic curve,with the random effect model,to summarize the global diagnostic accuracy of EPDS.Using the 2×2 table,we calculated positive and negative likelihood ratios.From the likelihood ratios,the Fagan’s nomogram was built for evaluating clinical utility using the Bayesian approach.We calculated the 95%confidence interval(95%CI)whenever indicated.STATA(version 15)with MIDAS and METANDI modules were used.RESULTS There was no publication bias.The area under the curve for EPDS was 0.97(95%CI:0.95-0.98).The pre-test probability for the nomogram was 22%.For a positive likelihood ratio of 9,the positive post-test probability was 72%(95%CI:68%,76%)and for a negative LR of 0.08,the negative post-test probability was 2%(95%CI:1%,3%).CONC

关键词： Clinical-utility Diagnostic-accuracy Edinburgh Postnatal Depression Scale Meta-analysis India Validation

Synapsin Polymorphisms Could Be Correlated with Stroop Simple Reaction Time Scores

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American Journal of Molecular Biology 2016年第1期6卷 25-32页

作者： Ahmet Buber Burge Kabukcu Basay Omer Basay Onder Ozturk Huseyin Alacam Kemal Utku Yazici Ali Bacanli Mustafa Ertan Ay Mehmet Emin Erdal Hasan Herken Eyup Sabri Ercan Child and adolescent psychiatry department Pamukkale University Medical Faculty Denizli Turkey psychiatry department Pamukkale University Medical Faculty Denizli Turkey Child and adolescent psychiatry department Firat University Medical Faculty Elazig Turkey Child and adolescent psychiatry department Gaziantep Children Hospital Gaziantep Turkey Medical Biology and Genetics department Mersin University Medical Faculty Mersin Turkey Child and adolescent psychiatry department Ege University Medical Faculty Izmir Turkey

Objective: The aim of this study was to research the relationship between Attention Deficit Hyperactivity Disorder (ADHD) and the synapsin III -196G>A and -631C>G polymorphisms and study their impact on neurocognition and behavior in Turkish children and adolescents. Methods: A total of 201 ADHD-diagnosed children and 100 control subjects aged between 8 and 15 years were recruited, and genetic material was obtained from saliva. In the diagnostic assessments, the KSADS- PL semi-structured interview was applied. Children with any comorbid psychiatric diagnosis (with the exclusion of oppositional defiant disorder (ODD)), medical conditions, prior psychotropic drug use history or IQ score below 80 were excluded. For the behavioral and ADHD symptom assessments, the Turgay DSM-IV Disruptive Behaviors Rating Scale, Teacher Report Form (TRF) and Child Behavior Checklist (CBCL) were completed by the parents and teachers. Neurocognitive profiles were evaluated with the CNS-Vital Signs computerized neurocognitive test battery. Results: No significant difference in ADHD prevalence was observed between subjects with the synapsin III gene -196G>A polymorphism and -631C>G polymorphisms. These polymorphisms were also not associated with subtypes of ADHD. We found a relationship between both polymorphisms and Stroop simple reaction time. Conclusion: Synapsin’s effect could be limited during childhood, but synapsin polymorphisms could be associated with Stroop simple reaction time.

关键词： Attention Deficit Hyperactivity Disorder Synapsin III Association Cognitive Function

Nutritional and herbal supplements in the treatment of obsessive compulsive disorder

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General psychiatry 2020年第2期33卷 101-106页

作者： Canan Kuygun Karci Gonca Gul Celik Child and adolescent psychiatry Dr.Ekrem Tok Psychiatry HospitalAdanaTurkey Child and adolescent psychiatry Cukurova University Medical FacultyAdanaTurkey

Obsessive-compulsive disorder(OCD)is a neuropsychiatric disorder that is characterised by obsessions and compulsions.The recommended treatments for OCD are cognitive-behavioural therapy using exposure and response prevention and/or pharmacotherapy.On the other hand,some nutritional and herbal supplements may be effective in the treatment of OCD.Nutritional and herbal supplements in OCD treatment will be reviewed in this paper.PubMed(Medline),Cochrane Library and Google Scholar databases were reviewed for the topic.There are some supplements that have been researched in OCD treatment studies such as vitamin D,vitamin B12,folic acid,homocysteine,trace elements,N-acetyl cysteine,glycine,myoinositol,St John's wort,milk thistle,valerian root,curcumin and borage.The effectiveness of herbal and nutritional supplements in the treatment of OCD should be supported with more conclusive evidence.

关键词： vitamin prevention treatment Cochrane

Development of alexithymic personality features

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World Journal of psychiatry 2014年第4期4卷 91-102页

作者： Max Karukivi Simo Saarij?rvi Psychiatric Care Division Satakunta Hospital District FI-29200 Harjavalta Finland department of adolescent psychiatry University of Turku FI-20700 Turku Finland Unit of adolescent psychiatry Turku University Hospital FI-20700 Turku Finland

The purpose of this paper is to review the current literature regarding the development of alexithymic personality features. Modern brain imaging technologies provide interesting data on the associations of alexithymia with different aberrations in brain function related to emotion regulation; however, the development of these deviations is poorly understood. A notable amount of research covers the relation of alexithymia to differentenvironmental factors. Many of these associations, for example, with low socio-economic status and general psychopathology in childhood, are well established. However, the retrospective and cross-sectional designs commonly used in these studies, as well as the use of self-report measures, hinder the ability to firmly establish causality. Certain individual developmental factors, such as lagging speech development and congenital cardiac malformations in childhood, have been associated with the development of alexithymia. Regarding the stability of alexithymia, a systematic review of the literature was conducted for this paper. In addition to being characterized as a personality feature in the general population, alexithymia also clearly has a state-like dimension that results in increases and decreases in alexithymic features in conjunction with mental disorder symptoms. An essential question is whether the alexithymic features in adulthood are, in fact, infantile features of a restricted ability to identify and describe emotions that simply persist in individuals through adolescence to adulthood. To firmly establish the roots of alexithymia development, longitudinal studies, particularly in younger populations, are needed. Furthermore, multifaceted study settings are encouraged.

关键词： Alexithymia Development Emotion Personality Stability

Ocular injuries,attention deficit and hyperactivity disorder,and maternal anxiety/depression levels:Is there a link?

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Chinese Journal of Traumatology 2020年第2期23卷 71-77页

作者： Helin Yilmaz Kafali Elif Demirkilinc Biler Melis Palamar Burcu Ozbaran department of Child and adolescent psychiatry Ankara City HospitalMinistry of HealthAnkaraTurkey department of Ophthalmology Ege University School of MedicineIzmirTurkey department of Child and adolescent psychiatry Ege University School of MedicineIzmirTurkey

Purpose:Given the increased risk of accidents in patients with attention deficit and hyperactivity dis-order(ADHD)or maternal anxiety/depression,we aimed to investigate the frequency of the two diseases in children with penetrating eye injury(PEI).Methods:Altogether 79 children,39 with PEIs and 40 healthy individuals(control group),aged 5-15 years,underwent a complete ophthalmologic examination.Afterwards,schedule for affective disorders and schizophrenia for school-aged children was conducted to assess the psychiatric diagnosis of all children.Turgay diagnostic and statistical manual of mental disorders(DSM-Ⅳ)-based child and adolescent behavior disorders screening and rating scale(T-DSM-Ⅳ-S)was flled by parents to evaluate the severity of ADHD symptoms.The depression and anxiety levels of mothers of each group were evaluated by two self-report measures:the Beck depression scale and the state-trait anxiety inventory(STAI),respectively.Data were analyzed by IBM SPSS version 22.0.The Chi-square and Fisher's exact test were used to determine whether there is a significant difference between qualitative variables while independent sample t and Mann-Whitney U tests to compare quantitative variables.Results:The only diagnostic difference was a significantly higher frequency of ADHD among patients with PEIs(48.7%in PEI vs.17.5%in control group,χ^2=7.359,p=0.007).The total scores of the T-DSM-Ⅳ-S(attention subscale U=418.000,p=0.006;hyperactivity subscale U=472.000,p=0.022)and maternal state-trait anxiety inventory(maternal STAI-state U=243.00,p=0.003;maternal STAl-trait U=298.000,p=0.021)were significantly higher in the PEI group than in control group.In logistic regression,children with PEI had a tendency to have a 3.5-fold increased risk for ADHD(OR=3.538,CI=0.960-13.039,p=0.058).Conclusion:ADHD was detected almost 1 in 2 children with PEls.Besides,the maternal anxiety level was significantly higher in the PEI group than in the control group.This association should be further explored via a future prospective longitu

关键词： Attention deficit and hyperactivity disorder Child Ocular trauma Penetrating eye injury Maternal anxiety

Extending the neurocircuitry of behavioural inhibition:a role for the bed nucleus of the stria terminalis in risk for anxiety disorders

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General psychiatry 2019年第6期32卷 309-315页

作者： Jacqueline Clauss Child and adolescent psychiatry Massachusetts General HospitalBostonMassachusettsUSA Child and adolescent psychiatry McLean HospitalBelmontMassachusettsUSA

Behavioural inhibition is a biologically based risk factor for anxiety disorders.Children with behavioural inhibition are shy,cautious and avoidant of new situations.Much research on behavioural inhibition has focused on the amygdala as an underlying neural substrate and has identified differences in amygdala function and volume;however,amygdala findings have yet to lead to meaningful interventions for prevention or treatment of anxiety disorders.The bed nucleus of the stria terminalis(BNST)is a prime candidate to be a neural substrate of behavioural inhibition,given current evidence of BNST function and development in human research and animal models.Children with behavioural inhibition have an increased startle response to safety cues and an increased cortisol response to social evaluative situations,both of which are mediated by the BNST.In rodents,activation of the BNST underlies contextual fear responses and responses to uncertain and sustained threat.Non-human primates with anxious temperament(the macaque equivalent of behavioural inhibition)have increased BNST activity to ambiguous social situations,and activity of the BNST in anxious temperament is significantly heritable.Importantly,the BNST is sexually dimorphic and continues to develop into adulthood,paralleling the development of anxiety disorders in humans.Together,these findings suggest that further investigation of the BNST in behavioural inhibition is necessary and may lead to new avenues for the prevention and treatment of anxiety disorders.

关键词： behaviour prevention finding

Effectiveness of lorazepam-assisted interviews in an adolescent with dissociative amnesia A case report

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Neural Regeneration Research 2013年第2期8卷 186-190页

作者： Yuna Seo Mi-Hee Shin Sung-Gon Kim Ji-Hoon Kim department of psychiatry Aram Hospital department of psychiatry Pusan National University School of Medicine Division of Child-adolescent psychiatry Department of Psychiatry Pusan National University School of Medicine

To facilitate gathering information during a psychiatric interview, some psychiatrists advocate augmenting the interview using drugs. Rather than barbiturates, benzodiazepines have been used for drug-assisted interviews. Dissociative amnesia is one of the indications for these interviews. Herein, we present the case of a 15-year-old female who was diagnosed as having dissociative amnesia because of conflicts with her friends. She was administered a Iorazepam-assisted interview to aid recovery of her memories. In this case, a small dose of Iorazepam was sufficient to recover her memories without any adverse effects.

关键词： neural regeneration clinical practice dissociative amnesia dissociative disorder dissociation drug-assisted interview amobarbital, Iorazepam benzodiazepine adolescent memory loss emotional distress distress grant-supported paper neuroregeneration

COVID-19 mental health care toolkit:an international collaborative effort by Early Career Psychiatrists section

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General psychiatry 2020年第5期33卷 352-355页

作者： Frances Adiukwu Laura Orsolini Drita Gashi Bytyçi Samer El Hayek Jairo M Gonzalez-Diaz Amine Larnaout Paolo Grandinetti Marwa Nofal Victor Pereira-Sanchez Mariana Pinto da Costa Ramdas Ransing Andre Luiz Schuh Teixeira Mohammadreza Shalbafan Joan Soler-Vidal Zulvia Syarif Ganesh Kudva Kundadak Rodrigo Ramalho department of Neuropsychiatry University of Port Harcourt Teaching HospitalChobaRiversNigeria department of Clinical Neurosciences/DIMSC School of MedicinePolytechnic University of MarcheAnconaMarcheItaly Mental Health Center Prizren Hospital and University Clinical Service of KosovoPrizrenKosovo department of psychiatry American University of BeirutBeirutLebanon CERSAME School of Medicine and Health SciencesUniversidad del Rosario-Clinica Nuestra Senora de la PazBogotaColombia psychiatry department D Razi Hospitalfaculty of Medicine of TunisTunis El Manar UniversityTunisTunisia Addictions Service(SerD) Department of Territorial AssistanceASL TeramoTeramoItaly Helwan Mental Health Hospital CairoEgypt department of Child and adolescent psychiatry NYU Grossman School of MedicineNew YorkNew YorkUSA Unit for Social and Community psychiatry(WHO Collaborating Centre for Mental Health Services Development) Queen Mary University of LondonLondonUK Institute of Biomedical Sciences Abel Salazar University of PortoPortoPortugal Hospital de Magalhaes Lemos PortoPortugal department of psychiatry BKL Walawalkar Rural Medical CollegeSawardeRatnagiriIndia Department of Childhood and Adolescent Psychiatry Universidade Federal do Rio Grande do SulPorto AlegreRSBrazil Mental Health Research Center Department of PsychiatrySchool of MedicineIran University of Medical SciencesTehranIran(the Islamic Republic of) Fidmag Research Foundation Hermanas HospitalariasBarcelonaSpain department of psychiatry Tarakan General HospitalJakartaIndonesia Early Psychosis Intervention Programme Institute of Mental HealthSingapore department of Social and Community Health School of Populatin HealthUniversity of AucklandAucklandNew Zealand

The collaborative effort of an international research team from the Early Career Psychiatrists section of the World psychiatry Association has brought about an easy-to-use,quick and stepwise mental health care toolkit for the identification and appropriate referral of those in need of mental health care during the pandemic.This simple guide can be applied in the general outpatient setting and is catered for all healthcare professionals,regardless of their expertise within the mental health field with minimal training.It is our hope that by incorporating this toolkit into our daily clinical care during the pandemic for high-risk patients and patients with non-specific complaints,we will be able to bridge the mental health gap present in our society.

关键词： Psychiat section clinical