11th International Congress on Psychopharmacology & 7th International Symposium on Child and Adolescent Psychopharmacology

Atypical antipsychotics (SGA) are used as first choice but this group of drugs may cause relatively more metabolic problems. Diabetic ketoacidosis (DCA) known as an acute, life-threatening complication of diabetes, can be triggered by use of SGA. In this presentation, we present a 17year-old male patient who had DCA that thought to be triggered by olanzapine treatment. Case presentation: E. has been followed up and treated for about 6 years in child and adolescent psychiatry outpatient clinic. He had no history of smoking, alcohol or substance abuse in any period of his life. There was no history of psychiatric disease in the family. His aunt has a history of type 2 diabetes. The first time he consulted us was about 2 years agowith the complaint of irritability, harm to his family and sleep problems. In this interview, we learned that she had been treated with risperidone 2 mg/day but had no benefit. Mental status examination revealed any hypomanic, manic, psychotic symptoms and signs. Aripiprazole 5 mg/day treatment was arranged and he benefited from drug. Patient was admitted again after 2.5 months and family had complaints of “inability to sleep, fears, biting himself, talking to himself”. Avolition, dirtiness obsessions and cleaning compulsions, visual, auditory and auditory hallucinations were determined in the examination. Patient was referred to child neurology and psychiatric hospitalization was recommended. However family did not want hospitalization and no pathology was found in her neurological examination. Patient was planned to have olanzapine 5 mg, 2 times a day. Approximately 1.5 months later, the patient re-admitted to us, he was so irritable, anxious, unsleeping and suggested to continuation of olanzapine in morning 5 mg and evening 10 mg. In third week of treatment, patient was admitted to the emergency room with nausea, vomiting, abdominal pain and blurred consciousness. In the evaluation; blood glucose 434 mg/dl, urine glucose 3+, protein 2+, ketone 3+, pH 6.0; The blood gas pH was found to be 7.146 and it was accepted to the pediatric intensive care unit with diagnosis of diabetic ketoacidosis. Olanzapine treatment was discontinued and he was discharged with insulin therapy. The patient is still followed up with aripiprazole 15 mg/day treatment. How SGA lead to hyperglycemia remains unclear. Due to the weight gain effects of olanzapine, increasing peripheral and hepatic insulin resistance and stimulating X receptor are most known factors contributing to this effect. This mechanism does not seem possible to explain the rapid onset of diabetes. Some clinical trials with olanzapine have shown biphasic changes in insulin secretion in patients. Olanzapine acts on direct beta cells in the early period of treatment and that insulin secretion decreases significantly may accompany this metabolic condition. As in our patient, it is stated that this possibility increases in case of genetic predisposition. Particular attention should be paid to use of olanzapine, which may cause metabolic side effects more frequently in young patients with familial predisposition.

etiopathogenesis of cognitive dysfunction is needed. Immune dysfuncion has been implicated to be important part of pathopysiology of OCD and different lines of evidence suggests immune abnormalities in OCD. But whether these immune changes are traits of disease or secondary to clinical burden of the disease such as cognitive dysfunctions has not been determined. In this study we aimed to examine the relation of blood levels of Interleukin 1-beta (IL-1ß), Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) with various neurocognitive functions in patients with OCD in comparison with its autogenous/reactive subtypes and healthy controls. METHODS: Forty-two patient with OCD and 45 age, sex and educational level matched healthy control were enrolled in the study. The diagnosis of OCD was made with with Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Yale-Brown Obsessive-Compulsive Scale, Beck Anxiety and Depression Inventory Scales were administered. Neuropsychological test battery including Wisconsin Card Sorting Test (WCST), Trail Making Test A and B (TMT-A, TMT-B) were used for evaluation of the patients and healthy control. The plasma of interleukin-1beta (IL-1ß), interleukin-6 (IL-6), Tumor Necrosis Factor-Alpha (TNF-α) of both groups were measured with ELISA kits. RESULTS: Blood levels of IL-1ß, IL-6 and TNF-α were significantly higher in patients with OCD than the healthy control. There was significant difference in IL-1ß, IL-6 but not in TNF-α between autogenous/reactive subtypes and healthy controls. TNF-α is positively correlated with TMT-A, TMT-B and Stroop Test Part 5, negatively correlated with immediate memory, verbal learning, interference effect, immediate recall, delayed recall and recognition in RAVLT. IL-1ß was positively correlated with TMT-A score. IL-6 was positively correlated with scores of TMT-A, TMT-B. IL-6 was negatively correlated with immediate memory, verbal learning, interference effect, immediate recall and delayed recall in RAVLT, positively correlated with number of perseverative error and negatively correlated with the number of categories completed in WCST. CONCLUSIONS: This is the first study that examines the relation of IL-1ß, IL-6 and TNF-α levels with cognitive functions in OCD. There may be a contribution to pathogenesis of OCD and subtypes then new choices for treatment might be developed. Moreover, uncovering the effect of cytokine blood levels on cognitive function of OCD, new data concerning etiopathogenesis and further treatment choices can be gained.    have been widely demonstrated by previous research, gaming can become pathological for some players when the activity becomes dysfunctional, harming an individual's social, occupational, family, school, and psychological functioning due emerging functional impairment caused by the activity. Internet gaming has a propensity to alleviate dysphoric moods and may therefore be used to cope with real life problems. Studies have shown that EDR is associated with IGD [3].
The aim of the present study was to evaluate relationship of IGD symptoms with SMB, while controlling the effect of EDR on this relationship among young adults.

METHODS:
The study was conducted with online survey among 1010 volunteered university students in Ankara and people who play games on the Internet and who are in the e-mail database of a company located in Istanbul that organizes e-sports tournaments. Participants were evaluated by applying the Difficulties in Emotion Regulation Scale (DERS) and the Internet Gaming Disorder Scale -Short Form (IGDS-SF). RESULTS: Age and gender did not differ between those with SMB (n=207, 20.5%) and those without SMB (n=803, 79.5%). IGDS9-SF and DERS scores were higher among those with SMB (Table 1). In linear regression analysis, severity of IGD predicted the presence of SMB, together with difficulties in emotion regulation, particularly "non-accept" (Nonacceptance of emotional responses), "impulse" (Impulse control difficulties) and "strategies" (Limited access to emotion regulation strategies) dimensions ( Table 2). CONCLUSIONS: These findings suggest that the severity of IGD is related with the presence of SMB, together with EDR, particularly "non-accept" and "impulse" and "strategies" dimensions among young adults. that cannot be prevented from repeating itself. Millions of people around the world suffer from OCD. According to 2017 data (World Health Organization), roughly %2,3 of any population (one in every 200 people) live with this disorder. In the study, environmental factors including sociodemographic characteristics which are among the factors that cause OCD formation were examined. This study was intended to examine the relationship between sociodemographic characteristics and OCD symptoms. Therefore, different types of obsessions and compulsions of the participants have been examined. METHODS: Data were collected from 62 people in two mid-Anatolian cities. 23 (37%) were male and 39 (63%) were female. Their ages ranged between 17-63 and average age was 32 years. 34 (55%) of them were married, 18 (39%) were single and remaining were separated. Sociodemographic data form, Diagnosis DSM-V, Global Obsessive-Compulsive Scale (OCI-R), and Yale Brown Scale (Y-BOCS) were used for data collection. They received a general psychiatric examination.

RESULTS:
The results showed that the most common obsessions were transmission and sexual suspicion. In addition, control, washing and questioning were found among the most common compulsions. Regarding the patients, 18 were first time, 29 were repetitive, and 15 were chronic OCD patients. Most common obsession types were found as suspicion, infection, and sexual. Their compulsions were mainly control, washing, avoiding or questioning. 40 of them (64%) indicated not having any internal health problem. Other patients were suffering from various internal health issues such as ophthalmologic problems, migraine, epilepsy, and hernia. The frequency of suffering internal health issues in females (46%) was found to be much higher than males (20%). However, no correlation was found between both genders. Most subjects (58%) reported having a relative person diagnosed with a mental issue especially OCD and depression. CONCLUSIONS: Preliminary results revealed that correlation coefficient between OCD symptoms and number of kids (-0.22) showed that the greater number of kids, the less OCD severity. It was found that age and OCD symptoms had negative correlation. On the other hand, similar to previous studies, OCD severity increases as age rises. Having close relatives with OCD symptoms proves that it has a genetic component. Suffering from any internal disease was another factor that increases the risk getting it. Our data comparing male and female subjects diagnosed with it resulted in inconclusive conclusion and supported previous studies. Finally, our findings correlated with the previous research findings and supported the OCD theories about its causes (biology, genetics and environments). However, more detailed and comprehensive studies should be conducted to get more sound proofs about it and related issues such its risk factors, gender and other features. OBJECTIVE: Certain negative changes in blood parameters are observed in patients with psychotic disorders due to disease induced inflammatory processes and factors such as negative living conditions, inadequate nutrition and psychotropic drug use. Also, smoking, which is common in this patient group, adversely affects blood cell functions and especially platelet aggregation in both acute and chronic periods. The present study aimed to examine the platelet count and functions in patients with psychotic disorders. For this purpose, patient and control group mean platelet volume (MPV) and platelet count and platelet/ lymphocyte ratio were compared. METHODS: Fifty 18-65 years old patients, who were diagnosed with an anxiety disorder based on DSM-5 diagnostic criteria, were included in the study. The control group included 50 healthy individuals similar in age and gender. A sociodemographic data form developed by the authors is applied to all participants. Complete blood count values for both the patient and the healthy control group were recorded based on the information stored on the system. MPV and platelet values for patients were compared with the test results of healthy controls. SPSS version 22 software was used for statistical analysis. The Student's t test was used for paired comparisons and the correlation between the variables was analyzed with Pearson's correlation analysis. p <0.05 was considered statistically significant. RESULTS: The mean age in the patient group was 38.8 ± 14.08 and the mean age in the control group was 36.76 ± 11.5. 58% of the patient group and 28% of the control group were smokers. The patient group platelet count was significantly lower when compared to the control group (p = 0.026). Although MPV rates were lower in the patient group, the difference was not statistically significant. There was no significant difference between patient and control group MPV, Hb, Htc, P / L, WBC and RBC values. There was no significant difference between the hematological parameters when the patient group was grouped as medicine users (n= 30) and non-medicine users (n= 20).

KEYWORDS
Psychosis; mean platelet volume; blood platelet RESULTS: The mean age of the patients FMS was 42.76 ± 10.08. Patients were divided into two groups as mild (70 below) and severe (70 and over) FMS according to FIQ scores. Of the 103 women, 54 were mild (52.4%) and 49 were severe (47.6%) FMS. As the FIQ score increased (FMS severity), the self-confident approach (r = -0,217; p = 0,028) score was decreasing significantly. CONCLUSIONS: In the study, it was shown that as the severity of the disease increased, the self confident approach score which is one of the appropriate coping ways, decreased in FMS. To consider psychotherapeutic approaches in the treatment of severe FMS including appropriate stress coping ways will contribute positively to the treatment. Further prospective studies with larger samples includeing both sexes will contribute to the literature.
[Abstract:0061][Neuroscience: Neuroimaging-Genetics-Biomarkers] Neuropsychiatric and sociodemographic features of centenarian people who live in rize deficiency was 64.1%, vitamin B12 deficiency was 10.6% and folic acid deficiency was 4.7%. In males, vitamin D deficiency was 51.5%, vitamin B12 deficiency was 11.4% and folic acid deficiency was 8.3%. No significant difference was found between vitamin D, vitamin B12 and folate levels in the comparison between the diagnoses. CONCLUSIONS: Due to the high number of patients with low vitamin D and vitamin B12 levels in this present study, more attention may be paid to vitamin D and vitamin B12 replacement. The lack of folic acid in men is noteworthy in this present study.
[ On the other hand studies especially in the group of children and adolescents is very limited. The aim of this study was to evaluate sociodemographic data, psychiatric comorbidity, onset and course of conversion disorders in this age group. METHODS: In this present study, we evaluated 36 adolescents (33 females, 3 males) with the age range of 12-18 years and 37 controls with the same age group. All participants were expected to fill out the sociodemographic data form prepared by the researchers. Afterwards, psychometric tests and semi structured interview (K-SADS-PL) were applied by the clinician for the purpose of psychiatric diagnosis and in order to exclude mental retardation. SPSS 18.0 was used for analysis of data. RESULTS: When findings were evaluated, no significant difference was observed between two groups regarding duration of education, family structure, number of siblings, average age of parents and education level of parents and socio-cultural / economic level. While onset of symptoms was 14±1 years in conversion disorder group, time to psychiatry admission was 5±3 months. When symptoms were evaluated as subtype, 77.8% were psychogenic seizures, 5.6% motor type, 5.6% unusual movements (ataxia, posture), 5.6% mixed type, 2.8% sensory type (vision, speech), 2.8% anesthesia and loss of sensation were observed. When frequency of symptoms was examined, 83% of patients had more than one psychogenic episode per month and 36% experienced multiple seizures per day.
Risk factor that could cause susceptibility to disease was determined in 94.6% (n=34) patients. Family problems were determined in 72% (n=26), difficulties in friendship in 25% (n=9) cases and risk factors for individual difficulties in 27.7% (n=10) cases. Symptoms started after sexual abuse in one adolescent. The academic achievement was significantly lower in conversion disorder group than in control group (p<0.05), school absenteeism was more frequent (p<0.05) and there were significantly more problems in peer relationships (p<0.05).
In assessment made according to Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime, 75% (n=27) of conversion disorder group had a psychopathology in premorbid period. The most common psychopathology was ADHD (11.1%; n=4) and generalized anxiety disorder (8.3%; n=3). In current examination, 75% (n=27) of adolescents had at least one psychiatric comorbidity. Most common cases were 41.7% (n=15) other somatoform disorders, 30.5% (n=11) depression.
While 58.3% (n=21) of patients with conversion disorder had a psychiatric disease in their relatives, this was 34% (n=13) in control group and showed a significant difference (p<0.05). CONCLUSIONS: Many variables found in this present study are compatible with the limited studies conducted in our country, but they are higher than those conducted abroad. The studies to be carried out in terms of presipitating, perpetuating and protective factors in conversion disorder, which is quite common in developing countries, will be valuable in terms of community mental health protection. KEYWORDS Adolescent; conversion disorder; psychopathology ±0.001 AU/mg protein, catalase 40.1±1.7 mmol of H2 O2 /mln. Erith*m), whereas patients with more than one year duration of narcotization the reduction of catalase activity was observed in 3.5 times -11.6±0.9** and the level of malondialdehyde -2.61±0.13** and medium molecular peptides -0.109±0.012** exceeded control in 5.0 and 5.5 times, respectively (Note: *-Significant in relation to the control, P<0.05).
It should be noted that our results of research on the state of the antioxidant system in patients who use opioids, according to the oppression of the enzymatic link of antioxidant protection and the need to include substances with antioxidant properties, in the treatment of these patients. Based on the identified pathochemical features of the course of acute and chronic drug intoxication opiates, as well as the availability of the system operating in the blood of opioid addicts, the therapeutic tactics has been optimized as follows: included pathogenetic therapy with an effect on metabolic processes with the use of antioxidants. As membrane-pathogenetic therapy administered ethylmethylhydroxypyridine succinate (mexidol) at a dose of 500 mg/day for 2 admission. A comparative study of two groups of drug users receiving different treatments -traditional and optimized in combination with ethylmethylhydroxypyridine succinate (mexidol) shows a more pronounced therapeutic effect bioregularly antioxidant therapy. CONCLUSIONS: Using optimized therapy helped achieve a significant reduction from baseline indicators of lipid peroxidation, which proves that the liver contribute to the development of the system operating in opium addiction, as well as the fact that the recovery of the antioxidant capacity of the body leads to the relief of the oxidative stress. The study period of abstinence in patients receiving optimized treatment including an antioxidant, found that significantly reduced the duration of withdrawal symptoms, reduced craving for the drug, and the low intensity of the generation of active forms of oxygen in the blood correlates with the effectiveness of therapy. Inclusion of ethylmethylhydroxypyridine succinate (mexidol) in the complex treatment of opioid addiction contributes to sustainable and prolonged suppression of free radical oxidation in the blood, observed immediately after treatment. Cultural dependence of attitude towards psychotherapeutic treatmentgerman compared to Turkish people in first and second generation Dilek Sahin Gesundheitsamt, KJPD, Berlin, Germany ABSTRACT OBJECTIVE: Migrants are affected by various stressors, which might adversely influence their mental health and might be associated with need of psychotherapeutic treatment. The present study compares the attitudes towards psychotherapy of Turkish migrants living in Germany and native Germans. Therefore, sex-and descent-specific differences concerning the open-mindedness towards psychotherapeutic treatment, the social support, the psychological burden and the demand of health services were analyzed. Additionally potential differences between migrants of the first and second generation were examined. METHODS: 129 Turkish migrants and 129 native Germans were analyzed with the following instruments: Frankfurt-Acculturation-Scale (FRAKKS-T), Questionnaire on Attitudes towards KEYWORDS Attitudes towards psychotherapy; Turkish migrants in Germany; social support; sociodemographic variables Psychotherapeutic Treatment (QAPT), Social Support Questionnaire (SSQ/F-SozU), Symptom-Checklist (SCL-14, short version) with the subscales anxiety, depression, somatization, Suinn-Lew Asia Self Identity Acculturation Scale (SL-ASIA) and Socio-Biographic Questionnaire (SBQ). The Turkish migrants were subdivided into migrants of the first (country of birth not Germany, n=97) and second (country of birth Germany, n=32) generation. RESULTS: The majority of the test-persons (81.0%) had no personal experience with psychotherapeutic treatment. Turkish migrants were significantly less frequently treated than native Germans.
The judgement of the social support (SSQ/F-SozU): Shows neither significant differences between Turkish migrants/native Germans, between migrants of the first/second generation and between women/men. Was significantly more positive by Turkish women than by Turkish men.
The attitude towards the use of psychotherapeutic support (QAPT): Was significantly (QAPTwhole-scale, QAPT-positive/negative-items) more negative by Turkish migrants than by native Germans. Was significantly (QAPT-whole-scale, QAPT-positive-items) more positive by migrants of the first than of the second generation. Was significantly (QAPT-whole-scale, QAPT-positiveitems) judged more positive by women than by men; difference was primary due to the difference in the group of Turkish migrants.
The psychological stress (SCL-14): Was judged significantly higher by Turkish migrants than by native Germans (whole scale and partial scales anxiety, depression, somatization). Was not judged significantly different between migrants of the first/second generation or between women/men.
The grade of acculturation (FRAKKS-T, SL-ASIA): was higher for the group of second generation migrants than for the group of first generation migrants. CONCLUSIONS: The data-analysis shows that (male) Turkish migrants in spite of their higher subjective psychological burden use institutional support-services of the health-system less frequently and are more skeptical towards psychotherapeutic treatment. The possible reasons for this discrepancy are discussed in the context of the literature. Finally, visions of possible improvements will be presented.

[Abstract:0079][Schizophrenia and Other Psychotic Disorders]
Evaluation of the clinical features of schizophrenia patients following psychosocial skills training in a community mental health center of a training and research hospital and PSPS (baseline 46.43±16.22, post-PST 66.86±11.55; p=0.002) improved significantly after the training. CONCLUSIONS: With this study, we emphasized the importance of creating therapy programs in CHMC. This study demonstrated that the PST program contributes considerable improvements to general psychopathology, treatment compliance, and functionality for schizophrenia patients. At the same time, significant improvement was obtained in terms of insight in the subjects who completed the program. Since the addition of this training program to the routine treatment of schizophrenia has contributed positively to the clinical pattern and functionalities of the patients, it is important to increase the awareness of mental health professionals in this area. Involuntary admission group showed significantly higher unemployment rate than voluntary admission group (77.3% and 51.6%, respectively; χ² = 4.44, p=0.03). Involuntary patients were more likely to live alone than voluntary patients (36.0% and 13.3%, respectively; χ² = 6.58, p = 0.10). Depression was the most common diagnosis among voluntary patients while schizophrenia and related disorders were the most common diagnosis among involuntary patients (55.7% and 48.0%, respectively; χ² = 17.9, p = 0.00). CONCLUSIONS: In the literature, involuntary admission rates vary from 3.2% and 42%. Studies from Turkey have shown rates of 13.1% and 23.11%. Our finding of involuntary admission prevalence is consistent with the literature. Most of the involuntary admissioned patients were unemployed, living alone, and had a diagnosis of a schizophrenia and related disorder. Our results support previous researches suggested involuntary admission is significantly associated with unemployment, living alone and having a diagnosis of schizophrenia and related disorder. However these findings should be supported with further studies with larger sample size. The relationship between leptin receptor polymorphism and suicide in depressed adolescents limited progress is achieved to identify the candidate genes in adolescents. In this study, we want to research the relationship between major depressive disorder, suicide and leptin receptor single nucleotide polymorphism. METHODS: 97 patients and 106 healthy controls were included study. Five leptin receptor SNP regions were examined. Depressive scores and suicidal behavior were measured by standardized scales. Logistic and linear regression analysis were used for determining to predictors. RESULTS: Previous suicide attempt (B:5,553, t:2,125 p=0,035) and having a mutant allel in rs1171276 SNP region (B:4,346 t:1,958 p=0,048) were found as two strong predictor for Suicide Probability Scale scores in whole sample. Family history of depression (B: 1,426, p=0,000, expB: 4,164) and number of stressful life events (B:0,547, p=0.001, expB: 1,728) predicted depression significantly. There is no statistically significant difference regarding number of person who has homozygote or heterozygote genotype between patient and control groups. CONCLUSIONS: Leptin receptor polymorphism could result an increase in impulsive behavior and suicide scores with leptin resistance. Our research is the first study examine the relationship between depression, suicidal behavior and leptin receptor polymorphism in adolescent sample. The relatively small sample size should be mentioned a limitation for this present study. Further studies are needed for generalize these results. ; is the most common psychiatric disorder and its incidence is increasing day by day. Due to its high prevalence rates, risk of recurrence or chronicity; results such as suicidal attempts, loss of functionality and economic burden, it is an important public health problem. The concept of treatment-resistant depression (TRD) is defined as lack of response to two different groups of antidepressants at adequate doses and duration. The concept of expressed emotion (EE) is a multifaceted measure of criticizing, hostile and overprotective attitudes and expressions of the relatives towards the individual with the disease. Clinical course of MD and EE associations were examined in a variety of studies, and in the majority of cases, high EE was found to be associated with relapse. Although the association of EE with relapse is shown, information about its relationship with clinical severity of major depression and treatment resistance is limited. In this study, it was aimed to examine whether there is any difference in terms of EE between treatment resistant and nonresistant major depression patients, and the relationship between EE and the clinical characteristics of depression. METHODS: The study included 50 patients with MD, 50 patients with TRD and the relatives of these 100 patients who were admitted to the Psychiatry Department of Marmara University Pendik Training and Research Hospital. The Quick Inventory of Depressive Symptomatology (QIDS-SR16) and EE scale were used to assess depressive symptoms and EE levels in both groups of patients. And patient's relatives were evaluated by LEE (Level of Expressed Emotion) scale. RESULTS: In the TRD group, the LEE total score (p = 0.020), the LEE_ emotional response subscale score (p = 0.011) and the LEE_ attitude toward illness subscale score (p = 0.036) were found to be significantly higher. When EE scale total score and subscale scores are examined; EE total score (p <0.001) and EE_emotional overinvolvement subscale score (p <0.001) were found to be significantly higher in TRD group. When QIDS-SR16 scale total scores are compared; there was a statistically significant increase in the TRD group (p <0.001). And there was a positive correlation between QIDS total score and total EE and LEE scores and all subscale scores (p <0.05). CONCLUSIONS: In this present study, there was no significant difference between the groups in terms of sociodemographic data (age, gender, etc.). When TRD and MD groups were compared in terms of clinical variables; as expected, inpatient treatment, ECT, number of suicide attempts, number of past depressive episodes and duration of current episode were found to be higher in TRD group than MD group.
In the TRD group, the LEE and EE total score, level of LEE subscale emotional response and attitude toward illness and level of EE subscale emotional overinvolvement were significantly higher compare to MD group.. To clarify the relationship between EE and treatment resistance, further research in larger groups is needed.

METHODS:
The outpatient clinic files of the juvenile delinquents patients aged between 12 and 17 years who were referred to the Department of Child and Adolescent Psychiatry of Suleyman Demirel University School of Medicine between January 2014 and December 2018 for psychiatric examination were examined retrospectively. RESULTS: A total of 189 children and adolescents in Isparta province between January 2014 and December 2018 were evaluated as forensic cases. The age range of the patients was 12-17 years and the mean age was 14.4 ± 1. 163 (86.2%) of the cases were male, 26 (13.8%) were female. 72.5% (n = 137) of the patients were diagnosed with psychiatric disorder. Only 16 (8,5%) of the children dragged to crime have regular child and adolescent psychiatry outpatient follow-up. CONCLUSIONS: With the data obtained from this study, it can be ensured that early detection of children at risk and early treatment of the patients with psychiatric disorder, and the establishment of school -family -child and physician cooperation and the reduction of the possibility of crime can be ensured.
[Abstract:0091] [Others] PMS/PMDD effects on attention and short-term memory in adolescent girls etiology of psychiatric problems is complex and the individual, social, environmental and genetic factors are blamed in the etiology. The aim of this study was to determine the predictive sociodemographic factors on psychiatric problems and to examine the relationship between psychiatric symptoms and perceived social support in adolescents. METHODS: This study was conducted with 862 (male: 451, female: 411) middle and high school students. The mean age of the participants was 14.6 ± 1.8 (min:12, max:18) years. The sociodemographic data form, multidimensional scale of perceived social support scale and brief symptom inventory were answered by the participants. Socio-demographic data form includes information about age, gender, family structure, income level of the family and the academic achievement of student. The multidimensional scale of perceived social support scale consists of 12 items in total and has 3 subscales (family support, friend suppor, special person support). Brief symptom inventory is consist of 53 items and 5 subscales (anxiety, depression, negative self concept, somatization, hostility). The relationship between sociodemographic characteristics and psychiatric symptoms was evaluated by multiple linear regression analysis. The relationship between social support and psychiatric symptoms was examined by correlation analysis. RESULTS: Increased age is a predictor of anxiety, depression, negative self concept, somatization and hostility. Female gender is a predictor of depression and hostility. Singleparent family is a predictor of anxiety, depression and negative self concept. Low academic achievement is a predictor of anxiety, depression and hostility. The anxiety, depression, negative self-concept and somatization scores were significantly higher in adolescents with low family and friend support. The hostility scores were significantly higher in adolescents with low family support. Additionally, anxiety, somatization and hostility scores of the adolescents with high special person support were significantly higher. CONCLUSIONS: In the current study anxiety, depression, negative self-concept, somatization and hostility were evaluated in adolescents. Age, gender, family structure and academic achievement were predictors of various psychiatric problems. In addition, the importance of social support in psychiatric problems was demonstrated. Research on social support shows that it plays a protective role in stressful life events and has positive effects on psychological well-being and disease severity. Furthermore, lower social support has been associated with poor treatment outcomes and has predicted higher health care utilization in mental disorders. In the light of these data, determining sociodemographic risk factors and knowing the importance of social support on psychiatric problems can make significant contributions to preventive mental health. The duration of pain tended to be inversely related to the presence of borderline and obsessive-compulsive PDs(p=0.05,p=0.049,respectively). CONCLUSIONS: Migraine seemed to be associated with a higher prevalence of PDs. In the literature, there are limited number of studies about the relationship between migraine and PDs. Kayhan and Ilık found that PDs are diagnosed in 81% of chronic migraine patients. Obsessive-compulsive PD ranks first place among PDs. In this present study,the most frequent PDs were paranoid and obsessive-compulsive PDs. Most of the studies in this era focused on the borderline PD due to treatment non-compliance, increased hospital KEYWORDS Migraine; Personality Disorders; Headache outpatient admissions,high risk of medication and substance overuse and poor treatment prognosis. Patients having borderline and obsessive-compulsive PDs revealed shorter pain duration than the other patients. In this present study, together with chronic migrainours, episodic migraine patients were included. Pain sensation in bordeline PD is different foracute and chronic pain. Shorter pain duration may be related with the form of the migraine as being episodic or chronic for borderline migrainours. The association of comorbid OCPD with shorter pain duration might be related with their perfectionist and overcontrolling features. For those migraine patients who have comorbidpersonality disorder, a comprehensive management strategy that addresses the underlying personality disorders may improve the treatment outcomes. The comparison of efficacy and tolerability of modified release methylphenidate, osmotic release methylphenidate, and atomoxetine in children with attention-deficit/ hyperactivity disorder

Serkan Gunes
Department of Child and Adolescent Psychiatry, Hatay State Hospital, Hatay, Turkey ABSTRACT OBJECTIVE: Attention-deficit/ hyperactivity disorder (ADHD) is a common psychiatric condition that affects the daily functioning of children, adolescents, and adults. ADHD symptoms can cause academic, social, and/or occupational problems. In this study, we aimed to compare the treatment response in terms of ADHD symptoms of modified release methylphenidate, osmotic release methylphenidate, and atomoxetine in drug-naive children with ADHD. We also examined the tolerability profiles of these three medications. METHODS: A total of 204 drug-naive primary school-age children (6-10 years of age) with documented DSM-5 ADHD diagnosis was included to the study. The subjects with the diagnosis of psychiatric disorders other than ADHD according to DSM-5 and those who had a physical illness and who used any other medications were excluded. The subjects were also not allowed to receive behavior therapy for ADHD symptoms. Clinical characteristics of the sample were obtained retrospectively from the medical records and structured psychiatric interviews. Improvement and side effects were assessed with Clinical Global Impression-Improvement Scale (CGI-I) and the adverse effect scale developed by the authors, respectively. ADHD treatments were grouped as following: modified release methylphenidate, osmotic release methylphenidate, and atomoxetine. METHODS: Sample for this study was drawn from a clinical sample of adolescents with post-traumatic stress disorder who were referred to Hatay State Hospital Child and Adolescent Psychiatry Clinic through August 2016 to 2018. A total of 726 drug-naive adolescents (12-16 years of age) with documented DSM-5 post-traumatic stress disorder diagnosis was included. The subjects with the diagnosis of psychiatric disorders other than post-traumatic stress disorder according to DSM-5 and those who had a physical illness and who used any medications other than fluoxetine and sertraline were excluded. Clinical characteristics of the sample were obtained retrospectively from the medical records and structured psychiatric interviews. Improvement and side effects were assessed with Clinical Global Impression-Improvement Scale (CGI-I) and the adverse effect scale developed by the authors, respectively. RESULTS: Mean age of the patients was 13.58 ± 1.34. 43.8% (N=318) of adolescents were male and 56.2% (N=408) were female. 46.7% (N=339) of the patients were using fluoxetine and 53.3% (N=387) were using sertraline. At the 6th month of treatment, the CGI-I was not significantly different between the groups. There was also no significance in terms of treatment compliance. Appetite and aggression-irritability were meaningfully different between the groups. CONCLUSIONS: Fluoxetine and sertraline appear to show similar effectiveness in the treatment of post-traumatic stress symptoms in Syrian adolescents. Fluoxetine may be associated with anorexia and aggression-irritability. OBJECTIVE: Social anxiety disorder (SAD), is a persistent fear and anxiety about being in one or more social or performance situations. To date, most data on characteristics of demographical and clinical features and comorbidity pattern of SAD has been obtained from epidemiological studies. Clinical studies investigating those issues are needed. The aim of this study is to determine the sociodemographical and clinical features and assess psychiatric comorbidity in patients with social anxiety disorder (SAD). METHODS: 500 patients with a primary diagnosis of SAD were included. All patients were assessed by using the clinical version of Structured Clinical Interview for DSM-IV (SCID-I/CV) and a clinical and sociodemographical questionnaire. RESULTS: We found a male and single patients preponderance in our sample. Lifetime comorbidity rate was approximately 90% and the most common comorbid conditions were mood disorders. The lifetime prevalence of major depressive disorder and bipolar disorder were 77% and 12.4 %, respectively. CONCLUSIONS: In more than two-thirds of the patients who have a comorbid mood disorder, SAD was the disorder that occurred first. We also found a high prevalence of atypical features in the current depressive episodes. SAD is highly comorbid with mood disorders which usually appears earlier than the comorbid mood disorder, and it is associated with atypical depression. Comparison of executive functions in adolescents with synthetic cannabinoid and semi-synthetic opiate use disorder METHODS: Thirty adolescent patients who using synthetic cannabinoid and thirty-two adolescent patients who using semi-synthetic opioid patients were included in the study. After the sociodemographic data form was completed, psychiatric comorbidities of the patients were evaluated by using the The Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (KSADS-PL). Then, Stroop Color Vocabulary Test and Wisconsin Card Sorting Test (WCST) were used to evaluate the executive functions of the cases. RESULTS: In this present study, no statistically significant difference was found between the sociodemographic characteristics, age of starting, duration, frequency of substance use, abstinence time of the patients (p>0ç05). No statistically significant difference was found between the study groups in terms of comorbid psychopathologies. In the Stroop Test, selective attention functions of the semi-synthetic opiate group were found to be worse than the synthetic cannabinoid group (p <0.05). In the WCST test, the synthetic cannabinoid group was shown to exhibit more perseverative behavior, but was not statistically significant (0.05 <p <0.10). The other Stroop and WCST performances were not significantly difference between the two groups (p> 0.05). We found that selective attention function is impaired with increased using amount of synthetic cannabinoids; selective attention, cognitive flexibility and response inhibition is impaired with increased using amount of semi-synthetic opiate. Moreover, it was determined that as the abstinence period decreased, the selective attention function worsened and the reading speed slowed down in semi-synthetic opiyate users. CONCLUSIONS: The sociodemographic characteristics, comorbid psychopathologies, substance use characteristics and executive functions other than selective attention of adolescents with synthetic cannabinoids and semi-synthetic opiates using are similar in this present study. In both groups, a positive relationship was found between the throughout life amount of substance used and impaired executive functions. İt was determined that as the abstinence period decreased, the selective attention function worsened and the reading speed slowed down in semi-synthetic opiyate users. There is a need for further studies on the effects of synthetic cannabinoids and semi-synthetic opiates on executive functions with limited number of studies in the literature. The aim of this study was to examine the relationship between emotional regulation difficulties and psychiatric problems in adolescents. METHODS: One thousands two adolescents (N=1002) between 12 and 18 years of age from secondary and high schools affiliated to the provincial ministry education in Malatya were included in the study. The participants completed the sociodemographic data form, the emotion regulation difficulties scale and the brief symptom inventory under the supervision of the teacher. Correlation analysis was conducted between emotion regulation difficulties subscales and brief symptom inventory subscales. RESULTS: The mean age of all adolescents was 14.7±1.8 years. Of the adolescents, 53.3% were male, 46.7% were female. Of these, 38.3% were in secondary school and 61.7% were in high school. All subscale scores of emotion regulation difficulties (except for awareness, nonacceptance, goals, impulse, strategies, clarity) were strongly associated with all psychiatric problems (Brief symptom inventory subscales: somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism). CONCLUSIONS: Similar to previous studies; the difficulties experienced in emotion regulation can cause important psychiatric problems, especially depression and anxiety. The present study contributes to the literature by demonstrating that there are significant associations in adolescents in terms of emotion regulation difficulties and psychiatric problems. Emotional regulation deficits are an important condition in various psychiatric symptoms and is a key target for psychiatric treatment interventions. Sleep characteristics assessed with actigraphy and their associations with neurocognitive functions in patients with bipolar disorder remission (2).Sleep has been reported to be critical in the regulation of mood as well as regulation of learning (3,4).Sleep deprivation has been shown to cause impairment in cognitive functions such as working memory and psychomotor vigilance(5).The purpose of this study is to assess the sleep characteristics in the euthymic period of bipolar disorder with actigraphy, which is an Objective assessment tool, and to examine the association between sleep characteristics and cognitive functions. METHODS: 40 patients diagnosed with Bipolar Disorder according to DSM-5 and whose treatments were still continuing, who agreed to participate in the study and who met the inclusion criteria and 35 age, education level and gender matched healthy controls were included in the study. Objective assessment of sleep and activity was made with actigraphy. Neurocognitive functions were assessed with Trail-making Test, Stroop Test, Wisconsin Card Matching Test and Rey Auditory Verbal Learning Test. RESULTS: In this present study, it was found that in terms of the sleep characteristics assessed with 5-day long actigraphy, patients with bipolar disorder had longer total sleep time and longer time in bed, lower sleep activities and longer sleep latency period when compared with healthy controls. In this present study, no significant difference was found between the patients and the control group in terms of the number of waking up at night and wake time after sleep onset (WASO).In this present study, the patients showed worse performance in trail-making test, stroop test and auditory verbal learning test. In Wiskonsin card matching test, significant results were found only in maintaining the setup sub-parameter. It was concluded that the patients' psychomotor speed, attention, executive functions, verbal learning and memory areas were affected. The association between sleep scales of the cognitive functions which are shown to be disrupted in patients when compared with healthy controls and actigraphy were examined. It was concluded that different cognitive areas were associated with different sleep characteristics. In this present study, it was concluded that total sleep time, WASO time, daytime sleepiness and disorders in sleep times negatively influenced verbal learning memory, psychomotor speed, attention and executive functions. CONCLUSIONS: In this study, it was found that there were significant deteriorations in the sleep and circadian rhythms and cognitive functions of bipolar patients in euthymic period when compared with the healthy controls. This present study showed that deteriorations in the sleep and circadian rhythms were associated with deteriorations in cognitive functions.Future studies should include larger samples and longer actigraphy record times. The results of this present study should be supported with neuroimaging, genetic researches and specific molecules to be examined in BOS and serum to understand the common pathophysiological mechanism of the deterioration in both areas. OBJECTIVE: New psychoactive substances, known as synthetic cannabinoids (SC) in Turkey, are the preferred substance of a significant proportion of patients with SUD who are inpatient.After the use of SC, myocardial infarction, acute renal failure, electrolyte disturbances and liver function tests were found to be high. Patients tend to hide the type of substance they use, the amount and duration of use, making it difficult to obtain sufficient and reliable information.The rate of positive results of urine illicit drug screening for SC is also very low.

Adolescents
All these characteristics revealed the need to determine the discriminatory characteristics of patients with SCI during their clinical follow-up.We aimed to determine the frequency of SUD among inpatients in psychiatric clinic, to draw attention to the increased use of SC and to compare the other substances with SC in terms of clinical findings and clinical features. METHODS: Patients who were diagnosed with SUD according to DSM-5 and hospitalized between July 2017 and December 2017 in 12th Psychiatry Clinic were included in the study.
The patients were divided into three groups according to the substance they used: patients with SC (SCUD), patients with other substance use associated with SC use (SC + other SUD) and those with substance use other than SC (Other SUD).A urine sample and blood sample was taken.Vital signs were recorded. A sociodemographic and clinical data form was used to determine the clinical features of the patients. Any consultation request, physical detection KEYWORDS Cardiac enzyme monitoring; new psychoactive substances; substance use disorder; synthetic cannabinoid and additional treatment applications were recorded..Three groups were compared to vital signs, liver function tests, renal function tests, cardiac enzymes, laboratory values.In addition, the patients were compared in terms of physical restraint application, parenteral additional treatment, consultation request, duration of substance use, number of inpatient treatment, number of parenteral additions, number of physical detections, duration of hospitalization. RESULTS: Patient diagnosed with SUD compose % 27,2 of all patients.Patients with SCUD were 74.4% of patients with SUD. While 49.6% of the patient group had only SC use, 24.8% had another substance use disorder associated with SC. Cannabis (35.7%) and ecstasy (32.1%) were the most common comorbid agents.The rate of patients with 'other SUD' group was 25.6%.Any substance metabolite was found to be positive in 56 patients in results of urine illicit drug screening and the most common metabolite was cannabinoid. Cannabinoid metabolite was detected in 20 of the 22 patients with recently used cannabinoid. But only, results of 13 of 73 SK users had positive results of urine illicit drug screening Cardiac enzymes were found statistically significant high in patients with SCUD. CONCLUSIONS: It is observed that SCs replace the other substances as the starting and preferential substances.The rate of substance metabolite detection in urine sample is very low due to the frequently changing substance contents of SC.Cardiac enzymes are elevated in patients with SCD.It is important to monitor vital and laboratory findings in order to manage the treatment of patients with SUD effectively and to prevent life-threatening medical conditions.Because of its fatal consequences, cardiac enzyme monitoring is important in patients with SCUD.  (MDD) are not yet sufficiently understood. The kynurenine pathway has been proposed to play a key role between peripheral inflammation and alterations in the central nervous system. This is due to reduced usability of tryptophan and production of oxygen radicals and highly potent neurotoxic agents in this pathway. In this study, we aimed to compare the metabolites of the serum kynurenine pathway (tryptophan, kynurenine, quinolinic acid and kynurenic acid) and interferon (IFN)-γ, interleukin (IL)-6, IL-1β and high-sensitivity C-reactive protein (hsCRP) levels in patients with MDD and in healthy controls and to evaluate the relationship between cytokine levels and the functioning of the kynurenine pathway. METHODS: In total, 48 adolescent patients (age, 13-18 years) with MDD (no drug use) and 31 healthy controls were included in the study. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), Child Depression Rating Scale-Revised (CDRS-R) were applied, and a sociodemographic data form was completed. All patients were asked to fill out the DSM-5 Level 2 Irritability Scale-Child Form and the DSM-5 Level 2 Depression Scale-Child Form. Serum tryptophan, kynurenine, kynurenic acid, quinolinic acid, IFN-γ, IL-6 and IL-1β levels were measured by the enzymelinked immunosorbent assay. The hsCRP level was measured by the immunoturbidimetric method. RESULTS: Tryptophan levels were observed to be significantly lower in patients with MDD than in healthy controls (p=0.046); the kynurenine/tryptophan ratio was significantly higher in patients with MDD than in healthy controls (p=0.032); the levels of quinolinic acid were significantly higher in patients with MDD than in healthy controls (p=0.003); the kynurenic acid/quinolinic acid ratio was significantly lower in patients with MDD than in healthy controls (p=0.040). No significant difference was found between the groups in terms of kynurenine (p=0.564), kynurenic acid (p=0.182), IFN-γ (p=0.897), IL-6 (p=0.086), IL-1β (p=0.134) and hsCRP (p=0.473). There was a significant negative correlation between the IFNγ and kynurenine/tryptophan ratio (r= −0.279, p=0.016). CONCLUSIONS: As a result of this present study, it was determined that the activity of the IDO enzyme (kynurenine/tryptophan ratio) increased in patients with MDD, and there was an imbalance between neurotoxic and neuroprotective products in the kynurenine pathway. These findings suggest that tryptophan is catabolised via the kynurenine pathway instead of the serotonin pathway in MDD cases, and neurotoxic molecules in this pathway increase and contribute to the aetiology of MDD. Further studies are needed for adolescents to clarify this relationship.  The prevalence of PDs among those who die by suicide is high, ranging from 30-40%. Despite current finding that BD and PD independence enhance suicide risk, few studies that examined the effect of this comorbidity on suicide attempt have considered the influence the symptomatological state may have on the diagnostic evaluation of comorbid PD among patients with BD. The Objective of this research was to examine the effect of PDs on SAs in patients with BD type I who were evaluated in euthymic state. METHODS: One-hundred seventy-two patients with BD type I, with and without a history of SA, were evaluated during euthymic state. The assessment included a clinical and sociodemographic questionnaire, the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Barratt Impulsiveness Scale, and Structured Clinical Interviews for DSM-IV Axis I and II Disorders. Logistic regression was performed to analyze associations between history of SA and patient characteristics. The study was approved by the Ethics Committee of Çukurova University. RESULTS: History of SA was considerably associated with comorbid axis I disorder, rapid cycling, high impulsivity (attentional, motor, non-planning, and total), having any PD, and cluster B and C PDs. Female preponderance was found in the total sample (3.52:1). Most of the patients were in the 31-50 years group. Manic episodes were found more frequent, but the difference was not considerable (p=0.239). Patients having more than 11 episodes were more frequent but were not considered when compared between with and without SA groups (p=0.069). Comorbid Axis I disorders was found significantly high in patients with SA (p=001). After performing multivariate analysis, only cluster B PDs (p=0.014), high attentional impulsivity (p=0.003), and lack of paid occupation (p=0.014) remained considerable. CONCLUSIONS: Cluster B PDs were considerably associated with SA in patients with BD type I. High attentional impulsivity and lack of gainful employment were also correlated with SA, which proposes that some cluster B clinical and social characteristics may aggravate suicidal behavior in this population. This finding offers alternatives for new therapeutic interventions.  RESULTS: Mean age of study and control groups were 9,22 ± 3,62 and 9,21 ± 3,57 years, respectively. 87% of the study and 85% of the control group were male. There was no significant difference in terms of age and gender between the two groups. MACROD2 gene expression was found to be decreased in the study group compared to control group (study group=2,8, control group=2,0; fold change=-0,46). Though, this finding was not significant statistically (p=0,127). CONCLUSIONS: Despite it was not statistically significant, MACROD2 expression level was found to be decreased in subjects with ASD when compared to the control group. Given the fact that MACROD2 gene expression profile and ASD relationship is not fully understood, this study may provide a basis for future studies in this area.

OBJECTIVE:
To evaluate the role of oxidative stress and antioxidant defense mechanism on the etiopathogenesis of autism with a novel oxidative stress marker, dynamic thiol/disulfide homeostasis (DTDH), and the relation of these plasma biomarkers to the severity of autistic symptoms and problem behaviors, which is studied on autism firstly. METHODS: A total of 60 children with ASD (54 boys) aged 3-10 years and 54 healthy children (51 boys) matched for age and gender were included. ASD and comorbid psychiatric diagnoses was controlled for all participants with an clinical interview according to DSM-5 and K-SADS-PL by a child and adolescent psychiatrist. A sociodemographic data form, Childhood Autism Rating Scale and Abnormal Behavior Checklist were administered to all participants with a difference of Autism Behavior Checklist only administered to ASD group. And also plasma levels of dynamic thiol/disulfide homeostasis parameters were measured for all participants. RESULTS: Distortion of dynamic thiol/disulfide homeostasis to the oxidative stress side for autism group compared to controls was determined. Native thiol (p<0.001) and total thiol (p=0.014) plasma levels of ASD group members were significantly lower than those of the controls, whereas disulfide (p<0.001) and thiol oxidation-reduction ratio (p<0.001) were significantly higher in autism group. However any statistically significant correlation between plasma biomarkers and symptom severities of autism and problem behaviors was not detected. According the results of ROC Analysis, the cutoff points was detected as 420.2 μmol/L for native thiol, 473.25 μmol/L for total thiol, 22.6 μmol/L for disulfide and 5.03 for thiol oxidation-reduction ratio, which might be used for predicted ASD. The sensitivity and specifity of these cutoff values were found as %41.7 and %91.1 for native thiol, %48.3 and % 78.6 for total thiol, %56.7 and %78.6 for disulfide, and %58.3 and %83.9 for thiol oxidationreduction ratio.   An independent association of thiol/disulfide homeostasis parameters with the age of father at birth, native thiol and disulfide in first model, and also with the age of father at birth, total thiol and thiol oxidation-reduction ratio in second model was detected in multivariate logistic regression analysis. The predictive values for the first and the second model were both moderate, however, with an R² of 46,6% and 47,4% respectively CONCLUSIONS: This study, for the first time in literature, demonstrates the influence of disturbed DTDH in children with ASD by measuring dynamic reduction/oxidation shifts. The most remarkable finding was the shift on oxidant-antioxidant equilibrium to the side of oxidative stress and the absence of expected compensatory increase in antioxidant response in ASD. This study supported and presented an different aspect of view to the literature about the oxidative hypothesis of ASD, in which claimed that the deficiencies in antioxidant defense mechanism during critical periods of early brain development, with the additive effects of any environmental factor disturbing the oxidant-antioxidant equilibrium and the intrinsic sensitivity of early brain tissues to oxidative demage, could have an essential role on heterogeneity of ASD phenotype.
[Abstract:0145] [ADHD] Psychosocial and clinical characteristics associated with attention-deficit/ hyperactivity disorder symptoms in males seeking treatment for opioid dependence

Medine Gıynaş Ayhan
Department of Psychiatry, Konya Training and Research Hospital, University of Health Sciences, Konya, Turkey ABSTRACT OBJECTIVE: Attention/Deficit and Hyperactivity Disorder (ADHD) are important for the treatment optimization symptoms in patients with opioid dependence. The aim of this study was to evaluate the ADHD symptoms in a sample of opioid dependent males and to examine the relationship of ADHD symptoms with socio-demographic and clinical characteristics. METHODS: Sixty male opioid dependent outpatients who have been receiving buprenorphine/ naloxone for at least one year were included in the study. Subjects were interviewed by using structured Clinical Interview for DSM-IV (SCID). ADHD symptoms were measured by the Adult ADHD Self Report Scale (ASRS). Participants were divided into ADHD-screened positive (ADHD-P) and ADHD-screened negative (ADHD-N) groups according to cut off scores of ASRS. Depressive symptoms were measured by the Beck Depression Inventory (BDI). RESULTS: The mean age of the sample was 26.47±4.81. Mean score of ASRS was 27.50±17.11 and a total of 30% of the opioid dependent outpatients screened positively for ADHD on the ASRS. ADHD-P group reported earlier onset of substance use and smoking, higher BDI score, and a greater likelihood of parenteral use of opioid (p=0.000; p=0.012; p=0.033; p=0.000 respectively). The ADHD-P group had more number of relapse in the last one year (p=0.014). There were no significant differences in terms of dosage of buprenorphine/naloxone and lifetime legal problems between ADHD-P and ADHD-N groups (p=0.188; p=0.424 respectively). In correlation analysis; there were statistically significant correlation between ASRS total score and parenteral use of opioid (p=0.000, r=0.646). CONCLUSIONS: As a result, ADHD symptoms were common in this sample of opioid dependent males. ADHD symptoms may contribute to increase risk of parenteral using, depressive symptoms and relapse. Recognizing comorbidity of ADHD may be important for clinicians when considering treatment of opioid dependence. Insula volume in patient with obsessive-compulsive disorder and relationshıp with the clinical variabilties characterized by intrusive unwanted thoughts, ideas, or images that are distressing and urge the sufferer to perform ritualistic behaviors or mental acts to reduce this distress. Neuroimaging investigations are very useful to reveal a neurobiological model of the OCD. Studies conducted in the last quarter century have shown clear results and revealed that specific corticosubcortical circuits could be involved in the occurrence of OCD symptomatology. These neuroimaging studies pointed out some important findings for OCD patients. For example; OCD structural neuroimaging studies have reported changes in frontal region and basal ganglia, from increases to decreases to no difference. In these studies, some areas have been described as key brain regions, including the orbitofrontal cortex (OFC), thalamus, anterior cingulate cortex and caudate nucleus. In this study; it has been aimed to examine the morphometric alterations of insula in OCD patients for understanding the pathophysiology. METHODS: The study comprised 20 OCD patients who had applied to Fırat University Hospital Department of Psychiatry as out-or in-patients and had been diagnosed with OCD according to the criteria of DSM-IV and 13 healthy controls. The patients were administered the sociodemographical data form, Hamilton Rating Scale for Depression(HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A), Yale-Brown Obsessive Compulsive Scale(Y-BOCS) and SCID. The volumetric measurement of insula was performed on patients and control group by using MRI. RESULTS: For the left and right insula volumes there were no differences between the patients and healthy controls. CONCLUSIONS: This can be considered insula has a relationship with both pathophysiology and clinical course of the disease. This present study suggested that the investigations which use together the imaging technique that examine the functional qualifications of this area and the tests research the cognitive functions, make us to provide to reach more important and effective results. Evaluation of the relationship between cardiovascular disease risk and lithium treatment response in bipolar disorder

Kürşat Altınbaş and Fatih Ekici
Mazhar Osman Mood Clinic, Department of Psychiatry, Selçuk University, Konya, Turkey ABSTRACT OBJECTIVE: Cardiovascular diseases are the leading causes of the morbidity and mortality among patients with bipolar disorders. Lithium with its anti-suicidal and anti-inflammatory properties is the cornerstone treatment option in bipolar disorders. With this background, we aimed to evaluate the relation between cardiovascular disease risk(Qrisk) and lithium treatment response level among subjects with bipolar disorders. METHODS: Data of the 35 patients who were followed in our mood clinic recruited for the study. Qrisk2 algorithm was used to calculate ten years of cardiovascular disease risk of the patients via www.qrisk.org web page and lithium treatment response scores were also calculated according to the Alda Lithium Treatment Response Questionnaire. Comparisons of Qrisk2 scores between good-bad lithium responders and the correlation analysis between Qrisk2 scores and lithium treatment response levels were done. RESULTS: Nearly half of the patients were female(45.7%,n=16) and mean age of the patients was 38.3±11.4 years. Mean duration of illness was 12.8±8.7 years while mean age of the first onset was 25.5±11.1 years. We found that median value of Qrisk2 score was 2.2%(min:0.2, max:29.1). Mean lithium treatment response scale score was 6.7±1.6. When we compared the Qrisk2 scores between good-bad lithium responders, we could not find any difference between groups(p=0.77). There was also no correlation between total lithium response scores and Qrisk2 scores(p=0.73). CONCLUSIONS: We expected to find lower scores of Qrisk2 in good lithium responders than bad responders considering the anti-inflammatory effects of lithium. However, we could not find any difference. Our cross sectional design makes it difficult to make further comments.

OBJECTIVE:
It has been shown that most of the patients with major depressive disorder (MDD) have an anxiety disorders as comorbidity. Social Anxiety Disorder (SAD) is the most common among anxiety disorders. In SAD patients, MDD is also one of the most common psychiatric disorders as an axis-I comorbidity [1]. The comorbidity of SAD and MDD is more common in patients with depression or anxiety than in the normal population [2]. In this present study, we aimed to compare the patients with the comorbidity of two diseases according to their primary diagnosis. METHODS: 74 patients (MDD-SAD group) with MDD and SAD comorbidity whose primary diagnoses were MDD and 130 patients (SAD-MDD group) with SAD and MAD comorbidity whose primary diagnoses were SAD according to DSM-IV were enrolled in the Kartal Training and Research Hospital Psychiatry outpatient clinic. Only patients with active MDD and SAD according to SCID-I were included in the study. The sociodemographic and clinical characteristics, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Global Assessment Scale (CTI), Childhood Trauma Scale (CTQ-28), Liebowitz Social Anxiety Scale (LSAI) scores were compared in two groups by the Student-t test and categorical variables of groups were analyzed by Chi-square analysis. RESULTS: In this present study, a statistically significant differences were found between MDD-SAD group and SAD-MDD group in terms of whether the episodes of depression were atypical, the diagnosis was accompanied by somatoform disorder and there was an asymptomatic period between the episodes of the disease. The atypical episodes of depression, accompanied by somatoform disorder, an asymptomatic period between the episodes of the disease were more common in the MDB-SAB group than in the SAD-MDD group (p <0.05). In the MDD-SAD group, the mean age of diagnosing SAD was statistically younger than the SAD-MDD group (p = 0.01). Finally, the mean Tas-A (p = 0.02), physical neglect (p = 0.02), emotional neglect (p = 0.049) subscale scores of CTQ-28 and the mean BDI (p = 0.01) score of MDD-SAD group were significantly higher than the scores of SAD-MDD group. CONCLUSIONS: Major depressive disorder and social anxiety disorder are often concurrent, which negatively affect quality of life, functioning and symptom severity [3]. To the best of our knowledge, this is the first study to compare differences of comorbid social anxiety disorder and major depression disorder according to primary disorder. In this present study also it can be seen that clinical features and prognosis of comorbidity may changed according to primary disease. If the primary diagnosis is depression, the severity of the childhood traumas and the clinical course of the disease may be much worse. Turkey mainly comprised of face-to-face surveys in young population without using structured diagnostic tools. Limited numbers of studies in Turkey revealed that prevalence of SUD in youth did not reach the levels as did developed countries but warned possible increase which should not be underestimated [1,2]. This research aimed to widen the clinical knowledge on comorbidity of AUD/SUD among psychiatric patient population in Turkey. METHODS: 734 patients were included to the study. Patients between 16 and 65 years of age who referred to outpatient psychiatry clinic, were enrolled in the study, independently from their primary psychiatric complaints. Michigan Assessment-Screening Test for Alcohol and Drugs (MATT-AM) was applied to all participants. At the second step, a substance screening list was given and the addiction module of The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was applied to the patients with a MATT-AM score of five and higher. Later, remainder of SCID-I and SCID-II were both administered on those who were identified with alcohol or substance use problems at the second step. RESULTS: 734 patients were included to the study. Out of these patients, 529 (72.1%) were females and 205 (27.9%) were males. Average age was 32.0 ± 9.5 years. 48 patients (6.5%) had MATT-AM scores of five and higher. 15 of them did not resume advanced interview.

KEYWORDS
Alcohol use disorder; clinical features; comorbidity; prevalence; substance use disorder The alcohol and drug abuse module of SCID-I was applied to 33 patients. Remainder part of SCID-I, as well as complete SCID-II, were applied on 33 patients (4.5%) who were diagnosed in the alcohol and drug abuse model. 26 of the 33 were alcohol use disorder while nine were cannabis, nine were benzodiazepine and three were polysubstance use disorder. Seven of the 33 patients were borderline personality disorder, five were major depressive disorder. SCID-I and -II both demonstrated any type of axis I or II disorders in the patients with confirmed AUD/SUD diagnosis. In 11 patients, SCID-II pointed out AUD and/or SUD as a single axis I disorder. CONCLUSIONS: In this present study, the prevalence of AUD/SUD among the patients who admitted to the general psychiatry settings and have not previously been treated in our clinic due to alcohol or substance problems has been found to be 4.5%. AUD/SUD are found to be not very prevalent among the patients referring to general psychiatry outpatient clinic. This result is fairly lower than the problematic alcohol use among psychiatry inpatients [3]. Depending on the results of this present study. It is useful to strictly inquire the alcohol and substance abuse particularly in patients with mood disorders (especially Major depressive disorder and Bipolar I disorder), anxiety disorders (especially Generalized anxiety disorder and Panic disorder) or personality disorders (especially Borderline personality disorder). Turkish adaptation of MATT-AM has been found to have a high specificity. Extensive studies based on broad participation are required to determine accurate prevalances of alcohol and/ or substance use disorder among psychiatry patients.
Investigation of the relationship between total oxidant and antioxidant levels, symptom severity, C-reactive protein and metabolic syndrome in patients with schizophrenia Gülşah Güçlü Çelme, Özden Arısoy and Mehmet Hamid Boztaş Department of Psychiatry, Abant Izzet Baysal University, School of Medicine, Bolu, Turkey ABSTRACT OBJECTIVE: In this study we aimed to examine; a) whether the schizophrenia group and the healthy control group differed in terms of metabolic syndrome parameters, oxidative stress parameters and C-reactive protein (CRP), b) whether there was any difference in terms of oxidative parameters and CRP in schizophrenia patients with and without metabolic syndrome, c) whether there was a relationship between disease severity and oxidative parameters and CRP in schizophrenic patients. METHODS: 26 drug-free schizophrenia patients (all on acute psychotic episode) and 26 healthy controls matched in terms of age, gender and educational status were compared in regard to metabolic syndrome, oxidative stress parameters and CRP. Positive and Negative Symptom Scale (PANSS) was used for disease severity assesment; while Global Assessment of Functionality Scale (GAF) was used to evaluate functioning and Calgary Schizophrenia Depression Scale (CDSS) was used to exclude depression in schizophrenia patients. RESULTS: There was a significant increase in TOS (total oxidant status) and OSI (oxidative stress index)in schizophrenia patientscompared to healthy controls; while there was no difference in terms of TAS (total antioxidant status). There was no significant difference between the two groups in terms of CRP levels as well. There was no significant difference in terms of metabolic syndrome prevalence between the two groups, although it was slightly higher in the schizophrenia group. Comparison of the schizophrenia patients with and without metabolic syndrome revealed no significant difference in regard to PANSS, CDSS, TOS, TAS, OSI, CRP, and other clinical variables. TOS correlated positively with duration of hospitalization and number of hospitalizations. A negative correlation was found between OSI and IGD. TOS level was predicted by being a schizophrenia patient and by not having metabolic syndorme. A significant difference was found in terms of TAS, when the schizophrenia and the healthy control groups were divided into four groups according to presence of metabolic syndrome (TAS level was the highest in the healthy control group with metabolic syndrome, followed by the schizophrenia group with metabolic syndrome, then by the schizophrenia group without metabolic syndrome, and then by the healthy control group without metabolic syndrome). TAS level positively correlated with the presence of MS in the whole sample. CONCLUSIONS: According to the results of this study, detailed investigation of oxidative stress in the etiopathogenesis of schizophrenia may contribute to prevention of neurodegeneration due to oxidative stress caused by metabolic syndrome, leading to a possible increase of lifespan in schizophrenia. Etiology and prevelance of tocophobia in an obstetric outpatient clinic, and its relationship between adult attachment styles And state-trait anxiety Yusuf Ezel Yıldırım a , Alevhan İnan a , Pınar Çetinay Aydın a , İbrahim Karaca b and Murat Ekin b a Department of Psychiatry, Bakırkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey; b Department of Obstetrics and Gynecology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey ABSTRACT OBJECTIVE: Tocophobia (Childbirth-related fear) has been described as a negative cognitive assessment of the anticipated childbirth, feelings of fear and anxiety when facing birth, very negative feelings towards birth, and the pathological dread and avoidance of childbirth [1]. A recent meta-analysis study revealed that the prevelance of tocophobia is estimated at 14% and it appears to have increased in recent years [2]. In this present study, we aimed to determine the prevelance of tocophobia and its relationship with the level of anxiety and adult attachment styles that may be associated with tocophobia. METHODS: In this present study, we included 266 pregnant women who were applied to the Bakırkoy Dr. Sadi Konuk Training and Research Hospital Clinic of Gynecology and Obstetrics. Wijma Delivery Expectancy/Experience Questionnaire Version A (W-DEQ A), Spielberger State-Trait Anxiety Inventory (STAI), Adult Attachment Scale and one other questionnaire that include sociodemographic and obstetric background were filled in for all patients. We assessed tocophobia with W-DEQ A and we used ≥85 as a cut-off for tocophobia. RESULTS: The mean age of women in this present study was 29.5 (±5.3) years. 40.2% (N=107) of the participants were nulliparous, 59.8 % (N=159) had at least one pregnancy history. In this present study, the frequency of tocophobia was found to be 7.5%. 21.1% (N=56) of the participants had a miscarriage history, and tocophobia in this group was 14.3%. The prevelance of tocophobia among 34 women (12.8%) with a history of curettage was 14.7%. The prevelance of tocophobia in women with a history of psychiatric treatment was found to be 15.4%. According the attachment syles, we found that 59% have a secure attachment, 23.7% have an avoidant attachment and 17.3 % have anxious-ambivalent attachment. We found that tocophobia group had statistically significantly higher scores than the other participants in state anxiety, trait anxiety and total anxiety (p<0.05). The prevalence of tocophobia was found to be 11.4% in pregnant women over 30 years of age (N=105). When the participants were compared according to their gestational weeks, the prevelance of tocophobia was 15.8% in the third trimester and the anxiety scores were higher in this group. CONCLUSIONS: The severity of child-birth related fear was significantly associated with a previous miscarriage, history of curettage, history of psychiatric treatment and high anxiety levels. In this study, no relation was found between the prevelance of tocophobia and the attachment styles and number of pregnancies. Fear of child-birth was found to be higher in women over 30 years of age and in the more advanced gestational week but it was not found statistically significant. Although the prevelance of tocophobia in this present study (7.5%) is low compared to a previous world wide meta-analysis (14%), however it seems to be compatible with the prevelance of 8% in Europe [2]. Both the prevelance of tocophobia and its importance seem to be a field that needs to be given more interest by mental health professionals as an increasing issue in recent years. investigating the effects of metacognitions and thought control strategies on social functioning in the literature. It is thought that the researches on metacognitions and thought control strategies affecting the deteriorations in social functioning will be beneficial for better understanding of the disease and development of appropriate treatments. The aim of this study is to examine whether metacognitions and thought control strategies have an impact on social functioning in OCD patients.

METHODS:
The study sample consisted of 62 patient volunteers diagnosed with OCD according to the DSM-V diagnostic criteria and age-and sex-matched 58 healthy controls. Participants filled in socio-demographic data form, Metacognition Questionnaire-30 (MCQ-30), Thought Control Questionnaire (TCQ), Social Functioning Scale (SFS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). The OCD symptoms severity of the patients were determined by the Yale-Brown Obsessive Compulsive Scale (YBOCS). After combining data, a multivariate model was created, and model tested with path analysis. RESULTS: Of the 120 participants included in the study, 52 were male and 68 were female. The mean age of the patient group was 32.7±9.5. Results revealed that metacognitions are associated with OCD symptoms severity and social functionality, especially metacognitions related to uncontrollability and danger, need to control thoughts and cognitive confidence effect anxiety symptoms, depressive symptoms, obsessions and compulsions; social functionality is affected by all of them but mainly over depression. CONCLUSIONS: In the present study, the relationship between metacognitive beliefs, metacognitive thought control methods, OCD severity and social functioning were examined. Metacognitions are related to disease severity and social functioning in obsessive compulsive disorder. It can be said that the main factor causing deterioration of social functions in OCD is based on the interactions of these three symptomatology ('uncontrollability and danger', 'need to control thoughts', and 'cognitive self-consciousness ) but mainly through the symptoms of depression. As far as, the results of this study are presented as an important contribution to the literature. As a result; these results were the first in the literature to guide the determination of metacognitive therapy goals for the improvement of social functioning in the treatment of OCD. In addition, it has been shown that treatment of depressive symptoms in OCD patients may be helpful in improving social functioning. More studies in the future should examine the results.

OBJECTIVE:
Delirium is a clinical syndrome that appears due to the temporary disruption of cerebral homeostasis accompanied by changes in consciousness, perceptions, thoughts, sleep-awake cycle [1]. Delirium is one of the most important emergency cases in geriatric patient population with high morbidity and mortality rates [2]. In clinical practice, three delirium types are defined as Hyperactive, Hypoactive and Mixed according to the psychomotor activity and the level of wakefulness [3]. In the present study, the purpose was to examine the treatment response of the subtypes of delirium and its relation with possible biochemical parameters. METHODS: Thirty patients, who were diagnosed with delirium and who were hospitalized for treatment, according to DSM-IV Structured Clinical Interview, were included in the present study. Following the classification of the patients according to the subtypes of delirium, they were evaluated before the treatment and on the 7th day of the treatment. In both interviews, the Delirium Rating Scale (DRS), Richmond Agitation and Sedation Scale (RASS), and Memorial Delirium Rating Scale (MDRS) were applied to the patients. In addition, the biochemical parameters that were required for the patients in relevant clinics were recorded. RESULTS: Delirium patients consisted of a total of 30 patients, 12 women and 18 men. The patients of all three subtypes of delirium responded to the treatment scores at significant levels in terms of scale scores. However, when the Hyperactive, Hypoactive and Mixed subtypes were evaluated in terms of the difference of change on the 1st and 7th days of the treatment separately, it was determined that the difference of change values were significantly higher in the hyperactive type in terms of RASS, DRS and MDRS (p=0.004; p=0.002; p=0.001, respectively). CONCLUSIONS: As a result, the findings of the present study showed that patients who are diagnosed with delirium might show different treatment responses according to motor subtypes. These differences are the treatment duration and the side effects that may appear during treatment. The comorbidities of the study group who were diagnosis with delirium being high due to their ages, and the limited number of the patients were the limitations of this present study. Further studies are required to be conducted with bigger sampling groups. RESULTS: When the statistical results are examined, In the conducted clinical interviews 83.9% (n = 52) of all cases were thought to have a psychiatric disorder diagnosis and it is seen that 47 of these cases were diagnosed with sensitivity of 90.38% in the structured DAWBA Adult Form interviews. 8 out of 10 cases, which were believed not to have any clinical disorder after clinical interviews, were detected with selectivity of 80% ratio with DAWBA. Cohen's Kappa coefficient which compares the consistency of DAWBA Adult Form and clinical interviews In terms of identifying persons diagnosed with any disorder, is calculated 0.63 (κ=0.63). After evaluating all the interviewed cases, it is found that Dawba, regarding it's validity, has the following values: positive predictive rate is %95.92, negative predictive rate is % 61.54, positive likelihood ratio is 4.52, negative likelihood ratio is 0.12 and Accuracy rate is %88.71. CONCLUSIONS: In conclusion, it has been shown that the diagnoses made with the Turkish version of the DAWBA adult form were consistent at a good level with the clinical diagnoses made by the clinicians. As a result of this present study, Turkish language has been gained an additional instrument which can be of use to clinicians in the progress of diagnosing cases, which can be used as a scanning tool and with a possibility of standing out comparing with other clinical interview scales because it will be possible in the near future to apply it through the internet, along with it's printed version. [Abstract:0182][Others] The prevalence of metabolic syndrome and its predictors among male patients in a psychiatry unit

Yusuf Ezel Yıldırım and Pınar Çetinay Aydın
Department of Psychiatry, Bakırkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey ABSTRACT OBJECTIVE: Metabolic Syndrome (MetS) is defined by a combination of abdominal obesity, high blood pressure, low high-density lipoprotein cholesterol (HDL-C), elevated triglycerides, and hyperglycemia. MetS indicates a preclinical state for the development of cardiovascular disease and diabetes. Patients with severe mental illnesses, particularly schizophrenia and chronic mood disorders, demonstrate a higher prevalence of MetS or its components compared with the general population [1]. In this study, we aimed to determine the prevalance and common causes of MetS in all patients who were treated in inpatient psychiatry clinic. METHODS: In this present study, 316 patients were included who were admitted in the 12nd Psychiatry Clinic of Bakirkoy Prof. Mazhar Osman Training and Research Hospital between April and October 2018 in a 6-month period. Patients' blood results and waist circumference measurements were evaluated according to IDF and ATP-III criteria for MetS. Past medical records of the patients were evaluated and classified according to DSM-5 based on discharge diagnosis.

RESULTS:
The mean age of the 316 patients included in this present study was found to be 36.4 (±12.4). The prevelance of MetS was 19% for IDF and 15.5% for ATP-III. The prevalance of MetS in schizophrenia and bipolar disorder, which constitute the two largest diagnostic groups, was 24.7% and 28%, respectively. The prevelance of MetS in patients with regular drug use in these two diagnostic groups was found to be 47.2% in bipolar disorder and 45.2% in schizophrenia. 22.8% (N=72) of the patients had substance use and the prevalence of MetS in this group was found to be 8.3%. The prevalence of MetS was found to be 34.3% in 99 patients (31.3%) with regular medication use before admission. The mean duration of disease was 10.3 years (±9.2). MetS was found 13.3% in patients with the duration of the disease less than 10 years, and 25.3% in those with disease duration for more than 10 years. The mean number of previous hospitalizations was 4.8 (±6,9), and the prevelance of MetS was 8.5% for patients with the first time hospitalization (N=82). In patients hospitalized more than 10 times, MetS prevelance was found to be 29.6%. The median age of the patients was 34, and prevalence of MetS was found to be 6.7% under median age and 29.9% over median age. CONCLUSIONS: In this present study, the prevalance of MetS was found to be higher in patients with advanced age, frequent hospitalizations, prolonged disease duration, being on regular medication, and absence of substance use (p < 0.05). According to the results of the study, the prevalance of MetS was found to be lower than the previous similar studies, however, there was a compatible prevelance in schizophrenia and bipolar disorder with regular drug use [2]. This result can be explained by the inclusion of all psychiatric inpatients at the hospital, high prevalence of substance use, poor treatment compliance and low socioeconomical characteristics of our patient group. MetS is seen more common in psychiatric patients, especially in elderly, and it is important to follow-up closely and select the right treatment options for these patients.

KEYWORDS
Metabolic syndrome; psychiatry ward; schizophrenia; bipolar disorder Effects of psychotropic drugs on emotion regulation in bipolar disorder patients: comparison with depressive and healthy controls

Murat Eren Özen
Özel Adana Hastanesi, Psychiatry Clinic, Adana, Turkey ABSTRACT OBJECTIVE: Considering the importance of emotion regulation (ER) in the etiology and / or protection of psychopathology, subjective reports of ER in a group of bipolar individuals were examined and the results were compared with a group of depressive patients and healthy controls. In addition, the effect of psychotropic drug therapy on ER was examined. METHODS: Total of 200 paricipitants were enrolled in the study. Patients were divided into 3 groups; bipolar disorder BD) (n=48), depressive disorder (MDD) (n=76) and healthy control (HC) (n=76). All groups were administered a multidirectional Difficulties in Emotion Regulation Scale (DERS). Impact of antidepressants on ER and whether the amount of psychotropic medication had a differential effect on ER were examined. RESULTS: The BD and MDD groups were significantly higher in the DERS than in the HC groups; this, presumably, suggests that the diagnostic groups have more difficulty in regulating their emotions. In addition, in the comparison of MDD and HC groups, it was observed that the depression group had difficulty in acceptance, goals, impulsivity and access to effective strategies. In contrast, BD participants showed selective difficulties in accessing emotion regulation strategies compared to the HC group. The discovery part of the study did not find the effect of antidepressants on MDD or any effect of psychotropic drug number on MDD. CONCLUSIONS: ERD (emotion regulation dysregulation) differed between healthy controls and patient groups. In addition, the patients with BD had less difficulty compared to the healthy control group, although they showed less ERD than MDD patients. If a multidimensional ERD measurement is used, it is possible to evaluate these differences. In addition, our results showed that antidepressants did not alter ERD, and that the total drug amount was not associated with ERD. Although there is no relationship between drug therapies and ERD, psychotropic drug effects, including antidepressants, seem to be an area where more research is needed.

KEYWORDS
Antidepressant; bipolar disorder; depression; emotion regulation; psychotropic medication Table 1. Descriptive statistics as well as results of the anova and post-hoc analyze for global and specific difficulties in regulating emotions between the bipolar, depressive, and healthy control groups.  A comparative examinataion of the relationship between early maladaptive schemas and symptom dimensions in patient with obsessive compulsive disorder, uneffected siblings of patients and healthy controls

Ali Baz and Evrim Özkorumak Karagüzel
Psikiyatri Bölümü, Karadeniz Teknik Üniversitesi, Trabzon, Türkiye ABSTRACT OBJECTIVE: The purpose of this study is (1) to evaluate the differences between the early unconformable schemes of the OCD patients and their siblings and the early unconformable schemes of the healthy controls; (2) to determine if the severity of OCD is related to the clinical variables like starting age, duration of the disease and its relation with the schemes. Thus, the OCD's resistance to treatment, occurrence, becoming chronic and the core pathologies before it comes to the clinical level can be predicted.

METHODS:
In this research, the study group is the outpatients who applied to Karadeniz Technical University School of Medicine Psychiatry Polyclinics from December 2017 to November 2018 and who got an OCD diagnosis and comply with the conformity criteria and the siblings of the patients, who accepted to participate in this study, under the condition that they belong to and have raised by the same parents and they comply with the conformity criteria; and the healthy controls. All of the participants were informed about the study and their written consent was obtained. The ethics committee approval was granted with Decision ref.

2018/3 of Karadeniz Technical University Clinical Researches Ethics
Committee. The socio-demographic data form, clinical consultancy structured for DSM-IV (SCID-I) and SCID-II, Yale-Brown Obsession Compulsion Scale, Beck Depression Scale, Young Scheme Questionnaire Short Form-3 were applied to all of the participant for purpose of evaluation of the personality disorders. The participants who did not comply with the SCID-I, SCID-II and BDS were left out. RESULTS: No difference was found between the groups in terms of age, sex, marital status, employment status, residence, income distribution. There was not difference between the OCD and healthy control in terms of education year. However, the sibling group was significantly different from the other two groups. It was found that compared to the control groups the patients are more dominant in the failure, pessimism, social isolation/ alienation, codependency, being abandoned, being punished, imperfection/embarrassment schemes and the scheme areas of impaired autonomy, disconnection and high standards are more dominant in the patient group. When the patient and sibling groups are compared, the pessimism and imperfection/embarrassment scheme is more dominant in the patient group and there is no difference in their scheme areas and there is no significant difference among the patients in the areas of social isolation/alienation, imperfection/embarrassment, failure, codependency, abandonment and being punished which are more dominant than the healthy controls. When the sibling and control groups are compared, it is observed that the codependency, being abandoned, check seeking schemes and the impaired autonomy scheme areas are more dominant in the sibling group.
CONCLUSIONS: This outcome allows to evaluate importance of the attitudes of parents in these schemes and the different schemes apart from such attitudes. Thus, the schemes which can pertain to OCD are examined. Consequently, this study has revealed findings which can be important in determination of etiopathogenesis of OCD and the therapy methods which are being studied.

Schemes; Scheme Areas; Obsessive Compulsive
Disorder; Non-Affected Siblings Table 3. Descriptive statistics as well as results of the anovas for global and specific difficulties in regulating emotions for the participants diagnosed with a psychiatric disorder and taking 1 as well as 2 or medications. RESULTS: There was significant differences in all cognitive subscales between the control group and the depression group with more negative cognitions of the depression group. When we compare the first episode and recurrent depression group within themselves, there was a significant difference between the groups only in the sub-factor of personal dissonance and change desire for ATQ..When we assessed depression on the basis of severity, on the whole cognitive scales, more negative attitudes of the severe depression group were detected and there was a significant difference between the groups. CONCLUSIONS: Symptomatology and cognitive structure of depression are in relationship, and this cognitive structure seemed to be more related to severity, rather than recurrence of depression. These findings suggest that severity of dysfunctional/irrational schemas rather then existence of them might be related to the symptomatology of depression.

CONCLUSIONS:
Despite lacking clarity about definition, contributing factors and phenomenology of PIU across different subpopulations of youth, it seems to be a growing problem with different aspects and possess a potential threat for mental health of individuals with ASD. In this present study, PIU is found to be affecting more than one third of participants and was showing negative correlation with the level of parental control. Despite identified high rates of psychiatric comorbidity in this diagnostic interview study, neither total number of comorbid disorders nor any particular disorder was found to be correlated with PIU. Nevertheless, such a correlation was found for self-reported symptoms of depression and anxiety. Thus, it is important for clinicians to be aware of problematic internet use and efforts should be made to examine and identify related problems while taking actions in individual's clinical management and treatment. Furter studies are needed to enhance our understanding about PIU and related factors in order to guide effectful management and prevention of internet related adversities in youth with ASD. swelling were evaluated. After calculating the score for each of the histopathological changes, the total score was obtained by summing all the scores. RESULTS: Parameters indicating nephrogenic diabetes insipidus, serum Na, Cl and urea levels, were observed to be high in the Li group and low in the LiMet treatment group. Similarly, in the LiMet treatment group, the reduction in serum osmolality level and increase in urine osmolality level were observed to be statistically significant compared to the Li group (p<0.001, p=0.007 respectively). Tissue AQP2 level was significantly high in the LiMet treatment group. Compared to the Li group, the total histopathological damage score significantly decreased in the LiMet treatment group ( p=0.005). CONCLUSIONS: The findings of this study indicate that metformin therapy prevents the development of lithium-induced nephrogenic diabetes insipidus by increasing AQP2 accumulation in the renal apical plasma membrane. Renal histology also showed convincing evidence regarding metformin protective nature. OBJECTIVE: According to World Health Organisation (WHO), obesity is an increasing public health problem in both developed and developing countries. WHO defines over weight people who has Body Mass Index (BMI) between 25 -29.9, obese people with BMI over 30 and finally WHO defines morbid obesity with BMI over 40. İmpulsivity is related with urgency, inevitability, spur of the moment, loss of control, loss of perseveration and looking for excitement. The researchs show that depression and anxiety diagnosis are more often and disease levels are higher in morbid obesity population than the normal population. Especially when the depression levels are higher, the impulsivity is seen more often and this affects negatively the eating behaviours and makes the BMI higher. The purpose of this study is the examination of impulsivity with depression and anxiety levels at morbid obese women. METHODS: In this study we have thirty-six voluntary women over eighteen years old with morbid obesity disorder. The voluntaries are evaluated with Sociodemographic questionnaire, Beck depression inventory (BDI), Beck anxiety inventory (BAI) and Barratt impulsiveness scale (BIS). SPSS 16.0 was used for statistical analysis. RESULTS: The BAI and BIS scores of our patients are higher than the cut-off points of this scales. BAI and BIS scores of the patients are not correlated with Barratt total and Barratt all subscale scores of the patients. There was no statistically significant difference between the BDI, BAI, BIS scores of married and single patients. There was no significant difference between BDI, BAI, BIS scores of patients who has psychiatric disorder and who has not psychiatric disorder. CONCLUSIONS: The anxiety and depression scores are higher in obese patients. Psychiatric comorbidities are seen more often especially anxiety and depression in morbid obese patients. We found no correlation between anxiety, depression and impulsivity. There were no statistically significant difference between marital status and anxiety, depression, impulsivity scores. Having psychiatric disorder doesn't affect the anxiety, depression and impulsivity scores statistically in morbid obese patients. So all these findings show us that impulsivity, anxiety and depression are affected in morbid obese patients independently from other factors. This present study's deficiencies are; we have few voluntaries, the study is one-centered and we have no control groups. There are few studies over morbid obese patients in our country but morbid obesity is an increasing disease in Turkey, so we hope that this present study will lead other studies over morbid obese patients. The impact of using social network services on the smartphone addiction and sleep quality in university student OBJECTIVE: Sleep is a healing, relaxing and nutritious natural way to protect body energy, restore normal processes, activate physical growth and ensure mental refreshment. Likewise, sleep quality is also important in some special populations, such as college students who are experiencing major risks, social changes and challenges because of low academic performance, reduced mental health and declining quality of life. Smartphones that have been increasing in features day after day have become the most practical and most preferred of mobile devices. The fact that smartphones are being used so often in our daily practice and that they are indispensable have caused us to face the concept of 'smartphone addiction'. The reason that increases the risk of addiction is the growing number of social media services in usage and variety. Previous studies in the literature have shown that smartphone overuse and addiction are related to sleep quality. The aim of this study is to determine the effect of social media networks on smartphone addiction and sleep quality and examine the various related factors, in college students. METHODS: Overall, 1369 university students (791 females and 578 males) were included in the study. The data were collected with a standardized, anonymous, self-report data collection page. Personal information, habits, educational information and smartphone information were asked for all attendees, along with the socio-demographic form. All volunteers were asked to question the quality of sleep, the Pittsburgh Sleep Quality Index (PSQI) self-rated scale, and Smartphone Addiction Scale Short Version (SAS-SV) for querying the smartphone addiction status. RESULTS: The students consisted of 57.8% females and 42.2% males. The mean age of the participants was 21.54±2.97 years. The average SAS-SV score was 31.06±10.33 and PSQI score was 5.48±3.40. The mean SAS-SV and PSQI score was analyzed based on demographic variables and statistically significant differences were found between frequency of smartphone change, monthly smartphone bill, smartphone addiction, and sleep quality. It was statistically significant when students' daily Facebook, Twitter, Instagram, Snapchat, Swarm and Foursquare user's times were compared with the mean score of SAS-SV and PSQI. CONCLUSIONS: This present study showed that overuse of smartphones along with social media networks in college students is potentially addictive and will affect sleep quality negatively. It was also discussed which popular social media networks increased smartphone addiction risk and affected sleep quality. As far as we know, these results are limited in the literature and so this present study will provide significant contributions. In conclusion, it will be useful to see the overuse of social media networks as a public health problem, to avoid dependency and to use it as intended. It should be read in mind that proper use of an object for any purpose may be of great benefit, but excluding it may lead to unintended consequences. We must take the necessary precautions, especially among our young people, to use them appropriately for the purpose of social media networks. Future research on this topic should be added to the literature in a well-structured and planned way of doing personality analysis and social interaction.    In this study, the ratio of boys / girls in OCD group was found to be 1.1. 30% of patients (n=18) had a single obsession, 70% (n=42) had more than one obsession, and 20% (n=12) had one compulsion type, while the rest (n=48) described more than one type. The most frequent type of obsession was contamination with a ratio of 60% (n=36), followed by the religious, aggressive, sexual, somatic obsessions with ratios of 30%, 15%, 13.3%, 10%, respectively. On the otherside, controlling was the most detected compulsion type with a ratio of 45% (n=27), whereas the percentage of washing and cleaning compulsion was 38.3 (n=23), and the repetitive ceremonial behaviors were ranked 3rd (28.3%). In the study group, the denial and behavioral disengagement subscale and the nonfunctional coping main scale scores of parents were significantly higher, while active coping and planning subscale and problem focused coping main scale scores were significantly lower than the control group. Emotional focused coping attitude was the most frequently referred coping strategy with a score of 53.7±9.2, and the nonfunctional coping attitude was the least used coping strategy (39.5±7.4) among all main scales of COPE. In whole subscales, positive reinterpretation and improvement subscale had the highest score with 12.7±2.5, conversely substance use subscale had the lowest score with 5.0±2.0. There was nostatistically significant relationship between parental coping attitude scale scores and OCD severity of the patients. Additionally, the COPE's behavioral disengagement subscale score of the parents of patients with religious dominant obsession type was significantly higher than those free from religious dominant obsession type. CONCLUSIONS: It is important to understand the contribution of the family in the beginning, care and/or treatment of the disorder starting during childhood. Parental coping strategies can be marked as important OCD-related characteristics where a suitable intervention might be required in family environment. Demonstrating the relation in this present study can be helpful in forming psychosocial interventions for improving parental coping abilities. Comparison of bipolar patients with their first degree relatives and healthy controls in terms of social cognition characteristics and neurocognitive functions

Kübra Kocagöz and Filiz Civil Arslan
Karadeniz Technical University School of Medicine ABSTRACT OBJECTIVE: It has been shown that in addition to cognitive functions, patients with bipolar disorder also have deterioration in social cognition. The fact that some studies have shown first degree relatives of bipolar patients to have deteriorations in social cognitive abilities such as theory of mind and emotion identification have caused the assertion that theory of mind and emotion identification disorders can be assessed as endophenotype candidate for bipolar disorder. The aim of this present study is to assess cognitive functions and social cognition in patients with bipolar disorder and their first degree relatives and to compare these functions with each other and healthy controls, to examine whether possible disorders in social cognition can be assessed as endophenotype candidate and to examine whether there is an association between social cognition and cognitive functions. METHODS: 40 patients who referred to Black Sea Technical University School of Medicine Psychiatry Polyclinic as outpatient whose treatments were still continuing, who were diagnosed with Bipolar Disorder I according to DSM-5, who agreed to participate in the study, who met the inclusion criteria and who had been in the euthymic period for at least two months were included in the study. by one on the hot plate at the 30th and 60th minutes. We indicated the duration passed on the mice's licking the hind legs or jumping as the pain threshold. In order to prevent injury in mice, we terminated the experiment for mice that did not show any pain response within 30 seconds and considered the pain threshold as 30 seconds. We evaluated the effect of duration for each dose with the paired t-test, and the effect of dose on the 30th and 90th minutes with the oneway ANOVA. RESULTS: We detected that with the increase of dose (0 mg p>0.05, 5 mg p<0.01, 10 mg p<0.01, 20 mg p<0.01), and the duration (on the 30th minute p<0.001, in the 60th minute p<0.001), the pain threshold is decreased (Diagram

OBJECTIVE:
The purpose of this present study is to determine the factors which may contribute to the occurrence of adult SAD in a sample of PD patients. We hypothesized that some clinical factors such as agoraphobia, clinical severity of PD, or childhood SAD are associated with the severity of adult SAD. Comorbidity between adult SAD and anxiety and mood disorders is frequent, so we preferred to study on PD patients without any lifetime and current comorbid anxiety and mood disorders, to examine the direct relationship between adult SAD and panic-related symptomatology. METHODS: Patients presenting with panic disorder symptoms at a university psychiatry outpatient clinics between 2016 and 2018, were recruited for this study. All subjects were assessed with the Structured Clinical Interview for the DSM-IV (SCID-I). Patients with psychotic disorders, substance use disorder, major depression, any other lifetime or current anxiety disorders were excluded. We used the self-rating format of the Turkish version of Panic and Agoraphobia Scale (PAS). The childhood and adulthood SAD were assessed by Turkish version of Structured Clinical Interview for Separation Anxiety Symptoms. The severity of SAD before 18 years were measured retrospectively using Separation Anxiety Symptom Inventory (SASI). We used the Turkish version of Adult Separation Anxiety Questionnaire (ASA) to assess the severity of separation anxiety experienced after 18 years of age. State and trait anxiety levels weremeasured with the Turkish version of the STAI. RESULTS: Gender, marital status, previous history and mean number of suicide attempts did not reveal significant differences between healty and patient groups. Patient groups showed different levels of education(F=3,687, p=0.01). Patient groups also differed in ratings of STAI I (F=4.510, p=0.005), and II (F=3.148, p=0.02), total (F=7,294, p<0.0001), agoraphobia and avoidance behaviour (F=3,567, p=0.01), anticipatory anxiety (F=3,870, p=0.01), disability (F=3,873, p=0.01), and fear for health concerns (F=8,153, p<0.0001) subscales of PAS. Post hoc analysis showed that PD patients with CSAD and ASAD had significantly higher scores on STAI I-II, total, agoraphobia-avoidance behaviour, anticipatory anxiety, disability, fear for health concerns subscales of PAS than those without CSAD and ASAD. PD patients with CSAD and ASAD had higher scores of STAI -II (ANCOVA, F=4.889, df=3, p=0.003), and disability subscale scores of PAS (ANCOVA, F=2.781, df=3, p=0.04) compared to other two groups, after ASA scores were controlled. There were no differences in clinical scores between three groups when SASI scores were controlled. CONCLUSIONS: Our findings might indicate that the continuity of SAD during adulthood seemed to be related to the severity of childhood SAD and trait anxiety, and was independent from panic or agoraphobia symptoms. This suggestion is consistent with some studies which proposed that there is a developmental continuity for childhood SAD, and ifadult SAD is considered as a subcategory of adult anxiety, any apparent relationship between chidhood separation anxiety and PD and/or agoraphobiadisappears. The delay in focusing on that category may have been a consequence of Bowlby's assertion that agoraphobia represents underlying separation anxiety in adulthood.

KEYWORDS
Seperation; anxiety; state; trait; adulthood,panic OBJECTIVE: Judicial cases related to adolescents in Turkey and the world are increasing day by day, and child psychiatrists and forensic physicians need more knowledge and experience in forensic and professional terms. It has been shown in different studies that aggressive behavior and crime is more frequent in boys and adolescents. The aim of this study is to determine the diagnosis, sociodemographic data, the nature of the crime and the risks that push against the crime by making the psychiatric examinations of the children brought to the child psychiatry outpatient clinic according to TCK 31 and TCK 32 by the judicial authorities. It is also aimed to examine the reports prepared in addition.

METHODS:
The study was designed to examine the retrospective files of 107 children who were admitted to Dicle University Child and Adolescent Mental Health and Diseases Outpatient Clinic between 2017-June and November 2018 under the scope of TCK 31 and 32 for forensic psychiatric examination. RESULTS: Male gender, dropout rates of school, substance use, attention deficit and hyperactivity disorder (ADHD), presence of behavior disorder and low socioeconomic status were found in the children included in the study. The most common crime was theft (37.3%), followed by terror (25.2%), wounding (17.8%), sexual abuse (15%) and drug (4.7%) crimes respectively. It has been determined that the ability to perceive the legal meaning and the consequences of the crime, which is claimed to be committed and to direct the behaviors related to this act, has not developed sufficiently in %77 of the cases. CONCLUSIONS: Knowing the general characteristics and risk factors of these children and meeting their social, cultural and economic needs are important in terms of preventing these behaviors and contributing to taking necessary measures.

RESULTS
: 63 children were included in the study. Mean age was 43,3 months. The mean age at diagnosis was 36,6 months and the mean age mothers realizing the abnormalities with their children is 26,8 months. There is a 9,7 months delay between the diagnosis and the mothers' doubt about their children's development. This delay was found to be positively correlated with ASQ total scores (R: 0,286 p=0,024) and social skills (R:0,308 p=0,014) communication subscales (R.0,269 p=0,033) in Pearson correlation analysis. There is no significant correlation between diagnostic delay and socioeconomic status. CONCLUSIONS: This study revealed valuable preliminary information regarding the age at ASD diagnosis in Turkey and associated factors. We found that, autistic features in mother of children with ASD is positively correlated with the diagnostic delay. No significant relationship was found between alexithymia traits and socioeconomic status. With the completion of this present study, more detailed results will be obtained.
[ The relationship between psychopathology-sociodemographic data and peer bullying in a child and adolescent psychiatry inpatient clinic: a controlled study, preliminary study 3% of the clinical group was exposed to bullying at least two or three times in the last three months and 18.7% of them were bullies. No significant correlation was found between the clinical group and the control group in terms of peer bullying victimization (p> 0.05) however, there was a significant correlation between the clinical group and the control group in terms of bullying (p = 0.01). There was no significant difference in the tobacco use (p> 0.05), alcohol use (p> 0.05) and substance abuse (p> 0.05) between bullies and victims. There was a significant difference in terms of involvement in legal issues (p = 0.044). CONCLUSIONS: Since it is known that peer bullying can cause serious traumas and that its effects can be persistent, risks for being a victim or bully should be defined clearly. The high prevalence of bullying in the clinical sample is one of the remarkable point of this present study. Further studies are needed in clinical and non-clinical sample to enhance our understanding in this field. METHODS: Sample for this study was drawn from a clinical sample of children with nocturnal enuresis who were referred to Hatay State Hospital Child and Adolescent Psychiatry Clinic through January to June 2018. A total of 135 drug-naive children (6-12 years of age) with documented DSM-5 nocturnal enuresis diagnosis was included. The subjects with the diagnosis of psychiatric disorders other than nocturnal enuresis according to DSM-5 and those who had a physical illness and who used any medications other than desmopressin, oxybutynin, and imipramine were excluded. Clinical characteristics of the sample were obtained retrospectively from the medical records and structured psychiatric interviews. Improvement and side effects were assessed with Clinical Global Impression-Improvement Scale (CGI-I) and the adverse effect scale developed by the authors, respectively. RESULTS: Mean age of the patients was 8.51 ± 2.35. 54.8% (N=74) of children were male and 45.2% (N=61) were female. 38.5% (N=52) of the patients were using desmopressin, 31.8% (N=43) were using oxybutynin, and 29.7% (N=40) were using imipramine. At the 2th month of treatment, the CGI-I was significantly different between three medication groups. There was no significance in terms of treatment compliance. Sleep disturbance, dry mouth, and constipation were meaningfully different between the groups. CONCLUSIONS: Imipramine seems to be more effective than desmopressin and oxybutynin. Desmopressin and oxybutynin appear to show similar effectiveness. Imipramine may be associated with more and severe side effects. The Effect Of The Psychosexual Stage Where Circumcision is Performed On The Sexual Myths seen right afterwards or after a certain time. Its effect on sexual function is uncertain. Subjects who believe in sexual myths have unscientific, incorrect and exaggerated sexual thoughts and concepts. A higher incidence of sexual disorder is seen in such subjects. Despite the many studies on circumcision, the effect of the age of circumcision on sexual myths is unknown. To compare groups circumcised at different ages regarding sexual myths. METHODS: A survey form including 30 common sexual myths was created through a literature survey and randomly selected university student males were informed about the study. Those who accepted to participate were asked to complete the survey form. The total sexual myth number for each subject was determined by using the total number of myths on each form. A total of 5 groups was then created according to Freud's psychosocial development periods and the age of circumcision and the mean number of sexual myths were determined for each group. The presence or absence of a difference between the group means was then evaluated. In this group of patients, deterioration of sleep structure including insomnia, hypersomnia and changes in sleep patterns are seen more frequently than healthy individuals.A limited of polysomnography studies have been conducted in patients with first-episode psychosis and there is no consensus on sleep structure.Concurrently, the effects of atypical antipsychotics on sleep structure could not be elucidated clearly. In this study, 13 firstepisode psychosis patients who underwent polysomnographic study were evaluated retrospectively and were aimed to compare effects on the sleep structures of the secondgeneration oral antipsychotics risperidone, olanzapine, aripiprazole were used in the treatment of these patients.

METHODS:
This study was carried out retrospectively from the inpatient files in the psychiatry clinic of Gülhane Education and Research Hospital. The records of the first episodes of psychosis patients with polysomnographic studies were examined and compared in Gülhane Sleep Research Center.It was learned from retrospective analysis that risperidone was started to 5, olanzapine to 4 and aripiprazole to 4 patients, as monotherapy.In the first month and sixth month, polysomnography recordings of the patients were examined and compared.Statistical analyzes were performed with IBM SPSS Statistics 25 package program.Since the data did not fit the normal distribution and the sample size was not sufficient, a non-parametric test, Wilcoxon test, was applied. According to this test, p<0.05 was accepted as significant. RESULTS: All patients included in the study were male and the mean age was 23.96 ±3.74.Comparison of polysomnographic evaluations at 1th month and 6th months; the mean dose of the drug was 6 mg/day in the patient group who used risperidone. From the parameters related to the continuity of sleep; increased sleep efficiency, increased total sleep time, decreased number of total wakefulness were found to and from sleep structure related parameters; increased Stage 3 sleep time and increased percentage were found to.These differences were statistically significant.The mean dose of the drug was 10 mg/day in the patients with olanzapine.From the parameters related to the continuity of sleep; decreased sleep latency, decreased the number of wakefulness were found to.From REM sleep related parameters;REM latency was found to be shorter.These differences were statistically significant.The mean drug dose was found to be 15 mg/day in the patient group who used aripiprazole.In this group, no statistically significant difference. CONCLUSIONS: Sleep disorders are commonly observed in patients with psychotic disorder.Sleep disorders, psychotic symptoms and psychotic symptoms are suggested to play a role in the exacerbation.Therefore, the effects of antipsychotic treatment for psychotic disorder on sleep should be well known.The effects of many antipsychotic drugs used in the treatment of psychotic disorder on sleep are different. In this present study, the effects of risperidone olanzapine and aripiprazole in the atypical antipsychotic group, which are frequently used in clinical practice, on sleep structures of the first episode psychosis patients were examined. It was determined that risperidone and olanzapine had a statistically significant effect on sleep continuity and structure however, aripiprazole did not cause a statistically significant change on sleep. Clinical studies have repeatedly demonstrated that anxiety disorders are associated with suicidal ideation, suicidal attempts and completed suicides. The metacognitive model asserts that individuals with generalized anxiety disorder, like most people, hold positive beliefs about worrying as an effective means of dealing with threat. However, worry is used as an inflexible means of coping, and this becomes a problem when negative beliefs concerning the uncontrollability and the dangers of worrying develop, leading to unhelpful control strategies. The aim of this study was to examine relationship between the metacognitive beliefs and suicide ideation of patients with generalized anxiety disorder. METHODS: Thirty two patients diagnosed with generalized anxiety disorder according to DSM-5 were enrolled in this study. The Socio-demographic Data Form, Metacognition Questionnaire-30 (MQ-30), Beck Anxiety Inventory (BAI), Beck scale for suicidal ideation (BSSI) were all administered. Data were analyzed statistically with SPSS. RESULTS: There were 26 (81.2%) female, 6 (18.8%) male patients. The mean age of the patients was 35.37±11.63 years old and the mean duration of education was 9.87±3.76 years. 56.3% of the patients were married, 54.2% of the patients were unemployed, 37.5% of the patients were smoking and 58.1% of the patients had suicide attempt history. Patients' mean MQ-30 scores were; the total score was 76.50±13.81, the positive beliefs about worry was 12.56±3.83, the negative beliefs about uncontrollability of thoughts and danger was 16.50±3.81, the cognitive confidence was 14.93±4.63, the beliefs about the need to control thoughts was 17.06±3.54 and the cognitive self-consciousness was 15.43±3.02. BAI mean score was 32.12±7.04 and SIS mean score was 14.12±5.01. There were positive moderate correlations between BSSI total score and MQ-30 total score and all of the MQ-30 subscales except the positive beliefs about worry. There were positive moderate correlations between BAI total score and "the positive beliefs about worry", "the beliefs about the need to control thoughts" of MQ-30 subscales. There were positive moderate correlations between BSSI total score and BAI total score. CONCLUSIONS: There are various studies showing the effects of metacognition on anxiety KEYWORDS Anxiety disorder; beliefs; DSM-5; metacognition; suicide disorders. In addition, there are studies showing that anxiety affects suicide. In this study, the positive correlations between BAI, BSSI and MQ-30 scores supports the literature. However, there is no data about the relationship between metacognitions and suicidal ideation in the literature of generalized anxiety disorder. Significant correlations in this present study supported the relationship between metacognitions and suicide ideation in generalized anxiety disorder.

[Abstract:0267][Others]
The sociodemographic and clinical assessment of children applied to the infant mental health unit of an outpatient clinic Esra Yürümez and Tuğba Menteşe Babayiğit Department of Child and Adolescent Psychiatry, Ankara University, Ankara, Turkey ABSTRACT OBJECTIVE: The increasing emphasis on the field of infant mental health in recent years makes the multidimensional and special assessment of the child essential. In this study, defining the sociodemographical features, psychiatric disorders and interventions recommended to the families and to present the data of the infant mental health unit is aimed. METHODS: A total number of 145 children applied consecutively to our unit between May-December 2017 were included. The records of participants were searched retrospectively. The sociodemographical features, developmental stages regarding to the test applied (Ankara Developmental Screening Inventory or Stanford-Binet Intelligence Test), scores of the scales Children Behaviour Checklist (CBCL) 1.5-5 fulfilled by caregivers, the properties of parent-child relationship and attachment behaviours with respect to the observation of clinic problem-solving procedure and finally diagnosis with respect to DC:0-5 and treatment suggested by the clinicans were evaluated. The observation of the children with their caregivers according to this procedure was completed in the play room while the professionals were watching behind the one side mirror. RESULTS: Fourty five (31%) of participiants were female and 100 (69%) were male with a mean age of 32 months (±9.2). Mothers were the primary caregivers of 71.2% of all children. The ratio of being enrolled in a kindergarten was 5.3%. The others were under the responsibility of a relative (17.5%) or a professional caregiver (6%). The most common complaints causing parents referring to the unit were speech delay (40%) and difficulty in eye contact and social relations (20%), being consulted for detailed assessment by different clinics (19.3%), bad temper (15.2%), hyperactivity (4.8%). The ratio of direct admission to the unit was 42.1%, whereas the 57.9% of all participants were referred to us from another clinic (e.g. pediatri, developmental pediatri or ear nose throat clinics). According to assessment of crowell procedure regarding to DC: 0-5, the ratio of secure attachment between the children and their caregivers was 16.3%, whereas anxious/ambivalent attachment was 15.8%. PIR-GAS scores were negatively correlated to the ages and to the education levels (p<0.05) of mothers and fathers as shown in Table 2. The correlation of CBCL scores and PIR-GAS was analyzed. The emotionally reactive and anxious/depressed subscales fulfilled by mothers were significantly correlated to PIR-GAS scores (p<0.05). As an intervention; the frequency of directing to a special education programme due to various diagnoses was 57%, directing to preschool education was 94.9%, appliying interactive guidance was 36.2%, consulting to other clinics was 31.6% and offering medical drugs was 6%. CONCLUSIONS: The interaction of child with a stable environment providing protection, care, opputunities for physical and cognitive with supportive, stimulating and sensitive interactions is essential for a healthy development. Thus, detecting the difficulties in relationships and developmental risk factors and providing the necessary support to both child and family is required to protect the mental health and apply of early diagnose and treatment strategies. The characteristics of children with speech and language delay Tülin Fidan, Fadime Güler Sökmen and Vural Fidan Department of Child and Adolescent Psychiatry, Eskisehir Osmangazi University, Eskişehir, Turkey ABSTRACT OBJECTIVE: Developmental -expressive language disorder is a frequently occurring condition in children, characterized by severe delay in the development of expressive language compared with receptive language and cognitive skills (1). In developmental speech and language delay KEYWORDS Devolopmental language delay; expressive language delay; child (SLD), expressive language disorder (ELD) articulation skills (2). In this study we examine the characteristics and differences of child and adolescents who admitted to Eskisehir Osmangazi University Child Psychiatry Department and diagnosed as speech and language disorders with and without lack of stimuli. METHODS: A total of 104 child and adolescents who were diagnosed as speech and language difficulties during 2016-2017. We analyze the demographic characteristic of child and adolescents with ELD, with and without lack of stimuli. as percentage, mean and standard deviation values were given. Pearson chi-squared and Fissher exact tests were used to compare the categorical variables. P <0.05 was considered statistically significant in all evaluations. RESULTS: The total of 104 SLD cases 77.9% were male and the mean age was 4.7±3. The 73% (n=76)of SLD cases were diagnosed as developmental-expressive language delay (D-ELD),18.3 % (n=19) as stuttering, 4.8% (n=5) as articulation disorder, as 3.8% Social Comminication Disorder (n=4). In D-ELD group 33 were having developmental language delay due to lack of stimulus, 43 having no enviromental risk factor.
Mother's literacy level (university level)was higher among D-ELD with lack of stimuli group and significant between group(p=0.015). There were no statistically difference in father's literacy level, socioeconomic level, family structure, sociaeconomic status, prenatal,natal and postnatal complications,psychiatric comorbity(p<0.05). CONCLUSIONS: D-ELD is more common among boys. D-ELD range from 13.5% in 18-to 23-montholds to 17.5% in children 30 to 36 months of age(3). Normal speech progresses through stages of cooing, babbling, words, and word combinations, whereas normal language progresses through stages of understanding and expressing more complex concepts. Development of proficiency in vocabulary and language use depends heavily on family and early school experiences. (2) Physical deprivation (e.g., poverty, poor housing, and malnutrition) and social deprivation (e.g., inadequate linguistic stimulation, parental absenteeism, emotional stress, and child neglect) have an adverse effect on speech development (4).In this study only mother's literacy level was found different. Future studies with more subjects are needed to determine the charasteristic of SLD children. Two hundreds and twenty two (64.7%) of 343 suicide attempts during the specified period were committed by using overdose of medication. Thirty four (9%) out of the patients used puncturing device for the attempt and high jumping was used as the most common third method by twenty out of patients (5.8%). It was found that overdose of medication was more likely to be used by women (71,6%) than men (51,2%). 119 (34,6%) patients had one or more suicidal attempt in the past. Men were more prone to have a plan before commiting suicide compared to women (respectively 38,8% and 19.4%). CONCLUSIONS: In line with the previous studies, suicide attempts were found to be more frequent in female gender in the present study and overdose drug intake was the most common method. Assessment of patients committing suicide or having suicidal ideation requires a careful management. It can be inferred from the results that clinicians should reveal the suicidal tendencies and intention prominently and enable to prevent the patients from recurrence of suicide attempt.

Suicide attempt; consultation; emergency department
The association with suicidal thougths and seperation anxiety, childhood trauma and temperament in patient with obsessive-compulsive disorder İrem Saraçoğlu a , Çağdaş Öykü Memiş a , Bilge Doğan a , Seda Derici Memiş b and Levent Sevinçok a a Adnan Menderes University School of Medicine, Department of Psychiatry, Aydın, Turkey; b Atatürk State Hospital, Aydın, Turkey ABSTRACT OBJECTIVE: Patients with obsessive-compulsive disorder (OCD) may be at risk of committing suicide . In fact, several studies suggested that between 5 and 25% of patients with OCD have attempted suicide at some point in their lives and generally have more suicidal ideation than non-affected individuals . Significant correlations were found between childhood traumas, seperation anxiety, temperament and suicidal thoughts in psychiatric disorders. In the present study, our primary Objective was to examine the associations of suicidal thougths with seperation anxiety, childhood trauma, impulsivity and temperament in a sample of patient with obsessive-compulsive disorder. We hypothesized that the associations of seperation anxiety, childhood trauma and temperament with suicidal thougths are differentially related to OCD. RESULTS: BDI, BAI, CTQ, BIS, depressive, cyclothymic and anxious temperament, the mean number of obsessions, current OCD severity, insight to OCD, history of depresive disorder, religious and miscellaneous obsessions were associated with suicidal thoughts. CONCLUSIONS: Our results demonstrated that there was a significant association between suicidal thoughts and current depressive, anxious symptom severity, childhood trauma, impulsivity, depressive, cyclothymic and anxious temperament, the mean number of obsessions, current OCD severity, insight to OCD, and history of depresive disorder in OCD patients. Future research might help us to better understand the complex relationships between suicidal thoughts and traits in patients with OCD. OBJECTIVE: Schizophrenia has been associated with an increased level of peripheral proinflammatory markers. These findings have supported to conceptualise schizophrenia as a chronic low-grade inflammatory disorder. It has been proposed that the duration of illness and clinical stage influence the response of inflammatory cells. An investigation of cytokines and their activation profiles might be helpful to understand the underlying mechanism. METHODS: 40 stable patients with schizophrenia (all medicated; 9 of all with treatmentresistant schizophrenia) and 40 age-sex-smoking status matched controls were recruited in this study. Cytokines (IL-2, IL-6, TNF-α) were measured from plasma samples by using ELISA cytokine kit. RESULTS: Patients with schizophrenia showed significantly higher plasma levels of IL-6 (p< 0.001) than healthy controls. Furthermore, the duration of illness is associated with the higher levels of IL-2 (p= 0.006) and the treatment-resistant subgroup is associated with the higher levels of TNF-α (p= 0,038). OBJECTIVE: Antipsychotic medication is the mainstay of pharmacological treatment in the acute phase, in the long-term maintenance therapy and in the prevention of relapse of schizophrenia. It is known that approximately two-thirds of patients with schizophrenia do not compliance with treatment. Therefore, long acting injectable antipsychotics have been developed in order to overcome the compliance problem.
Paliperidone palmitate 3-month (PP3M) formulation, a long-acting injectable atypical antipsychotic has been introduced in the market since 2015 in the US and Europe and since 2018 in Turkey for the treatment of schizophrenia in adult patients who have already been treated with paliperidone palmitate 1-month formulation (PP1M) for ≥4 months.
We aimed to present the follow-up results of the PP3M formulation treatment of 7 patients with schizophrenia, previously stabilized on PP1M. METHODS: The patients who were admitted to psychiatry clinic of Selçuk University School of Medicine between January 2017 and January 2019 with the diagnosis of schizophrenia under the PP1M treatment were reviewed retrospectively. A sociodemographic and clinical data form arranged by researchers filled from reports of patients with schizophrenia including the total Positive and Negative Symptom Scale (PANSS) score, Clinical Global Impression Scale-Severity (CGI-S) and Simpson Angus Scale (SAS), body mass index (BMI), serum prolactin levels and metabolic parameters including fasting blood glucose, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. RESULTS: 7 of 28 patients using PP1M were switched to PP3M. Of the seven patients, 6 were female and one was male. The mean age was 51.8 years and the mean disease duration was 19.5 years. Two patients were using clozapine and one patient was using clozapine and aripiprazole as an additional oral treatment. The mean duration of PP1M use was 31.7 months and the mean dose of PP1M was 114.2 mg. The mean PANSS score was 52.2, the mean Abnormal Involuntary Movement Scale (AIMS) score was 2.0 and the mean CGI-S score was 2.85, the mean BMI score was 32.3, the mean prolactine level was 71.3 before the PP3M treatment.
The evaluations of the patients at the 3rd and 6th months of PP3M are as follows: The mean PP3M dose was 387.5 mg both in 3rd and 6th months; the mean PANSS score was 51.4 and 61.0; the mean AIMS score was 2.0 and 1.5; the mean CGI-S score was 2.7 both in 3rd and 6th months; mean BMI score was 31.3 and 31.9; the mean prolactine level was 81.9 and 69.7. It was revealed that metabolic parameters including fasting blood glucose, total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides did not differ also in the first 6 months.
As a result, after switching to PP3M treatment, patients were determined to be stable in terms of side effects, clinical and metabolic parameters. CONCLUSIONS: Treatment compliance in schizophrenia affects the course of the disease and the patients with regard to the frequency of hospitalization, the level of functioning and the quality of life. Long-acting injectable forms are recommended in patients with poor treatment compliance. Since PP3M treatment is applied every 3 months, it provides convenience for the patients. The association between vitamin D levels and sleep disorders in alzheimer's disease examine sleep disorders the neurologist conducted Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS) and Insomnia Severity Index (ISI) to all participants. RESULTS: There was no significant difference for age, gender, body mass index (BMI) and education between groups. Vitamin D levels was significantly lower in Alzheimer group (p=0.018). The mean score of MMSE was 20,5 in Alzheimer group and it was 26,5 in control group (p<0.001). The mean score of ISI and PSQI was higher in Alzheimer group but the difference was not significant (respectively p=0.364, p=0.325). The mean score of ESS was significantly higher in Alzheimer group (p=0.026). The ratio of daytime sleepiness in Alzheimer group was %56,5 where as it was %15,4 in control group (p=0.007). There was a negative correlation between vitamin D levels and the beginning time of amnesia (p=0.037, r=-0.420). There was no significant relation between vitamin D levels and sleep disorders in Alzheimer group. CONCLUSIONS: The level of vitamin D is lower patients with AD. As the beginning time of amnesia is longer, the level of vitamin D is lower in AD patients. The ratio of daytime sleepiness in Alzheimer group is higher when compered to control group. We need more studies in order to reveal the relationship between vitamin D levels and sleep disorders in patients with AD.

METHODS: The study included 60 individuals followed in Ankara Dışkapı Training and Research
Hospital between the ages of 18-59. Individuals who were diagnosed with schizophrenia according to DSM-5, who did not have mental retardation or organic brain disease, had no alcohol / substance abuse or dependence, were not hospitalized in the last six months and could adapt to group environment were included in the study. As psychosocial interventions, social skills training (SST) was applied to one group and occupational therapy intervention with social skills training (OT+SST) was applied to the other group. Individuals were divided into groups equally and homogeneously. The effect of both interventions on psychopathology was compared. Before, after the interventions and 6 months follow up, Sociodemographic Data Form, Brief Psychiatric Rating Scale (BPRS), Negative Symptoms Assessment Scale (SANS), Calgary Depression Scale for Schizophrenia (CDSS) were administered. RESULTS: There was no significant difference between the groups in terms of sociodemographic data and clinical scales. According to the results of 2-way analysis of variance for the repeated measures, the effect of time and Time x group interaction was found to be statistically significant on the BPRS scale score. According to the results of the variance analysis for the repeated measurements, the change in time was significant in terms of depression score, whereas the effect of interaction between time and group was not statistically significant. According to the results of 2-way analysis of variance for the repeated measures, the effect of time and Time x group interaction was found to be statistically significant on the total score of SANS scale. CONCLUSIONS: According to the results of this present study, there was a decrease in general psychiatric symptoms, depressive symptoms and negative symptoms at the end of each intervention. In the follow-up, general psychiatric symptoms and negative symptoms continued to decline. In literature, researches on this topic support the notion that psychosocial skills training results in a decrease in the negative symptoms of schizophrenia. Psychosocial skills training decreases symptom severity in schizophrenia patients and reduces the rate of comorbidity, such as substance use. Xiang and colleagues conducted a study with 96 schizophrenia patients that received routine psychiatric outpatient care and in addition, 50% of the patients also received psychosocial skills training and the other 50% received supportive counseling, each for the duration of 6 months. They stated that the psychosocial skills training group improved significantly more in terms of psychiatric symptoms and social functioning.
We compared the groups in term of psychosocial intervention, it was seen that there was a change in terms of psychiatric symptoms and negative symptoms in both groups; this change was more in the occupational therapy with social skills group. We assume that this finding support that occupational therapy is essential in psychosocial terapy interventions of schizophrenia. The relationship between peer bullying and online game addiction Serdar Karatoprak a and Yunus Emre Dönmez b a Department of Child and Adolescent Psychiatry, Elazığ Mental Health Hospital, Elazığ, Turkey; b Department of Child and Adolescent Psychiatry, Malatya Training and Research Hospital, Malatya, Turkey ABSTRACT OBJECTIVE: Peer bullying is defined as exposure of a child or an adolescent having difficulty in defending himself/herself against disturbing behavior made by one or more students deliberately and in a repetitive manner. Online game addiction(OGA) is a kind of behavioral addiction in which the control over playing game is lost, failure to reduce the amount of time spent by playing game is occured and eventually impaired functionality develops. It is remarkable that there are many common points when psychological and social aspects of adolescents involved in peer bullying and adolescents with OGA are examined. The aim of this study is to identify the relationship between peer bullying and OGA. METHODS: This study was conducted with 196 adolescents aged 12-16 years. Olweus Bully/ Victim Questionnaire, Digital Game Addiction Scale has been applied to the all participants. Questions of digital game addiction scale have been re-arranged for online games. In addition, sociodemographic features of the participants, online game play times, online game play tools, online game type they play are recorded. According to the results of the Olweus Bully/Victim Questionnaire, participants have been splitted into two groups; those who were not involved in peer bullying and those involved in peer bullying(victim or bully). The groups have been compared in terms of OGA and online game types. RESULTS: The participants in the study have been constituted of 83(42.3%) male and 113 (57.7%) female adolescents. The mean age of the cases was 14,56±1,4. %38,2 of the participants has declared to play online games. The prevalence of OGA has been determined as %14,8. It has been determined that the prevalence of OGA involving in peer bullying was %19,5 and % 10,1 for non-peer bullying. OGA was significantly higher in peer bullying (p=0.032). The prevalence of OGA in the victims was 18.6%, it was 22.2% in bullies, and there was no statistically significant difference between victims and bullies. 41.3% of the participants playing online games play games for 1-3 hours and 12% of them play more than 6 hours per day. 45.3% of online gamers have declared to play on their mobile phones and 38.6% of them have declared to play on their computers. It has been determined that the most preferred type of play by the participants is the shooting games(18.3%). No relationship has been found between game types and peer bullying. CONCLUSIONS: The prevalence of OGA ranges from 0.7% to 27.5%. In this study, the prevalence of OGA was 14.8% and our results were consistent with literature data. No data were found in the literature regarding OGA in peer bullying. The results obtained from this present study show that OGA is higher in those included in peer bullying. When the subgroups were evaluated as victim and bully, there was no statistically significant difference although the rate was higher than those who did not participate in peer bullying. This result might be due to the low number of participants with OGA. We, as authors, are of the opinion that more studies are needed to determine the relationship of OGA with peer bullying Krill oil is associated with improvement in sleep functioning, but not ADHD symptoms in school-aged children ABSTRACT OBJECTIVE: There is an increasing interest in the possible efficacy of Omega-3 fatty acid preparations in psychiatric disorders. It has been suggested that omega 3 use may be useful in children with ADHD. The present case-control study examined the short-term efficacy of krill oil in children with ADHD. METHODS: A total of 70 children with newly diagnosed DSM-V ADHD diagnosis were included. The sample were randomized into two groups: ADHD medication + basic parent training (group 1) and ADHD medication + basic parent training + krill oil (group 2). Group 1 received ADHD treatment while group 2 received both ADHD treatment and 750 mg/day krill oil for 2 KEYWORDS ADHD; children; krill oil; sleep months. The baseline characteristics, including the scores of Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), Conners' Parent Rating Scale (CPRS), Conners' Teacher Rating Scale (CTRS-R), Children's Sleep Habits Questionnaire (CSHQ) and Children's Eating Behavior Questionnaire (CEBQ), of both groups were compared with the 2 months' follow-up scores. There were no significant differences regarding the baseline ADHD severity and ADHD medications used (MPH or ATX) between the study groups. RESULTS: After two months of treatment, T-DSM-IV-S, CPRS and CTRS-R scores indicated that both groups had significant improvement on ADHD symptoms. Krill oil use did not have an impact on the treatment of ADHD symptoms. CSHQ scores after treatment was found to be limitedly but significantly improved in Group 2 (51.8 and 49.3 p=0.010) but not in Group 1 (50.6 and 51.1 p=0.72). Between study groups, there was no significant difference regarding the frequency of adverse reactions and CEBQ scores. CONCLUSIONS: Krill oil is associated with a limited improvement in sleep functioning, but not ADHD symptoms in school-aged children. Placebo-controlled studies with larger sample size are needed to clarify the possible role of krill oil in the sleep problems of children with ADHD.

[Abstract:0323][Anxiety Disorders]
The role of metacognitive beliefs and schemas in social anxiety disorder

Erkan Kuru
Boylam Psychiatric Hospital ABSTRACT OBJECTIVE: Social anxiety disorder (SAD) is one of the most common disorders in the general population. Based on the cognitive model of SAD, the core of social anxiety appears to be a strong desire to convey a particular favorable impression of oneself to others and marked in security about one's ability to do so. The contemporary cognitive models of SAD posit that socially anxious individuals have maladaptive schemas regarding themselves and relationships with others, which when activated in social situations would guide the above mentioned cognitive and attentional processes. Several studies have documented the role of these schema domains in a variety of psychological disorders. In contrast, few studies have examined their role in SAD. Metacognition is an upper system that allows to be aware of the events and functions of mind, and directs the mind's events and functions. Preliminary findings suggest a positive relationship between metacognitive beliefs and social anxiety. In this study we aimed to evaluate the early maldaptive schemas and metacognitive beliefs in SAD. METHODS: The subjects of this study were forty patients diagnosed with social aniexty disorder according to DSM 5. Additionally, forty healthy controls which evaluated with similar sociodemographic features were included in the study. We used the Sociodemographic Data Form, Liebowitz Social Anxiety Scale (LSAS), Beck Depression Inventory (BDI), Young Schema Questionnaire (YSQ-SF) and Metacognition Questionnaire-30 (MQ-30) to identify and evaluate the participants. All statistical analysis was performed using SPSS. RESULTS: The mean age of the patients was 21.56±4.90 years old and the mean duration of education was 9±2.8 years. There was no statistically significant difference between the groups in terms of mean age, education year, gender and marital status. While the patients' mean total scores of the LSAS was 116.81 ± 16.29, BDI score was 27.42±8.56. The mean total scores of MQ-30 was 75.69±17.58, the positive beliefs about worry was 12.56±4.44, the negative beliefs about uncontrollability of thoughts and danger was 15.93±4.19, the cognitive confidence was 14.29±4.45, the cognitive self-consciousness was 16.17±4.08 and the beliefs about the need to control thoughts was 16.00±4.09. The social anxiety group scored significantly higher than the control group in five out of fourteen early maladaptive schemas. The LSAS scores were high and closely correlated with MQ-30 scores. CONCLUSIONS: In the present study, we aimed to examine early maladaptive schemas and metacognitions in SAD. The results show that early maladaptive schemas and metacognitions can play a relevant role in the development and maintenance of social anxiety. Replication of these results from a larger sample with diagnoses of SAD would help to confirm these findings. The relationship of smoking addiction with type D personality, impulsivity and childhood trauma İbrahim Yağci a , Gökhan Perinçek b and Yüksel Kıvrak c problematic online games, little is known about interpersonal factors that contribute or protect to ADHD comorbid IGD. Thus, the aim of this study was to examine the relationships between parental attitudes, adolescent perception of family functioning and IGD in adolescents with ADHD. METHODS: Forty-one adolescent with ADHD and thirty-three healthy volunteers were included in the study. The subjects in both groups were administered the Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) to confirm their diagnosis and to determine their psychiatric comorbidities once their informed consents were obtained. Online gaming questionnaire (OGQ) was given in the both groups. Perceived family climate was assessed by the Shortened Level of Expressed Emotion Scale (SLEES), and parenting styles were evaluated using the Parental Attitude Research Instrument (PARI). RESULTS: There were no significant differences between the two groups in terms of sociodemographic data (p>0.05). When data of ADHD and control groups were compared in terms of OGQ total scores, it was found that the ADHD group obtained statistically significant high scores compared to the control group (p=0.002). The number of adolescents with IGD (29.3%) in ADHD group was significantly higher than adolescent with IGD (3.0%) in the control group (p=0.003). In ADHD group, adolescents with IGD had significantly higher scores in irritability subscales of SLEES than adolescents without IGD (p=0.026). In our sample, there was a weak positive correlation between OGQ scores and irritability subscales of SLEES scores (r=0.251, p=0.031). There was a moderate negative correlation between OGQ scores and equalitarian/democratic attitude subscales of PARI scores (r=0.314, p=0.006). CONCLUSIONS: In this present study, percentage of IGD in the ADHD group was higher than control group as in the previous literature. This study showed that the adolescents with ADHD and IGD describing their families as more irritating the adolescents with ADHD and without IGD. According to the findings, higher levels of IGD were associated with high irritability perception and less egalitarian attitudes in whole group. Evaluation of the relationship between parental attitudes and IGD of adolescents with ADHD can guide diagnosis and treatment of ADHD, and thus is of critical importance. Researching this relationship using other evaluation tools in larger samples can contribute greatly to the understanding of factors involved in ADHD with comorbid IGD, potentially leading to improvements in its diagnosis and treatment.

KEYWORDS
Internet gaming disorder; ADHD; Family; Adolescents treatment option for patients with treatment-resistant depression. Thanks to a moderate side effect profile and ease of administration, TMS is a potential alternative to ECT. On the other hand, the number of studies on the effect of TMS treatment for suicide is rather limited compared to ECT. The role of cognitive functions in suicidal ideation in MDD-diagnosed patients has not been adequately examined. In this study, we aimed to examine the relationship between suicidal ideation, cognitive functions and TMS and the relationship between these two parameters.
METHODS: This study consists of thirty patients who applied to the outpatient clinics, firstly diagnosed with major depressive disorder (MDD) according to DSM-V and then were referred to TMS treatment due to treatment resistance. The Montgomery-Asberg Depression Rating Scale (MADRS), Colombia Suicide Severity Rating Scale (C-SSRS), Scale for Suicidal Ideation (SSI) and Beck Hopelessness Scale (BHS) were administered before and after the treatment.
Computer-based Cambridge Neurophysiological Assessment Battery (CANTAB) was used to assess cognitive flexibility, motor response inhibition, decision-risk taking and social cognition skills. RESULTS: There were no statistically significant changes in cognitive tests (IED, SST, CGT) before and after treatment, including cognitive flexibility, motor response inhibition, decision-risk assessment. The test which evaluated social cognition (Emotion Recognition Test) showed statistically significant improvement. Changes in the scores of Beck Hopelessness Scale, Colombian Suicide Severity Rating Scale (CSSRS), Montgomery-Asberg Depression Rating Scale were found to be highly significant. When the relationship between cognitive functions and suicidal ideation was examined, it was determined that Colombia Suicide Severity Rating Scale (C-SSRS) and Suicidal Ideation Scale (SIS) scores were significantly correlated with the Intra-Extra Dimensional Set Shift (IED) test that assessed cognitive flexibility. CONCLUSIONS: There was no significant change in cognitive flexibility, decision-making, risk taking and response inhibition functions after rTMS treatment in treatment-resistant depression patients, and it was found that there was a positive change in emotion recognition skills. In the depression clinic, it appeared that there was a significant improvement with treatment of hopelessness thoughts and suicidal thoughts. There was a significant relationship between suicidal ideation and cognitive flexibility as an executive function. We believe that curation of Treatment-Resistant Depression can be more effective through treatments targeting specific symptom clusters such as cognitive functions and suicidal ideation. We recommend increasing the number of studies involving healthy controls and sham groups in this area and working with larger sample groups. There is an increasing knowledge about the role of inflammation in the pathophysiology of bipolar disorder. Evaluation of complete blood count parameters is an economical and easy method and is preferred for demonstration of inflammation due to these properties. In this study, the hematological parameters of patients who were diagnosed with bipolar disorder in the past, who were still diagnosed with bipolar disorder and who were diagnosed with bipolar disorder in the past and were still in the manic period were compared.

METHODS:
The study sample consisted of bipolar disorder manic episode male patients hospitalized at Gülhane Training and Research Hospital/Ankara. Inclusion criteria include being a male, not having a disease causing inflammation, and not having chronic disease. 35 patients with first manic episodes of bipolar disorder and 42 patients with manic episodes of chronic bipolar disorder were included in the study. The blood samples of the patients were taken in the morning on the first day of hospitalization from antecubital vein with minimum tourniquet and studied on the same hemogram device. The severity of the illness was evaluated with Young Mania Rating Scale (YMRS). The data were analyzed with the appropriate method.

OBJECTIVE:
Non-suisidal self injury is an act that involves self-harm without a thought about suisid. Non-suisidal self injury may be associated with many psychiatric disorders. Interpersonal interaction (attachment to family and friends), peer bullying, and a history of abuse can be caused by the occurrence of non-suisidal self injury. METHODS: Thirty-one patients aged between 10 and 17 years and 33 healthy controls were included in this present study who applied to Manisa Mental Health Hospital. Sociodemographic data form, Family Assesment Device, Inventory of Parent and Peer Attachment, Adolescent Decısıon Makıng Questıonnaıre and Problem Solving Inventory were applied to the patient and control groups. RESULTS: Suicide attempt was significantly higher in non-suisidal self injury group (P<0.05). The presence of family mental illness was higher in the patient group (P<0.05). In the subscale of the Family Assesment Device showing the required attention, was found significantly lower in the non-suisidal self injury group than the control group (P<0.05). When Adolescent Decısıon Makıng Questıonnaıre was evaluated, self-esteem subsscale in decision making was found to be significantly lower in non-suisidal self injury group (P<0.05).
The panic part of the same questıonnaıre was significantly higher in non-suisidal self injury group (P<0.05). The family subscale of the attachment inventory was significantly lower in in non-suisidal self injury group (P<0.05). When the Problem Solving Inventory was evaluated, it was found that the non-suisidal self injury group had significantly higher scores (P<0.05). CONCLUSIONS: In children and adolescents with non-suisidal self injury, there are problems in relation to family, decision-making processes, family attachment and problem solving in accordance with literature. Supporting children and young people in these areas should be part of the treatment.

METHODS:
The data of a total of 33 cases admitted to our outpatient clinic between January 2017 and September 2018 with skin picking behavior or determined to have skin picking behavior after the evaluation were examined retrospectively. SPSS 20 package program was used. RESULTS: Of the cases, 60.6% (n = 20) were girls and 39.4% (n = 13) were boys. The mean age of the girls and boys was 14.25+3.32 and 14.31+3.54 respectively, and the mean age of the whole group was 14.27+3.35. 39.4% (n = 13) of the cases consulted a doctor with the complaint of skin picking. In the remaining cases, skin picking behavior was detected during psychiatric evaluation. The mean time elapsed between the onset of skin picking behavior and referral to a physician of these 13 cases admitted with the complaint of skin picking was 15.62+5.42 months. Only six of the cases (18.2%) had lesions in one region. The remaining cases had lesions in multiple regions. The regions where the lesions were located were ranked as head-neck (face), hands, arms, legs, feet, torso and back according to the frequency order. In all cases, the mean age at the onset of complaints of skin picking was 12.15+3.02. In 66.7% (n = 22) of the cases, psychosocial stress factor was defined as the concurrent onset of complaints of skin picking. The first-degree relatives of 12 cases (36.4%) had a skin picking behavior. The first-degree relatives of 17 cases (51.5%) also had another psychiatric diagnosis other than skin picking. Two of the cases (6.1%) had mental retardation. Thirteen cases (39.4%) also had a concurrent nail biting. In addition, skin picking disorder was detected to be accompanied by depression in 30.3% (n = 10), anxiety disorder in 27.2% (n = 9), obsessive compulsive disorder in 12.1% (n = 4), trichotillomania in 9.1% (n = 3), attention-deficit/ hyperactivity disorder in 9.1% (n = 3), body dysmorphic disorder in 3% (n = 1) and autism spectrum disorder in 3% (n = 1) of the cases. Lesions were likely to require antibiotics in nine cases (27.2%). Lesion that will require surgical intervention was not detected in any of the cases. CONCLUSIONS: Skin picking disorder, one of the new diagnoses of DSM-5, is a disorder that can lead to serious problems if not treated. It was considered that knowing the clinical characteristics of the skin picking disorder are important for the clinical practice of physicians. It is also important to evaluate comorbid diagnoses in the cases admitted to the clinic with skin picking behavior. Considering that the comorbid diagnosis rate is high, it is useful to examine whether there is comorbidity or not, in any case when a skin picking disorder is detected.

Clinical characteristics and psychiatric comorbidity distribution in children and adolescents diagnosed with trichotillomania
İpek Perçinel Yazıcı and Kemal Utku Yazıcı Department of Child and Adolescent Psychiatry, Firat University, Elazig, Turkey ABSTRACT OBJECTIVE: Trichotillomania is a disorder characterized by repetitive hair pulling behaviors, resulting in significant hair loss. It is classified with obsessive compulsive disorder, hoarding disorder, skin picking disorder, and body dysmorphic disorder under the title of "Obsessive Compulsive and Related Disorders" in DSM-5. In this study, it was aimed to evaluate the clinical characteristics of children and adolescents diagnosed with trichotillomania admitted to Child and Adolescent Psychiatry Outpatient Clinic of Fırat University, School of Medicine. METHODS: The data of a total of 35 cases diagnosed with trichotillomania who were admitted to our outpatient clinic between January 2017 and September 2018 were examined retrospectively. SPSS 20 package program was used. RESULTS: Of the cases, 57.1% (n = 20) were girls and 42.9% (n = 15) were boys. The mean age of the girls was 14.0+2.57, the mean age of the boys was 12.2+3.17, and the mean age of the whole group was 13.2+2.93. In 51.4% (n = 18) of the cases, it was observed that the pulling behavior was in a single localization. The remaining cases had the pulling behavior in more than one area. The most frequent affected area was scalp, and this was followed by eyebrows and eyelashes. 48.6% of the cases (n = 17) had nail biting in addition to trichotillomania. The mean age at the onset of complaints was determined as 11.3 years. The mean time between the onset of complaints and referral to a physician was 11.5 months. The pulling behavior was determined to be mostly when studying, reading, being at the computer and watching television. The first-degree relatives of 11 cases (31.4%) also had hair pulling behavior. The first-degree relatives of 20 cases (57.1%) had another psychiatric diagnosis other than trichotillomania. These diagnoses were obsessive compulsive disorder, body dysmorphic disorder, depression, bipolar disorder, anxiety disorder, eating disorder, psychotic disorder, and skin picking disorder. In 21 cases (60.0%), psychosocial stress factor was defined as the concurrent onset of pulling behavior. Two of the cases (5.7%) were determined to have mental retardation. In addition, trichotillomania was detected to be accompanied by depression in 37.1% (n = 13), anxiety disorder in 25.7% (n = 9), obsessive compulsive disorder in 17.2% (n = 6), skin picking disorder in 8.6% (n = 3), attention-deficit/ hyperactivity disorder in 8.6% (n = 3), disruptive behavior disorder (n = 2) in 5.7%, body dysmorphic disorder in 2.9% (n = 1) and autism spectrum disorder in 2.9% (n = 1) of the cases. Trichophagia was not detected in any of the cases. CONCLUSIONS: Trichotillomania is a serious disorder that can significantly impair functionality if not treated. A clear description of the clinical characteristics of the disorder was considered to be highly important for the clinical practice of physicians. Due to the frequent comorbidity, it would be useful to arrange treatment by considering the comorbidities in evaluating the patients. Appropriate interventions applied during activities where the pulling behavior is frequent may reduce the pulling behavior. The association between ADHD symptomatology and the severity of addiction among patients hospitalized due to substance use disorders Samuray Özdemir a and Buse Şafak Müftüoğlu b METHODS: This cross-sectional study included 100 male patients hospitalized for a SUD and the diagnostic criteria for SUD were defined according to the DSM-V and ICD-10. The patients were determined on a voluntary basis and all of them read and signed the informed consent form. The severity of addiction is evaluated with the Substance Use Profile Index-Short Form (BAPI-K) and the sample group were screened using Adult ADHD Self-Report Scale (ASRS). In addition, the sociodemographic data were collected by using a questionnaire which is drawn up by the researchers. RESULTS: Overall, 100 male patients, in the age range of 15-54 years, were enrolled to the study. Opiates (n=64), cocaine (n=13), synthetic cannabinoids (n=14), cannabinoids (n=7), methamphetamine (n=1) and ecstasy (n=1) were identified as the substances which were being used by the patients prior to hospitalization. The 85% of the patients reported that they have started to use substance regularly before 24 years of age. The mean BAPI-K total score, which is defined as addiction severity, was 7,66 ± 1,30 and the mean ASRS total score was 32,00 ± 9,81 of the sample group. ASRS subscale's mean scores were found as 14,00 ± 6,13 for attention deficit and 19,00 ± 5,24 for hyperactivity/impulsivity, respectively. There was a statistically significant relationship between addiction severity and attention deficit (p<0.01), and also between hyperactivity/impulsivity (p<0.01) and ADHD symptoms (p<0.01). Addiction severity was significantly associated with work loss (p<0.01), marriage problems (p<0.01), aggression and destructive behavior (p<0.01), financial loss (p<0.01) and legal problems (p<0.01). CONCLUSIONS: The results of this study indicate that comorbid ADHD symptoms may increase the severity of addiction among the patients diagnosed with SUDs. Additionally, ADHD symptoms may be associated with early onset of SUDs. The results suggest that SUDs and ADHD comorbidity may related with negative outcomes such as work loss, marriage problems, aggression and destructive behavior, financial loss and legal problems. Even though the findings of this cross-sectional study cannot address the causal relationships between SUDs and ADHD; clinicians should take into consideration that there's a well-known higher rate of comorbidity between these two psychiatric disorders and earlier diagnosis and intervention of these disorders may prevent adverse social consequences among these patients. OBJECTIVE: Panic Disorder is characterized by recurrent and unexpected panic attacks, which severely affects quality of life of the patients. One of the methods used to assess autonomic nervous system function is heart rate variability (HRV). HRV is guided by parasympathetic and sympathetic cardiac nerves and reflects the capacity of inhibition of autonomic stimulation by the parasympathetic system. The time measurement method used in this present study is based on the analysis of the intervals (NN interval) between two consecutive regular pulses from the sinus node in the 24-hour holter electrocardiogram (ECG) recordings. The aim of this study was to evaluate HRV time domain parameters based on twentyfour hour holter ECG analysis among drug-naïve patients with panic disorder (PD) without any other medical and psychiatric comorbidity.

METHODS: The study was conducted between March 2016 and September 2016 at Erzurum
Training and Research Hospital. The study group consisted of 41 patients with PD and 46 healthy controls. Neurological diseases affecting the cognitive functions; cardiac or endocrinological disease (including DM); alcohol and / or substance intoxication or use disorder; any other psychiatric diagnosis; psychotropic medication use; benzodiazepine use or alcohol consumption in the last 24 hours; in the last two hours, using nicotine or caffeine was used as exclusion criteria. Participants were evaluated for any psychiatric diagnosis according to SCID-I. Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Panic Disorder Severity Scale (PDSS) and Clinical Global Impression Scale (CGI-S) were also applied to participants. Twentyfour hour Holter ECG outcomes were analyzed on a computer program and time domain parameters were evaluated. RESULTS: Sociodemographic characteristics such as gender, age, education level and marital status were compared and no significant difference was found between the two groups. While SDANN was found to be significantly higher in PD group (p <0.001); duration of RMSSD, NN50 and pNN50 were found to be lower in PD group than the control group (p = KEYWORDS Panic disorder; heart rate variability; spectral analysis; autonomic nervous system 0.003, p = 0.005, p = 0.047, respectively). In the correlation analysis, there was a moderate negative correlation between CGI-S and NN50 and pNN50. In logistic regression analysis, the increase in SDNN was found to increase the probability of PD by 1.11 times (95% CI, 1,010-1,209); the increase in SDANN was found to decrease the probability of PD by 0.892 times (95% CI, 0.818-0.973), and the increase in pNN50 was found to decrease the probability of PD by 0.523 times (95% CI, 0.342-0.801). CONCLUSIONS: Our results support the findings that there are some cardiovascular system characteristics in PD patients that are different from healthy controls.The data obtained in this present study confirm that there is a decrease in some HRV parameters reflecting parasympathetic activity among patients with PD. The reduced HRV observed in PD patients is also clinically relevant as it is also associated with an increased risk of cardiac disease and cardiac mortality. Long-term Holter studies are needed to assess the PD group's HRV value and autonomic functions in daily living conditions.

[Abstract:0353][PTSD]
The relationship between post-traumatic stress symptoms, symptoms that can cot be explained with other medical conditions and alexithymia among sexually traumatized women   relationship between PTSD, somatization and alexithymia in people who have experienced a traumatic event. People who suffer from sexual violence hide the incident because of shame, guilt, fear of getting harm, and fear of stigmatization. This may result in victims being deprived of medical and social assistance, having difficulties in maintaining their mental health problems or being exposed to unnecessary medical examinations and interventions due to many somatic complaints and frequent physician applications. The leading cause of frequent physician visits by victims of sexual violence is somatic symptoms that cannot be explained in spite of all medical examinations and investigations. The aim of this study was to examine the relationship between post-traumatic stress symptoms, symptoms that can not be explained with other medical conditions and alexithymia among sexually traumatized women over the age of 18. METHODS: The patients who were referred to Kocaeli University School of Medicine Department of Forensic Medicine with the request of the forensic report from the court between 01.12.2010 and 01.12.2013 were included in the study. Individuals aged 18 years and over who are literate and don't have psychoactive substance use or psychotic disorder and do not have medical disease to explain the mental and physical symptoms that not allow to have an interview were included in the study. The study group consisted of 30 sexually traumatized women and 30 women with no sexual trauma history as a control group. The participants were evaluated by Impact of Event Scale-R (IES-R), Symptom Checklist-R (SCL-90-R) Somatization Subscale, Functional Somatic Syndromes (FSS) List, The List of Mental Disorders Related with Somatization, Toronto Alexithymia Scale-20 (TAS-20). RESULTS: The mean scores of total and subscales of IES-R, SCL-90-R somatization subscale and the number of alexithymic individuals have been found significantly higher in sexually traumatized women group. In the correlation analysis, there was a statistically significant positive correlation between IES-R total score, IES-R re-experiencing and IES-R avoidance subscales and SCL-90-R somatization subscale and TAS-20. There was no statistically significant correlation between IES-R avoidance subscale and SCL-90-R somatization subscale and TAS-20. CONCLUSIONS: Relationship that we found between posttraumatic stress symptoms and the symptoms that can not be explaind with other medical conditions and alexithymia among sexually traumatized women is important to recognize and to treat posttraumatic stress symptoms in treatment seeking patients with the symptoms that can not be explaind with other medical conditions.

[Abstract:0355][Bipolar and Related disorders]
Dynamic thiol/disulphide homeostasis as a novel oxidative stress marker to differentiate bipolar and unipolar depression: a machine learning case study Gamze Erzin a , Güven Özkaya b , Canan Topçuoğlu c , Rabia Nazik Yüksel d , Özcan Erel e and Erol Göka d  There are significant differences in bipolar depression compared to unipolar depression, such as the addition of mood stabilizers to treatment, and the fact that many antidepressants are not preferred as the first option. This has led to the need for a biomarker to differentiate the two diseases. We aimed to compare thiol disulphide balance of bipolar disorder -depressive episode (BPD) and unipolar depression (UPD) with healthy controls to determine whether there is similarity of oxidative indicators in UPD and BPD. We also applied two different decision tree machine learning algorithms to find out if it is possible to classify these disorder with using data concerning thiol disulphide balance.

METHODS:
The patients who were admitted to our hospital and diagnosed either as depressive episode with bipolar disorder or unipolar depression according to DSM criteria were included in the study. A 5 cc of venous blood was collected from each participant. Blood cells were separated from serum and the samples were stored at -80°C. Thiol disulphide homeostasis were calculated. Using H2O artificial intelligence platform, distributed random forest and gradient boosting machine learning algorithms were used to analyze the data set using machine learning. RESULTS: 111 volunteers also participated in the study, 37 of them were patients with BPD, 24 of them were patients with UPD and 50 of them were healthy controls. There were significant differences in disulphide, disulphide/native thiol, disulphide/total thiol between the BPD and the control group, and between the UPD and the control group. Disulphide, disulphide/ native thiol, disulphide/total thiol were significantly higher in patients with BPD and in patients with UPD than the control group. No significant differences between BPD and UPD were detected in terms of disulphide level, disulphide/native thiol ratio, disulphide/total thiol ratio. In addition to this, both distributed random forest and gradient boosting algorithms were able to classify bipolar disorder and unipolar depression patients with 80% success rate. CONCLUSIONS: According to our knowledge, this is the first study concerning thiol/disulphide homeostasis in patients with BPD. The results may imply that thiol and disulphide levels could be considered as oxidative markers for BPD and UPD and also therapeutic targets in terms of future pharmacological trials. No significant differences obtained between UPD and BPD which may imply that there is a common oxidative damage in both disorders. Klotho is a transmembrane protein associated with lifespan and is mainly expressed in the kidney, parathyroid gland and choroid plexus. In addition, the klotho has brain-specific functions and its relationship with neuroplasticity has recently been on the agenda. As an important aging suppressor, Klotho's transmembrane form functions as a compulsory coreceptor for fibroblast growth factor 23 (FGF23, a bone-derived hormone that regulates the balance of phosphate, calcium, and vitamin D). Also, defects in Klotho or FGF23 lead to premature aging syndrome and phosphate retention. The Klotho gene (KL) has a KL-VS allele, and it has been shown that the heterozygous KL-VS gene is associated with higher Klotho levels, better cognitive functions, and longevity, whereas homozygotes are associated with worsening cognitive functions and shorter lifespan.
Vitamin D deficiency is known to be associated with a deterioration of cognitive functions. Klotho protein works together with vitamin D in calcium metabolism. According to recent studies, it was found that the vitamin D / PTH pathway and the Klotho / FGF23 pathway were related to each other. In particular, 1,25-dihydroxyvitamin D[1,25(OH)D2], the active form of vitamin D, increases the expression of klotho. Recent studies have focused on the relationship between neurodegeneration and Klotho, homocysteine and vitamin D levels. In this study, our aim was to examine this relationship in schizophrenia.

KEYWORDS
Aging; biomarker; homocysteine; klotho; schizophrenia; vitamin D METHODS: This study included 30 schizophrenic inpatients, 30 schizophrenic outpatients in remission and 28 healthy volunteers as the control group. The psychiatric diagnoses of our patients were evaluated according to DSM-IV criteria. The Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression (CGI) scale and the Global Assessment of Functioning (GAF) scale were used for clinical measurements. Serum Klotho, vitamin D, homocysteine, vitamin folic acid and B12 levels were analysed using ELISA and compared with the clinical properties. RESULTS: The PANSS scores and CGI scores were significantly higher in schizophrenic inpatients than outpatients, and the GAF scores were significantly lower (p<0.05). Three groups: acute schizophrenia, remission group and control group were compared for Klotho, homocysteine and vitamin D serum levels; Klotho levels were higher but the difference was not statistically significant (p>0.05). However, vitamin B12, folic acid and homocysteine levels were higher in schizophrenic patients than the control group (p<0.05). CONCLUSIONS: High levels of vitamin B12 and folic acid accompany high homocysteine levels and this association shows the relationship of schizophrenia with this pathway. Higher levels of homocysteine with concomitant higher levels of vitamin B12 and folic acid suggest a relationship of this pathway with the related pathways with schizophrenia. Differences in Klotho levels were found but it was not significant. Further studies are needed to examine possible relationships with larger samples. METHODS: 17 volunteers who are psychology students and psychiatry residents were included in the study. Pre-session PCL-5 and Olaylatin Effect scales were applied to all volunteers. 30minute Flash Technical application was done. At the end of the first week and at the end of the first month, the scales were repeated. RESULTS: The decline in psychological trauma complaints of a single session Flash Technique group was statistically significant. CONCLUSIONS: Unlike trauma therapies, Flash Technique, which is thought to treat trauma without being subjected to trauma, is a very ambitious practice. In this present study, we have seen that this practice can be performed safely on the group and without questioning the traumas. Controlled studies are needed to observe the difference of this effect from placebo and other treatments. Grouping of rats according to the prepulse inhibition (PPI) which is the biological marker of schizophrenia and the differences in response of groups to pharmacological agents groups can give different responses to pharmacological agents (apomorphine, amphetamine, MK-801, scopolamine, nicotine, caffeine) which have a role in the etiology of schizophrenia. METHODS: Male Sprague Dawley rats (250-350 g) were used in the experiments. In each experiment, PPI values were measured in 24-40 rats by the startle reflex measurement device. Rats were sequenced from the lowest inhibition to the highest inhibition according to the inhibition values given to 78 dB pre-stimulus. 'Low group (n=8)' and 'high group (n=8)' were determined. Pharmacological agents that have a role in the etiopathogenesis of schizophrenia were injected to the groups which have statistically significant difference. To examine the effects of pharmacological agents on the groups, apomorphine (0.5 mg/kg and 1 mg/kg), amphetamine (4 mg/kg), MK-801 (0.05 and 0.15 mg/kg), scopolamine (0.4 mg/kg), nicotine (1 mg/kg) and caffeine (10 mg/kg and 30 mg/kg) were used. The t-test was used to compare the results from these two groups. RESULTS: PPI values of the rats grouped as 'low' and 'high' inhibition were measured at intervals of one week and it was observed that the significant difference between the groups continued in the 3rd week. While apomorphine, MK-801, scopolamine and nicotine disrupt the PPI values at high group, amphetamine had a lowering effect on PPI in both low and high groups. Both doses of caffeine had a decreasing effect in the high group, whereas in the low group, 10 mg/kg dose increase PPI levels. CONCLUSIONS: The reduction of PPI values with pharmacological agents is considered to be the disruption of PPI and this disruption is accepted as an experimental schizophrenia model. Studies are performed using pharmacological agents on this model. However, given that the low PPI value is considered to be one of the biological and endophenotypic marker, the subjects can be separated according to basal PPI values as 'low inhibition' for disrupt sensorimotor gating and as 'high inhibition' for normal or good function. Again, groups give different responses to the pharmacological agents that support the important hypotheses of the etiopathogenesis of schizophrenia. Our findings show that it is possible to create an endophenotypic model by experimental grouping according to basal PPI values besides pharmacological schizophrenia model. Using this model, antipsychotic effects of a newly developed molecule or drug can be evaluated.

Mean platelet volume in adolescents with bipolar disorder
Nihal Yurteri a and İbrahim Ethem Şahin b a Department of Child and Adolescent Psychiatry, Düzce University, Düzce, Turkey; b Department of Medical Biochemistry, Düzce University, Düzce, Turkey ABSTRACT OBJECTIVE: It has been revealed by recent research that there is a relationship between Bipolar Disorder (BD) inflammatory responses (1,2). It is suggested that there is a mild increase of inflammation during the episodes and even in remission (2). In this study, we examined MPV values of adolescents in BD manic episode as an inflammation marker with respect to healthy controls. METHODS: In this retrospective study about MPV among BD adolescents, we compared blood count in terms of platelet count (PLT) and MPV values of 21 BD manic episode diagnosed adolescents with age and gender matched 30 healthy controls. Measures of age, MPV and PLT in adolescents with BD and control subjects were compared by using two-tailed t-test. RESULTS: The mean age of adolescents was (195,3 ± 12,9 month) in the case group and (200,5 ± 15,2 month) in the control group. MPV values were found to be significantly higher in adolescents with BD (p = 0.002). There was no significant difference between the PLT values of the case and control groups (p = 0.199). CONCLUSIONS: We found that mean platelet volume (MPV), a marker of platelet activity and inflammation, was significantly elevated in adolescents with BD manic episode compared to healthy controls. Our results are consistent with the literature and support the hypothesis that there is an increase in inflammation in adolescents with BD. Further studies are needed and may provide a new dimension to the treatment.   The age range of the patients was 3-17 years and the mean age was 13.2 ± 3.6 years. 147 (80.3%) of the cases were female and 36 (19.7%) were male. The most common type of sexual abuse reported by the victims was sexual penetration (41.5%). It was found that 57.9% of the cases were abused once. 79.2% of the cases were found to be familiar to the abuser. 59% (n = 108) of the patients had psychiatric disorder after abuse.
The psychiatric comorbidity rate was found as 17.5%(n=31).The rate of OSD was found as 66.7%, ADHD 29.5%,CD 21.0 %, encopresis 14.3%, enuresis %7.7 and depression 2.3%.İn İD cases OSD, ADHD,CD comorbidity was found statistically significant higher than cases without İD diagnoses (p<0.005). 51.9% have neurological disorder and 29.9% have medical problems.. İD,ADHD,speech and language delay were most seen related diagnosis with preterm birth(%25.3) and low birth weight (25.4%). CONCLUSIONS: Cerebral palsy and MR were seen together.37-71% of the children with cerebral palsy have an accompanying İD (2). Similar to previous studies in this present study; 51.9% of İD patients having also neurological disease (p <0.001).The preterm children have both lower processing rate and academic achievement so that it was found that İQ scores were lower than healthy children (3). İn this present study, the preterm delivery and low birth weight was higher.Low birth weight, hypoxic ischemic encephalopathy, prematurity, infections and multifactorial states are etiologic risk factors for neurodevelopmental disorders such as ADHD, OSD, Learning Disorder(4). İD is a chronic disorder that effects throughout life.The delivery complications were seen higher and and a risk factor for nerodevolepmental disorders. Early diagnosis and treatment of comorbid conditions is essential to increase the functioning and quality of life in İntellectually disabled children. According to our knowledge Diagnostic Interview for ADHD in adults (DIVA-2.0) is the only diagnostic interview translated to Turkish and used in Turkey. DIVA-2.0 had been validated only in Swedish and Spanish. This study aims to examine the psychometric characteristics of DIVA-2.0 in a sample of ADHD patients to demonstrate the validity and reliability in Turkish language. METHODS: 272 patients were included to study. The criteria for inclusion in this study included being between the ages of 18-65, being treatment-naive for ADHD medications and having cognitive competence to complete the study. ADHD diagnosis were conducted according to KEYWORDS ADHD; DIVA; adult ADHD; validity DSM-5 ADHD criteria. One hundred and fifty eight (% 62.2) participants met the criteria for ADHD following the interview, whereas ninety-six (% 37.8) patients who did not meet the criteria for ADHD constituted the 'non-ADHD group'. The study was approved by Zeynep Kamil Hospital Ethics Committee in 23/05/2018. All participants were informed about the study. RESULTS: The scale, item total score correlation coefficients were found to vary between 0.29 and 0.76. All the items total score correlation coefficient except one (Adulthood Hyperactivity/ impulsivity item-1: 0.298) were found to be higher than 0.52. Cronbach alpha internal consistency coefficients were calculated as 0.888, 0.901, 0.890 and 0.819, for childhood inattentive, adulthood inattentive, childhood hyperactivity/ impulsivity and adulthood hyperactivity/ impulsivity, respectively. These values show that the internal consistency of DIVA 2.0 is high. Factor analysis was conducted to examine the construct validity of DIVA 2.0. Suitability of the data for factor analysis was examined, the sample size was found to be appropriate, and it was concluded that there was sufficient relationship between the variables to perform factor analysis (Kaiser-Meyer-Olkin sampling adequacy coefficients: 0.925, 0.921, 0.923 and 0.899, respectively and the Bartlett sphericity test-Chi Square values 964.514, 1123.465, 968.757 and 672.209, respectively, and p <0.001). The Principal Component Analysis was applied to the correlation matrix obtained from the DIVA 2.0 items and a factor greater than eigen value 1 was obtained for each scales. These factors accounts for 53.1%, 56.1%, 53.3% and 44.7% of the scales, respectively. As a factor has been obtained after the initial analysis in factor analysis, no other methods of analysis have been undertaken. Factor values of the items are presented in table 2. Values range was from 0.38 to 0.82. CONCLUSIONS: DIVA-2.0 is available in 19 languages, however it has not been validated in Turkish. These values show that the internal consistency of DIVA 2.0 is high. In conclusion, the results of this study demonstrate that the DIVA 2.0 instrument can be used in Turkish population with acceptable psychometric properties for the diagnose of ADHD in adults.

Özge Gizli Çoban, Arif Önder and Aslı Sürer Adanır
Department of Child and Adolescent Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey ABSTRACT OBJECTIVE: Enuresis and encopresis are common childhood problems related to the absence of bladder or bowel control that is expected based on the child's age or developmental status. Both conditions are very distressful to children and their family members and have significant social and psychological consequences in children and adolescents. Some studies have found elevated rates of internalizing problems,externalizing behaviors and attentional difficulties in children with elimination disorders. In this study, it is aimed to evaluate emotional and behavioural problems of children with elimination disorders(ED). METHODS: 70 children and their mothers included in the study. The inclusion criteria were admission to the child and adolescent psychiatry outpatient clinic with a complaint of incontinence and diagnosis of ED; lack of medical causes of incontinence; volunteering for participation; and being aged of 5-18 years. The diagnostic procedure included clinical interview by a certified child psychiatrist, with the child and mothers, and filling out DSM-based specific ED criteria. A sociodemographic information form was handed out to participants. Mothers were given Strength and Difficulties Questionnaire(SDQ)-Parent Report Form to assess patient's emotional and behavioural problems. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL) was applied to participants to assess any psychiatric comorbidity. SPSS 20 was used for statistical analysis. Chi-square was used for categorical data. Because the scale scores of the groups didnt show normal distribution, Mann Whitney U was used. p<0,05 was accepted statiscally significant. RESULTS: Participants were divided 3 groups as; enuresis, encopresis and comorbidity of enuresis and encopresis. Upon the comparison of sociodemographic characteristics of group members, no significant difference was found among the groups. Constipation was found significantly lower in enuresis group(p<0,001). No significant difference was found between groups in terms of diagnosis rate according to K-SADS(P=0.056). According to SDQ results, no significant difference was found between groups in terms of hyperactivity/ inattention, conduct problems, peer relationship problems, prosocial behaviour and emotional symptoms. CONCLUSIONS: Some studies have found elevated rates of internalizing problems, externalizing behaviours and attentional difficulties in children with elimination disorders, whereas others demonstrated no significant differences when compared to controls. In this present study, no significant difference was found between the 3 groups in terms of emotional and behavioural problems. The present study has several strengths and limitations. Firstly, this must be notable that the absence of a control group was major limitation of this present study. More studies with large samples, including control groups should be carried out.

KEYWORDS
Children; encopresis; enuresis OBJECTIVE: Substance use disorders (SUD) are very common in the whole world and affect people with their biopsychosocial environment. It has been observed that personality traits are defined as negative and inconvenient in the individuals using substance in the studies about whether personality characteristics are a risk factor for SUD. It is known that negative personality traits are associated with the risk of starting alcohol and substance use at an early age, non-compliance with treatment and the risk of not being treated. In this present study, we aimed to compare the sociodemographic and substance use characteristics of the patients diagnosed with opioid use disorder (OUD) according to their personality profiles. METHODS: The study included 33 male patients who were inpatient at the Pamukkale University School of Medicine, Psychiatry/AMATEM Department. Sociodemographic data form prepared by our clinic and The Minnesota Multiphasic Personality Inventory (MMPI) were applied to the patients. RESULTS: 33 male patients with OUD were included in this present study. The mean age was 23.1 ±4.5 (18-39) years. 21.2% of the patients were married (n=7) and 78.8% were single (n=26). 57.6% (n=19) of the patients were graduated from primary school, 39.4% (n=13) of the patients were graduated from high school and 3.0% (n=1) of the patients were graduated from university. 45.5% (n=15) of the patients were still working.The age of onset of substance use was 17.8±3.9 (13-28), duration of drug use 5,2±2,5 (1-12) years however, 57.6% (n=19) and 42.4% (n=14) were using the substance through inhalation with the use of foil and intravenous injections, respectively. 21.2% (n=7) of the patients had an additional axis I diagnosis, 12.1% diagnosed with attention deficit and hyperactivity disorder (ADHD), 3.0% diagnosed with anxiety disorder, 3.0% diagnosed with psychotic disorder and 3.0% diagnosed with both ADHD and depressive disorder. While 57.6% (n=19) of the patients' hospitalization were the first time; 42.4% (n=14) of them had also a history of admission. The mean duration of hospitalization was 30.5±11.8 (5-55) days. 60.6% (n=20) of the patients were discharged after completion of treatment and 39.4% (n=13) did not complete the treatment due to various reasons (refusal of treatment, noncompliance with treatment). No significant difference was found between the substance use and treatment compliance according to the MMPI subscale scores. According to MMPI subtest scores, the paranoia subtest scores were found to be significantly higher in the first hospitalization group than the group had a history of previous hospitalization (p=0.037). Hypochondriasis subtest scores were found to be significantly higher than those with a history of previous hospitalization (p=0.048). There was a weak negative correlation (r=-0.347, p=0.04) between the age of onset of substance use and psychopathic deviation with subtest scores. CONCLUSIONS: The presence of psychopathic-antisocial features was found to be compatible with the literature, which could increase the risk of earlier age of onset of substance use. Considering the low rates of treatment for SUD, the assessment of personality can be important in predicting substance use risk and planning treatment in the light of personality traits, since it is the main target in combating SUD. Sleep habits of children diagnosed with attention/ deficit/ hyperactivity disorder and effects of treatment on sleep-related parameters: methylphenidate vs. atomoxetine Çiğdem Yektaş a , Ali Evren Tufan b and Enes Sarıgedik a a Duzce University; b Acıbadem University ABSTRACT OBJECTIVE: Sleep problems are known to be more prevalent among children diagnosed with ADHD. Those problems include higher levels of resistance at bedtimes, delayed settling to sleep, frequent awakenings during the night, higher apnea/ hypopnea indices and day time sleepiness. Psychostimulants have been reported to delay sleep onset, reduce total sleep duration and suppress non-REM cycles in ADHD children although there are other studies reporting no significant effects. As for atomoxetine, which is a non-stimulant widely used in treatment of ADHD, some of the studies report somnolence as an adverse effect while others report no significant disruption in sleep parameters in children using this agent.
Therefore, the primary aims of this study were; a) to evaluate the baseline sleep habits of treatment-naive children with ADHD applying to the outpatient clinics of Child Psychiatry department of a tertiary treatment center b) to evaluate the effects of treatment with methylphenidate and atomoxetine on sleep parameters. METHODS: Sixty-two treatment naive children with clinically normal intelligence capacity diagnosed with ADHD according to DSM-5 criteria [APA 2013] and K-SADS-PL-Turkish who gave verbal assent and whose parents provided informed consent were enrolled in the study. Treatment compliance (according to pill counts), receiving treatment for at least three KEYWORDS Attention deficit/ Hyperactivity Disorder (ADHD); Atomoxetine; children sleep habit questionnarie (CSHQ); Methylphenidate; sleep parameters months, lack of general medical disorders requiring treatment (according to pediatric consultations), lack of primary sleep disorders (according to clinical interview and pediatric neurology consultation) were criteria for inclusion. Children were treated naturalistically with methylphenidate formulations (ATC: N06BA04).Both MPH and ATX treatments were started at 0.5 mg/ kg/ day and titrated weekly to a maximum of 1.2 mg/ kg/ day. Parents completed Children Sleep Habit Questionnarie (CSHQ) at baseline and at the end of treatment. Clinicians blinded to treatment status also scored the CGI-Severity and CGI-Improvement scales. RESULTS: Regardless of treatment choice, both MPH and ATX reduced symptom severity of ADHD, in all domains (i.e. inattention and hyperactivity/ impulsivity) with similar effect sizes [33].Treatment-related adverse effects and improvement according to clinician evaluations were similar When a score of ≥ 41 in CSHQ was used for cut-off 93.5 % of children with ADHD (n=58) had clinically significant sleep problems at baseline. At baseline, CSHQ scores of children receiving ATX were similar to those receiving MPH except daytime sleepiness (Mann-Whitney U test, Z= -2.3, p= 0.03, Effect size, r=0.29). After treatment, rate of children with clinically significant sleep problems were found to be 83.9 % (n= 52). Both MPH (Z= -4.8, p=0.000) and ATX (Z= -2.8, p=0.005) significantly reduced total CSHQ scores with similarly large effect sizes (0.7 for MPH vs. 0.8 for ATX). CONCLUSIONS: ATX treatment in children with ADHD significantly reduced parasomnias and daytime sleepiness with a large effect size. Respectively. MPH treatment in this sample significantly improved all domains of sleep except delayed sleep onset and sleep-disordered breathing with moderate effect sizes. Studies using standardized dosing and treatment schemes with longer treatment durations and using both Objective and subjective (i.e. sleep diaries, CSHQ etc.) measurements may clarify differential effects of treatments on sleep among children with ADHD. In schizophrenia treatment, clinicians have difficulties to manage treatment resistance and non-adherence that result in relapses, severe clinical course, rehospitalizations and functional disabilities. In this study, we aimed to assess the clinical management of anti-psychotic treatment in patients with schizophrenia with moderate and severe clinical course. METHODS: This was a retrospective study carried out in a University Hospital in Turkey. The data of patients with schizophrenia who were followed up at the Community Mental Health Center or hospitalized at the Psychiatry Clinic between January and September 2018 were recruited to the study. Inclusion criteria were as having 4 or higher scores at the Clinical Global Impressions Severity Scale (CGI-S), non-adherence to drug treatment, relapsing a psychotic episode, changing the antipsychotic treatment due to insufficient response and having the clinical assessment data for the analysis.Sociodemographic data, scores of the psychopathology assessments [The Clinical Severity Scale (CGI), Negative and Positive Symptoms Assessment Scales (SANS, SAPS) and Brief Psychiatric Rating Scale (BPRS)] before and after the drug treatment change during study period were recorded. The scores of the clinical scales at the onset and after 8 to 12 weeks after the treatment intervention were enrolled. RESULTS: There were 215 patients who had 4 points or higher at the CGI-S scale and available hospital records both before and after the antipsychotic treatment. Table 1 summarizes the sociodemographic characteristics, duration of the disease, and the antipsychotic treatment of the patients. Assessment of the sociodemographic data revealed that there were no significant differences between the treatment groups in terms of age, gender, and duration of the disease (p>0.05). According to the documented and available data of the patients, 113 of the patients (40.1%) were treated with a combination of depot and oral antipsychotics and it was the most common use of antipsychotic treatment. The second common use of antipsychotic therapy was long acting depot antipsychotic treatment and 35 patients (12.8%) were followed up with only intramuscular depot injections. Table 2 shows the SANS, SAPS scores before and after the antipsychotic therapy via ANOVA. All of the groups showed significant clinical improvement at the SANS, SAPS and BPRS scales after the antipsychotic therapy (p=0.000). CONCLUSIONS: It was remarkable that combination treatments were common in the patients with schizophrenia with moderate and severe clinical symptoms. Although antipsychotic monotherapy is recommended in most of the treatment guidelines of schizophrenia, KEYWORDS Schizophrenia; combination treatment; clozapine; longacting injection common use of antipsychotic combinations were also reported in many previous studies. The negative and positive symptoms were more severe in the patients on clozapine, and twentythree percent of the patients were followed up with clozapine as a single drug or in a combination. That indicates proper use of clozapine in treatment resistant patients in this study. The approach of using long acting depot injections is getting more common in the clinical practice to avoid treatment non-adherence of the patients. Finally, the outcomes of that study was consistent with the current literature, and necessity of the use of combined treatment should be inquired in future studies.

[Abstract:0405][ADHD]
Sluggish cognitive tempo is associated with autistic traits and anxiety disorder symptoms in children with ADHD   scores was statistically significant in schizophrenia patient relatives (p = 0.04). The relationship between the burden of the relatives of schizophrenia patients and the MPSSS scores was statistically significant (p = 0.04). The relationship between the burden of the relatives of schizophrenia patients and the GHQ results was statistically significant (p=0.03). A dominance of female caregivers was found in the study. A negative correlation was found between social support and burden in the caregivers of patients with schizophrenia. CONCLUSIONS: The results of this study underline the importance of social support in alleviating the burden of the caregivers of schizophrenia. The monitorization of the psychological states of caregivers of the schizophrenic patients has to be taken into consideration.
[ METHODS: Fortythree patients with schizophrenia and 39 age and sex-matched healthy controls were included in this cross-sectional study. Patients with diabetes mellitus, hypertension, cardiovascular disease, mental retardation or an ophthalmological disease that could affect the OCT-A measurements were excluded from the study. Schizophrenic patients were evaluated with Positive and Negative Syndrome Scale (PANSS) for the severity of the disorder on admission. Retinal microvascular network was evaluated with OCT-A (Optovue, Inc., Freemont, CA) at the macula and optic disc and the OCT-A findings were compared between the groups. RESULTS: The mean age of patients with schizophrenia was 37.6±1.0 and the mean age of healthy controls was 41.3±9.3. In the schizophrenia group; the mean disease duration was 8.3 ±6.4 years and mean total PANSS score was 60.5±35.6. The foveal retinal thickness was significantly lower in schizophrenia patients ( 245.1±23.8 vs 256.1±19.5, p=0.03). Retinal vascular density at the superficial and deep capillary plexuses, foveal avascular zone area, foveal avascular zone perimetry, acirculatory index and non-flow area were similar between the groups. The capillary vessel density within the optic disc was significantly lower in patients with schizophrenia (46.6±4.9 vs 49.1±5.2, p=0.03). Retinal nerve fiber layer thickness showed a moderately negative correlation with disease duration (r=-0.41, p=0.006). No significant correlation was found between the PANSS score and OCT-A measurements. CONCLUSIONS: The present study showed that the capillary density within the optic disc was reduced in patients with schizophrenia. This finding supports the previous studies that found that retinal microvascular changes could serve as a proxy marker for liability to psychosis symptoms. Further studies with a longitudinal follow-up are required to evaluate the role of OCT-A in schizophrenia research. While the age at admission to the clinic was decreased, the application of families have a low level of education had increased. The referral to the clinic for consultation was increased.
Although the most common complaints were similar between groups, the rate of normal psychiatric examination, attention deficit and hyperactivity disorder, and oppositional defiant disorder were increased; while the rate of any speech disorder was decreased. Autism and developmental delay rates were similar. The rate of offering pharmacological agent treatment has increased from 14.1% to 22.9%. In earlier group, most frequently prescripting pharmacological agents were risperidone (36.3%), thioridazine (26.4%), fluoxetine (13.2%), in late group risperidone (76.9), fluoxetine (14.1%) and methylphenidate (4.8%) were most frequently prescripting agents. The prescription of risperidone was found to be significantly increased among the groups. There was no difference between the rates of fluoxetine or methylphenidate prescription. CONCLUSIONS: The results of this study suggest decreasing the prejudices against psychiatric science and raising acceptance of possible psychiatric disorders by a wider population of society. İncreasing rating of diagnosing as attention deficit and hyperactivity disorder and oppositional defiant disorder may be explained by increasing sensitivity to the psychiatric disorders by society depending on increment expectation of adaptation to the rules of collective life in this age group. While the rate of referral with the speech problem remained unchanged, decreasing of diagnosing with any speech disorder indicates families to be more sensitive to deviations which are variants of normal depending on the increasing psychiatric awareness. Remaining unchanged of the rate of developmental delay or autism extension disorders can be explained by forcing severe psychiatric disorders the parents to seek help at all times. Despite similar efficacy, more acceptable side effect profiles raise preferabilities of atypical antipsychotics. It is a striking and thought-provoking finding of this study is that one of the most commonly used agents in preschool children 15 years ago is not used today. Considering the average human life and time of risperidone in use we may say this agent is quite new. When all of these issues are considered, it is clear that it is needed to followingup of patients treating by these agents meticulously, runing long-term and large-sample studies, and increasing cumulation of literature on these agents for this age period.
It is truth that developing psychiatry science will continue to affect us about psychiatric disorders. The psychopharmacological treatment strategies applied on rapidly developing brain are also affected by these developments. Therefore it should be accepted that evidence for these agents needs to be expanded. The clinical and psychosocial correlates of ADHD subtypes in adolescence are not completely identified. Problematic internet use is highly common in adolescents, especially those with ADHD. This study aims to examine the possible association between ADHD subtypes and problematic internet use in adolescents. METHODS: A total of 98 adolescents (mean: 14.1 years,73.5% male) with a documented DSM-V ADHD diagnosis were included. ADHD subtypes, including the proposed restrictive subtype, were diagnosed based on clinical interview, parental reports and teacher reports. To assess the severity and types of problematic internet use; Young's Internet Addiction Scale (IAS), Digital Game Addiction Scale (DGAS) and Facebook Addiction Scale (FAS) were administered to the sample. RESULTS: 43 adolescents (43.9%) had ADHD combined (ADHD/C), and 55 (56.1%) had ADHD predominantly inattentive (ADHD/I) subtypes. Among those with (ADHD/I), 22 (40%) had met the proposed restrictive subtype (ADHD/R) criteria. The total score of IAS was signficantly higher in adolescents with ADHD/I when compared to those with ADHD/C (mean: 51 vs. 45, p<0.05). 38.8% of the adolescents with ADHD/I had a DGAS score indicative of game addiction, while the same frequency was 25.5% in those with ADHD/C (p<0.05). There was no significant difference regarding the FAS total score between the suybtpe groups. No significant associations were found for ADHD/R. KEYWORDS ADHD; subtypes; internet use; adolescents CONCLUSIONS: When compared to those with ADHD/C, adolescents with ADHD/I had a higher frequency of problematic internet use. ADHD/I is specifically associated with digital game addiction but not facebook/instagram addiction. In light of these findings, it may suggested that the management of internet addiction may differ between adolescents with ADHD/I and ADHD/C. Future studies are needed to clarify the correlates of internet addiction in adolescents with ADHD.
[Abstract:0419] [ADHD] Is there a relationship between inflammation and ADHD? CONCLUSIONS: When compared to those with ADHD/I, adolescents with ADHD/C had a worse performance on WSCT. Given that adolescents with ADHD/C had poorer executive functions, they may need specialized interventions for academic skills and daily life. ADHD/R and SCT symptoms did not appear to be associated with a specific executive functioning profile. Future studies with larger sample sizes are needed to clarify the possible impact of ADHD/R and SCT on executive functions.

[Abstract:0445][Others]
The relationship of peer bullying with familial expressed emotion and psychopathology Neslişah Gür a , Şafak Eray a , Ayşe Pınar Vural a and Deniz Sığırlı b a Departmant of Child and Adolescent Psychiatry, Uludag University, Bursa, Turkey; b Departmant of Biostatistics, Uludag University, Bursa, Turkey ABSTRACT OBJECTIVE: Peer bullying (PB) is defined as "one or more students constantly behaving negatively towards another student". For an action to be considered as bullying, it must be intentional and intended to cause harm, be repetitive and there must be power inequality between the bully and the victim. In addition, the relationship between peer bullying and family attitudes of children and young people has been reported. However, it is not clear whether this relationship is a direct cause for peer bullying or it causes peer bullying by creating psychopathology. The aim of this study was to examine the prevalence of peer bullying among the 5th, 6th, 7th, and 8th grade students in the city of Bursa and to multidimensionally determine the accompanying factors. The long-term aim of the study was to conduct a prestudy for developing a protective program for the case of peer bullying. METHODS: The sample of the study consisted of 5th, 6th, 7th, and 8th grade students, and the students were divided into four groups as victim, bully, bully-victim and no peer bullying. In the study, a personal information form prepared by the researchers, the "Olweus Bullying Questionnaire", the "Strength and Difficulties Questionnaire" and the "Shortened Expressed Emotion Scale" were used as data collection tools. The statistical analysis of the data was done with IBM SPSS Statistics Version 23.0. RESULTS: The sample of the study consisted 856 students. When the study groups were compared in terms of sub-scales, behavioral problems and emotional problems were significantly higher in both the bully and the victim groups, while prosocial behaviors were found to be significantly less in these two groups. However, teenagers, who were a victim or a bully, were found to perceive their families significantly less emotionally supportive and intrusive compared to their peers who were not. The perception of the family as intrusive (p=0.005) increased the chances of being a victim by 1.042 times, experiencing emotional problems (p=0.002) by 1.161 times and peer problems (p=0.040) by 1.147 times. Experiencing behavioral problems (p=0.043) increase the chances of being a bully by 1.330 times. Intrusiveness (p<0.001) increase the chances of being a bully-victim by 1.075 times, the lack of emotional support (p=0.044) by 1.030 times, emotional problems (p<0.001) by 1.301 times and peer problems (p=0.027) by 1.268 times. Increased prosocial behaviors (p=0.027) decrease the chances of being a bully-victim by 1.219 times. CONCLUSIONS: In this present study, the effects of the perceived family climate and psychopathology on peer bullying was analyzed. Considering the place of family climate in the etiology of psychopathology, it was thought that this effect might be caused through psychopathologies. The findings showed the importance of family climate in peer bullying. For this reason, the necessity of therapeutic interventions protecting the mental health of individuals in the reduction of peer bullying and developing family-based protection methods besides the existing school-based protection methods were considered. Clinical use of transcranial magnetic stimulation in children and adolescents: a retrospective chart review

Mine Elagöz Yüksel
Üsküdar University, Istanbul, Turkey OBJECTIVE: Transcranial magnetic stimulation (TMS) is one of the noninvasive brain stimulation techniques used for the treatments of neurologic or psychiatric disorders. During a TMS procedure a coil is placed on the targeted region of the scalp, in which an electric current flow and produces a magnetic field. The magnetic field stimulates nerve cells which results in improving of symptoms. There are different types of TMS: Single pulse, paired-pulse, Repetitive TMS and theta burst. Transcranial magnetic stimulation is commonly welltolerated. The most common side effects are headaches and scalp discomfort. Low-frequency stimulations (≤ 1 Hz) results in cortical inhibition and high frequency rTMS (≥ 5 Hz) results in cortical activation. Clinical uses in child and adolescent psychiatry practice are depression, eating disorders, psychosis, bipolar disorder, tics. METHODS: The charts of the patients treated with TMS in the child and adolescent department of NP Istanbul Brain Hospital were retrospectively reviewed. The side effects were recorded. To assess the efficacy of TMS, the changed scores of scales were recorded. Hamilton Depression Rating Scale was used for depression. Yale-Brown Obsessive-Compulsive Scale was used for obsessive compulsive disorder. RESULTS: Transcranial magnetic stimulation is generally safe and well tolerated in children and adolescents. Some patients with autism spectrum disorders could not tolerate the procedure mainly because of its loud noise. One patient aged 13 underwent deep TMS for her eating disorder. The TMS was found to be effective in depressive disorders and autism spectrum disorders. CONCLUSIONS: There is a need for further studies of TMS as a therapeutic intervention.

Fatih Hilmi Çetin and Serhat Türkoğlu
Selçuk Üniversitesi Tıp Fakültesi Çocuk-Ergen Psikiyatri Anabilim Dalı ABSTRACT OBJECTIVE: Attention-deficit/ hyperactivity disorder (ADHD) is a commonly diagnosed psychiatric disorder in the childhood and it has been suggested that both environmental and genetic factors take place in the etiology. Therefore, it is important to determine metabolic and endocrine abnormalities. MOXO test, which is a recently developed continue performance task (CPT) test that incorporates distractors during continous performance is shown to be more specific in detecting domains that are affected in ADHD. The aim of this study was to assess how the different domains (attention, hyperactivity, impulsivity and timing with/without visual/auditory distractor(s)) of d-CPT (distractor incorporated CPT) MOXO test change with levels of biochemical markers such as vitamin B12, folic asid, vitamin D, TSH, ferritin, serum iron and total iron-binding capacity. METHODS: Thirty-one children with ADHD were included in the study between time period December 2018 -January 2019. The subjects were administered the Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) to confirm their diagnosis. All cases were diagnosed with ADHD-combined type and drug-naïve patients. d-CPT MOXO test were administered before medical treatment. RESULTS: This study included 31 children age between of 6-14 years (mean age 9.06 ± 2.39) with ADHD whose 87.1% were boys (n=27) and 12.9% of children (n=4) were girls. There was a significant positive correlation between serum iron and timing with combined distractors (r=0,369, p=0,041); a significant negative correlation between total iron-binding capacity and timing without distractors (r=-0,375, p=0,037), with auditory distractors (r=-0,356, p=0,049) and with combined distractors (r=-0,368, p=0,040). Likewise, a significant positive correlation between serum ferritin and timing without distractors (r=0,370, p=0,040) and with auditory distractors (r=0,367, p=0,042); and also between serum ferritn and attention domain with visual distractors (r=0414, p=0,021), with auditory distractors (r=0,533, p=0,002) and with combined distractors (r=0,417, p=0,020) were found. CONCLUSIONS: In this study, it was determined that serum ferritin, iron and total iron-binding capacity level were correlated with timing and attention domains of d-CPT MOXO test. It was understood that serum iron parametres should be evaluated before treatment for optimal treatment response. Iron deficiency which is known to have important roles on neurocognitive functions are frequently accompanies with ADHD in childhood. According to results of this study, iron parametres is more related with attention and timing functions with respect to hyperactive/impulsive domains; it is suggested that iron metabolism considered to have more important effects on symptoms related with attention and processing speed.

KEYWORDS
Attention-deficit/ hyperactivity disorder; ferritin; d-CPT MOXO; biochemical markers; iron; children age at diagnosis of 251 ASD patients was 3.6 years. Of all patients, 83.6% (n = 353) were male, and 6.2 % (n = 26) were from foreign nationalities. It was determined that 42.4% (n = 179) of the sample consisted of cases diagnosed with OSD for the first time. It was found that approximately 1/3 of the cases (n = 153) admitted for renewal of their ASD health committee report, about 1/3 (n = 137) had speech retardation and the remaining 1/3 admitted for other reasons.
16.1% (n = 68) had at least one medical disorder that the most common was epilepsy with a rate of 8.9% (n = 38). In 52.6% (n = 222) of the patients with ASD, there was no other accompanying psychiatric disorder, while 47.4% (n = 200) had at least one comorbid psychiatric disorder. Among these psychiatric comorbidities, attention-deficit/ hyperactivity disorder (ADHD) was seen with a rate of 17.8% (n = 75). It was found that 80.1% of the sample (n = 338) continued special education for ASD. The median age at onset of special education was 3.8 years and the minimum age was 1.6 years whereas the maximum was 12 years.. 44.3% (n = 187) of the cases followed with the diagnosis of ASD had been recommended at least one psychotropic drug, and the most commonly prescribed pharmacotherapeutic agents were antipsychotics (35.8%, n = 151), followed by medications for ADHD (16.8%, n = 71). Considering age, medical comorbidity, and presence of psychiatric comorbidity, there was no significant predictor of psychotropic agent use in patients with ASD (p>.05). CONCLUSIONS: According to this present study, psychotropic drug use in patients with ASD is independent from the presence of medical and / or psychiatric comorbidity. This suggests that psychotropic agents may be used to reduce the severity of autism-related symptoms in patients with ASD. The high rates of psychotropic drug use and special education of the patients with ASD in our sample may be related to the fact that the sample was taken from a Training and Research Hospital in Ankara where it is relatively easy to access to these treatments. OBJECTIVE: This study aims to evaluate the effects of the acute impact of methylphenidate (MPH) on sleep parameters in attention-deficit/hyperactivity disorder (ADHD) children. Second aim of this study also evaluates the effects of the chronic impact of methylphenidate (MPH) on BMI in these patient group and compared with healthy children. METHODS: Fourty five ADHD children were enrolled and daily sleep diaries were evaluated after taking medication. This cross-sectional case-control study also included sixty five healthy children. BMI Z scores were measured at baseline and at last follow-up. All subjects are evaluated with Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version (K-SADS-PL). Socio-demographic data form, Conners Parent Rating Scale-Revised Short, The Pittsburgh Sleep Quality Index (PSQI) and Children's Sleep Habits Questionnaire (CSHQ)-Abbreviated Form were administered. RESULTS: Fourty five patients (mean [standard deviation] age: 14,02 [1,6] years, 35 (77%) males) were included. Mean dose was 27,07(9,89) mg/(kg·d). After 32,22(19,6) months taking MPH, BMI standard deviation score (SDS) were reduced by treatment baseline BMI-SDS: 18,28 (4,25), and follow-up BMI-SDS [SDS]: 19,88(5,4), t-test p < 0,05). When we compared ADHD and healthy control group, we observed significant statistical difference between two groups on the mean total scores of CSHQ and PSQI (p<0,05). For CSHQ, subscales about sleep delay, sleep duration and daytime sleepiness are also significantly higher in ADHD group (p<0,05). For PSQI, subscales about sleep disturbance, sleep latency and subjective sleep quality differed significantly. CONCLUSIONS: These findings indicate children with ADHD under stimulant treatment experience more sleep problems than healthy peers acorrding to both self and parent reports. Future research is needed to examine the findings, sleep habits and disorders of the present study on more specific issues and to determine differences between children on sleep and growth development as a result of MPH use.

KEYWORDS
Methylphenidate; attentiondeficit/hyperactivity disorder; body mass index; child; sleep  OBJECTIVE: Arterial spin labeling (ASL) is a relatively new imaging modality in the field of the cognitive neuroscience. In the present study, we compared the dynamic regional cerebral blood flow alterations of children with ADHD and healthy controls by using event-related ASL scanning.

METHODS:
The DSM-IV-based Disruptive Behavior Disorders Rating Scale (DBDRS-parent and teacher form) was utilized to diagnose for ADHD. The go/no-go test is widely used in the neuroimaging research of ADHD. Arterial spin labelling imaging technique was employed to evaluate dynamic cerebral blood flow alteration during the cognitive task. The image analyses were performed by FEAT (fMRI Expert Analysis Tool) Version 6. RESULTS: The study comprised of 17 healthy controls and 20 children with ADHD. The mean age was 10.88±1.45 and 11±1.91 for the control and ADHD group, respectively (p=0.112).
The go/no-go task was utilized during the ASL scanning. The right anterior cingulate cortex (BA32) extending into the right medial frontal cortex (BA10 and 11) displayed greater activation in ADHD children relative to the control counterparts (p<0.001). With a lenient significance threshold, greater activation was revealed in the right-sided frontoparietal regions during the go session, and in the left precuneus during the no-go session. CONCLUSIONS: In sum, we found that children with ADHD displayed increased rCBF in the right anterior cingulate cortex (BA32) and MFG (BA10 and 11) relative to control subjects during a cognitive attention task. Additionally, we observed increased rCBF in the dorsal and ventral network-associated parietal areas in these child ADHD patients relative to their counterparts.
These results indicate that children with ADHD needed to over-activate their dorsal and ventral attention network-related regions to compensate for the attention demand by a given task.

KEYWORDS
ADHD; arterial spin labelling; perfusion fMRI There is a few research on the relationship between attachment and suicide attempts of the adolescents in Turkey. The aim of this study was to examine the relationship between parental attachment patterns and adolescents with and without suicidal behavior. METHODS: Adolescents who were admitted to a training and research hospital due to suicide attempt were included in the study group whereas those who applied to a pediatric outpatient clinic due to their acute physical complaints without chronic physical disease or suicide attempt history or active psychiatric complaints were included as control. The Inventory of Parent and Peer Attachment-Short Form (IPPA-SF) was used to identify the attachment patterns of the adolescents with their parents. SPSS 17.0 was used for analyses. Student's t test and Mann-Whitney U tests were applied where appropriate. P <.05 significance level was accepted. RESULTS: A total of 109 patients with a total of 56 suicide attempts and 53 controls were included in the study. The mean age of the whole sample was 15.2 years ± 1.3 years (range: 12-17 years). The mean age of the suicide group and the control group were similar. Of 80.7% (n = 88) were girls and 19.3% (n = 21) were boys. The groups were similar in terms of gender distribution. It was found that the level of education of the parents was significantly lower in the suicide group than in the control group. As regards IPPA-SF scoring, the median value of the maternal attachment score was found to be significantly lower in the suicide group compared to the control (56 vs. 69.5, respectively, z = -4.224, p <.001). Similarly, the mean of father attachment score was significantly lower in the suicide group compared to the control (48.6 vs. 62.1, respectively, t (92) = 4.497, p.001). CONCLUSIONS: The low scores of attachment to parents in suicide group are consistent with the literature that insecure attachment may be an important risk factor for suicidal behavior.
In the suicide group, low levels of parental education may cause attachment problems. It is thought that education level may affect the quality of parenting and parental quality may have a positive effect on secure attachment. Approaches to improve parental attachment can play an important role in preventing of suicide. There is a need for further studies in this field. . All participants were asked to retrieve specific autobiographical memories in response to 5 neutral cue words. After ECT course and at 3-and 6-month follow-up, participants were asked to recall the same memories which they produced at pre-ECT baseline. Assessments were carried out by the first author in terms of specificity and episodic richness for each of the retrieved and recalled memories. Richness was scored on a scale of 0 to 3, and specificity on a scale of 0 to 2. We utilized a reliable assessment method with an almost perfect interrater agreement. RESULTS: Using the generalized estimating equations (GEE) analysis, we found that at post-ECT assessment, both the specificity and episodic richness were lower in patients compared to the controls. Both scores improved 6 months after ECT and patients' scores became comparable to the control group. (For specificity, post-ECT scores were 1.34±0.88 and 1.96±0.15 and 6-month follow-up scores were 1.72±0.53 and 1.83±0.29; for episodic richness, post-ECT scores were 1.54 ±1.10 and 2.32±0.42 and 6-month follow-up scores were 2.04±0.75 and 2.27±0.36, in patient and control groups respectively). This difference remained statistically significant after controlling for the severity of depression.

CONCLUSIONS:
Our results indicate a decrease in the specificity and episodic richness of autobiographical memories in patients with major depressive episode after an acute course of 6 to 20 brief pulse bilateral electroconvulsive treatments. However, these autobiographical memory deficits improved at 6-month follow-up and no significant differences between the patients and controls were found.

METHODS:
The sample of this retrospective and cross-sectional study consisted of schizophrenia and bipolar disorder (BD) patients who were inpatient in 2018 at Gülhane Training and Research Hospital. Preferred antipsychotics have been identified for the included patients. Afterwards, comparisons were made according to gender and diagnosis. RESULTS: Antipsychotic profile is presented in Table 1. There was a statistically significant difference in the use of oral olanzapine, LAI-paliperidone LAI-aripiprazole and LAI-zuclopentixhol in the antipsychotic choices in female and male. When the diagnoses were compared according to gender, the antipsychotic profile was statistically different only in LAI-zuclopentixhol. CONCLUSIONS: The results of the study play an informative role in assessing how often physicians prescribe drugs in actual clinical practice. Olanzapine had been the most preferred oral antipsychotic in inpatient schizophrenia and BD patients. The second most common oral antipsychotic was risperidone. The most preferred long-acting injectable antipsychotics were paliperidone, risperidone and aripiprazole, respectively. These results reveal the antipsychotic usage profiles of inpatient schizophrenia and BD patients.

[Abstract:0456][Mood disorders]
Relationship between theory of mind and metabolic parameters in patients with bipolar disorder

Gamze Erzin
Ankara Dışkapı Research and Training Hospital, Psychiatry Department, Ankara, Turkey ABSTRACT OBJECTIVE: It is widely accepted in the literature that there are pathologies of theory of mind in bipolar disorder. In addition to this, it is reported that the presence of metabolic syndrome in bipolar disorder increases the level of cognitive insufficiency. The aim of this study is to examine the relationship between theory of mind and metabolic parameters in patients with bipolar disorder in remission using Reading the Mind in the Eyes test. METHODS: Patients with bipolar disorder in remission were recruited in the study when they applied to our clinic for annual blood lipid panel evaluation. To all subjects it was given a Reading the Mind in the Eyes test.  RESULTS: As a result of the statistical analyses, significant difference was observed between the patient and control group in all of the Sniffin Sticks Odor Test parameters. Total odor score was found to be 9.4 ± 1.9 (4.5-13.8) in patients and 13.0 ± 2.0 (7.3-15.5) in control group (p <0.001). Patients showed lower and significantly different scores on QCAE total and cognitive empathy (CE) subdimension (p = 0,05, p = 0,007). In this present study, correlation between the total odor score and QCAE was found to be statistically significant (r = 0.372, p = 0.009), consistent with our hypothesis. Especially the correlations between CE (r = 0,481, p = 0,001), its subdimensions PT (r = 0,372, p = 0,009), OS (r = 0,459, p = 0,001) and odor threshold and CE (r = 0,395, p = 0,005), its subdimensions PT (r = 0,275, p = 0,05), OS (r = 0,411, p = 0,004) and odor total score were found to be significant. Furthermore, in twenty two patients that have a duration of illness more than ten years; olfactory threshold (R2 = 0,70, β = 0,42, p= 0,001), negative symptomps (R2 = 0,70, β = -0,009, p= 0,048) and QCAE (R2 = 0,70, β = 0,41, p= 0,023) showed a statistically significant predictive relationship with PSP in multivariate regression model. CONCLUSIONS: In this present study, we showed that patients' smell perception and cognitive empathy are impaired and odor threshold is the strongest prognostic factor that predicts decreased social functioning. These findings suggest that the social cognition can be improved with empathy and odor attempts in the treatment of patients with schizophrenia in the coming years It has been found that the incidence of metabolic syndrome increases the risk of cardiovascular disease in patients with schizophrenia. The aim of this study was to compare the metabolic syndrome frequencies and metabolic syndrome related parameters of patients with schizophrenia and schizoaffective disorder who received antipsychotic (AP) drug treatment, who received antipsychotic and mood stabilizing (MSD) drug treatment, and who didn't received drug treatment. METHODS: 90 patients that diagnosed with schizophrenia and schziaffective disorder were admitted to the psychiatry outpatient clinic of Atatürk University Research Hospital between October 2017 and June 2018. All patients were divided into 3 groups: Patients receiving antipsychotic medication for at least 6 months were Group-1, patients receiving antipsychotic and mood stabilizer treatment for at least 6 months were Group-2 and drugnaive and newly diagnosed patients were group-3. Groups were compared according to presence of metabolic syndrome, sociodemographic characteristics, BMI, waist circumference, blood pressure, HDL, LDL, triglycerides and fasting blood glucose levels. RESULTS: 28.9% of the patients were female and 71.1% were male; the mean age was 35,30 ± 11,49 years. MS was present in 33% (n=30) of all patients and 67% (n=60) of MS was not detected in the whole group. The MS rate in the newly diagnosed group (26,7%) was not significantly different than the other two groups. Diastolic blood pressure and BMI values in group-2 were statistically higher than group-3. LDL and TG levels in group-1 were statistically higher than group-3 and waist circumference values were higher in group-1 and group-2 than group-3. In group 1, total cholesterol level was statistically higher than group 2. CONCLUSIONS: Our findings suggest that drug use with antipsychotic treatment does not affect rate of metabolic syndrome. However, some parameters related to metabolic syndrome such as waist circumference, diastolic blood pressure, BMI, total cholesterol, LDL and TG levels were found to be higher in patients receiving medication than drug-naive patients. Aripiprazole is an atypical antipsychotic drug that is proposed to act via partial agonism of dopamine D2 receptors. Two different aripiprazole LAI formulations have been developed. The once-monthly polymorphic monohydrate-water preparation has a lower molecular weight (m.w. = 466.4 g/mol), and the aqueous suspension can be lyophilized. The second aripiprazole depot injection preparation uses a prodrug approach, where the lauroxil formulation (N-acyloxymethyl) results in a higher molecular weight compound (m.w. = 660.7 g/mol). An extended-release injectable formulation of the dopamine, serotonin receptor partial agonist (DS-RPA) antipsychotic aripiprazole monohydrate 400 mg has been approved by the Turkish Ministry of Health for once-monthly treatment of psychiatric disorders in 2017.

METHODS:
The aim of this study was to describe the clinical and sociodemographic characteristics of a sample of inpatients treated with aripiprazole once-monthly 400 mg. This is a a retrospective study of patients treated with LAI aripiprazole in Department of Psychotic Disorders, Psychiatry Hospital, Pamukkale University, from January 2017 upto now. The following variables were studied: sociodemographic characteristics, diagnosis, longacting injectable aripiprazole monotheraphy, concomittant oral treatment or another longacting injectable treatment. RESULTS: A total of 97 patients were included into the study. The mean age of patients was 33.24 (±13.43). The gender of the patients was 40.20% (n=39) male and 49.80% (n=58) female. The most commonly used psychiatric disorder in aripiprazole treatment was bipolar disorder with 40.21% (Table 1). While 13 of the patients were treated with only long-acting injectable aripiprazole, 84 patients were treated with long-acting injectable aripiprazole and other antipsychotics. 28 patients treated with long-acting injectable aripiprazole combined with other LAI antipsychotics; Schizophrenia in 35.71 %, schizoaffective disorder in 32.14%, bipolar disorder in 25.00%, other psychiatric disorders 7.14% (Table 2). 13 patients treated with only long-acting injectable aripiprazole; 5 for bipolar disorder, 3 for depressive disorder, 3 for schizophrenia, 1 for obsessive-compulsive disorder, 1 for other psychiatric disorders (Table 3).

KEYWORDS
Long-acting injectable aripiprazole; psychopharmacology; antipsychotic CONCLUSIONS: In Turkey; depot antipsychotics such as long-acting injectable risperidone, long-acting injectable paliperidone, long-acting injectable flupentixol, long-acting injectablehaloperidol, long-acting injectable zuclopenthixol have been used for many years. Long-acting injectable aripiprazole has been used in treatment since January 2017. Longacting aripiprazole, given at intervals of 4 weeks, are generally used for patients with a history of relapse due to poor adherence to oral maintenance therapy.

[Abstract:0507][Psychopharmacology]
Evaluation of psychotropic drug use in epileptic patients simultaneous with antiepileptic medication: preliminary results Selma Yenen a , Ecem Selin Akbaş a , Dilek Ünal a , Kevser Nalbant a , Nesibe Gevher Ertuğrul b and Dilek Yalnızoğlu b a Department of Child and Adolescent Psychiatry, Hacettepe University, Ankara, Turkey; b Department of Child Neurology, Hacettepe University, Ankara, Turkey ABSTRACT OBJECTIVE: Psychiatric comorbidities are common in patients with epilepsy, occurring at rates 2-3-fold or higher than in the general population without epilepsy. Therefore, psychotropic drugs are frequently needed for this population. The aim of this study is to examine the benefits, side effects of psychotropic drug use and clinical variables affecting the utilization of psychotropic drugs in patients receiving concomitant antiepileptic medication. METHODS: We retrospectively reviewed the medical records of patients on antiepileptic treatment, aged 0-18, who were evaluated both in the Child and Adolescent Psychiatry and Child Neurology Departments of Hacettepe University between 2017-2019. The patients who had at least two psychiatric evaluations after the psychotropic drug prescription were included. The psychiatric comorbidities, psychotropic drug doses, side effects, clinical parameters which may have an effect on clinical outcomes were recorded. The psychiatric symptom severity and clinical functionality were also reassessed by using the Clinical Global Impression Scale(CGI) and the Global Assessment Scale(GAS).

RESULTS:
In the MDD and bipolar depressive disorder (BDD) groups, other subscale scores except the positive beliefs of Metacognitive-30 Scale and Metacognitive Scale total scores didn't show statistically significant difference but were found higher than the control group. The Ruminative Thinking Style Scale score didn't show any statistically significant difference in the MDD and BDD groups and was higher than the control group. Young-Rygh Avoidance Scale total score, cognitive / emotional avoidance and behavioral / somatic avoidance scores in the MDD and BDD groups weren't statistically different but higher than the control group. There were no statistically significant differences in the subscale scores of the Leahy Emotional Schema Scale in the MDD and BDD groups. In both groups, uncontrollability, weakness, comprehensibility, rationality, rumination, difference, denial of emotions, validation, feelings of guilt and criminality scores were statistically significant and higher than the control group CONCLUSIONS: Our findings indicate that the emotional schemas and metacognitions may be targets in the treatment of BDD like MDD. [Abstract:0517][ADHD] The effect of methylphenidate treatment on the peer bullying in children and adolescents with attention-deficit/hyperactivity disorder In cross-sectional studies, patients taking medication for ADHD or not but diagnosed with ADHD are compared in terms of peer bullying. Yet, there has been no longitudinal study conducted to see the peer bullying in this same group of patients before and after the treatment. Current study aims to examine the effect of ADHD treatment on peer bullying as well as the relationship between the severity of ADHD symptoms and peer bullying. METHODS: 50 patients between the ages of 8-16 who are diagnosed with ADHD, started using metilfenidat for treatment and are observed to have been exposed to or displayed peer bullying behavior over the past few months were included in this study. In order the evaluate the severity of the ADHD symptoms, Conners Parent and Teacher Rating Scales (CPRS and CTRS) were used while Olweus Bully/Victim Questionnaire for students, parents and teachers forms were employed to evaluate peer bullying in pre-treatment and after a three-month treatment period. Then, the results obtained in three months time were compared and the effect of metilfenidat treatment on peer bullying among the child and adolescent patients diagnosed with ADHD was examined. RESULTS: In pre and post medication, statistically significant differences were found in the total the scores of the CPRS and CTRS as well as the scores related to all sub parameters (p<0,001). In pre-medication, it has been found out that the scores of the sub parameters CPRS-Oppositional (p=0,004), CPRS-Hyperactive Impulsive (p=0,016) and CTRS-Oppositional (0,022) are statistically significant between the bullies and the victims. According to the data driven from the Olweus Bully/Victim Questionnaire for students, there is a statistically significant decrease between the ratios of being a bully (p=0,008) and bully/victim (p=0,039) in pre and post medication but no significant difference the ratios of being a victim. CONCLUSIONS: Current study concludes that CPRS-Inattentive, CPRS-Hyperactive Impulsive and CTRS-Oppositional subscale scores in children and adolescents with ADHD were higher than the victim group, and there was a decrease in peer bullying after the methylphenidate treatment in bullies and bullies-victims groups. RESULTS: A negative correlation between the self-centred expression of the emotion of happiness and psychosomatic symptoms has been found while a positive correlation between the aggressive expression of the emotions of sadness and anger and psychosomatic symptoms has been found. As the self-centred expression of the emotion of happiness increases, the psychosomatic symptom point decreases (p=0,001) and as the aggressive expression of the emotions of sadness and anger increases, the psychosomatic symptom point increases too (p=0,006; p=0,015). A negative correlation between the use of instrumental social support, positive reinterpretation and growth, the use of emotional social support that are ways of coping with stress and the psychosomatic symptoms has been found whereas a positive correlation between denial and substance use and the psychosomatic symptoms has been found. As the use of instrumental social support, positive reinterpretation and growth and the use of emotional social support increase, the psychosomatic symptom point decreases (p=0,006; p=0,030; p=0,011), and as denial and substance use increase, the psychosomatic symptom point increases too (p=0,049; p=0,009). CONCLUSIONS: Somatic symptoms are the most prevalent and important problems that are commonly seen in MDD patients. According to the results of this present study, there is a correlation between somatic symptoms and the emotional expression styles of the individuals and their attitudes towards dealing with stress. The fact that the verbal expression of emotions and functional coping strategies are related to positive affect puts forth the importance of aiming at verbal expression of emotions and functional strategies of coping with stress in the treatment of depression patients with somatic symptoms. OBJECTIVE: Treatment of Attention-Deficit/ Hyperactivity Disorder (ADHD), which is one of the common mental disorders, should be multimodal. Comorbidities are common and must be kept in mind during the assessment and intervention. In guidelines behavioural therapy is considered as the first-line treatment for children aged 4-5 years and drug treatment is recommended as a part of treatment for older children because of its effectiveness with acceptable side effects. In Turkey, stimulant preparations (immediate-release methylphenidate (IR-MPH), modified release methylphenidate (MR-MPH)) and a nonstimulant preperation (atomoxetine (ATX)) could be prescribed. The duration effect of IR-MPH and MR-MPH is 4-6 and 8-12 hours respectively. Although ATX has a duration effect of 24 hours, its effect occurs in 6-8 weeks which could influence drug selection. There are two kind of MR-MPH with different release profiles in Turkey: Osmotic release oral system technology methylphenidate (OROS-MPH) containes 22% IR-MPH, prolonged (slow) release methylphenidate (MPH-Retard) containes 50% IR-MPH. This study aimed to explore the drug treatment of patients with ADHD according to age, comorbidity and side effects.

METHODS:
The medical files of 138 children treated in Hacettepe University Department of Child and Adolescent Psychiatry with diagnosis of ADHD since June 2018, were reviewed retrospectively.

KEYWORDS
ADHD; atomoxetine; comorbidity; methylphenidate; treatment RESULTS: Mean age of girls and boys were 12.22±3.31 years and 10.86±3.32 years respectively. The first prescibed drugs for ADHD were: 54.3% OROS-MPH, 26.1% MPH-Retard, 13.0% IR-MPH and 6.5% ATX. MR-MPH was the most common prescribed among school aged children (45.9% OROS-MPH, 29.4% MPH-Retard, 16.5% IR-MPH, 8.2% ATX) and adolescents (66% OROS-MPH, 23.4% MPH-Retard, 6.4% IR-MPH, 4.3% ATX). Prescriptions according to patients' mean age were: 9.11±2.73 years for IR-MPH, 12.25±3.50 years for OROS-MPH, 10.17±2.50 years for MPH-Retard and 10.69±2.11 years for ATX. 79.7% had no side effects while appetite suppression was the most common mentioned (12.3%). Learning disorder (20.3%) and distruptive behavior problems (10.8%) were the most common comorbidities, while 50.7% had no any comorbities. 11.6% had more than one comorbidity. 75.4% used only ADHD medication and 92% mentioned the improvement as "good". Although 83.3% used only one drug for ADHD, IR-MPH was added (12.9%) because of comorbidity (15.9%) and to start the morning effect earlier or to prevent the afternoon/night effect from ending earlier (13.8%). Most of the patients continued their first prescribed ADHD medication (73.2%), the switching between MR-MPH preparations was common (15.2%) mainly because of inadequate response (13.0%) and side effects (11.6%). Except ADHD medication, risperidone was added to the treatment mostly (13.0%). CONCLUSIONS: These preliminary results suggest that stimulant treatment is preferred mostly and it is effective and well tolerated for ADHD. IR-MPH alone has been prescribed to young children mostly in order to manage its possible side effects easily. The prolonged action of MR-MPH sometimes leads to appetite suppression and insomnia. Adding IR-MPH to MR-MPH is an alternative to augment the morning/afternoon effect or to maintain the evening effect longer without increasing the dose. Because amphetamine is not approved in Turkey, switching between MR-MPH preparations is an option to provide the effect. [Abstract:0547][Others] The effectiveness of parenting program based on Video Interactive Guidance: Ten cases

Didem Behice Öztop, Merve Çıkılı Uytun, Esra Yürümez and Belgin Üstün Güllü
Department of Child and Adolescent Psychiatry, Ankara University, Ankara, Turkey ABSTRACT OBJECTIVE: Programmes targeting parenting are the leading early intervention strategy for child mental health and behavior problems. Interventions that utilise video feedback methods promote children's behaviour through increased parental sensitivity. In our infant mental health outpatient clinics, interactive guidance without video based on The Video Interaction Guidance (VIG) based on Netherlands is most often. These typically involve watching parents and infants together during playing together which are then reviewed with a therapist to highlight moments of positive interaction. Although, this is frequently used intervention, there has been a few pilot studies and limited data. In this study, it is aimed to assess the effectivenessof this method on infants and mothers. METHODS: This study is a prospective study. The sample of the study consisted of 10 children, aged between 2-6 years, diagnosed as having an neurodevelopmental disorder. Following diagnostic process, parents of the cases participated in Interactive Guidance based Parenting Programme for 4 sessions. The group were compared before and after the implementation on rates of variables. Data were collected from mothers' by using a sociodemographic data form Beck Depression Inventory, State Trait Anxiety Inventory, Coping Style Questionnaire, Parenting Attitudes Styles and Crowell procedure scores. The study data were evaluated with Paired Sample t test and Willcoxon signed rank test. RESULTS: The data of the study was planned to be included in 10 patients, but data of 6 patients were presented in this abstract. Oral presentation will be planned to present data of 10 patients. The mean of patients' age was 32±6.41 months. One patient was female and five patients was male. OBJECTIVE: Thalassemia is the most commonly observed hereditary blood disease in the worldwide. Thalassemias are autosomal recessive inherited diseases resulting from reduction or absent production of one or more of the globin chains. The incidence of thalassemia has been reported as 2.1 % in Turkey but differences region. In the literature, the role of cellular and humoral immune responses and possible autoimmune responses related to Pediatric Acute Onset Neuropsychiatric Syndrome (PANS)/Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infections (PANDAS)/PANS have gained importance. Current reports shown that β-thalassemia trait creates a tendency to autoimmune disorders and the prevalence of β-thalassemia minor is significantly increased in in these disorders (e.g. rheumatoid arthritis, diabetes, fibromyalgia). İt is suggested that thalassemia trait accompaniment to autoimmune disease and psychiatric disorders may be the result of haplotypal associations between the close proximity genes. Beta globin genes reside at 11p15.5 close to brain derived neurotrophic Factor, tyrosine hydroxylase and dopamine receptor 4 (DRD4). Alfa globin genes reside at 16p13.3 which associates with bipolar disorder, tic disorders. Chromosome 11 and 16 has been implicated to have a linkage associated with psychiatric disorders such as ADHD, Tourette syndrome, impulse control disorders, and bipolar disorder. The aim of this study was to examine the frequencies of thalassemia trait in children and adolescents with PANS/PANDAS and the relationship between thalassemia trait and inflammation and immunity. METHODS: In this study, A total of 319 children and adolescents with PANS/PANDAS who had been followed between the years of 2015-2017 were analyzed retrospectively. Psychiatric disorders of patients were diagnosed by using DSM-V criteria and demographic characteristics of patients have been obtained from socio-demographic chart review. We evaluated biochemical parameters, red blood cell (RBC) counts, mean corpuscular volume (MCV), mean corpuscular hemoglobin (Hb), and red cell distribution width (RDW), serum ferritin level and Mentzer Index (MCV/RBC), antistreptolysin O (ASO), Vitamin B12 and 25-OH VİT D3 levels. RESULTS: In this study, we included 319 patients who applied with PANS/PANDAS (mean age: 9,77. ± 3,45 years; range: 2-18 years). Samples were obtained from 185 (58.9%) boys and 129 (41.1%%) girls. This present study found the prevalence of thalassemia trait in PANS was 12,1% (Of the 38 enrolled, 14 were girls (36,8%) and 24 boys (63,2%). Psychiatric disorders were obsessive-compulsive symptoms/disorder (OCS/OCD) 138(43,3%), tic disorders 135 (45,8%), Attention-Deficit/ Hyperactivity Disorder 192 (66,4%), anxiety disorders 81 (29,3%), obsessivecompulsive spectrum disorders 18 (6,9%). CONCLUSIONS: We concluded that the frequency of thalassemia traits is high in PANS (12,1%). It may be a possible genetic link between PANS and thalassemia trait. Thalassemia traits may be play roles in pathogenesis of PANS and as a susceptibility factor in PANS. Investigation of the relationship between attention-deficit/hyperactivity disorder and mitochondrial DNA (mtDNA) copy number: one-year follow up study found that mtDNA copy number was significantly higher in patients with ADHD than healthy controls, and that there was no significant correlation between other factors and the mtDNA copy number. These findings support that mitochondrial dysfunction may involve in the etiopathogenesis of ADHD. In this second study, it was aimed to examine mtDNA copy number, one of the best biomarkers of mitochondrial dysfunction, in patients with ADHD after one-year follow up. The patient group included in the previous study would be reevaluated after one year, and the resulting mtDNA copy numbers would be compared with the first mtDNA copy numbers. METHODS: Twenty-eight ADHD patients, whose fourteen of them used the drug for ADHD and fourteen drug-free patients participated in the study. Sociodemographic data form, Kiddie-Sads-Present and Lifetime Version -Turkish Adaptation (K-SADS-PL-T), Conners rating scales were applied and DSM-V based clinical interviews were conducted to participants. Venous blood samples were taken from all participants and DNA isolation was performed and DNA stored until the day of analysis. The analysis was performed by Real Time PCR method and the ratio of the amount of mitochondrial DNA (mtDNA) to the amount of nuclear DNA, the relative mtDNA copy number was reached. RESULTS: In the study, it was determined that there was no change in the mtDNA copy numbers of ADHD patients after one year follow-up (p=0.546). Moreover, there were no significant differences between two groups with medication (mtDNA copy number= 53.073 ± 28.359) and without medication (mtDNA copy number= 55.686 ± 30.174) (p=0.667). CONCLUSIONS: As a conclusion, it was revealed that the mtDNA copy number did not change in ADHD patients after one-year follow-up and the usage of drugs for ADHD did not affect the mtDNA copy number. Add-on aripiprazole treatment for atypical antipsychotic-induced hyperprolactinemia in female schizophrenic patients: preliminary findings of a 12-week follow-up study

Sinay Önen
University of Health Sciences, Bursa Yüksek İhtisas Research and Training Hospital ABSTRACT OBJECTIVE: Symptomatic hyperprolactinemia is one of the most distressing side effect of antipsychotic treatment in schizophrenia which often causes disruption of treatment adherence. Add-on aripiprazole to the preexisting antipsychotic medication has been recommended as an effective strategy in the management of antipsychotic-induced hyperprolactinemia. The present study aimed to evaluate the efficacy and safety of adjunctive aripiprazole treatment in schizophrenia patients with atypical antipsychoticinduced hyperprolactinemia.

METHODS:
The study group consisted of 26 female schizophrenic patients who were on a stable dose of atypical antipsychotic medication (risperidone, paliperidone and amisulpiride) and were detected hyperprolactinemia in laboratory examinations. All patients were continued on the previous antipsychotic medication and add-on aripiprazole 5 mg/day was initiated. Serum prolactin(PRL) levels were measured administered at baseline and at the 1st, 4th, 8th and 12th weeks. The Positive and Negative Syndrome Scale(PANNS), Clinical Global Impression Scale(CGI) were administered at baseline and at the 1st, 4th, 8th and 12th weeks of the add-on aripiprazole treatment follow-up period. Also Barnes Akathisia Rating Scale (BARS) was administered at baseline and at the 1st week of aripiprazol treatment.
CONCLUSIONS: This present study results demonstrated that add-on therapy with aripiprazole 5 mg/day in female schizophrenic patients resulted in a significant reduction of serum PRL levels compatible with improvement in hyperprolactinemia symptoms. These findings are consistent with previous studies. The decrease in PRL levels due to aripiprazole is considered to be associated with its functional agonist properties under antipsychotic-induced KEYWORDS Hyperprolactinemia; atypical antipsychotics; aripiprazole; schizophrenia hypodopaminergic state. However, studies focusing on the temporal linkage of the reduction of PRL levels with the adjunctive aripiprazole treatment are limited. This present study findings indicate that the decrease in prolactin levels are tend to initiate after the 4th week of treatment but symptomatic recovery seems to be more prominent after 8th week of add-on therapy. It can be concluded that add-on aripiprazole therapy is a safe and reliable treatment option for schizophrenic patients with remission, but at least 8 weeks is recommended to wait for recovery of hyperprolactinemia symptoms.
[Abstract:0568][Specific Learning Disorder] Speech delay, articulation problems, and hemispheric laterality assessment in dyslexia and ADHD

Uğur Tekin
Department of Child and Adolescent Psychiatry, Health Sciences University Bakirkoy, Dr. Sadi Konuk Research and Training Hospital, Istanbul, Turkey effects of dysbiosis on intestinal permeability and bacterial translocation.

METHODS:
The study group is consisted of 30 patients with ASD and 30 siblings aged between 4−12 years. The control group is also 30 healthy children with similar ages. All participants were assessed according to DSM 5 criteria, and administered Gastrointestinal Severity Index (GSI) and Development and Well-Being Assessment (DAWBA). Childhood Autism Rating Scale (CARS) was only applied for ASD group. Lipopolisaccarid binding protein (LBP) and soluble CD14 were assayed in serum samples, and calprotectin was determined by ELISA method in feces. Differences and variability of GM were analyzed via quantitative real-time PCR between groups. RESULTS: The mean age of the participants was 8.39 (± 2.45), and 61,1% (n=55) male and 38,9% (n=35) female were consisted. 18 (60%) of the case and sibling groups with the same sociodemographic characteristics were in urban areas and 12 (40%) were in rural areas; all control group have lived in urban areas. There was no statistically significant difference between two groups in terms of the presence of psychiatric disease in the family. A significant difference was found between three groups in terms of the copy numbers of GM (p=0.001). When compared to control group, it was seen that microbial of copy number case and sibling groups decreased. GSI scores of case group were significantly higher than others, and related to CARS scores. The mean value of fecal calprotectin was higher in case group, but no statistically significant difference was found between three groups (p=0.951). A correlation was determined between fecal calprotectin and CARS scores(r=0.369, p=0,049). The mean value of s-CD14 and LBP were the highest in the sibling group and a significant difference was found between three groups (p=0.000, p=0.000; respectively). CONCLUSIONS: Although the relationship between GM and ASD has been examined several times, studies on the correlation of the mechanisms, caused by dysbiosis, with biological markers are limited. With this study, the inclusion of siblings exposed to similar genetics and occurring in similar conditions with ASD patients provided a different comparison possibility. Results will be discussed in detail in the presentation.
life. These diseases are a risk factor for other psychiatric comorbidities if it continues in adulthood. In this study, it was seen that the counselor teachers did not have sufficient equipment about ADHD and LD. But they are especially stabilized to serve as a key intermediary between parents and teachers. Also, counselors can be essential in helping students with ADHD and LD thrive. It is very important that ADHD or LD manifests itself in many different ways, so counselors should be equipped with adequate in these common diseases. Adequate training efforts are required for teachers to enhance their equipment. Further research is required for the structure of adequate training efforts. RESULTS: Psychotic symptoms were found in 76.7% of the cases in this present study. Psychotic symptoms were significantly higher in male cases. The most common symptom was found to be decreased need for sleep (90%). Subsequent symptoms were increased speech, irritability and motor hyperactivity. Suspiciousness was found to be significantly higher in psychotic bipolar cases and elevated mood was significantly higher in nonpsychotic cases. In psychotic bipolar cases, the duration of hospitalization and the time to remission were not statistically significant, but were found to be longer. The scores of YMRS and PANSS were significantly higher in the group with psychotic symptoms. Depression (50%) was the most common comorbidity. The comorbidity of ADHD was found to be significantly higher in nonpsychotic cases. There was no difference in terms of resilience scores. When the prognostic factors were examined, it was determined that the severity of disorder was related to poor judgement and persecutory delusions. CONCLUSIONS: In this present study, it was found that bipolar disorder in children and adolescents was frequently with psychotic symptoms, mostly in males and the most frequent symptom was decreased need for sleep. Poor judgement and persecutory delusions were found to be predictors of poor clinical course in children and adolescents with bipolar disorder. It will be important to evaluate poor judgement and persecutory delusions in children and adolescents with bipolar disorder in terms of clinical course. Nigella sativa oil improved cognitive symptoms in subchronic MK-801 model of schizophrenia in rats Gökhan Ünal a , Hacer Zortul b and Feyza Aricioglu b attention) symptoms. Current antipsychotic drugs commonly attenuate the positive symptoms of schizophrenic patients while negative and cognitive symptoms, unfortunately, remain untreated, yet. Nigella sativa (black seed) is used for the treatment of various diseases by the traditional methods in many geographies. Certain studies have shown the antidepressant, anxiolytic, neuroprotective and procognitive effects of Nigella sativa products. It has been thought that the major components such as thymoquinone, thymohydroquinone, and dithymoquinone were responsible for the beneficial effects of Nigella sativa. In this study, we aimed to firstly examine the effects of Nigella sativa essential oil on behavioral deficits in the subchronic MK-801 model of schizophrenia in rats. METHODS: Wistar Hannover rats divided into five groups as the followings; control, Nigella sativa oil (0.2 ml/kg), MK-801 (0.2 mg/kg), MK-801+Nigella sativa oil (0.2 ml/kg) and MK-801 + Clozapine (5 mg/kg) (n=8 per group). MK-801 was intraperitoneally and bidaily injected for the seven days for modeling schizophrenia. Prepulse inhibition of the acoustic startle response (PPI) test was performed 15 min after the last dose of MK-801. Clozapine and Nigella sativa oil were intraperitoneally injected to rats 30 min before the PPI test. Then, a seven days washout period was waited to avoid the acute effect of MK-801. After the washout period, clozapine and Nigella Sativa oil were daily administered for six days. Locomotor activity and novel object recognition (NOR) tasks were conducted at the fifth and sixth days of treatments, respectively. Paired Student's t-test, one-way and two-way analysis of variance (ANOVA) followed by Tukey's post hoc test were used for the statistical analyses in the GraphPad Prism software. RESULTS: In NOR task, all groups including MK-801 spend more time with the novel object than familiar one (p<0.05). For the discrimination index, MK-801 administered rats had lower discrimination index compared to the control group (p<0.001). Nigella Sativa oil (p<0.01) and clozapine (p<0.05) treatments reversed the effects of MK-801 on the discrimination index of NOR task. In the PPI test, MK-801 administration decreased (p<0.001) PPI compared to the control group while only clozapine treatments increased (p<0.05) the PPI in rats. None of the treatments significantly altered the locomotor activity of rats even though there were small fluctuations in their activity. CONCLUSIONS: This present study showed that Nigella Sativa oil, commonly used as a nutritional supplement, may improve cognitive symptoms of schizophrenia which is still an unsolved problem for patients. In further studies, it may be important to identify the compound responsible for this beneficial effect and the mechanism underlying this effect. In addition, the interaction of Nigella sativa oil with current antipsychotic drugs used in clinical treatment is also an important issue to be examined.

KEYWORDS
its sub parameters (p<0.05). No significant difference was found between FGAG, SGAG, and CG (p>0.05) while there was a significant difference between the control group and the patients with schizophrenia group, more prominent in TRS, in terms of GCL and IPL (p<0.05). In terms of the choroidal thickness that SGAG has the highest value for both eyes; the choroidal layer thickness of control group, CG, and FGAG decreased with the same order. A non-significant difference between the SGAG and the control group (p>0.05), a significant difference between SGAG and CG, FGAG (p<0.05), a significant difference between control group and FGAG (p<0.05) were found. CONCLUSIONS: The fact that RNFL sub-parameters were different in the patient groups compared to the control group was considered as an indicator of axonal degeneration. It was observed that schizophrenia caused thinning in GCL and IPL and there was a negative correlation between these parameters and resistance to treatment. The absence of a significant difference between FGAG, CG, and SGAG in terms of GCL and IPL suggests that the course and severity of the disorder play an important role in the pathophysiology of neuronal degeneration, rather than the AP drugs use. The presence of the choroidal layer thickness of SGAG was thicker than the control group, and the choroidal layer thickness of SGAG was less than FGAG and CG were associated with the deterioration of the metabolic parameters of the SGA use. Thinner choroidal layer thickness in the CG compared to the SGAG and control group was thought to be related to the patients with schizophrenia using clozapine had a resistance to the treatment and antiinflammatory properties of clozapine. Thinner choroidal layer thickness in the FGAG compared to the other drug sub-groups and control group was associated with the use of FGAG in accordance with the literature in daily practice when there was not sufficient response to the SGAG, evaluation of an intermediate stage treatment prior to the switch to clozapine, and re-use of FGAs in TRS that did not respond to clozapine treatment.
Hasan Cem Aykutlu a and Işık Görker b a Edirne Sultan 1. Murat State Hospital, Child and Adolescent Psychiatry Department, Edirne, Turkey; b Trakya University School of Medicine, Child and Adolescent Psychiatry Department, Edirne, Turkey ABSTRACT OBJECTIVE: Breastfeeding is crucial for the early developmental period. It is shown that the duration of breastfeeding has a positive relation with cognitive development and its gains are persistent in childhood [1]. Also, it is known that both environmental and genetic factors play an important role in the etiology of Attention-deficit/ hyperactivity disorder (ADHD). Absence or short duration of breastfeeding is found to be among the possible risk factors in the emergence of ADHD [2]. Thus, there is growing interest to elucidate the possible association in the recent studies [1][2][3]. In the light of above, we aimed to examine the duration of breastfeeding in children with ADHD and compare it with healthy counterparts. METHODS: 86 children diagnosed with ADHD without other neurodevelopmental disorders and chronic medical disease were included in the study group. 86 age and sex matched children without chronic medical and psychiatric disease were obtained as the control group. The Turgay DSM-IV Based Disruptive Behavior Disorders Child and Adolescent Rating and Screening Scale (T-DSM-IV-S) and Schedule for Affective Disorders and Schizophrenia for School Age Children were used to assess psychiatric disorders. The duration of breastfeeding is recorded based on the parents' report.

RESULTS:
The mean age of the cases was 7±1 years and %83.7 (n=72) was male both in the ADHD and the control group. The duration of breastfeeding was found to be 12,5±9,8 months in ADHD group and 15,6±9,2 months in control group. In addition, when we grouped the duration of breastfeeding in 6 months' period, the number of children who had breastfeeding less than 6 months in ADHD group (n=29) was significantly higher than the controls (n=11) (p=0,001). CONCLUSIONS: Studies had shown the association between ADHD and short breastfeeding period [2]. Our findings are found to be consistent with the previous studies. Although, these cross-sectional designed studies awaken more questions than the answers, we may assume that breastfeeding period has an important role in the emergence of ADHD. Further studies with well-designed methodologies will clarify this relationship.

KEYWORDS
Attention deficit disorder with hyperactivity; breast feeding; child Evaluation of ischemia modified albumin levels in major depression patients

Özgül Karaaslan, Özge Ceren Amuk and Yunus Hacımusalar
Bozok University, School of Medicine, Department of Psychiatry, Yozgat, Turkey ABSTRACT OBJECTIVE: Depression is an important public health problem. The association of depression with antioxidant defence system has been reported. In studies, increased serum superoxide dismutase activity was found in depressive patients. Ischemia-modified albumin (IMA), calculated by the evaluation of cobalt binding to albumin, is a new biomarker that measures ischemia. IMA has also been associated with diseases related to oxidative stress such as psoriasis, diabetes, multiple sclerosis, some cancers, polycystic ovary syndrome, schizophrenia and bipolar disorder. The aim of this study was to evaluate IMA levels as a new parameter related to oxidative stress in patients with major depressive disorder (MDD) METHODS: A total of 59 patients diagnosed with major depressive disorder in Yozgat Bozok University Psychiatry Department who are between 18-65 years of age, not using psychotrophic medication for 3 months and 59 age and gender matched healthy controls (control group) were included in the study. Patients with comorbid psychiatric or systemic disease, history of chronic drug use due to any disease, smoking, alcohol and substance use, pregnancy or breastfeeding were not included in the study. Serum IMA and albumin levels were measured in blood samples taken from patient and control groups. 9 ml blood was taken into the biochemical tubes without preservatives and centrifuged at 2500 g for 10 minutes in half an hour. IMA measurement in serum was performed spectrophotometrically according to the method described by Bar-Or et al. Yozgat Bozok University Clinic Research Ethics Committee approved the study. RESULTS: Among of the patients with depression, 27 (45.8%) were male and 32 (54.2%) were female and among control group 29 (49%) were male and 30 (51%) were female. The mean age of the patients was 39.40 ± 12.20 years and the control group had a mean age of 38.67 ± 9.29. No statistically significant difference was found between the patient group and the control group in terms of age and gender (p = 0.942, p = 0.714, respectively). The mean IMA level of the patients was 84.40 ± 3.92 and the control group was 82.62 ± 3.02 and the difference was statistically significant (p <0.01). The mean albumin levels were 4.16 ± 0.36 and 4.03 ± 0.32 in the patient group and the control group, respectively, and the difference was statistically significant (p = 0.01). CONCLUSIONS: IMA has recently been proposed as a marker for oxidative stress and has been reported to increase in the inflammation process. On the other hand, it is argued that oxidative damage caused by iron increase enhances IMA. In this context, IMA may be a new marker in determining iron induced oxidative injury. In this present study, higher IMA levels were determined in depression patients than healthy controls. This result may be an indicator of increased oxidative stress in patients with depression. As far as we know, a study evaluating IMA levels in depression patients has not been found in the literature.

KEYWORDS
Major depressive disorder; ischemia modified albumin; oksidative stress