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    Does augmentation with antipsychotic agents affect the medication adherence of the child with obsessive-compulsive disorder?
    (2019) Kara, Tayfun; Yılmaz, Semra; Kınay, Duygu; Akaltun, İsmail
    Antipsychotic agents can be used for augmentation when the response to treatment is insufficient in children with obsessive compulsive disorder. Our aim was to investigate adherence to treatment between patients with and without antipsychotic augmentation and factors potentially related to this. One hundred fourteen children and adolescents aged 8-18 years diagnosed with OCD and still receiving treatment were included in the study. Fifty-two subjects were received antipsychotic therapy for augmentation, while 62 were not receiving it. All subjects were evaluated using a sociodemographic data form, the 8-item Morisky Medication Adherence Scale (MMAS-8), and the Udvalg for Klinikse Undersegelser (UKU) side-effects rating scale. The results were then subjected to statistical analysis. Total MMAS-8 scores were statistically significantly lower in the augmentation group than in the monotherapy group (p: 0.01). Sex, receipt of psychotherapy and family monitoring of treatment had no effect on total MMAS-8 scores (p: 0.949, p: 0.394, and p: 0.198, respectively). Higher UKU side-effect rating scale scores were determined in the augmentation group compared to the monotherapy group (p<0.05). Correlation analysis revealed that UKU total score (r:-0.272, p:0.003) and UKU psychological side-effects subscale score (r:-0.263, p:0.005) were significantly inversely correlated with MMAS-8 total scores. Side-effects deriving from medications affected adherence to treatment more significantly than several other environmental factors in children with OCD. Our findings show the need for side-effects, and particularly psychological side-effects, the frequency of which increases with augmentation, to be monitored in terms of adherence to treatment.
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    Evaluation of depression among children and adolescents with brucellosis without neurological involvement593
    (2019) Akaltun, İsmail; Kara, Soner Sertan; Ayaydın, Hamza; Kara, Tayfun
    Purpose: Brucella infection may appear with varying clinical manifestations, from subclinical infection to severe bacteremia or central nervous system infections. The aim of this study was to compare depression rates in brucellosis cases without neurobrucellosis with a non-brucellosis control group. Materials and Methods: One hundred and twenty children and adolescents, 60 with brucellosis and 60 controls, were included in the study. All subjects were administered the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children -Present and Lifetime Version-Turkish Version (K-SADS-PL-T), and psychiatric evaluation was performed on the basis of DSM-5 diagnostic criteria. Subjects were also assessed with the administration of the Children's Depression Inventory (CDI) and a detailed information form. Results: Depression was diagnosed in 16 (26.7%) of the patients with brucellosis, and in 3 (5%) of the control group, the incidence being significantly higher in the case group. CDI scores were also higher in the case group than in the control group. Conclusion: The higher rate of depression in children and adolescents with brucellosis, even in the absence of neurological involvement, suggests the importance of these cases being evaluated in psychological terms.
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    Foveal avascular zone and vessel density in children with attention deficit hyperactivity disorder
    (Springer, 2020) Tarakçıoğlu, Hatice Nur; Yılmaz, Semra; Kara, Tayfun; Yıldız, Ayşegül Mavi; Yiğit, Ulviye; Özkaya, Abdullah
    Purpose To compare the retinal and choroidal microvasculature quantitatively via optical coherence angiography (OCTA) in children with attention deficit hyperactivity disorder (ADHD) who were under methylphenidate (MFD) treatment or newly diagnosed as ADHD and were not taking any medication. Methods This was a cross-sectional, comparative, and observational study. The children who were between 6 and 17 years old and previously diagnosed as ADHD and were under MFD treatment or who were newly diagnosed as ADHD were included in the study. Optical coherence tomography angiography imaging was performed via OCT RT XR Avanti with AngioVue software (Optivue Inc, Freemont, CA). The main outcome measure of the study was OCTA parameters of the children with ADHD. Results A total of 186 eyes of 186 patients were included in the study. There were 80 eyes in the control group (newly diagnosed) and 106 eyes in the treatment group (under MFD treatment). The mean duration of methylphenidate use in the treatment group was 33.9 +/- 20.1 months (between 6 and 84 months). The choriocapillary flow area (p = 0.03), superficial parafoveal thickness (p = 0.01), and deep parafoveal thickness (p = 0.01) were statistically greater in the treatment group than the control group. Conclusion Most of the important OCTA parameters especially foveal avascular zone (FAZ) area and FAZ perimeter were similar in the two groups. There was a significant difference between the two groups in parafoveal thickness values which might point to a slight effect of MFD on retinal circulation.
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    Nursing personality and features in children with autism spectrum disorder aged 0-2: an exploratory case-control study
    (Taylor & Francis Ltd, 2020) Kara, Tayfun; Alpgan, Ömer
    Aim Although studies have investigated relationships between autism spectrum disorder (ASD) and breastfeeding duration, information concerning these children's nursing styles is limited. This study investigated nursing personality and features and ASD. Method One hundred forty-one children aged 24-72 months diagnosed with ASD and 128 healthy children were included. Information concerning the family's sociodemographic characteristics and the child's developmental stages was obtained through forms prepared by the authors and from hospital records. The Childhood Autism Rating Scale (CARS) was used to determine symptom severity in ASD. Development levels of children with ASD were determined using the Denver Developmental Screening Test 2nd Edition (DDST II). Results Mothers of children with ASD reported higher rates of unintended pregnancies (p = 0.029) [2.380*(1.093-5.182)]. Children with ASD exhibited less nursing strike (NS) behavior (p = 0.042) [0.388(0.156-0.967)] and less eye contact during breastfeeding (ECDB) (p = 0.009) [2.300(1.236-4.282)]. NS reduced the risk of ASD 2.6-fold, while absence of ECDB increased the risk 2.3-fold, and unintended pregnancy increased the risk 2.4-fold. Higher CARS scores were determined in children with ASD with vaginal delivery histories (p = 0.041) and histories of incubation (p = 0.025). Lack of ECDB was associated with decreased social and gross motor scores at DDST-II (p = 0.005). Conclusion Babies with ASD began breastfeeding at least as early as typically developing peers and for similar lengths of time. However, babies with ASD exhibited less NS behavior and less eye contact during breastfeeding. Babies with ASD perceive no emotional cues even in the first months, and may therefore not exhibit NS behavior.
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    The mental health and marital adjustment of mothers of children with attention deficit hyperactivity disorder
    (2022) Akyüz Karacan, Fatma; Yılmaz, Semra; Kara, Tayfun
    Aim: The mental health of parents is affected by the behavior of their children due to parent-child relationships. This study aimed to examine the marital adjustment, emotional problems, and attention deficit hyperactivity disorder (ADHD) symptoms in the mothers of children with ADHD, and the relationships of these parameters with each other and with the offspring’s behavioral problems. Methods: This study was conducted with 152 mothers, 90 of whom had children with ADHD, between October 2020 and April 2021. The Conners’ parent rating scale-revised long version (CPRS-RL) was used to rate the children’s symptoms. Mothers were evaluated using a sociodemographic information form, the Beck anxiety inventory (BAI), the Beck depression inventory (BDI), the adult ADHD self-report scale (ASRS), and the marriage adjustment scale (MAS). Statistical comparisons were made between the data obtained from scales and hospital records. Results: Significant associations were observed between oppositional and anxious-shy symptoms in children and the BAI and ASRS; between social problems and psychosomatic symptoms and the BAI, BDI, ASRS, and MAS; between restless-impulsive symptoms and BAI-BDI, ASRS, and MAS; between emotional lability and BAI, BDI, and ASRS; between inattention and BAI; and between hyperactivityimpulsivity and ASRS scores (p<0.05). The BAI, BDI, and ASRS scores were significantly higher, and MAS scores were significantly lower in the mothers of children with ADHD compared to the controls (p<0.05). A positive correlation was observed between ASRS scores and BAI (r=0.497 p=0.001) and BDI (r=0.04 p=0.001) scores. MAS scores were significantly negatively correlated with ASRS (r=-0.383 p=0.001), BAI (r=-0.477 p=0.001), and BDI (r=-0.437 p=0.001) scores. Conclusion: This study demonstrated that in children with ADHD, problematic behaviors exacerbate anxiety, depression, and adult attention deficiency symptoms and reduce marital adjustment in mothers
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    Theory of mind and related factors in parents of children diagnosed with autism spectrum disorders
    (Klinik Psikiyatri Dergisi, 2019) Kara, Tayfun; Yilmaz, Semra
    Objective: Impairments constituting the basis of Autism Spectrum Disorder (ASD) are explained in terms of theory-of-mind (ToM). Our study aimed to investigate psychiatric disorders and sociodemographic characteristics potentially associated with ToM in the parents of children with ASD in the context of gender variation. Method: The study involved 84 families with a child diagnosed with ASD (mother, father and child with ASD - 252 participants). The Reading the Mind in the Eye Test (RMET) was applied to evaluate parental ToM. Parents were also assessed using a Sociodemographic Information Form, the Toronto Alexithymia Scale (TAS), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The Childhood Autism Rating Scale (CARS) was applied to assess severity of autism in children. The data obtained were subjected to statistical comparisons. Results: No statistically significant difference was determined between parents' RMET, BAI, or TAS scores. Mothers' BDI scores were significantly higher than those of fathers (p=0.009). Higher RMET scores were determined in pa-rents of children with mild ASD and no accompanying disease. Significant negative correlation was determined between children's CARS scores and parental RMET scores (r=-0.528 p=<0.0001/r=0.473 p=<0.0001). Negative correlation was determined between parental TAS and RMET scores (r=-0.303 p=0.005/r=-0.327 p=0.002). Discussion: ToM disturbance in parents increased with severity of ASD in children, although no gender diffe-rence was determined. Further ToM studies involving parents of children with severe ASD are needed.
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    Tip 2 diyabet tanılı hastalarda uygulanan tedavi yöntemi ile hastalardaki tedaviye uyum, yaşam kalitesi ve depresyon arasındaki İlişki
    (2019) Kara, Ayşe Melike; Kara, Tayfun
    Amaç: Çalışmamızda Tip 2 Diabetes Mellitus (Tip 2 DM) tanısı alan hastalarda görülen depresif belirtiler, yaşam kalitesi ve tedavi uyumunun; kullanılan tedavi türü ve sosyo-demografik değişkenler ile ilişkisinin araştırılmasını amaçladık. Yöntemler: İki yüz seksen altısı DM tedavisi için Oral Antidiyabetik ilaçlar + İnsülin (OAD + İNS) kullanan ve 246’sı yalnızca OAD kullanan hastalardan olmak üzere 532 hasta çalışmaya alındı. Bilgi formları, HbA1c düzeyi, Hasta Sağlık Anketi-9 (HSA-9), EQ-5D-3L genel yaşam kalitesi ölçeği, EQ-VAS görsel analog ölçek, Morisky-8 Maddeli İlaca Uyum Anketi (MMAS-8) ile veriler elde edildi. Elde edilen veriler daha sonra istatistiksel analizlere tabi tutuldu. Bulgular: OAD + İNS kullananlarda istatistiksel olarak anlamlı oranda daha yüksek HSA-9, daha düşük EQ-indeksi yaşam kalitesi ve EQ-VAS skorları saptandı (p<0,001). OAD + İNS kullananlar daha düşük tedavi uyumu skorlarına sahipti (p=0,002). OAD grubunda hastaların tedavi uyumu arttıkça yaşam kalitesinin arttığı görüldü (r=0,184 p=0,002). Her iki grupta da HSA-9 skoru ile MMAS-8 skorları arasında negatif yönlü (r=-0,346 p=<0,001/ r=-0,185 p=0,004) ilişki saptandı. OAD + İNS grubunda MMAS-8 ile HbA1c (r=-0,161 p=0,012) arasında negatif yönlü korelasyon saptandı. Sonuç: OAD + INS kullanımı olan hastaların daha kötü tedavi uyumu, HbA1c, depresyon ve yaşam kalitesi skorlarına sahip oldukları görüldü. Tip 2 DM hastalarına ve özellikle de OAD + INS kullanıcılarına yönelik tedavi uyumunu, yaşam kalitesini ve depresif semptomlarını iyileştirecek yeni araştırmalar yapılmasının faydalı olacağı kanaatindeyiz.