The role of mindfulness on the psychological aspects of anorexia nervosa

OBJECTIVE

Emotion regulation, perfectionism, and rumination are perpetuating factors in anorexia nervosa (AN). Mindfulness can be protective and therapeutic. We aimed to understand the relationship between these factors and mindfulness in AN.

METHODS

20 adolescent girls in the acute phase of the AN, 16 in remission, and 40 in the control group were evaluated.

RESULTS

Mindfulness was lowest in the acute AN group. The difference in the acute AN group regarding body dissatisfaction, emotion dysregulation, perfectionism, and mindfulness disappeared after controlling for the effects of depression and anxiety. The predictors of disordered eating in the entire study population were body dissatisfaction and depressive symptoms. Emotion regulation and perfectionism were the predictors of mindfulness in the acute AN group and the entire study population. When mindfulness decreased, concerns about body shape increased in both acute AN and remission groups, while dietary restriction and disordered eating behaviors increased only in the remission group.

DISCUSSION

Emotion regulation difficulties in acute AN could be related to depression and anxiety. Mindfulness interventions for emotion regulation could be used for depression during the acute phase while for perfectionism in remission. Early intervention for depression and body dissatisfaction seems protective, and mindfulness could be an appropriate intervention.

Effect of Impairment on the Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder in a National Survey: Nation-Wide Prevalence and Comorbidities of ADHD

OBJECTIVE

This study aimed to determine the prevalence and comorbidities of attention-deficit hyperactivity disorder (ADHD) by evaluating a large-scale nation-wide sample of children.

METHOD

The inclusion criterion was being enrolled as a 2nd, 3rd, or 4th-grade student. A semi-structured diagnostic interview (K-SADS-PL), DSM-IV-Based Screening Scale for Disruptive Behavior Disorders, and assessment of impairment (by both parents and teachers) were applied to 5,842 participants.

RESULTS

The prevalence of ADHD was 19.5% without impairment and 12.4% with impairment. Both ADHD with and without impairment groups had similar psychiatric comorbidity rates except for oppositional defiant disorder (ODD) and conduct disorder (CD) diagnoses. Impairment in the ADHD group resulted in significantly higher ODD and CD diagnoses.

CONCLUSION

Even when impairment is not described, other psychiatric disorders accompany the diagnosis of ADHD and may cause impairment in the future. Impairment in the diagnosis of ADHD significantly increases the likelihood of ODD and CD.

An examination of the characteristics of mothers neglecting their children

BACKGROUND

This study is aimed to recognize families who have neglected their children in the early period, to raise awareness among experts especially pediatricians-working in this field about the reasons contributing to the neglect.

METHODS

For this purpose, data were collected by quantitative and qualitative methods. The mothers of 32 neglected children and 30 children who were not neglected were included in to the study. Sociodemographic Information Form, Neglect Assessment Tool, Close Relationships Inventory, Perceived Social Support Scale, Marital Adjustment Scale, Childhood Trauma Survey Scale, Semi Structured Interview Form, SCID I and SCID II were used as data collection tools. T-test, ANOVA, Chi-square test, Kruskal Wallis, Pearson Correlation test were used for quantitative analysis and descriptive analysis method was used in the analysis of qualitative data.

RESULTS

In the quantitative findings obtained; mothers of neglected children and control group mothers differed in terms of their age, income perceptions, multidimensional perceived social support, marital adjustment, physical and emotional abuse subscales on the scale of childhood abuse, adult attachment patterns, however; it was found that there was no difference in terms of mental illness and personality disorder, and scores on sexual abuse subscale of child abuse. Qualitative results demonstrated that most of the mothers did not consider themselves adequate for parenting, were not satisfied with their parenting role, had insufficient emotional investment in their children and could not balance their roles.

CONCLUSIONS

It was concluded that the mothers of neglected children had problems in the areas of social support, marital adjustment, adult attachment patterns and they were also exposed to physical and emotional abuse during their own childhood and these problems negatively affected the quality of their childcare. For this reason, it is important to provide support to neglectful families and family interventions should be established.

Killing One's Own Baby: A Psychodynamic Overview with Clinical Approach to Filicide Cases

OBJECTIVE

This review article discusses the multi-dimensional and complex pattern of filicide from a psychodynamic perspective with reference to the recent publications. Creating awareness to filicide among professionals will help to the correct assessment of the cases, recognition of and intervention on filicide before the act, and the development of preventive mechanisms.

METHOD

Published articles between January 1960 and March 2020 were searched using the keywords 'filicide, infanticide, neonaticide, mother/ parent/ maternal/ paternal, psychodynamics' in the Google Scholar, EBSCHO-HOST, Science-Direct, PubMed and Web of Science databases.

RESULTS

The term filicide refers to the murder of the offspring by the parent. Although it is a common belief that the children are murdered boy strangers, the reported figures may not be representing the truth. No families are detected in one fourth of all murdered infants within the first 24 hours. The death of abondoned children are classified as 'due to natural causes'. Some murders might not be reported properly and therefore, actual murders by own parents might have been missed on the records. It is known that filicide is a heterogeneous phenomenon requiring a multidimensional evaluation in being affected by cultural values, belief systems of the society as well as the bio-psycho-social and developmental variables. It is reported in the literature that filicide cases have a common profile and that training clinicians on this complex phenomenon would be effective on prevention strategies.

CONCLUSION

The concept of filicide is controversial in many aspects and mental health professionals tend to distance themselves since the concept is associated with 'crime'. However it is crucial to elucidate the psychodinamic background on violence and discuss the risk factors, triggers, background dynamics and psychopathologies underlying this phenomenon.

Killing One's Own Baby: A Psychodynamic Overview with Clinical Approach to Filicide Cases

OBJECTIVE

This review article discusses the multi-dimensional and complex pattern of filicide from a psychodynamic perspective with reference to the recent publications. Creating awareness to filicide among professionals will help to the correct assessment of the cases, recognition of and intervention on filicide before the act, and the development of preventive mechanisms.

METHOD

Published articles between January 1960 and March 2020 were searched using the keywords 'filicide, infanticide, neonaticide, mother/ parent/ maternal/ paternal, psychodynamics' in the Google Scholar, EBSCHO-HOST, Science-Direct, PubMed and Web of Science databases.

RESULTS

The term filicide refers to the murder of the offspring by the parent. Although it is a common belief that the children are murdered boy strangers, the reported figures may not be representing the truth. No families are detected in one fourth of all murdered infants within the first 24 hours. The death of abondoned children are classified as 'due to natural causes'. Some murders might not be reported properly and therefore, actual murders by own parents might have been missed on the records. It is known that filicide is a heterogeneous phenomenon requiring a multidimensional evaluation in being affected by cultural values, belief systems of the society as well as the bio-psycho-social and developmental variables. It is reported in the literature that filicide cases have a common profile and that training clinicians on this complex phenomenon would be effective on prevention strategies.

CONCLUSION

The concept of filicide is controversial in many aspects and mental health professionals tend to distance themselves since the concept is associated with 'crime'. However it is crucial to elucidate the psychodinamic background on violence and discuss the risk factors, triggers, background dynamics and psychopathologies underlying this phenomenon.

Excessive screen time is associated with maternal rejection behaviours in pre-school children

AIM

Early childhood screen exposure leads to multiple adverse health events and parents have a major influence on their children's screen time. Our aim was to determine the association between maternal acceptance-rejection/control behaviours and excessive screen exposure in pre-school children.

METHODS

In this cross-sectional descriptive study, children aged 2-5 years who had daily screen time <1 h (n = 76) and >4 h (n = 62) were enrolled. A structured survey form and Parental Acceptance-Rejection/Control Questionnaire were completed by mothers.

RESULTS

Total rejection scores were found to be lower in those with screen time <1 h than cases with >4 h (82.7 ± 13.2, 89.3 ± 17.2; P = 0.015). In addition, higher hostility, neglect and reverse-affection scores were detected in excessive screen-exposed group (P = 0.033, P = 0.003, P = 0.047, respectively). Multivariate logistic regression analyses revealed that mothers' low acceptance of their children and high neglect score were associated with excessive screen exposure after adjusting possible confounding factors. The undifferentiated rejection and control behaviours of the mothers had no association with excessive screen exposure.

CONCLUSION

Children with excessive screen time may have a problematic relationship with their mothers. The relationship between parent and child should be examined and corrective actions should be taken.

Factitious Disorder Presented by Haematemesis / Factitious Disorder Imposed on Another (FDIA): A Case Report

Factitious disorder imposed on another (FDIA-DSM-5), formerly known as Munchausen Syndrome by Proxy (MSP) is a form of child abuse. A case can be recognised by only keeping the relevant diagnoses in mind. There are many cases of FDIA diversified by the contributions of both the caregiver and the child. Most of these cases are complicated by the difficulty of accurately determining the relative roles of the parent and the child and their levels of awareness and motivation. Here, we present the case of an 11-year old girl admitted to our hospital with the complaint of haematemesis 6-8 times a day. A case of factitious disorder was considered following the physical and psychological examinations on the patient. Evaluating the case within this context suggested a case of FDIA by drawing attention to the continuity of the symptoms described in the patient with the those of the caregiver. In approaching cases of FDIA, unravelling the interdependence of the dynamics of different awareness levels of feigning and motivation by the caregiver and the child is very crucial. Considering the variations in the process of FDIA development through interweaving of the motivations of the mother and child, the case presented here is believed to bring a different point of view that will contribute to the understanding of the nature of this disorder.

The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T)

AIM

The aim of this study was to determine the prevalence of childhood psychopathologies in Turkey.

METHOD

A nation-wide, randomly selected, representative population of 5830 children (6-13 years-old) enrolled as a 2nd,3rd or 4th grade student in 30 cities were evaluated for presence of a psychiatric or mental disorder by a Sociodemographic Form, Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and DSM-IV-Based Screening Scale for Disruptive Behavior Disorders in Children and Adolescents scales. Impairment criterion was assessed via a 3 point-Likert scale by the parent and the teacher independently.

RESULTS

Overall prevalence of any psychopathology was 37.6% without impairment criterion, and 17.1% with impairment criterion. Attention-deficit hyperactivity disorder was the most frequent diagnosis, followed by anxiety (19.5% and 16.7% without impairment, 12.4% and 5.3% with impairment, respectively). Lower education level and presence of a physical or psychiatric problem of the parents were independent predictors of any psychopathology of the offspring.

CONCLUSION

This is the largest and most comprehensive epidemiological study to determine the prevalence of psychopathologies in children and adolescents in Turkey. Our results partly higher than, and partly comparable to previous national and international studies. It also contributes to the literature by determining the independent predictors of psychopathologies in this age group.

[Reliability and Validity of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, DSM-5 November 2016-Turkish Adaptation (K-SADS-PL-DSM-5-T)]

The aim of this study was to evaluate the reliability and validity of the Schedule for Affective Disorders and Schizophrenia for School-Age ChildrenPresent and Lifetime Version, DSM-5 November 2016 -Turkish Adaptation (K-SADS-PL-DSM-5-T).  METHOD: A total of 150 children and adolescents between 6 and 17 years of age were assessed with K-SADS-PL-DSM-5-T. The degree of agreement between the DSM-5 criteria diagnoses and the K-SADS-PL-DSM-5-T diagnoses were considered as the measure of consensus validity. In addition, concurrent validity was examined by analyzing the correlation between the diagnoses on K-SADS-PL-DSM-5-T and relevant scales. Interrater reliabilities were assessed on randomly selected 20 participants. Likewise, randomly selected 20 other participants were interviewed with K-SADS-PL-DSM-5-T three weeks after the first interview to evaluate test-retest reliability.  RESULTS: The consistency of diagnoses was almost perfect for eating disorders, selective mutism and autism spectrum disorder (κ=0.92-1.0), substantial for elimination disorders, obsessive-compulsive disorder, oppositional defiant disorder, generalized anxiety disorder, social anxiety disorder, depressive disorders, disruptive mood dysregulation disorder and attention deficit hyperactivity disorder (κ=0.67-0.80). Interrater reliability was perfect for selective mutism (κ=1.0), substantial for oppositional defiant disorder, disruptive mood dysregulation disorder, attention deficit hyperactivity disorder, depressive disorders and social anxiety disorder (κ=0.63-0.73). Test-retest reliability was almost perfect for autism spectrum disorder (κ=0.82), substantial for attention deficit hyperactivity disorder, oppositional defiant disorder, disruptive mood dysregulation disorder, depressive disorders and generalized anxiety disorder (κ=0.62-0.78).  CONCLUSION: The results of this study show that the K-SADS-PL-DSM-5-T is an effective instrument for diagnosing major childhood psychiatric disorders including selective mutism, disruptive mood dysregulation disorder and autism spectrum disorder which have recently been added to the schedule.

[Relationship between the Psychiatric Symptoms in Expecting Parents and Postpartum Depression and Infantile Colic: A Multicenter Follow up Study]

OBJECTIVE

The aim of this study is to evaluate the relationship between postpartum depression (PPD), infantile colic (IC) and different psychosocial variables, psychiatric symptoms, attachment style and perceived social support in expecting parents.

METHOD

Two hundred forty five expecting mothers and 150 expecting fathers were first interviewed between the 22-34 weeks of pregnancy. Sociodemografic data form, Adult Attachment Style Scale (AASS), State Anxiety Inventory (SAI), Edinburgh Postnatal Depression Scale (EPDS), Multidimensional Scale of Perceived Social Support (MSPSS) and Brief Symptom Inventory (BSI) were filled out by each expecting parent. Second interview was conducted between the postpartum 4-24 weeks. Data form consisting health, nutrition, sleep and crying problems of the infant and EPDS and SAI were filled out by mothers and SAI by fathers.

RESULTS

One in every four mothers had PPD symptoms above the threshold on EPDS. Maternal and paternal insecure attachment style, maternal psychiatric symptoms and postpartum anxiety level were found to be the predictors of PPD. One in every five infants had IC and maternal education level, hostility score and PPD symptoms along with paternal insecure attachment style and psychiatric symptoms were the main predictors of IC.

CONCLUSION

Results about PPD and IC regarding maternal variables are consistent with the literature. In addition, paternal insecure attachment style is found to be an important risk factor for both PPD and IC. Fathers should also be included in further studies exploring PPD or IC.

Munchausen syndrome by proxy presented as recurrent respiratory arrest and thigh abscess: a case study and overview

While many physicians are familiar with the sexual or physical abuse of children, there is little awareness about Munchausen syndrome by proxy (MSBP). As case reports of MSBP increase, awareness among physicians is thought to increase as well. We thus present herein a 16-month-old girl who admitted to Hacettepe University İhsan Doğramacı Children's Hospital with the complaint of seizure, recurrent apnea and thigh abscess, who was later diagnosed as MSBP. The case was being followed by the Child Protection Team of the hospital (Haceteppe University Child Protection Unit [HU-CPU]). HU-CPU contributed to the early detection of this case and protected the child from a possible fatal outcome. The mother was confronted for MSBP and refused to take responsibility for her child's symptoms. As seen in this case, when MSBP is suspected, psychiatric evaluation of the mother, evaluation of the mother-child interaction and collection of a detailed family and social history can have a positive impact on the prognosis in these cases. This case report underlines the importance of multidisciplinary team work to share the responsibility and reduce the burden during the treatment process of these difficult and complicated cases.

[A case of Munchausen Syndrome by proxy in the context of folie a famille]

The occurrence of similar psychotic symptoms in two or more people is called shared paranoid disorder. In this disease, the person who exhibits psychotic symptoms first is the "primary patient". The symptoms are contracted by the other people through persuasion. This disorder is seen among people who share the same house or are emotionally bound. In some cases, shared paranoid disorder may include other diagnoses, such as Munchausen Syndrome. This report discusses the case of a six-year-old, sexually abused boy who, when admitted to the hospital at the age of 10, claimed to have been repeatedly sexually harassed by several different people. His family's frequent changes in hospitals, negative perceptions of and accusations against medical staff, and improper methods of responding to harassment led clinicians to a diagnosis of Munchausen by proxy syndrome. In addition, both parents believed the abuse story, suggesting a potential diagnosis of shared psychotic disorder. In the literature, Munchausen by proxy has rarely been reported with symptoms of sexual abuse. The psychotic symptoms were shared by the family, complicating the case. This report emphasizes that psychodynamic evaluations of Munchausen by proxy and shared psychotic disorder may be helpful in understanding underlying factors.