Publications by authors named "Gresa Carkaxhiu Bulut"

9 Publications

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The severity of inflammation in major neuropsychiatric disorders: comparison of neutrophil-lymphocyte and platelet-lymphocyte ratios between schizophrenia, bipolar mania, bipolar depression, major depressive disorder, and obsessive compulsive disorder.

Nord J Psychiatry 2021 Jul 28:1-9. Epub 2021 Jul 28.

Department of Child and Adolescent Psychiatry, Maltepe University Medical School, Istanbul, Turkey.

Background: As non-specific markers of immune dysregulation, neutrophil-lymphocyte and platelet-lymphocyte ratios (NLR and PLR) have been consistently shown to be increased in major neuropsychiatric disorders. Although this increase seems to be trans-diagnostic, the extent to which its magnitude differs between disorders remains largely unclear.

Aim: The aim of this study was to directly compare the severity of inflammation (as reflected by NLR and PLR) between schizophrenia (Sch), bipolar mania (BD-M), bipolar depression (BD-D), major depressive disorder (MDD) and obsessive compulsive disorder (OCD).

Methods: NLR and PLR were obtained for a total of 417 subjects (91 Sch, 70 BD-D, 37 BD-M, 93 MDD, 37 OCD, and 95 controls) and analyzed for group differences.

Results: Sch, BD-M, BD-D and MDD presented with significantly higher NLR compared with both OCD and HC. NLR in BD-M was significantly higher than all the remaining groups, whereas Sch, BD-D and MDD presented with comparably elevated NLR. Moreover, BD-M, Sch and MDD had significantly higher PLR compared with HC.

Conclusion: These results suggest that the underlying inflammation may be most severe in BD-M, followed by Sch, BD-D and MDD. On the other hand, inflammation may be of negligible intensity in OCD, or at least undetectable by means of NLR or PLR.
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http://dx.doi.org/10.1080/08039488.2021.1919201DOI Listing
July 2021

Children with supracondylar humerus fractures have an increased risk of attention deficit hyperactivity disorder.

Acta Orthop Belg 2021 Mar;87(1):159-166

Children with attention deficit hyperactivity disorder (ADHD) have an increased risk of sustaining fractures during their preschool years. Supracondylar humerus fractures (SHFs) comprise the majority of fracture surgeries in the pediatric age range. We hypothesized that ADHD symptoms would be present in children with SHFs, and this characteristic trauma may be associated with an ADHD diagnosis. Thus, we compared the ADHD symptoms of children with and without SHFs. Further, we compared the trauma characteristics, gender, proneness to injury, and presence of prior trauma history of children diagnosed with and without ADHD. We recruited 41 children who were admitted to emergency service with an SHF and 41 age- and gender-matched children without a fracture history. A semi-structured diagnostic inter- view and a Swanson Nolan Pelham questionnaire were used to obtain data about ADHD symptoms. A clinical intake form was utilized for further clinical data. ADHD symptoms were significantly higher in the fracture group ; male gender, parent- reported proneness to injury, and prior history of trauma were significantly associated with ADHD. Orthopedic surgeons may provide early detection of ADHD by using screening tools or asking questions to caregivers and making referrals when needed. This may lead to prevention of further injuries.
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March 2021

Predictors of ADHD persistence in elementary school children who were assessed in earlier grades: A prospective cohort study from Istanbul, Turkey.

Brain Dev 2021 Apr 19;43(4):495-504. Epub 2021 Jan 19.

Erenkoy Research and Training Hospital for Neurology and Psychiatry, İstanbul, Turkey.

Background: Attention-deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorders among school-age children worldwide. In a more recent follow-up study, Biederman et al. found that 78% of children diagnosed with ADHD between the ages of 6-17 years continued to have a full (35%) or a partial persistence after eleven years.

Objective: In this study, it was aimed to identify the factors contributing to the persistence of ADHD symptoms in elemantary school children who were prospectively assessed both in their earlier and upper grades.

Methods: The sample was drawn from a previous community-based study where ADHD symptoms in 3696 first/or second graders were examined in regard to their school entry age. Two years after, the families of the children that participated in the initial study were called by phone and invited to a re-evaluation session. Among those who were reached, 154 were consequently eligible and were assessed with Swanson, Nolan and Pelham questionnaire (SNAP-IV), Conners' rating scales (CRS) and the Kiddie schedule for affective disorders and schizophrenia (K-SADS).

Results: Of the 154 children, 81 had been evaluated to have "probable ADHD" by the initial interview. Among these 81 children, 50 (61.7%) were indeed diagnosed with ADHD after two years. Initial scores of the teacher reported SNAP-IV inattention subscale predicted the ADHD diagnosis after two years, with an odds ratio of 1.0761 (p = 0.032, Wald: 4.595).

Conclusions: Our results suggest that high inattention symptom scores reported by the teacher in the earlier grades, might predict an ADHD diagnosis in upper grades.
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http://dx.doi.org/10.1016/j.braindev.2020.11.013DOI Listing
April 2021

Validity and reliability of the Turkish version of the adult ADHD Self-Report Screening Scale for DSM-5.

Balkan Med J 2021 03;38(2):111-115

Department of Child Psychiatry, Marmara University School of Medicine, İstanbul, Turkey;Child Study Center, Yale University School of Medicine, New Haven, CT, USA.

Background: Approximately half of the children with attention-deficit hyperactivity disorder continue to meet diagnostic criteria in adulthood. The prevalence of adult attention-deficit hyperactivity disorder is reported between 2.5% and 4.4% and is associated with significant impairment in quality of life and increased psychiatric comorbidity. Attention-deficit hyperactivity disorder in adults remains mostly undiagnosed and/or untreated despite the availability of effective treatments. The majority of people who do not receive necessary treatment are in the nonclinical or nonpsychiatric clinical population. Screening is an important step for diagnosing adults with attention-deficit hyperactivity disorder. Yet, there are no valid and reliable screening questionnaires calibrated for the Diagnostic and Statistical Manual for Mental Disorders-5 in Turkish.

Aims: We aimed to test the reliability and the validity of the Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 screening questionnaire designed according to DSM-5 in the Turkish population.

Study Design: Methodological and cross-sectional study.

Methods: The translation was carried out according to the World Health Organization Composite International Diagnostic Interview translation guide using a linguistic adaptation approach. We used a convenience sampling method to recruit an individual with adult attention-deficit hyperactivity disorder (n = 68) and a control group (n = 68). The participants completed a sociodemographic form, 6-items Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5, and the previous version 18-items Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 for the concurrent validity analysis. For the diagnostic validity, clinical diagnosis made by psychiatrists according to the Diagnostic and Statistical Manual for Mental Disorders-5 criteria was used. Internal consistency and item-total correlation coefficients, exploratory factor analyses, correlation with Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1, and receiver operating characteristic curve analysis were conducted.

Results: The internal consistency measured by Cronbach alpha was 0.869. Item-total correlation coefficients were calculated to be between 0.602 and 0.717, and the correlations were statistically significant (P < 0.0001). The Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 showed to have a unidimensional factor structure explaining 60.54% of the variance. The correlation between Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 and Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 total score was calculated as 0.992 (P < 0.0001), and that between Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 and Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-v1.1 attention-deficit subdimension was 0.868 (P < 0.0001). In the receiver operating characteristic analysis of Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5, the area under the curve was found to be 0.916. The cut-off score was calculated as 9 of 10 with a sensitivity of 85.2% and specificity of 89.7%.

Conclusion: Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale-5 is a valid and reliable self-report measure to assess and screen attention-deficit hyperactivity disorder in the Turkish population. It may be useful for both clinical and population studies.
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http://dx.doi.org/10.4274/balkanmedj.galenos.2020.2020.5.119DOI Listing
March 2021

Heart rate variability response to affective pictures processed in and outside of conscious awareness: Three consecutive studies on emotional regulation.

Int J Psychophysiol 2018 07 19;129:18-30. Epub 2018 May 19.

Department of Psychiatry, Marmara University Medical School, Turkey.

Previous research has increased understanding of the neurobiological basis of emotional regulation. However, less is known concerning the unconscious processing of affective information. Three experiments were performed to investigate the extent to which complex affective stimuli can be processed outside of consciousness and demonstrate possible mechanisms for regulation of resulting emotional responses. In Experiment 1, participants were either instructed to passively observe blocked-picture cues (neutral and negative) or to downregulate their emotions by distancing. Resulting emotional regulation activity was assessed with 0.1-Hz heart rate variability (HRV) indices. In Experiment 2, participants were presented with affective pictures that were rendered consciously invisible by means of continuous flash suppression (CFS). In Experiment 3, two equivalent sets of negative affective pictures were covertly presented and the effect of a cognitive task on emotional regulation was evaluated. Our findings revealed that 0.1-Hz HRV indices exhibited greater change over baseline in response to negative compared to neutral stimuli for both presentation conditions (consciously perceived or not). The implementation of distancing and the cognitive task were both associated with higher 0.1-Hz HRV change scores. These results indicate that even complex affective stimuli can be processed without awareness, resulting in a congruent emotional response that is physiologically detectable. Cognitive strategies can help more effectively regulate this response, implying that conscious perception of a triggering stimulus may not be essential for cognitive regulation.
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http://dx.doi.org/10.1016/j.ijpsycho.2018.05.006DOI Listing
July 2018

Efficacy of bright light therapy in bipolar depression.

Psychiatry Res 2018 02 12;260:432-438. Epub 2017 Dec 12.

Private Practice, Vizyon Psychiatry, Istanbul, Turkey. Electronic address:

For 30 years, bright light therapy (BLT) has been considered as an effective, well-tolerated treatment for seasonal affective disorder (SAD). Because of low response rates, new treatment strategies are needed for bipolar depression (BD), which resembles SAD in certain respects. Few placebo-controlled studies of BLT efficacy have been carried out for BD. Accordingly, this study evaluates the efficacy and safety of BLT as an add-on treatment for BD. Thirty-two BD outpatients were randomly assigned to BLT (10000lx) or dim light (DL, < 500lx). During a two-week period, light was administered each morning for 30min. The Hamilton Rating Scale for Depression and the Montgomery-Ǻsberg Depression Rating Scale assessed clinical outcome, and the UKU Side Effects Rating Scale evaluated side effects. No significant difference was observed in baseline depression scores in the two groups. Response rates for BLT and DL were 81% and 19%, and remission rates were 44% and 12.5%, respectively. Analyses showed statistically significant reductions in depression scores for the BLT group compared with the DL group on all scales. Side effects were similar in both groups, with headache as the most common side effect. The results suggest that BLT is an effective and safe add-on treatment for BD.
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http://dx.doi.org/10.1016/j.psychres.2017.12.020DOI Listing
February 2018

Evaluation of 5-HTTLPR Gene Polymorphism and Resilience Components on the Development of Psychopathology in Adolescent Sexual Abuse Cases.

Noro Psikiyatr Ars 2017 Sep 1;54(3):234-238. Epub 2016 Sep 1.

Department of Medical Genetics, Marmara University School of Medicine, İstanbul, Turkey.

Introduction: More than one-fourth adolescents are exposed to unexpected frightening experiences and traumas until adulthood. In this study, we aimed to determine the potential role of serotonin transporter (5-HTT) gene polymorphism regarding resilience factors in the symptom variability of individuals exposed to sexual abuse.

Methods: Adolescents aged 11-17 years, who were admitted to the Marmara University Child Psychiatry Outpatient Clinic Forensic division with sexual abuse experience history, were informed about the research, and volunteers were included in the study. Turkish versions of "Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (K-SADS-PL)" was used to assess the psychopathology and functionality. The evaluation of participants also included self-reports based on "Eysenck Personality Inventory" and "Ways of Coping Inventory" for reflecting the resilience domain.

Results: The sample included 16 girls (88.9%) and 2 boys (11.1%), and the mean (±standard deviation) age was 14.58±1.97 years. Genotyping of the insertion/deletion polymorphism (5-HTTLPR) in the 5-HTT gene's transcriptional control zone was established, and 8 participants (44.4%) were determined to be of the LL genotype, while 7 (38.8%) were LS and 3 (16.6%) were SS carriers. Considering the relationship between coping styles regarding resilience and genetic variants, 87.5% of participants (n=7) exhibiting problem-focused coping style were determined found to carry the LL allele, while 90% (n=9) who exhibited emotion-focused coping styles were the SS-LS allele carriers (p=0.003).

Conclusion: Our findings suggest that 5-HTTLPR gene polymorphism has a significant impact on the formation of coping styles. More studies are needed to determine other factors involved in the complex relationship between 5-HTTLPR gene polymorphism and development of psychopathology.
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http://dx.doi.org/10.5152/npa.2016.12528DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630101PMC
September 2017

Association Between Age of Beginning Primary School and Attention Deficit Hyperactivity Disorder.

J Dev Behav Pediatr 2017 01;38(1):12-19

*Maltepe University Medical School, Child and Adolescent, Maltepe University Research and Training Hospital, Istanbul, Turkey; †Department of Child and Adolescent, Marmara University Faculty of Medicine, Istanbul, Turkey; ‡Department of Psychology, Guzel Gunler Health Services, Istanbul, Turkey; §Marmara University Training and Research Hospital, Istanbul, Turkey; ‖Medical Park Gaziosmanpaşa Hospital, Istanbul, Turkey; ¶Department of Neurology and Psychiatry, Erenkoy Training and Research Hospital, Istanbul, Turkey, for Psychiatry and Neurology; **Department of Neurology and Child Adolescent, Muş State Hospital, Muş, Turkey.

Objective: In April 2012, the Turkish national education system was modified, and the compulsory school age of entry (first grade) was redefined as a minimum of 60 months and a maximum of 66 months (replacing the former minimum criterion of 72 months). In this study, we hypothesized that students starting school before 72 months (the previous age standard for the first grade) may experience (1) a greater number of symptoms of attention deficit hyperactivity disorder (ADHD) and (2) lower functioning in social, behavioral, and academic domains.

Method: We performed a cross-sectional community-based study in the first and second grades of all primary schools (4356 students) located in the Kadıköy county of Istanbul, Turkey. Teachers completed Swanson, Nolan, and Pelham version IV and Conners' Teacher's report forms for symptoms of ADHD, the Perceived Competence Scale for functioning, and a sociodemographic questionnaire.

Results: Among first graders, the group that began primary school before the age of 72 months had a higher ADHD prevalence than both of the groups that began primary school between the ages of 72 to 77 months and 78 to 83 months (p < .001 for both groups). ADHD symptoms diminished and academic, social, and behavioral functioning improved with age for the first and second grade students.

Conclusion: The probability of displaying ADHD symptoms (and caseness) is greater among the "earlier" beginners, whereas the "conventional" classmates exhibited better academic, social, and behavioral functioning.
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http://dx.doi.org/10.1097/DBP.0000000000000370DOI Listing
January 2017

Disrupted latent decision processes in medication-free pediatric OCD patients.

J Affect Disord 2017 Jan 20;207:32-37. Epub 2016 Sep 20.

Department of Psychology, Koç University, İstanbul, Turkey. Electronic address:

Background: Decision-making in Obsessive Compulsive Disorder has typically been investigated in the adult population. Computational approaches have recently started to get integrated into these studies. However, decision-making research in pediatric OCD populations is scarce.

Methods: We investigated latent decision processes in 21 medication-free pediatric OCD patients and 23 healthy control participants. We hypothesized that OCD patients would be more cautious and less efficient in evidence accumulation than controls in a two alternative forced choice (2AFC) task.

Results: Pediatric OCD patients were less efficient than controls in accumulating perceptual evidence and showed a tendency to be more cautious. In comparison to post-correct decisions, OCD patients increased decision thresholds after erroneous decisions, whereas healthy controls decreased decision thresholds. These changes were coupled with weaker evidence accumulation after errors in both groups.

Limitations: The small sample size limited the power of the study.

Conclusions: Our results demonstrate poorer decision-making performance in pediatric OCD patients at the level of latent processes, specifically in terms of evidence accumulation.
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http://dx.doi.org/10.1016/j.jad.2016.09.011DOI Listing
January 2017
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