Biomedical subjects

Fatih Unal

Publications and source records attributed to Fatih Unal.

6 recordsLinked to original sources

PubMed2006

[Early onset conversion disorder: a case report].

Conversion disorder is defined as the presence of functional impairment in motor, sensory and neurovegetative systems that cannot be fully explained by a general medical condition. In western countries, conversion disorder is rare in children and adolescents. However, clinical studies from our country demonstrated a high frequency of conversion disorder diagnosis in child and adolescent psychiatry clinics. Conversion disorder is more frequently seen in adolescents and young adults compared to children. The likelihood of this disorder in children younger than five years of age is very low. This case report presents an 8 years old patient with conversion disorder diagnosis whose complaints started at three years of age. Her clinical condition had been continuous and resistant to non-psychiatric treatment approaches. Her complaints included inability to stand up and walk, complete bed dependence, presence of jerking type of movements in both legs, contractures as a result of decreased muscle movements and joint use, and presence of curving in her back due to continuous sitting bent to one side. Therapeutic interventions had been successful and the patient completely recovered. In this paper, the clinical presentation of conversion disorder, possible etiological factors and how these factors were handled, concrete treatment strategies and the follow-up of this patient are discussed. In addition, importance of early diagnosis and treatment of conversion disorder in children in our country and requirement of interdisciplinary cooperation in treatment are emphasized.

Child↗

PubMed2004

Biliary atresia in Turkish children.

AIM: To evaluate surgical success, survival rate and relationship of outcome parameters with time at diagnosis and operation of extrahepatic biliary atresia (EHBA) patients in Izmir, Turkey. METHODS: Clinical and laboratory data were reviewed from case reports of 27 EHBA patients. Twenty-five patients were operated on using Kasai procedure and two cases received liver transplants without portoenterostomy due to decompansated liver cirrhosis on diagnosis. Post operational success was defined as clearance of jaundice (bilirubine level <2 mg/dL). Patients were studied in two groups: I (jaundice free and/or compensated liver disease with liver transplant if needed after 3 years of age) and II (progressive liver disease with death or liver transplant if needed before 3 years of age). Kasai success, age at diagnosis and operation, survival and correlation of outcome with age, preoperative liver functions were evaluated. Eight patients received liver transplants. RESULTS: Median age at diagnosis was 63.5 days (21-212) and portoenterostomy was performed at median age of 67.5 days (25-220). Kasai operation was successful in two cases (8%) and the operation was performed at 35 and 42 days. Age at diagnosis (P = 0.13) and operation (P = 0.2) was not different between the two groups. Group I and II consisted of seven (28%) and 18 (72%) infants. Pre-existing ascites, serum alanine aminotransferase (ALT) and globulin levels were significantly higher in group II patients (P = 0.008, P = 0.04, P = 0.017, respectively). CONCLUSIONS: The results of the present study indicate that general practitioners should pay close attention to the evaluation of infants with prolonged jaundice in Turkey. Because of frequent late diagnosis presenting with cirrhosis at admission and also because of the low organ donation rates in Turkey, living related liver transplantation is an option and is currently undergoing detailed ethical consideration.

Age Factors↗

PubMed2002

Conversion disorder in children and adolescents: a 4-year follow-up study.

OBJECTIVE: To assess the outcome of conversion disorder in children and adolescents and to identify factors affecting the prognosis. METHOD: Forty adolescents with conversion disorder were reevaluated 4 years after their initial interview. Changes in demographic and clinical data and the presence of any mood and anxiety disorders were recorded using the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). In addition, Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) were applied. RESULTS: Thirty-four patients (85%) had completely recovered from their conversion symptoms and two patients had improved (5%), whereas only four (10%) were unchanged. Fourteen (35%) patients received the diagnosis of mood and/or anxiety disorder. Favourable outcome was associated with early diagnosis (P=.04) and good premorbid adjustment (P=.01). CONCLUSION: Conversion disorder has a favourable outcome in children and adolescents. However, mood and/or anxiety disorders are encountered at a considerable rate in these patients even after recovery from conversion symptoms. Long clinical follow-up seems appropriate in children and adolescents with conversion disorder.

Adolescent↗

PubMed2002

Alpha interferon and lamivudine combination therapy for chronic hepatitis B in children.

BACKGROUND: Lamivudine is a new alternative therapeutic agent for chronic hepatitis B, in which alpha interferon (IFN-alpha) monotherapy is not successful enough. Published reports have revealed no satisfactory data on IFN-alpha and lamivudine combination therapy in children. The aim of this study is to investigate the efficacy and safety of this combination therapy in children with chronic hepatitis B. METHODS: Children with chronic hepatitis B were given either IFN-alpha and lamuvidine (group 1, n = 47) or IFN-alpha alone (group 2, n = 30). Alpha interferon was administered as 5 million U/m2 s.c., thrice a week for 6 months and lamivudine 4 mg/kg per day p.o., maximum 100 mg, for 1 year. Clinical examination was performed; blood cell counts and serum alanine aminotransferase (ALT) and amylase were studied at each visit. At the third, sixth and twelfth month, serological markers were determined. RESULTS: End of therapy response was achieved in 19 (40.4%) patients in group 1 and in 14 (46.7%) children in group 2 (P > 0.05). In group 1, pretreatment serum ALT and hepatic activity index (HAI) were statistically higher in children who responded to therapy (P < 0.005). In group 2, mean serum ALT was higher and hepatitis B virus (HBV) DNA was lower in responders. Sustained response rate was 40.4 versus 43.3% in two groups. CONCLUSION: The response rate of IFN-alpha and lamivudine combination therapy in children with chronic hepatitis B was similar to that of IFN-alpha monotherapy. High ALT level and HAI, rather than low HBV-DNA level were found to be important predictors of response.

Adolescent↗

PubMedDate not supplied

Comorbid psychiatric disorders in 201 cases of encopresis.

Although encopresis is a common and complex disorder, relatively few studies have evaluated the comorbid psychiatric disorders in this condition. This study was performed to investigate the comorbid psychiatric disorders in encopresis. One hundred and sixty boys (79.6%) and 41 girls (20.4%) fulfilled the diagnostic criteria for encopresis according to DSM-IV. There was at least one comorbid diagnosis in 149 (74.1%) patients. The most frequent comorbid diagnosis was enuresis (55.2%). Clinical and demographical data were compared between patients with comorbid disorders and others. Primary encopresis was significantly more frequent in patients with comorbid disorders, and the mean age at admission was lower in these patients. The mean interval between the onset of symptoms and the diagnosis was significantly shorter in secondary encopretic patients with comorbid disorders. Furthermore, there were significantly more psychiatric disorders in the first-degree relatives of patients with comorbid disorders. Encopresis is frequently accompanied with a psychiatric disorder. Clinicians need to inquire about symptoms of other psychiatric disorders in patients who present with encopresis and vice versa.

Adolescent↗

PubMedDate not supplied

Encopresis: long-term clinical outcome of 67 cases.

In this study we attempted to investigate the outcome of encopresis and to determine factors affecting prognosis. The sample consisted of 52 boys (77.6%) and 15 girls (22.4%) diagnosed as encopresis according to DSM IV diagnostic criteria. These patients were evaluated six years after their initial examination in the Department of Child Psychiatry. Clinical and demographical data were compared between initial and follow-up interviews and between patients with complete recovery and others. Fifty-six patients (83.6%) recovered completely and 11 (16.4%) continued to be encopretic after six years. Good school performance (p<0.005), high levels of parental education (p<0.005) and absence of constipation (p<0.05) were associated with favorable outcome. In addition, secondary encopretics who were diagnosed within a year from onset of the symptom recovered significantly earlier (p<0.001). Encopresis is a chronic disorder and complete recovery rates tend to increase with time. Families and primary health care providers should be informed about the treatment possibilities of encopresis for early intervention.

Age Factors↗