Parna Prajapati

 Objective: To examine the types of substance use associated with suicidal ideation based on age group, gender, and school type in a sample of Turkish youth. Methods: The study data was collected by the Istanbul Department of Education on 31,604 high school students who received a 66-question survey that was administered in the school setting. Systematic sampling was used to select the allocated sample of classrooms. Every third classroom from each grade was included in the sampling. The sample consisted of 53% female and 46.3% male participants. The participants' ages ranged from 13 to 21, with an average age of 16 years (SD ± 1.06 years). The sub-questions for substance use were added to generate new independent variables used to examine the relationship between substance use and suicidal ideation based on age, gender, and school type. Binary logistic regression was run between the dependent variable (suicidal ideation) and independent variables (type of substance use) based on three models; age, gender, and type of school. The study examines the use of legal (sleeping pills, tobacco, steroids, and alcohol) and illegal (amphetamine, LSD, ecstasy, cocaine, mushroom, homemade brews, cannabis) substances. The standardized coefficients were calculated with a p-value of 0.05 and odds ratios were reported. Results: Tobacco and sleeping pill use were significantly associated with suicidal ideation among all age groups, and both gender participants and those in regular and vocational schools. Ecstasy was significantly associated with suicidal ideation among older age groups and Anatolian school participants. Inhalant use was significantly associated with suicidal ideation in female participants and those who were in regular schools. Substance use among vocational school participants and those who were in older age groups had a significant association with suicidal ideation. Conclusions: A pattern of substance use was seen in this study, specifically highlighting the need for educational and other preventive measures among Turkish youth with greater emphasis on youth in older age groups and vocational high schools. 

 Objective: To report the risk factors associated with conduct disorder traits in a sample of Turkish high school participants. Methods: The survey encompassed 31,604 high school students, from which a final sample of 31,272 was selected for data analysis. The survey instrument had 66 questions in total with multiple subquestions and it was collected by the Istanbul Department of Education using trained counselors and teachers. The questions used to explore the risk factors associated with conduct disorder had sub-questions that were added to generate variables of interest used in this study. Linear regression between the dependent variable (conduct disorder traits) and independent variables (psychosocial and substance use) was used, with the level of significance set at p<0.05. Results: The model explains about 13.2% and 11.6% of the variance in conduct disorder traits among male and female participants respectively. Participants with high anomie, high irritability, and high religious self-practices, and less religious beliefs were significantly more likely to have higher conduct disorder traits scores. The participant characteristics that had significantly low conduct disorder traits scores include those who spent less time with peers, spent more time with family, having more parental involvement, low family substance use, high peer influence, better school grades, higher depression and anxiety scores, and those with low substance use. Conclusion: In this data, many statistically significant risk factors were associated with the development of conduct disorder traits. This is the first study to report risk factors for conduct disorder traits in a large sample of Turkish youth. 

Background: Osteopathic lymphatic pump treatments (LPT) are used to treat edema, but their direct effects on lymph flow have not been studied. In the current study, we examined the effects of LPT on lymph flow in the thoracic duct of instrumented conscious dogs in the presence of edema produced by constriction of the inferior vena cava (IVC). Methods and Results: Six dogs were surgically instrumented with an ultrasonic flow transducer on the thoracic lymph duct and catheters in the descending thoracic aorta and in IVC. After postoperative recovery, lymph flow and hemodynamic variables were measured 1) pre-LPT, 2) during 4 min LPT, 3) post-LPT, in the absence and presence of edema produced by IVC constriction. This constriction increased abdominal girth from 60 AE 2.6 to 75 AE 2.9 cm. Before IVC constriction, LPT increased lymph flow (P < 0.05) from 1.9 AE 0.2 ml/min to a maximum of 4.7 AE 1.2 ml/min, whereas after IVC constriction, LPT increased lymph flow (P < 0.05) from 7.9 AE 2.2 to a maximum of 11.7 AE 2.2 ml/min. The incremental lymph flow mobilized by 4 min of LPT (ie, the flow that exceeded 4 min of baseline flow), was 10.6 ml after IVC constriction. This incremental flow was not significantly greater than that measured before IVC constriction. Conclusions: Edema caused by IVC constriction markedly increased lymph flow in the thoracic duct. LPT increased thoracic duct lymph flow before and after IVC constriction. The lymph flow mobilized by 4 min of LPT in presence of edema was not significantly greater than that mobilized prior to edema.

Objectives: Youth suicide is a major social and health problem worldwide. Over the last decade Turkey has become a regional power with growing regional aspirations with a young population and rapidly growing economy. The limited literature on Turkish youth suggests that suicidality is a growing challenge for Turkish youth. This study aims to examine the prevalence and risk factors of suicidal ideation amongst Turkish youth in Istanbul, its main metropolitan center. Methods: This study analyzed responses from 31,272 students, consisting of 20 percent of the total high school (HS) student population of Istanbul. The main survey instrument was a combination of the ESPAD 2007 survey and the Youth in Europe 2012 survey, examining risk factors commonly reported in the literature. Results: Our findings indicate a prevalence of one week suicidal ideation of 25.77 %, with depression, anxiety, self-esteem, anomie, irritability, "antisocial" behavior, peer influence, and illicit substances identified as associate risk factors. Other contextual factors were significant in different student subgroups. Conclusions: To our knowledge this is the first study with results generalizable to all HS students of Istanbul and confirms findings of similar studies with other populations of Turkish youth as well as other nations.

A 19-year-old Hispanic male with past psychiatric history of illicit drug use was brought by his mother to the emergency room of a tertiary care hospital with altered mental status. According to patient's mother his paranoid symptoms consisted of increased suspiciousness towards his friends and other family members, but were not to the extent for him to seek out any medical help. Clinical course and management of this patient, who later progressed to full blown catatonia, is described in this report. Patient had paradoxical disinhibition when treated with benzodiazepine, limiting treatment options. Patient's mother would not consent for ECT treatment after which Olanzapine was selected to manage his catatonic symptoms. This patient's preexisting paranoid ideations and catatonia were stabilized successfully with a few days of olanzapine with significant decrease in Bush-Francis Catatonia Score. Initial catatonia score of 14 points at baseline decreased to 3 points after 20 days of inpatient management. Historically, when risperidone (strong 5HT2A antagonist) was combined with sertraline (serotonin reuptake inhibitor), it potentiated action of 5HT1A receptors and was implicated in development of catatonia. Olanzapine does not bind to 5HT1A receptors; hence it does not possess this risk. On the contrary, it has strong potency for 5HT2A receptors, inhibition of which increases dopamine concentration in striatum via glutamate-GABA pathway. At his 10 months follow-up, patient reported sustained improvement in his symptoms after 6 months of treatment. Rationale of selecting Olanzapine as medication alternative based on pathophysiological basis of catatonia is described and follow-up information after 10 months is presented in this report. Patient's vital parameters, results of investigation modalities, catatonia rating scores and serial description of the events are documented in the report. Despite limited evidence of the use of second-generation antipsychotics for catatonia, this can be a viable treatment option, especially in adolescent patients who are more prone to paradoxical disinhibition. Conclusion: The LOI-CV and OBQ-CV had promising psychometric properties in a community sample of Turkish children and adolescents.