Objective: Criminal cases involving children and adolescents have been increasing. Therefore, physicians working in the field of children’s mental health require more information and experience on the judicial aspect of the cases and professional practice. There is not an education specialized in forensic child and adolescent psychiatry in addition to child and adolescent psychiatry in our country and around the world. Therefore, criminal cases involving children and adolescents have been referred to child psychiatry policlinics for expert review. Besides preparing reports, patients with psychopathology have been also treated and followed in the child psychiatry policlinics. Trauma-associated disorders (posttraumatic stress disorder, acute stress disorder, and adjustment disorder) and affective disorders have shown to be the most common disorders in sexually abused children. Therapy methods such as trauma-focused psychotherapy, psycho-education, game therapy, psychodynamic psychotherapy are commonly used methods. However, in cases of patient non-compliance, unresponsiveness to treatment or severe impairment, initiation of drug therapy may be considered. In our study, sociodemographic status, medication and response to treatment of the victims of child sexual abuse were evaluated.
Methods: 114 patients with no sexual abuse history, no mental retardation determined in the examination and no medication history due to any psychopathology were enrolled in the study and were asked “whether they had deterioration of mental health because of sexual abuse”. In evaluation of the initial diagnosis of the patients, 54 (47.4%) had no psychopathology, 24 had (21.1%) acute stress reaction, 23 (20.2%) had adjustment disorder, 8 (7%) had post traumatic stress disorder (PTSD), 3 (2.6%) had depression, 2 (1.8%) had impulsive suicide attempt diagnosis. After the first evaluation, in 91 patients (79,8%) no drug therapy has been initiated, whereas in 23 patients (20.2%) drug therapy has been initiated. However, of 23 patients who had drug therapy initiated, 12 (52.2%) did not continue their therapy, 10 (43,5%) continued to take medicine, 1(4.3%) continued the therapy intermittently. Considering the causes of discontinuation of medicine, of 12 patients 6 (50%) discontinued because they did not go to control visits, 5 (41.7%) because they did not want to take the medicine, 1 (8.3%) because of oversleeping side effect. Besides these patients, drug therapy was initiated in 9 patients at the 6th month.
Conclusion: Mental disorder and comorbid mental disorder rates were found to be high in abuse cases. Although a mental disease specific to abuse cases was not defined, it was determined that physical and sexual abuse increased the frequency of mental disorder. Most common mental disorders were determined as PTSD, major depressive disorder (MDD), mental retardation (MR) and attention deficit hyperactivity disorder (ADHD), respectively. PTSD treatment in children and adolescents include individual, family, group, behavioral, cognitive and psychopharmacological treatment approaches. In a study about fluoxetine in the treatment of children with PTSD, 92.2% of the patients had a little recovery, 3.8% had no changes in symptoms with the treatment and 3.8% had their symptoms worsened. In our study, fluoxetine has been a preferred drug among SSRIs.