Double Blind Controlled Study of Adding Folic Acid to Fluoxetine in the Treatment of OCD.

BACKGROUND: Folate is important for the synthesis of serotonin the neurotransmitter which plays a main role in OCD. We, therefore, explored the efficacy of folic acid as add on treatment to fluoxetine in a double blind study among patients with OCD. SUBJECTS AND METHODS: A double blind, 12-week study comparing the efficacy of folic acid as add on treatment and placebo in patients with OCD was conducted on thirty six (36) patients. Patients were randomly assigned to folic acid (5 mg/day) or placebo group in addition to fluoxetine (40 mg/day). After the baseline assessment, on week 2, 4, 6, 8 and 12 assessments were performed by using YBOCS, HAM-D, HAM-A and CGI-S. Serum folate, erythrocyte folate, serum homocysteine and B12 levels were measured both baseline and the end of study. RESULTS: A mixed model repeated measures ANCOVA on Y-BOCS scores were used to determine the difference between folic acid and placebo groups. No significant differences were found in the ratios of gender or in the mean age, serum folic acid level, erythrocyte folate level, serum homocysteine level and serum B12 level between the treatment groups at the baseline. Consecutively scores collected over six measurements on YBOCS, HAM-D, HAM-A and CGI showed non-significant differences between folic acid and placebo groups. CONCLUSION: None of the biological markers of one carbon metabolism were associated with the change in YBOCS scores. It may be assumed that there is no beneficial effect of folic acid addition to fluoxetine in the treatment of OCD.

Psychiatric morbidity and its effect on the quality of life of patients with chronic hepatitis B and hepatitis C.

OBJECTIVE: The primary aim of our study was to determine the prevalence of psychiatric morbidity in a cohort of consecutive chronic hepatitis patients not receiving antiviral therapy. The secondary aim of our study was to determine if psychiatric morbidity, type of hepatitis, and the level of depression correlated with health-related quality of life (HRQL). METHODS: The study was conducted in collaboration with Hepatology and Infectious Disease Clinics at three-major university hospitals. One hundred seven patients who met the criteria for being diagnosed with either chronic hepatitis B or C, had non-cirrhotic compensated liver disease, had not received antiviral treatment in the preceding 6 months, and had no accompanying physical illness were included in the study. The Structured Clinical Interview for DSM-IV Axis I Disorders, the Short Form--36 for measuring HRQL, and semi-structured interviews for assessing psychosocial variables were used. Sixty-seven healthy adults formed the control group. RESULTS: 43.9% of the patients had hepatitis B, 56.1% hepatitis C. A psychiatric diagnosis was made in 48.6%, of which 15% was depression. No significant difference was found in the rate of psychiatric diagnosis between hepatitis B and hepatitis C patients. Hepatitis B and C patients were found to vary significantly (p < 0.001) from the control group on all subcategories of quality of life criteria. Psychiatric morbidity (mainly depression) was the major variable on lowering HRQL (p = 0.000). CONCLUSIONS: Chronic hepatitis B and C patients presented a high rate of psychiatric disorder. HRQL was significantly decreased in patients with psychiatric morbidity.

[Tobacco, alcohol and substance use prevalence among elementary and secondary school students in nine cities of Turkey]. / Dokuz Ilde Ilk ve Ortaögretim Ogrencilerinde Tütün, Alkol ve Madde Kullanim Yayginligi.

OBJECTIVE: Previous studies in Turkey regarding substance use have failed to take into consideration the elementary school students. The purpose of the present study is to determine prevalence of tobacco, alcohol, and substance use among elementary and secondary school students in Turkey. METHOD: The study was conducted in 9 big cities that were selected from different geographic regions of Turkey. According to the student population size of the cities, a sample of 1250 or 2500 students were selected from each city. The questionnaire was administered to 11.989 elementary school students, and 12.270 secondary school students. In elementary school students' questionnaire, for the substances other than tobacco, alcohol, inhalants and cannabis a general term "drug" was used. RESULTS: Overall, Izmir had the highest rate of substance use. The prevalence of tobacco use at least once in life time was found to be 16.1% in the elementary school. The lifetime prevalence was found to be 15.4% for alcohol use and 1.7% for inhalants and for general term "drug". The prevalence of tobacco use at least once in life time was 55.9%, for alcohol use it was 45.0%, for cannabis use 4.0%, for inhalant use 5.1%, and for heroin and ecstasy use 2.5% among secondary school students. A significant difference was found between males and females in terms of tobacco, alcohol and other drug use both in the elementary and the secondary school. The risk for substance use was found to be greater in private schools than public schools. CONCLUSION: Although the prevalence of substance use among elementary and secondary school students is low when compared to the findings from other countries. It was observed that especially the prevalence of tobacco use was quite high.

A cross-sectional study on expression of anger and factors associated with criminal recidivism in prisoners with prior offences.

OBJECTIVE: The purpose of this study is to determine demographical characteristics leading to crime recidivism and define anger levels and anger expression manners for those who re-commit crime. METHOD: All the literate inmates in Izmit Closed Penitentiary were included in this cross-sectional study. The prisoners were asked to respond to State-Trait Anger Expression Inventory. Their socio-demographic data were collected and a questionnaire was given to them to determine their state of imprisonment, sentence, nature of the crime in which they were involved, their criminal history, their relationship with inmates and prison staff and substance and alcohol use. RESULTS: Of the 438 prisoners, 302 (68.9%) responded to the questionnaires. Crime recidivism among the study cohort was observed to be 37.4%. Mean trait anger, anger out and anger in scores were significantly higher in prisoners with criminal recidivism in comparison with those who did not have prior criminal records. However, mean anger control scores for prisoners with or without criminal recidivism were similar. Unemployment, education level completed at secondary school or below, having committed a crime under the influence of alcohol or narcotics, having been involved in prison fights, having resisted police officers, caused damage in their vicinity when angry and violent crimes were all found to be possible causes of criminal recidivism. Educational level completed at secondary school or below, getting into fights with other prisoners, unemployment and resisting police officers were determined to be the strongest indicators to predict criminal recidivism when all variables were considered according to a logistic regression model. CONCLUSION: It can be proposed that those who have problems with officials or hostile towards others constitute a risk group for criminal recidivism. If prisoners with criminal recidivism can be helped to identify and control their anger, their risk of committing a new crime can be minimised.

Factors associated with Ecstasy use in Turkish students.

AIMS: The purpose of this study was to establish the factors associated with Ecstasy use in secondary school students in Turkey. DESIGN, SETTING AND PARTICIPANTS: This is a survey of a representative sample drawn from cities in different geographical regions in Turkey in 1998 and 2001. The questionnaire was administered to a total of 18,556 and 11,911 10th-grade students in 1998 and 2001, respectively. MEASUREMENTS: The questionnaire administered in the study was adapted from the questionnaires used in 'Monitoring the Future' study in the United States and ESPAD (the European School Survey Project on Alcohol and Other Drugs). It included questions about demographic characteristics, family characteristics, school life, social contacts and use of substances. FINDINGS: While the percentage of those who used Ecstasy at least once in their life-times was 2.65% in 1998, the figure reached 3.31% in 2001. Male gender, older age, use of alcohol, cannabis, heroin and cocaine, non-medical use of psychotherapeutic drugs and participation in a meeting concerning the adverse effects of substance use were found to be significant variables predicting 'ever use' of Ecstasy in both years by logistic regression analysis. CONCLUSIONS: Ecstasy use, while low in Turkey, appears to be on the increase and follows a pattern in terms of correlates that is similar to other illicit drugs. Whatever the causes behind the rise in Ecstasy use, creative, personalized and informative educational programmes should be conducted in all educational institutions to curb Ecstasy use.

A prospective randomized single-blind, multicenter trial comparing the efficacy and safety of paroxetine with and without quetiapine therapy in depression associated with anxiety.

OBJECTIVE To evaluate quetiapine as an adjunct to paroxetine in patients with comorbid depression and anxiety. METHOD Prospective, multicenter, single-blind trial of patients with DSM-IV major depression and associated anxiety, who were randomized to an 8-week treatment with paroxetine alone (n=54) or paroxetine+quetiapine (n=58). Quetiapine was dosed to 200 mg/day and paroxetine to 60 mg/day, as required. RESULTS Decrease in HAM-A scores was significantly greater in the combined therapy group than with paroxetine alone at weeks 2, 4, 6 and LOCF (P<0.008). Decrease in HAM-D scores was significantly greater in the combined therapy group than with paroxetine alone throughout the study period (P<0.008). Regarding adverse events, it was found that increases in anxiety and insomnia were more prevalent in the paroxetine only group, while increased appetite was more prevalent when quetiapine was added (P<0.05). CONCLUSION Quetiapine added to paroxetine is well tolerated and may speed up and improve response in patients with comorbid depression and anxiety.

Adaptation of revised Brief PHQ (Brief-PHQ-r) for diagnosis of depression, panic disorder and somatoform disorder in primary healthcare settings.

OBJECTIVE: The aim of this study was to determine the diagnostic accuracy of the Turkish version of the revised Brief Patient Health Questionnaire (Brief PHQ-r) in depression, panic disorder and somatoform disorder, in primary care settings. METHODS: This was a cross-sectional study with blinded psychiatric evaluation. The study was conducted at three sites which provide primary health services. Total number of the participants was 1556. Of these, 1387 comprised the analysis population. Diagnoses of depression, panic disorder and somatoform disorder made according to the patient's responses to the questions on Brief PHQ-r form were compared with the diagnoses made by psychiatrists using DSM-W. RESULTS: Diagnostic performance parameters of Brief PHQ-r were calculated. Main results are as follows: for any diagnosis k = 0.567, sensitivity 79.0%, specificity 82.9%; for major/minor depressive disorder k = 0.536, sensitivity 76.0%, specificity 85.3%; for panic disorder k = 0.640, sensitivity 74.4%, specificity 98.4% and for somatoform disorder k = 0.476, sensitivity 61.9% and specificity 92.5%. CONCLUSIONS: Diagnostic performance of Brief PHQ-r was found to be quite good in the diagnosis of major/minor depressive disorder, panic disorder and somatoform disorder, in primary healthcare settings. We recommend its use in routine clinical practice in order to help primary healthcare physicians, and also infield surveys on psychiatric disorders. Qnt] Psych Clin Pract 2004; 8: 11-18).

Psychological consequences of the 1999 earthquake in Turkey.

We explored the prevalence of posttraumatic stress disorder (PTSD) and its relation to demographic characteristics and other risk factors for developing PTSD in a large sample (N = 910) of earthquake survivors living in tent city. Twenty-five percent of the sample met DSM-IV criteria for PTSD assessed with the Posttraumatic Stress Disorder Self Test (PTSD-S). Peritraumatic factors explained the most variance when the risk factors were grouped as demographics, pretraumatic, peritraumatic, and posttraumatic. The study emphasized that PTSD among the earthquake victims was as prevalent in Turkey as after disasters in other developing countries but higher than usually found after disasters in developed countries, and there was a relation between some factors-mostly peritraumatic-and PTSD.