Successful treatment of severe alcohol withdrawal delirium with very high-dose diazepam (260-480 mg) administration.

INTRODUCTION: Alcohol withdrawal delirium, commonly known as "delirium tremens (DT)", is the most severe clinical condition of alcohol withdrawal syndrome (AWS). Symptoms of DT include changes in consciousness and cognitive and perceptual impairments that fluctuate during the day. Treatment includes general support, such as helping the patient to re-orientate, close monitoring of vital signs and adequate hydration, and symptomatic treatment for agitation, autonomic instability, and hallucinations. In symptomatic treatment of DT, benzodiazepines are most commonly preferred due to their GABA-ergic effects. Diazepam, a benzodiazepine, has a faster onset of action than other benzodiazepines when administered intravenously (iv) and effectively controls symptoms. Although low doses of diazepam usually relieve DT symptoms, very high doses may be required in some patients. This case series discusses patients receiving high doses of diazepam to relieve DT symptoms. CASE REPORT: Four male patients aged from 43 to 57 years who regularly consumed alcohol with a daily average of 20-100 standard drinks and developed DT afterwards and were followed up in the intensive care unit are presented. In these patients, the symptoms of DT were relieved, and somnolence was achieved with the administration of very high-dose IV diazepam (260-480 mg/day), contrary to routine treatment doses. All patients were successfully treated and discharged without any morbidity. CONCLUSION: Severe AWS can potentially result in death otherwise managed quickly and adequately. Diazepam is a suitable agent for severe AWS or DT treatment. Clinicians should keep in mind that high-dose diazepam treatment may be required in the treatment of DT that develops after a long-term and high amount of alcohol consumption. Publications reporting the need for very high doses of diazepam in DT are limited and usually published long ago; in this context, our findings are significant. The evidence is often based on case reports and uncontrolled studies, so controlled trials are needed to determine optimal treatment doses in severe DT.

Mental health, suicidality and hopelessness among university students in Turkey.

Psychological symptoms of university students can affect perceptions of physical and mental health and can influence the emergence of suicidal behavior. We investigated the association among psychological symptoms, suicidal thoughts, perceptions of physical and mental health in university students. 4330 students at Onsekiz Mart University completed an internet-based questionnaire. 15.1% of the students reported suicidal thoughts at least once in their lifetime. The severity of mental symptoms was found to increase with a decrease in perceived physical and mental health. 28.2% of the students had depression, 33.1% had anxiety. This research aims to contribute to the extensive body of work done regarding the mental health, suicidal thoughts and hopelessness among university students.

[Cognitive functions in patients with obsessive compulsive disorder]. / Obsesif kompulsif bozuklukta bilissel islevler.

AIM: This literature review aimed to examine the relationship between cognitive impairment and obsessive-compulsive disorder (OCD). Studies based on neuropsychological testing were prioritized, but those dealing with clinical features, therapy, comorbidity, neuroimaging, and the families of OCD patients were also considered. MATERIALS AND METHODS: The literature on cognitive impairment in OCD was reviewed and then the studies evaluating the relationship with these above mentioned findings were discussed. RESULTS: The clinically most important cognitive impairment in OCD is executive dysfunction, followed by impaired memory. Cognitive impairment has also been observed in the healthy relatives of OCD patients. Findings regarding the effects of comorbidity on cognitive function in OCD patients are inconsistent. Brain imaging studies suggest that frontostriatothalamic dysfunction might occur in OCD. CONCLUSION: Executive dysfunction in OCD patients is well documented; however, the precise nature of the relationship between the severity of cognitive dysfunction and the clinical features of OCD are not well understood. Longitudinal family studies that employ both neuropsychological testing and brain imaging are needed to more clearly elucidate the relationship between cognitive dysfunction and OCD.

Psychosocial factors affecting various types of intimate partner violence against women.

OBJECTIVE: Intimate partner violence against women is a growing global public health problem that is related to various psychosocial, cultural, mental, and economic factors. In this study, psychosocial factors affecting various types of intimate partner violence against women were investigated based upon affected individuals' statements. METHODS: Demographic data, exposure to various types of partner violence, individual habits, partner habits, family functioning, and social support were inquired about during face to face interviews with 306 women chosen by stratified sampling to represent adult women living in Edirne, Turkey. RESULTS: Among the participants, 54.5% were exposed to psychological violence, 30.4% were exposed to physical violence, 19.3% were exposed to economic violence, and 6.3% were exposed to sexual violence. Partner's age and the duration of marriage had a protective effect on intimate partner violence while worsening of marital relations, marriage by family decision, marriage against family consent, and the presence of a violent history against women in a partner's family had incremental effects on intimate partner violence. The duration of marriage, the worsening of marital relations and a history of violent exposure during childhood increased physical violence. Additionally, a decreasing family income, increasing economic violence, worsening of marital relations, and a decreasing social support network increased sexual violence against women. CONCLUSIONS: Recognizing and defining the effecting factors of intimate partner violence will aid in the understanding of the sources that generate and feed the violent behavior. Risk factors of different types of intimate partner violence vary. Our results indicate that any kind of violent behavior increases intimate partner violence against women.