The effect of obstructive sleep apnea syndrome on the central auditory system

Background/aim: Obstructive sleep apnea syndrome (OSAS) is a disease characterized by repeated hypoxia attacks during sleep. The effect of hypoxia on the central nervous system is a well-known entity. In this study we aimed to investigate the effect of OSAS on the central auditory system. Materials and methods: Twenty-one OSAS patients diagnosed by polysomnography (PSG) and 10 control subjects were included in the study. After a thorough otorhinolaryngology examination, all subjects underwent pure tone audiometry (250 to 8000 Hz frequency). The subjects with normal otoscopic examination and hearing threshold were included in the study. All participants underwent speech discrimination analyses and auditory time processing and sequencing tests, i.e. frequency pattern test (FPT) and duration pattern test (DPT). Results: Although hearing was normal in the OSAS patients, significant loss was observed in the speech discrimination rates compared to the control group (P < 0.05). Significant disruption was also detected in the FPT and SPT in the OSAS patients (P < 0.05). Conclusion: Repeated hypoxic episodes in OSAS resulted in statistically significant impairments in the central auditory pathways, even if the hearing threshold was within normal limits.

The relationship of psychological trauma with trichotillomania and skin picking.

OBJECTIVE: Interactions between psychological, biological and environmental factors are important in development of trichotillomania and skin picking. The aim of this study is to determine the relationship of traumatic life events, symptoms of post-traumatic stress disorder and dissociation in patients with diagnoses of trichotillomania and skin picking disorder. METHODS: The study included patients who was diagnosed with trichotillomania (n=23) or skin picking disorder (n=44), and healthy controls (n=37). Beck Depression Inventory, Traumatic Stress Symptoms Scale and Dissociative Experiences Scale were administered. All groups checked a list of traumatic life events to determine the exposed traumatic events. RESULTS: There was no statistical significance between three groups in terms of Dissociative Experiences Scale scores (P=0.07). But Beck Depression Inventory and Traumatic Stress Symptoms Scale scores of trichotillomania and skin picking groups were significantly higher than the control group. Subjects with a diagnosis of trichotillomania and skin picking reported statistically significantly higher numbers of traumatic and negative events in childhood compared to healthy subjects. CONCLUSION: We can conclude that trauma may play a role in development of both trichotillomania and skin picking. Increased duration of trichotillomania or skin picking was correlated with decreased presence of post-traumatic stress symptoms. The reason for the negatively correlation of severity of post-traumatic stress symptoms and self-harming behavior may be speculated as developing trichotillomania or skin picking symptoms helps the patient to cope with intrusive thoughts related to trauma. Future longitudinal research must focus on whether trauma and post-traumatic stress or trichotillomania and skin picking precede the development of mental disorder.

Baseline sacroiliac joint magnetic resonance imaging abnormalities and male sex predict the development of radiographic sacroiliitis.

We evaluated the relationship between the baseline sacroiliac joint (SIJ) magnetic resonance imaging (MRI) findings and the development of radiographic sacroiliitis and tested their prognostic significance in cases of ankylosing spondylitis. Patients who had undergone an SIJ MRI at the rheumatology department were identified. Individuals for whom pelvic X-rays were available after at least 1 year of MRI were included in the analysis. All radiographs and MRI examinations were scored by two independent readers. Medical records of the patients were reviewed to obtain potentially relevant demographic and clinical data. We identified 1,069 SIJ MRIs, and 328 fulfilled our inclusion criteria. Reliability analysis revealed moderate to good inter- and intra-observer agreement. On presentation data, 14 cases were excluded because they had unequivocal radiographic sacroiliitis at baseline. After a mean of 34.8 months of follow-up, 24 patients developed radiographic sacroiliitis. The presence of active sacroiliitis (odds ratio (OR) 15.1) and structural lesions on MRI (OR 8.3), male sex (OR 4.7), fulfillment of Calin's inflammatory back pain criteria (P = 0.001), and total MRI activity score (P < 0.001) were found to be related to the development of radiographic sacroiliitis. By regression modeling, the presence of both active inflammatory and structural damage lesions on MRI and male sex were found to be predictive factors for the development of radiographic sacroiliitis. Our present results suggest that the occurrence of both active inflammatory and structural lesions in SIJs revealed by MRI is a significant risk factor for radiographic sacroiliitis, especially in male patients with early inflammatory back pain.

Discerning the effects of psychopathology and antidepressant treatment on sexual dsyfunction*.

OBJECTIVE: To compare the frequency and correlates of sexual dysfunction in patients with Major Depressive Disorder on SSRI treatment with those who are not. METHODS: Patients diagnosed with Major Depressive Disorder, without comorbid psychopathology/medical disorder/alcohol/nicotine use for the past year with a CGI-S severity score of 4 were included. Two groups were formed, one using SSRIs at least for 6 weeks before the study, and another who were free of drugs for the last month. Arizona Sexual Experience Scale (ASEX) was given to determine sexual dysfunction. P was set at 0.05. RESULTS: Thirty-three patients (25 female, 75.8%) were included. The study group was using sertraline (n = 10, 52.6%) and citalopram (n = 9, 47.4%). Fourteen patients on SSRIs (73.7%) and 12 controls (% 85.7) displayed sexual dysfunction with no difference between groups. Female gender was associated with sexual dysfunction, regardless of treatment (P = 0.04). Arousal sub-test of ASEX differed significantly in the group with dysfunction (P = 0.04). CONCLUSIONS: Female gender may be a risk factor for sexual dysfunction in the presence of depression, regardless of drug use. Arousal may be affected in patients, regardless of treatment, and this may reflect the effect of depressive cognitions on libido.

The evaluation of suicide letters in Turkey from a cognitive perspective.

BACKGROUND: Different methods are used to understand the suicidal mind. Suicide note analysis may be most direct way to do this. AIMS: To study the content of suicide letters under forensic evaluation in terms of psychological and cognitive aspects. METHODS: A total of 51 letters were referred to The Council of Forensic Medicine from different cities of Turkey and analyzed by a research group with ten members including forensic medicine specialists and psychiatrists. The Questionnaire of Content Analysis of Suicide Letters (The Q-CAS), developed by researchers, was used to analyze the cognitive and cultural themes of suicide letters. The cognitive distortions about the self, the world, and the future as well as cultural phenomena were evaluated including sociodemographic features. RESULTS: Financial problems in males and relationship problems in females were the most frequent life events related to suicide. Hopelessness, weakness, loneliness--in decreasing order--were the most predominant cognitions and emotions. The total score of females were higher than that of males (p=.002). CONCLUSIONS: These negative cognitions should be taken into consideration when therapeutic interventions are planned on individuals with suicidal thoughts.