Childhood Trauma as an Environmental Determinant of Risk of Violence in Bipolar Disorder.

Introduction: The complex interaction of violent behavior, childhood trauma and bipolar disorder (BD) is unclear. Therefore, we aimed to investigate the risk factors of violence in BD and studied the relationship between different types of childhood trauma and violence. Methods: We assessed 105 remitted patients diagnosed with BD I (n=91) or BD II (n=14). All patients were evaluated with the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Childhood Trauma Questionnaire (CTQ), Buss-Perry Aggression Questionnaire (BPAQ) and Violence Tendency Scale (VTS). Uni- and Multivariable Linear Regression Analyses were conducted to predict violent behavior. Results: All patients scored high points on CTQ and violence scales. In the univariate regression analysis, CTQ total and subscale scores (except physical neglect), age and presence of lifetime suicide attempts were correlated with both VTS and BPAQ. Emotional and sexual abuse subtypes had a significant correlation with violence. In the multivariate analysis, only CTQ total score and age were significantly correlated with violence. There was a negative relationship between age and violence. Conclusion: All types of childhood traumas seem to be correlated with violent behavior in patients with BD. Childhood trauma and younger age are significant determinants of violence in BD. The VTS, which emerged in Turkey, may assist clinicians to detect potentially aggressive behavior before it becomes obvious.

Association of Domestic Violence Against Women With Sociodemographic Factors, Clinical Features, and Dissociative Symptoms in Patients Who Receive Services From Psychiatric Outpatient Units in Turkey.

Domestic violence (DV) against women is a serious problem with its negative effects on all family members and the society. Women exposed to DV not only have physical but also psychological damage. This study investigates prevalence of DV and its relations with some descriptive and clinical features in a psychiatric outpatient population in Turkey. A total of 277 female outpatients were included in the study. After a semistructured clinical interview, they were assessed by sociodemographic data form, DV questionnaire, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Dissociative Experiences Scale (DES), and Somatoform Dissociation Questionnaire (SDQ). Prevalence of exposure to DV by intimate partner is found to be 58.8% (n = 163). The current study provided strong evidence that occupation status of the woman, education level of the partner, and family type are predictors of DV. Another predictor of DV exists where the child is battered by either parent. Prevalence of depression, conversion disorder, and other somatoform disorders are higher in women exposed to DV. These women also have higher scores from HDRS, HARS, DES, and SDQ compared with female patients who have not experienced DV (p < .001). Number of women scoring above cutoff levels for DES and SDQ were significantly higher in women exposed to DV (p < .001).

Intensive Care Psychological Assessment Tool (IPAT): Turkish validity and reliability study

Background/aim: It is of crucial importantance to be able to detect acute psychological distress in patients. The Intensive Care Psychological Assessment Tool (IPAT) was developed for this purpose in intensive care units. This study aims to evaluate the validity and reliability of the Turkish version of IPAT. Materials and methods: In total, 98 patients were included. To assess concurrent validity, the Intensive Care Experiences Scale (ICES) and the Hospital Anxiety Depression Scale were performed. Cronbach's alpha coefficient was used to estimate internal consistency. Interitem and item-total score correlations were also performed. Sensitivity and specificity were derived for concurrent anxiety and depression. Results: The internal reliability was good. Cronbach's a = 0.85. Items were well-correlated, with an average interitem correlation of 0.38. The concurrent validity of IPAT was good. Correlation between IPAT scores, anxiety, depression, ICES, and the diagnosis of delirium were as follows, respectively: r = 0.61, P < 0.01, r = 0.54, P < 0.01, r = −0.66, P < 0.01, r = 0.37, P < 0.01. With a cutoff score of ≥ 6, IPAT showed 85% sensitivity and 61% specificity to detect concurrent anxiety, and 74% sensitivity and 82% specificity to detect concurrent depression [AUC = 0.77 (95% CI, 0.68­0.87) and 0.84 (95% CI, 0.76­0.92), respectively]. Conclusion: The Turkish version of IPAT was found to be a valid and reliable tool to assess acute psychological distress among patients in intensive care units.

Fundamental Characteristics, Attitudes and Behaviors Regarding Substance Use Focusing on Cannabis: Findings from the General Population Survey in Turkey, 2011.

Cannabis is the most prevalent illicit drug used in the world. We aimed to determine prevalence and some characteristics of cannabis use in Turkey. The study was based on a cross-sectional survey conducted with a nationally representative sample of 8045 individuals with in-house interviews. The life-time prevalence of substance use was found as 2.8%. Cannabis with 0.7% life-time prevalence, was the most commonly used substance. Cannabis users were concerned about some adverse outcomes such as anxiety with withdrawal (14%), losing control about using the drug (14%), daily performance problems (10.9%) and problems about interpersonal violence (6.9%). 35.1% of them wanted to quit and 18% regretted using cannabis. Prevalence of cannabis use is lower in Turkey compared with most of the other countries in the world. Nevertheless, it is a significant health concern. Identifying characteristics and attitudes related with cannabis use may help to improve policies about protective measures.

Diagnostic Classification Systems Based on Psychoanalytical Principles.

The diagnostic classification systems in psychiatry practice which are used worldwide extensively, The Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Statistical Classification of Diseases and Related Health Problems (ICD) are far away from the psychoanalytical point of view. It is thought that this gap results in the difficulty to understand psychiatric patients in clinical practice for many years. It has also created an obstacle to scientific researches addressing the validity and reliability of the psychoanalytical principles. On the other hand, psychoanalysis has been much criticised for years due to the lack of empirical foundations. As a result of this paucity, psychiatry is led by the biomedical approach. Without enough grounds in evidence-based medicine, psychoanalytical principles could not become widespread in psychiatric practice. To survive criticism and strengthen its place in contemporary psychiatry, empirical research in psychoanalytical discipline has gained momentum in the last two decades. Development of objective psychodynamic diagnostic tools enabled the design of such studies. The aim of this review is to introduce such diagnostic tools, namely Psychodynamic Diagnostic Manual (PDM) and Operationalized Psychodynamic Diagnosis (OPD), and to discuss the possible contributions they provide for psychoanalytical perspective to take its deserved place in the psychiatry discipline.

Explanatory Models of Illness, Help Seeking Behaviours and Related Factors in Patients with Schizophrenia: A Comparative Study from Two Different Provinces of Turkey.

This study aims to identify the help seeking behaviours of patients from two geographically distinct provinces of Turkey. A questionnaire about sociodemographic characteristics and help seeking ways was applied to 49 schizophrenia patients from Van, 99 from Ankara. The ratio of patients seeking psychiatric help at the beginning of their illness was 76% in Ankara, the capital city, in contrast to 54% in Van (p = 0.01). Twenty-two percent of patients from Ankara and 69% from Van reported that non-psychiatric help seeking was the choice of their families (p < 0.001). Thirty-five percent of all patients sought religious support when their symptoms started. Patients with lower education levels sought more religious help (p = 0.002). Help seeking behaviours show regional variations. Religious help seeking behaviour is a major way of dealing with the illness. Psychoeducation is a crucial need both for patients and families.

Could psychiatric assessment before hematopoietic stem cell transplantation predict the need for psychiatric consultation during transplantation period?

Psychiatric morbidity seems to be a significant concern associated with all stages of hematopoietic stem cell transplantation (HSCT). We aimed to understand whether psychiatric consultation before HSCT procedure could predict the need for psychiatric support during isolation period. Seventy-eight patients undergoing HSCT were included in the study. Patients were diagnosed according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). Standard anxiety and depression scores were performed. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and State and Trait Anxiety Inventory (STAI) were performed. Psychiatric consultation was required for 45 (58%) patients during hospitalization. Only pre-HSCT STAI trait scores were higher in patients who were found to have psychopathology at consultation during hospitalization compared to patients without established psychopathology. Sixteen (76%) and 29 (51%) patients needed consultation with and without pre-HSCT psychopathology, respectively. Our study showed that the psychiatric consultation request rate during the transplantation process was higher for cases previously diagnosed with psychopathology and who had high trait anxiety scale scores before HSCT.

Do anxiety and depression statuses differ in differentpolycystic ovary syndrome phenotypes?

BACKGROUND/AIM: To evaluate psychological parameters and health quality profiles in women with reproductive polycystic ovary syndrome (PCOS) phenotypes and age matched controls. MATERIALS AND METHODS: The study groups included 101 women with PCOS (54 with the National Institutes of Health [NIH] phenotype and 47 with the non-NIH phenotype) and 49 healthy female controls. The participants completed anxiety and depression scales and four quality of life domains. RESULTS: We identified the women with PCOS as having a 3.39 times increased risk for depression (subscale ≥ 7) and a 3.64 times increased risk for anxiety (subscale ≥ 10) compared to the controls. Both NIH and non-NIH phenotypes showed similar rates of depression (46.3% vs. 46.8%, respectively; P = 0.57) and anxiety (31.5% vs. 36.2%, respectively; P = 0.47). Regarding the quality of life scale, the women with NIH PCOS had significantly lower mental health scores compared to those with non-NIH PCOS (P = 0.03). Furthermore, while mental health scores were similar in the women with PCOS and the controls, physical health scores were significantly lower in the women with PCOS (P = 0.007). CONCLUSION: Nearly half of the women with PCOS had higher depression scores and one third had higher anxiety scores. Thus, psychiatric evaluations appear necessary for PCOS patients in order to diagnose and treat clinical depression and anxiety.

Prevalence and Socio-Demographic Determinants of Tobacco, Alcohol, Substance Use and Drug Misuse in General Population in Turkey.

INTRODUCTION: The aim of the current study is to determine prevalence ratios of tobacco, alcohol, substance use and drug misuse in a large scale sample of general population and recognize related socio-demographic factors. METHODS: The study was based on a cross-sectional survey conducted with a nationally representative sample of 8045 individuals with face-to-face, in-house interviews implemented by a trained team of interviewers. RESULTS: Life-time prevalences of tobacco, alcohol, substance use and drug misuse are 51.8%, 28.3%, 2.8% and 10.5% respectively. Age, gender, education level and marital status are important socio-demographic determinants for tobacco, alcohol use and drug misuse. Income level is an important determinant for alcohol and substance use. CONCLUSION: Tobacco, alcohol, substance use and drug misuse are significant health concerns in Turkey. Socio-demographic status is an important determinant of several aspects of tobacco, alcohol, substance use and drug misuse and should therefore be evaluated carefully to develop effective protective and preventive strategies.

Serum brain-derived neurotrophic factor, vascular endothelial growth factor and leptin levels in patients with a diagnosis of severe major depressive disorder with melancholic features.

OBJECTIVE: Brain-derived neurotrophic factor (BDNF), vascular endothelial growth factor (VEGF) and leptin have been hypothesized to be involved in the neurobiology of depression. The aim of this study was to investigate BDNF, VEGF and leptin levels in patients with severe melancholic depression. METHODS: A total of 40 drug-free patients with major depressive disorder (MDD) with melancholic features and 40 healthy controls were included in the study. Demographic information, psychiatric evaluation and physical examination were documented for both groups. Serum BDNF, VEGF levels were determined by enzyme-linked immunosorbent assay and leptin with radioimmunoassay methods. The Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale were applied to the patients. RESULTS: There were no significant differences in serum BDNF, VEGF and leptin levels between the patient and control groups. There was a negative correlation between BDNF levels and the number of depressive episodes. It was noted that VEGF levels decreased with increasing severity of depression. CONCLUSIONS: These findings suggest that BDNF levels might be associated with the recurrence of depression and VEGF levels might be a determinant of the severity of depression.

Metabolic, endocrinologic and cardiac effects of amisulpride: a 24-week follow-up study.

BACKGROUND: Amisulpride is a second-generation antipsychotic which has been proved to be effective in the control of both positive and negative symptoms of schizophrenia. In this study we aimed to determine metabolic, endocrinologic and cardiac effects of amisulpride commonly used in our clinical practice. METHODS: A total of 18 patients (11 males, 7 females) diagnosed with schizophrenia received amisulpride at the dosage of 800 mg/day and were followed up for 24 weeks. Positive and negative psychotic symptoms, extrapyramidal and sexual side effects, metabolic, endocrinologic and cardiac parameters were evaluated at regular intervals. RESULTS: Significant improvement in both positive and negative symptoms was observed in patients starting from the second week of treatment. Prolactin levels increased significantly both in men and women starting from the measurement on day 4. Prolactin elevation was significantly higher in women than in men. Increase in total cholesterol level became significant at week 24. No other significant difference was observed between weeks 1 and 24 regarding the other parameters. CONCLUSIONS: The clinical data from the present study supports the fact that amisulpride is an effective and safe antipsychotic drug, but elevates prolactin levels in both sexes.

A patient using ziprasidone with polydipsia, seizure, hyponatremia and rhabdomyolysis.

We aimed to report a case with rhabdomyolysis related to hyponatremia and/or its correction. A 32-year-old male schizophrenic patient on ziprasidone treatment was admitted to the hospital following a seizure. Patient had primary polydipsia and secondarily developed hyponatremia. After the correction of hyponatremia, due to the high liver enzyme levels, he was diagnosed as rhabdomyolysis. Although the role of antipsychotics in this situation is speculative, development of rhabdomyolysis related to hyponatremia and/or its correction should not be underestimated and should be assessed thoroughly.