[Two stiff person cases misdiagnosed as conversion disorder]. / Kati insan sendromunda konversiyon bozuklugu yanlis tanisi: iki olgu.

Modern psychiatric diagnostic systems classify neurological symptoms that cannot be explained by a physical disease or another psychiatric disorder as conversion disorder (CD) or dissociative motor disorder. It is a well-known fact that the overall rate of misdiagnosis of conversion symptoms is high. The most common presenting symptoms of misdiagnosed patients are gait and movement disturbances. Stiff-person syndrome (SPS) is a rare progressive autoimmune neurological disorder. The identification of antibodies against glutamic acid decarboxylase (GAD) in association with SPS provided an important contribution to the understanding of the pathophysiology of this syndrome. Patients may present with severe muscle rigidity and sudden contractions. Simultaneous contraction of agonist and antagonist muscles produces gait disturbance. SPS can be exacerbated by emotional stressors, and sudden auditory, visual, and tactile stimuli. Herein we present 2 patients that were referred for psychiatric assessment, because their neurological symptoms initially could not be explained by a neurological disease, and subsequently diagnosed as SPS. The aim of this case report is to draw attention to the psychiatric presentations of SPS and to emphasize the importance of complete psychiatric and neurological examination, including brain imaging and electrophysiological studies, in the differential diagnosis of CD.

[Prefrontal cortex: implications for memory functions and dementia]. / Prefrontal korteks: bellek islevi ve bunama ile iliskisi.

OBJECTIVE: The prefrontal cortex (PFC), which is one of the most complex areas of the human brain, is a frontal lobe segment that is consistently implicated in motor behaviors. In recent years it has been suggested that it is involved in memory functions via its diffuse anatomical networks. In this review, it was aimed to summarize the recent literature about PFC neuroanatomy, and its role in memory, normal aging, and dementias. METHOD: We retrospectively reviewed the literature, including recent relevant studies. In addition, textbooks were included for essential themes. PubMed and the Google search engine were used, and the keywords chosen for searches were: prefrontal cortex, dementia/types, and memory. RESULTS: Although the PFC has considerable cognitive and social functions, only minor cognitive dysfunction is observed when the frontal lobes are severely damaged. It is possible to say that the memory deficits could be masked by rigorous behavioral symptoms. The PFC has a critical role in memory retrieval. There is growing evidence that the PFC is involved not only in frontal lobe-type dementias, but also Alzheimer disease, mild cognitive impairment, and normal aging. The psychiatric and behavioral symptoms in such cases may be related to PFC dysfunction. CONCLUSION: Memory-related disorders are commonly associated with the frontal lobes and PFC. It may be considered that different parts of the PFC are related to different memory types and memory dysfunctions. Further studies with advanced neuroimaging techniques and valid animal models for all types and stages of dementias will help us to understand the role of the PFC in memory, physiology, and pathologies.

[Klüver-Bucy-like syndrome and frontal symptoms following cerebrovascular disease]. / Beyin Damar Hastaligi Sonrasi Gelisen Frontal Belirtiler ve Klüver-Bucy Benzeri Sendrom.

We present a case with frontal lobe symptoms and Klüver-Bucy-like syndrome following subarachnoid hemorrhage and hydrocephaly. Klüver-Bucy syndrome is a rare neurobehavioral condition characterized by placidity, visual agnosia, hypersexuality, hyperorality, and hypermetamorphosis (the tendency to react to or to touch every visual stimulus). The syndrome is usually associated with lesions of the amygdala or its pathways, and it occurs after head trauma, anoxia-ischemic encephalopathy, herpes simplex encephalitis, and Reye 's syndrome. A 45-year-old right-handed female patient, who developed hydrocephaly after meningitis due to bilateral middle cerebral artery aneurysm surgery presented to our psychiatry clinic with various behavioral and emotional changes. In her psychiatric examination, increased and disinhibited speech, perseveration, placidity, impaired go/no go task performance, and hyperphagia were observed. The patient was treated with risperidone 0.5 mg/day. Magnetic resonance imaging (MRI) of the brain showed encephalomalacic-gliotic changes in the anterior superior medial temporal lobe (including bilateral amygdala), hydrocephalus, bilateral abnormal signal intensity in the white matter of the frontal region, and bilateral infarction in the centrum semiovale. Symptoms, such as placidity (loss of anger and fear) and altered dietary habits are some of the clinical features of Klüver-Bucy syndrome, whereas disinhibition and perseveration are associated with prefrontal cortex dysfunction.

[General Health Questionnaire-12 for the detection of depression]. / Depresyon Saptanmasinda Genel Saglik Anketi-12.

OBJECTIVE: The aim of this study was to assess the validity and the possible cut-off points of the General Health Questionnaire-12 (GHQ-12) in detecting depression in university students. METHODS: The study included 170 students (115 females and 55 males) that consecutively applied to a university student health center psychiatric clinic and who were asked to complete a sociodemographic data form and the GHQ-12 before their visit with the psychiatrist. DSM-IV psychiatric diagnoses were established using the Structured Clinical Interview for DSM-IV Axis-I Disorders (SCID-I). RESULTS: Depression was the most prevalent DSM-IV diagnosis (49%) and 35% of the students did not have any psychiatric diagnosis. Mean GHQ-12 score was 7.5+/-3.7 (8.0+/-3.6 for females and 6.4+/-3.7 for males, p<0.05). Sensitivity and specificity for depressive disorder were 83% and 65% (for the cut-off point 7/8), 75% and 77% (for the cut-off point 8/9), and 62% and 88% (for the cut-off point 9/10), respectively. The internal consistency (Cronbach's alpha 0.88) was good. Kappa coefficient for agreement between DSM diagnosis for depression and GHQ (cut-off 8/9) was 0.52. Item 9, which inquired about pleasure, produced the highest odds ratio for the diagnosis of depression (OR(CI)=11.84 (4.66-30.08)). CONCLUSION: The results of this study revealed that GHQ-12 is a useful screening instrument for the detection of depression with a high cut-off point (8/9). The students' tendency to report more psychological symptoms and the administration of the instrument in a student psychiatric clinic could be the reasons for the high GHQ-12 cut-off points. We propose the use of high cut-off points for students who applied to a psychiatric clinic for more accurate detection of depression.

[The neurobiology of hallucinations]. / Varsanilarin nörobiyolojisi.

OBJECTIVE: Although hallucinations are among the cardinal features of schizophrenia, the mechanisms underlying these symptoms have not been fully understood yet. In this review our objective is to summarize the studies about the neurobiology of auditory hallucinations in schizophrenia and discuss their significance for understanding schizophrenia. METHOD: This is a retrospective literature review and the relevant studies within the last 10 years are included. For this purpose Pubmed search engine and 'hallucination, schizophrenia, neurobiology' key words are used. RESULTS: Hallucinations cause sensory modality specific activation in cerebral areas involved in normal sensation. A disturbance in perception of speech seems to have a central role in occurrence of auditory hallucinations. Anatomically, auditory hallucinations appear to involve primary and association cortices, Broca's and Wernicke's areas, subcortical, paralimbic, limbic regions, ventral striatum and thalamus. Furthermore they are suggested to be associated with the dysmodulation of the information flow from ventral striatum to thalamus and cortex caused by increased dopaminergic activity in mesolimbic pathway. CONCLUSION: The validity of the models which are proposed to explain neurobiology of hallucinations in schizophrenia should be tested by new studies. The difficulties regarding the assessment and measurement of subjective mental phenomena are important impacts in studying and understanding the neural correlates of hallucinations. Functional neuroimaging, cognitive and molecular biological studies will hopefully enhance our knowledge about this disease.

[The effect of day and night shift working on the attention and anxiety levels of anesthesia residents]. / Gece ve Gündüz Vardiya Calismasinin Bir Grup Anestezi Asistaninin Dikkat ve Anksiyete Düzeyleri Uzerine Etkisi.

OBJECTIVE: To evaluate the attention, learning and memory related cognitive functions after 12-hour day versus night shift-work in anaesthesia residents. METHOD: Fifteen residents working on the day shift and 18 working on the night shift volunteered. All were interviewed with the Rey Auditory Verbal Learning Test (AVLT), Visual Aural Digit Span Test (VADST), and State Trait Anxiety Inventory (STAI) before and after the shifts. Residents' self-evaluations of their fatigue, stress, sleep quality and duration of sleep were sought. RESULTS: The two groups were similar regarding age, gender, attention, fatigue, stress, affection, sleep quality and duration of sleep. The number of words learned in the first trial of the Rey AVLT decreased after the shifts in both groups. Before the night shift the word list could be learned more effectively and with fewer trials compared to the pre-day shift. The learning deteriorated, and repetitions and forgotten words increased after the night shift. The aural oral, aural written and visual written subtest scores deteriorated after the night shift. State anxiety levels did not differ between the night and day shift groups or before and after the shifts. CONCLUSION: The cognitive functions of residents may be impaired after the night shift. We think that close supervision of residents and provision of more rest for them during night shifts would be beneficial in decreasing their errors, which may affect patients.

[The neurobiology of sleep and its influence on memory]. / Uykunun Nörobiyolojisi ve Bellek Uzerine Etkileri.

OBJECTIVE: Recent developments in neuroscience have increased our knowledge of the physiology of sleep and dreaming, and thus the number of studies about the influence of sleep on learning and memory have increased rapidly. In this review the objective is to assess the relationship between sleep and memory considering the evidence regarding the neurobiology of sleep and dreaming. METHOD: This is a retrospective literature review and the relevant studies from the last 10 years are included. For this purpose the PubMed search engine and the key words "sleep, neurobiology, synaptic plasticity, memory" were used. RESULTS: Sleep-wake and NREM-REM cycles are accompanied by neuromodulatory influences on forebrain structures that affect behavior, consciousness and cognition. Animal and human studies in which learning paradigms are used to assess the influence of sleep deprivation on memory show the influence of sleep on memory consolidation. Different sleep stages have different effects on memory processes. Some investigators claim that NREM improves declarative memory while REM improves procedural and implicit memory. Other investigators suggest that NREM and REM affect memory in a complementary and sequential way. Molecular and electrophysiological evidence suggests that the influence of sleep on memory is through synaptic plasticity. CONCLUSION: Studies about the physiology of sleep and dreaming will help us to understand consciousness and memory better. The reverse is also true: understanding the contribution of sleep stages to memory will help us to determine the advantages of sleep and dreaming in an evolutionary perspective.

[A review on augmentation of clozapine treatment]. / Klozapin tedavisini güçlendirme: bir gözden geçirme.

Clozapine is one of the most effective pharmacological agents in the treatment of treatment-resistant patients with schizophrenia, schizoaffective and bipolar disorder. Nevertheless, there is still an important proportion of patients who do not respond to clozapine treatment given at a sufficient dose and duration. Some patients cannot tolerate the dosage necessary for an adequate treatment. Case reports, series, various open and controlled trials suggest that there are effective strategies of augmenting clozapine treatment in such cases. In this article, strategies of clozapine augmentation are reviewed in the light of findings related with the efficacy, safety and pharmacokinetic/dynamic interaction profiles of such combinations used for augmentation. To our knowledge, there is only one study in the current literature reviewing this subject. Augmenting strategies are reviewed through the combination of clozapine with the serotonin reuptake inhibitors (SSRI), typical and atypical antipsychotics, mood stabilizers, NMDA agonists and electroconvulsive treatment (ECT).