Evaluation of sexual function in patients presenting with Behçet's disease with or without depression.

AIM: Sexual dysfunction has been found in many disorders that are chronic or disabling. The aim of this study was to evaluate the sexual satisfaction levels, sexual function and their relationship with the mental state in a group of patients being followed-up with a diagnosis of Behçet's disease (BD). METHOD: A total of 50 BD patients and 50 control-group subjects were administered the Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Golombok Rust Sexual Satisfaction Scale (GRISS) and Arizona Sexual Experiences Scale (ASEX). RESULTS: The ASEX, GRISS total, HDRS and HARS scores were significantly higher in the patient group than the control subjects (P = 0.0001, P = 0.007, P = 0.0001, P = 0.0001 respectively). Sexual dissatisfaction was seen in 40 (80%) of the patient-group and 16 (32%) of the control-group subjects according to the GRISS (P = 0.0001). Female study participants had higher mean scores than the control subjects for the ASEX, GRISS total scores and the GRISS satisfaction, avoidance, vaginismus and orgasm subscale scores (P = 0.0001, P = 0.002, P = 0.02, P = 0.001, P = 0.006, P = 0.03 respectively). Male study participants had different mean scores for the controls regarding the ASEX scores and the GRISS impotence, premature ejaculation, satisfaction and frequency subscale scores (P = 0.01, P = 0.01, P = 0.0001, P = 0.03, P = 0.007 respectively). DISCUSSION: The negative effect of the disorder on the biological and functional status and daily living activities in BD patients also influences the patients' sexual experiences and satisfaction. The negative effects of chronic diseases such as BD should therefore be defined and the disorder evaluated from a wide perspective during the treatment process.

Ketofol (mixture of ketamine and propofol) administration in electroconvulsive therapy.

The aim of this study was to evaluate the effect of a ketamine:propofol combination ('ketofol') for electroconvulsive therapy on seizure activity, haemodynamic response and recovery parameters, and to compare with these with the effects of propofol alone. Twenty-four patients underwent a total of 144 electroconvulsive therapy sessions, allocated in this prospective, double-blind, crossover study. Patients were randomly assigned to receive 1 mg/kg ketofol (0.5 mg/kg propofol plus 0.5 mg/kg ketamine) or 1 mg/kg propofol 1% for anaesthesia induction. Seizure duration and quality, haemodynamic data, recovery parameters and side-effects were recorded and analysed between groups. Both motor and electroencephalography seizure durations in the ketofol group (29 ± 17 and 41 ± 17 seconds, respectively) were similar to that in the propofol group (28 ± 13 and 38 ± 16 seconds, respectively). Postictal suppression index was higher in the ketofol group (89.63 ± 7.88) than in the propofol group (79.74 ± 14.6) (P <0.05). In the ketofol group, heart rate after the seizure ended and mean arterial pressures, recorded at 0 and 5 minutes after the seizure ended, were higher than in the propofol group. Time to obeying commands was longer in the ketofol group (P <0.05). There were no untoward psychological reactions following ketofol. Although no superiority to propofol in terms of seizure duration, haemodynamic or recovery parameters was found, the ketofol mixture selected in our study provided better seizure quality than propofol. We conclude that ketofol can be an alternative strategy to enhance the seizure quality and clinical efficiency of electroconvulsive therapy.

Diffusion-weighted imaging in chronic Behçet patients with and without neurological findings.

Our aim was to investigate whether neurological impairment in chronic Behçet's disease (BD) patients with normal appearing brain can be assessed by means of diffusion-weighted imaging (DWI). The averaged apparent diffusion coefficient (ADC) values were calculated in 22 different radiologically normal appearing brain regions in 32 patients with and without neurological findings and 20 control subjects. The ADC values in bilateral frontal, temporal and occipital normal appearing white matter were significantly higher in the patient groups compared with the control subjects (p < 0.05). In these brain regions, DWI revealed differences in the ADC values between patients with neurological findings (including symptomatic and neuro-Behçet patients) and the asymptomatic patient group. The similarity of the ADC values of patients without symptoms to those of the control group allowed clear discrimination between patients with and without neurological findings. DWI may serve to assess subclinical neurological involvement in BD, even when structural changes are absent.

Proton MRS in Behçet's disease with and without neurological findings.

Our aim was to investigate whether neurological impairment in Behçet's disease (BD) can be assessed by means of proton MRS and whether it can assist in prognosis. We used single-voxel MRS to measure metabolites in regions of normal-appearing pons, basal ganglia and periventricular white matter (PWM) in 32 patients with chronic BD patients with and without neurological deficits and 29 control subjects. Patients had significantly higher N-acetylaspartate (NAA)/creatine (Cr) and choline (Cho)/Cr ratios in the basal ganglia than the controls. The Cho/Cr ratio in the PWM was also significantly higher in the patients. MRS enabled clear discrimination of patients and controls and also revealed spectral differences between non-neuro-Behçet's disease and neuro-Behçet's disease in the basal ganglia. MRS can be used to assess brain involvement in BD even if structural changes are absent.

Stressful life events, anxiety, depression and coping mechanisms in patients with Behçet's disease.

BACKGROUND: Behçet's disease is a systemic immunoinflammatory disease of young adults characterized by systemic vasculitis of arteries and veins. Although many studies have been published since its discovery in 1937, the etiopathogenesis of this unique disorder is still unclear. OBJECTIVE: To assess the relationship between stress factors, psychological and somatic symptoms, and coping mechanisms in patients with Behcet's disease. METHOD: Thirty-four patients with Behcet's disease and 43 control subjects were compared by using sociodemographic data collection forms, a psychosocial and environmental problems list, the Beck Anxiety Inventory (BAI), Hamilton Depression Rating Scale (HAM-D) and Toronto Alexithymia Scale (TAS). RESULTS: Twenty-four patients (70.6%) defined stress factors in the first stage of the disease. Twenty-seven (79.4%) out of 34 patients stated that the recurrence period of the disease was related to the stress factors. Fear was expressed by 10 (29.4%) patients, sadness by 11 (32.3%), and fear plus sadness by 13 (38.2%) when they first learnt the diagnosis. While coping with these emotions 14 (41.2%) revealed active-reliance strategy. A statistically significant difference was present between the Behcet's patients and control subjects regarding TAS (P < 0.05), HAM-D (P < 0.001) and BAI (P < 0.001) scores. CONCLUSION: It seems that stressful life events have important implications in both relapsing and remission periods of Behçet's disease via secondary problems.