Eating Disorder-15: Factor Structure, Psychometric Properties, Validity, and Reliability of the Turkish Version for Clinical and Non-Clinical Samples. / Yeme Bozuklugu-15: Klinik ve Klinik Olmayan Örneklemler için Türkçe Versiyonun Faktör Yapisi, Psikometrik Özellikleri, Geçerligi ve Güvenilirligi.

OBJECTIVE: Eating Disorder-15 (ED-15) is a self-report scale recommended for use to evaluate weekly progress and treatment results in eating disorders. This research aims to examine the factor structure, psychometric properties, validity, and reliability of the Turkish version of ED-15 (ED-15-TR) for clinical and non-clinical samples. METHOD: Translation-back translation method was used for language equivalence of ED-15-TR. The research was conducted with a total of 1049 volunteers, with two sample groups as non-clinical (n=978) and clinical (n=71). The participants completed an information form, ED-15-TR, Eating Disorder Examination Scale (EDE-Q), and Beck Depression Inventory (BDI). Three hundred fifty-two participants from the non-clinical group and 18 from the clinical group completed ED-15-TR again within a week. RESULTS: Factor analysis confirmed the two-factor structure of ED-15- TR. Cronbach's alpha value was 0.911 (0.773, and 0.904 for the two subscales respectively), the intraclass correlation coefficient for testretest reliability was 0.943 in the clinical group (0.906, and 0.942 for the two subscales respectively); 0.777 (0.699, and 0.776 for the two subscales respectively) in the non-clinical group (for all p<0.001). The high level of a positive correlation between ED-15-TR and EDE-Q supported concurrent validity. CONCLUSION: This research indicates that ED-15-TR is an acceptable, valid, and reliable self-report scale for Turkish society.

Psychometric Evaluation of Adapted Transsexual Voice Questionnaire for Turkish Trans Male Individuals.

AIMS: This study aims to evaluate the psychometric properties of the adapted transsexual voice questionnaire for male-to-female (a-TVQFtM) for trans male individuals in order to determine the suitability for use in research and clinical practice among Turkish trans male individuals. METHODS: This study was conducted by the Gender Dysphoria Clinic and Voice Clinic of a tertiary hospital referral center. The a-TVQFtM, voice-related quality of life, and self-perception of voice masculinity rating scale were administered to 50 trans male individuals, of whom 27 were hormone naïve and 23 were undergoing hormone treatment. Psychometric properties were investigated with reliability and validity analysis. RESULTS: The a-TVQFtM showed a strong internal consistency; the Cronbach's alpha coefficient for overall a-TVQFtM was 0.975, anxiety and avoidance factor was 0.948, vocal identity factor was 0.940, and vocal function factor was 0.923. No item needed to be deleted following adaptation. The a-TVQFtM scores showed a significant strong inverse correlation with the overall voice-related quality of life scores and the self-perception of voice masculinity rating (r = -0.863, r = -0.715, and P<0.001, respectively). The a-TVQFtM scores were significantly reduced in trans male individuals undergoing hormone treatment when compared with hormone naïve individuals. CONCLUSION: Although not specifically designed for trans male individuals, the current results provide confidence as to the psychometric properties of a-TVQFtM and, therefore, its suitability for use with Turkish trans male individuals.

The Relationship of Intimate Partner Violence With Psychiatric Disorders and Severity of Pain Among Female Patients With Fibromyalgia.

Objectives: This study aims to compare the prevalence of intimate partner violence and comorbid psychiatric disorders among patients with fibromyalgia syndrome (FMS) and healthy controls and also to investigate the relationship of intimate partner violence with psychiatric disorders and severity of pain in FMS patients. Patients and methods: The study group consisted of 136 females including 68 patients with FMS (mean age 43±10.4 years; range, 25 to 70 years) and 68 FMS-free healthy females (mean age 38.5±11.3 years; range, 22 to 70 years). Following a Structured Clinical Interview for Diagnostic and Statistical Manual-IV Axis I Disorders by a psychiatrist experienced in psychological trauma, Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), Visual Analog Scale (VAS) for the severity of pain and Domestic Violence Against Women Scale (DVAWS) were applied. Results: In FMS group, 85% of the patients were diagnosed with mood or anxiety disorder. Almost half of these patients had major depressive disorder. The total scores of DVAWS and all subscales were significantly higher in the FMS group than in the control group (p<0.01). The severity of domestic violence were related to the presence of any psychiatric disorder only in FMS patients (p<0.01). Almost half of the FMS patients with high DVAWS score had comorbid mood and anxiety disorders. There was a significant positive correlation between the total scores of DVAWS, HDRS, HARS, and VAS (p<0.01). Conclusion: Although the etiology of FMS is still uncertain, psychosocial factors may play role as risk factors. Therefore, a multidisciplinary approach to the treatment should be considered.

[Persistent Genital Arousal Disorder Treated with Duloxetine: A Case Report]. / Duloksetin ile Tedavi Edilen Sürekli Genital Uyarilma Bozuklugu: Olgu Sunumu.

Persistent Genital Arousal Disorder is characterized with unwanted, uncontrollable and persistent genital arousal symptoms that occur spontaneously in the absence of simultaneous sexual fantasy, sexual desire or sexual stimulation. The condition may last for hours or days. Patients often find it difficult to share this condition with their health care providers because they are afraid of being diagnosed with hypersexuality and they often get different psychiatric diagnoses such as Obsessive Compulsive Disorder and Major Depressive Disorder. Therefore, little is known about the real prevalence, pathophysiology or etiology of Persistent Genital Arousal Disorder. In addition, since there is no study conducted in this field, our information in this area is limited to case reports. Although there is no consensus about the treatment of Persistent Genital Arousal Disorder in the psychiatric literature, there are some case reports about the use of pregabaline, clomipramine, duloxetine, clonazepam, varenicline, olanzapine, risperidone in addition to the case reports on treatment with hypnotherapy, pelvic floor physiotherapy and electroconvulsive therapy (ECT). In this case report, we aimed to present the detailed description of a successful treatment procedure with duloxetine in a forty two years old female patient diagnosed with Persistent Genital Arousal Disorder. She had been using various antidepressants, antipsychotics, anxiolytics and mood stabilizers for sixteen years with different psychiatric misdiagnoses like Bipolar Disorder, Obsessive Compulsive Disorder, Anxiety Disorder and Major Depressive Disorder and yet, had not shared her symptoms of genital arousal with any psychiatrist previously.

Mental health in elite athletes: International Olympic Committee consensus statement (2019).

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

Hypersexuality Manifesting as Excessive Masturbation in a Female Patient After Temporal Lobe Epileptic Surgery: A Rare Case Report.

Interictal sexual behavior changes are frequently reported in patients with epilepsy, especially those with temporal lobe epilepsy. Changes in sexual function after temporal lobe epileptic surgery can vary within a wide range, ranging from disappearance of paraphilias existing in preoperative period, decreased libido or sexual activity, sexual arousal and orgasmic disorders, sexual activity arising to a normally acceptable level, or hypersexuality. Hypersexuality can be defined as having excessive sexual arousal and drive in abnormal frequency and intensity. Many hypotheses have been developed to explain etiology in hypersexuality in the literature. But there is no consensus on treatment. Here we aimed to present diagnosis and treatment process of hypersexuality manifesting as excessive masturbation in 38 years old, single female patient who underwent selective hippocampectomy (temporal lobe resection) 11 years ago.

Social stigma and familial attitudes related to infertility.

OBJECTIVE: To determine the perceived social stigma and familial attitides and perception of sexuality in infertile couples attending infertility clinics. MATERIALS AND METHODS: Infertile couples attending infertility clinics between the years of 2014 and 2015 were requested to complete detailed evaluation forms including questions related to the social stigma on their infertility, their familial attitudes, and perception of sexuality. Any partner of the infertile couple accepting to enroll in the study was given the evaluation forms. Their scores related to answers and demographics, and parameters related to infertility were analyzed. RESULTS: A total 598 partners of infertile couples enrolled in the study, 58% represented 177 couples. Their infertility was primary in 98.3% and the duration of marriage and infertility was 9.81±5.58 and 9.76±5.53 years, respectively. The perception of social exclusion was present in 38% (p<0.001) of infertile couple, which was more significantly pronounced in female partners (p=0.013). Fifteen percent of the infertile couples thought themselves as isolated in public and losing value in public (p<0.001). However, sixty percent of infertile couples thought that they would achieve a notable place in community after having a baby (p<0.001). Infertility was accepted as a reason of divorce in only 13% of infertile couples (p<0.001). The majority of perticipnats, irrespective of sex, rejected that infertile women or men lost sexual appeal (86%; p<0.001). CONCLUSIONS: There is significant effect of infertility on familial attitudes and perception of sexuality of infertile couples. Unfortunately, there is significant negative social stigma on infertile couples.

Psychiatric comorbidity and childhood trauma in fibromyalgia syndrome.

OBJECTIVES: In this study, we aimed to compare patients with fibromyalgia syndrome (FMS) and those with myofascial pain syndrome (MPS) and healthy women and to investigate the prevalence of childhood traumatic experiences (CTEs) in relation to comorbid mood and anxiety disorders. PATIENTS AND METHODS: Between February 2014 and May 2014, a total of 136 women including 52 with FMS, 35 with MPS, and 49 healthy controls were included in the study. The Sociodemographic Data Form, Mood and Anxiety Disorders Modules of Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) Axis I Disorders (SCID-I), Fibromyalgia- related Symptom Scale (FSS), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Childhood Trauma Questionnaire-28 (CTQ-28) were applied to participants. RESULTS: As a result of the semi-structured clinical interview conducted by a psychiatrist experienced in psychological trauma, the prevalence of any mood or anxiety disorder were found to be significantly more common in the FMS group. Childhood traumatic experiences, not only in general, but also with all subtypes, were also reported to be significantly more in FMS patients. Besides, only in patients with FMS, a significant relationship was found between the psychiatric diagnoses and the presence of CTEs. Furthermore, the CTQ-28 scores were correlated positively with the FSS scores as well as HDRS and HARS. Among the symptoms screened by the FSS, only crying and over-reacting to incidents were significantly associated with CTEs in FMS group. CONCLUSION: Based on our study results, CTEs may play a critical role in the development of fibromyalgia and may be related with comorbid mood and anxiety disorders in FMS patients. Associating psychological symptoms such as crying or over-reacting to incidents in FMS patients should be, therefore, alerting for psychiatric consultation.

Leukocytosis after Clozapine Treatment in a Patient with Chronic Schizophrenia.

Clozapine is an atypical antipsychotic drug that is approved by the US Food and Drug Administration (FDA) for the treatment of psychotic disorders. Agranulocytosis is a well-established side effect of clozapine; clozapine has also been associated with other blood dyscrasias like leukocytosis, albeit rarely. In this paper, we aim to report a case of possible clozapine-associated leukocytosis in a 41-year-old woman.

Treatment Approach to Sleep Terror: Two Case Reports.

Parasomnias are a group of disorders characterized by abnormal behaviors, physical activities, and autonomic arousal symptoms while transition to sleep or continuation of sleep. Sleep terror (ST) is classified under parasomnias characterized by sudden fear attacks beginning with crying attacks or high-frequency screams and continuing with increased autonomic symptoms. ST occurs in the first few hours of sleep during the delta phase. Further, the lifetime prevalence of ST in adults is less than 1%. It is important to obtain; anamnesis from patients' bed partner for a clinical evaluation of ST. Methods, such as evaluating sleep diaries and video recordings, can help ST diagnosis. It is also important to evaluate patients' medical history, history of substance or alcohol abuse, psychological traumatic experiences, primary or secondary incomes, and detailed neurological aspects. Physician can select some serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCADs) as medical treatment if patients have a high frequency of attacks. Because of addiction and relapse of ST episodes, benzodiazepines are not preferred as the first-line treatment. In this study, we will discuss ST, which is rare in adulthood, and use of long-acting benzodiazepine based on two cases.

The effect of alprazolam on acoustic stapedius reflex thresholds in healthy volunteers.

Alprazolam, a widely used drug, has widespread, nonspecific depressant effects on the central nervous system, similar to other benzodiazepines. This inhibitor effect may cause changes in reflex thresholds by affecting the acoustic stapedial reflex (ASR) arc. This study was performed on 31 healthy volunteers. Initially, the basal ASR thresholds were measured and measured again 2 h after oral intake of 1 mg of alprazolam; by measuring the reflex thresholds once again the mean values of thresholds before and after the drug were compared. Only the left ipsilateral and contralateral 2,000 Hz increases were significantly different. The left ipsilateral and contralateral 500, 1000, and 4000 Hz, and the right ipsilateral and contralateral 500, 1000, 2000, and 4000 Hz measurements showed no differences. Although an increase in ART thresholds was generally observed after the intake of alprazolam, it was not significant. Its use in healthy adults does not statistically produce an additional risk of acoustic trauma at most of the frequencies, but its use with the agents potentiating the effect of alprazolam may increase this risk.

The Turkish version of the eating disorder examination questionnaire: reliability and validity in adolescents.

The Eating Disorder Examination Questionnaire (EDE-Q) is the self-report questionnaire version of the Eating Disorder Examination Interview. The aim of the current study was to validate a Turkish version of the EDE-Q in a sample of Turkish primary and high school students (626 girls and 299 boys) in Istanbul. Subjects also completed the Eating Attitudes Test, the General Health Questionnaire and the Body Image Satisfaction Questionnaire, and they were weighed. Girls had higher scores on all EDE-Q subtests. EDE-Q scores increased as body mass index increased. EDE-Q total score and subscales were highly correlated with the Eating Attitudes Test and the Body Image Satisfaction Questionnaire, supporting its validity. A small test-retest reliability study provided satisfactory results. The present study suggests that the Turkish version of EDE-Q is an acceptable, reliable and valid measure in nonclinical adolescent samples. More psychometric studies are needed concerning wider age ranges and various clinical samples.

The effects of maternal anxiety prior to amniocentesis on uterine and fetal umbilical blood flow.

OBJECTIVE: To investigate the mothers' anxiety levels and determine its effect on fetomaternal circulation in pregnant women undergoing genetic amniocentesis. MATERIAL AND METHODS: A prospective case-control study was conducted regarding the assessment of maternal anxiety levels by means of the Spielberger State-Trait Anxiety Inventory in 60 pregnant women having genetic amniocentesis and 60 control cases having their early second trimester ultrasonographic screening, 30 minutes before and immediately after the procedure. Additionally, maternal-fetal hemodynamic changes and Doppler ultrasonographic measurements of fetoplacental circulation were recorded in both groups. RESULTS: The maternal anxiety state scores were found to be significantly higher in the amniocentesis group (p<0.001). Maternal heart rate was significantly higher in the amniocentesis group (p<0.05), while the fetal heart rate was significantly lower (p<0.05) compared to the control group. Uterine artery Doppler measurements were comparable in the two groups but umbilical artery resistance index (p<0.05) and S/D ratio (p<0.05) were significantly higher in the amniocentesis group. Regression analysis revealed that the time which elapsed from offering amniocentesis until it was performed is the main predictor of fetal umbilical artery S/D ratio measured prior to amniocentesis in the amniocentesis group (ß=0.66, p<0.001) and maternal anxiety state scores (ß=0.04, p=0.003) are the main predictors of fetal umbilical artery S/D ratio measured prior to amniocentesis or ultrasonography in the two groups. The education of the patient in years decreased (ß=-0.13, p=0.04), while the amniocentesis procedure (ß=1.44, p=0.02) and the time which elapsed in days from offering amniocentesis or ultrasonography up to its performance (ß=0.41, p=0.04) increased the S/D ratio measured after the procedures. CONCLUSION: Our study provides the evidence that maternal anxiety and its duration has effects on the fetal blood flow. Early booking and patient support may help to overcome undesired consequences of an invasive prenatal procedure.

Civil commitment in Turkey: reflections on a bill drafted by psychiatrists.

Involuntary hospitalization of the mentally ill has been an issue that still remains outside the judicial system in Turkey. Despite the new Turkish Civil Code, which includes several articles relevant to involuntary psychiatric hospital admissions, there still appears to be a need for a comprehensive mental health law to address specific issues concerning civil commitment of the mentally ill. As a result of the lack of specific statutory regulation, an insufficient number of psychiatric hospital beds and limited appreciation of the safety risks involved in untreated mental illness, involuntary hospitalization remains an underutilized option by psychiatrists and the courts alike. In response to its concerned members, the Psychiatric Association of Turkey has appointed a task force to draft a proposed mental health law, entitled the "Psychiatric Patients' Bill of Rights." Although the draft suggests a model with emphasis on the right to psychiatric treatment, it also recommends close judicial oversight to prevent potential abuses of discretion by the system. However, this might present logistic problems in a country with already overburdened courts. Authors discuss the highlights of the draft within the context of Turkey's current cultural, social and judicial structure, and compare it to similar laws of other countries.

Clinical predictors of response to pharmacotherapy with selective serotonin reuptake inhibitors in obsessive-compulsive disorder.

The objective of this study was to investigate the clinical predictors of response to treatment with selective serotonin reuptake inhibitors (SSRI) in a sample of patients with obsessive-compulsive disorder (OCD). A total of 55 patients diagnosed as OCD according to revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders criteria underwent a 12-week standardized SSRI treatment. According to 'treatment response', defined as at least a 35% drop in the Yale-Brown Obsessive-Compulsive Scale total score, OCD patients were divided into two groups. A total of 32 (58.2%) patients who responded to treatment and 23 (41.8%) who did not, were compared in terms of sociodemographic and clinical characteristics. The authors' findings demonstrated that the severity of obsession-compulsions and disability in work, social and family lives at the beginning of treatment were significantly higher in OCD patients who did not respond to treatment in comparison to those who did. Linear regression analysis, however, revealed that Sheehan Disability Scale-work score at baseline was a predictor of response to SSRI treatment. The higher levels of disability at the beginning of treatment in patients with OCD are associated with a poorer response to SSRI.

The impact of antistigma education on the attitudes of general practitioners regarding schizophrenia.

The aim of this study was to examine the views and attitudes of general practitioners (GP) with respect to schizophrenia, and the changes in their attitudes after antistigma education. A total of 106 GPs working in 71 health institutions were included in the study. A questionnaire of 16 items, focussing on doctors' views and attitudes towards schizophrenia, was applied. Questions were about the views and attitudes of doctors towards general myths related to schizophrenia. Doctors were asked to select one of two responses: 'I agree' or 'I disagree', for statements such as 'schizophrenic patients cannot work' and 'schizophrenic patients are aggressive and dangerous'. After completing the questionnaire, all the GPs were given a single session of antistigma education. The questionnaire was repeated 3 months after training meetings in a subsample of 54 GPs which represented the whole sample in terms of gender, age, and years in medical practice. The authors found statistically significant, positive changes on five items out of the 16 items in the post-test survey when compared to attitudes before training, including items about the treatability of schizophrenia, harmfulness and untrustworthiness of schizophrenic patients. The authors' findings suggest that one antistigma education session, supported by the distribution of related documents, can improve GPs attitudes towards schizophrenia.

Eating disorders and celiac disease: a case report.

OBJECTIVE: Although chronic physical illness may be associated coincidentally with an eating disorder, some clinicians may overlook the possibility that another medical illness may coexist and contribute concurrently to symptoms such as peculiar eating behaviors, restrictive eating, and/or vomiting accompanied by body dissatisfaction. We present a 31-year-old single woman initially diagnosed with an atypical eating disorder. METHOD: After a gastroenterology consultation prompted by the atypical characteristics of her eating disturbance, the diagnosis of celiac disease was established. RESULTS: Cause-and-effect relationships between anorexia nervosa and celiac disease are unclear, and celiac disease may lead to confusion in the differential diagnosis of anorexia nervosa. CONCLUSION: Particularly in atypical cases, and in cases where nausea and bloating are prominent complaints, workup for celiac sprue may reveal the presence of this condition. In such instances, patients may achieve additional relief through the implementation of gluten-free diets.

One year outcome in first episode schizophrenia. Predictors of relapse.

The aim of this study was to identify the predictors of outcome at one year follow-up after the first psychotic episode of schizophrenia. Seventy-nine first-episode schizophrenia patients were assessed monthly with the Brief Psychiatric Rating Scale (BPRS), Scale for Assessment of Positive Symptoms (SAPS), and Scale for Assessment of Negative Symptoms (SANS) after discharge from their first hospitalization. Outcome measures were presence of relapse and rehospitalization, level of global functioning, employment status and severity of symptoms at one year. A total of 33% of the patients had a relapse, and 12.1% were rehospitalized during one year follow-up. Premorbid childhood functionality was worse in patients who had relapse, but there was no correlation between premorbid adjustment scores and BPRS, SANS and SAPS scores at one year. There was no difference in duration of untreated psychosis (DUP) between patients who had relapse and not; however, the patients who had double relapse, had longer DUP than those without relapse. The time period between discharge and rehospitalization was shorter in patients with longer DUP. Functionality in childhood and noncompliance to the treatment independently contributed to the relapse rate. Functionality in late adolescence independently contributed to the Global Assessment of Functioning (GAF) scale score at one year and the GAF score at discharge appeared as a predictor of employment. The results of the present study suggest that treatment compliance and early premorbid adjustment level seem to be important predictors of relapse rate in first episode schizophrenia.