Mania profile in a community sample of prepubertal children in Turkey.

BACKGROUND: Mania in youth is increasingly recognized and accompanied by substantial psychiatric and psychosocial morbidity. There are no data on prepubertals in the general population and we aimed to search for mania symptoms and its clinical correlations in a community sample of prepubertal Turkish children. METHODS: Among all children (n = 56,335) aged 7-11 in Adana, Turkey, 2,468 children (48% girls) were randomly included. Parents completed Child Behavior Checklist (CBCL) 4-18 and Parent-Young Mania Rating Scale (P-YMRS). Cut-off scores of 17 and 27 on total P-YMRS were defined as efficient (probable-mania group) and specific (mania group), respectively, for bipolar profile. We searched for clinical correlations and used logistic regression to show how well each CBCL subscale predicted the presence of mania and probable-mania, after adjusting for any demographic differences. RESULTS: Parent-Young Mania Rating Scale scores were > or =17 but <27 (probable-mania) in 155 (6.3%) children and > or =27 (mania) in 32 (1.3%) children. Elevated mood, increased activity levels, and poor insight were the most frequent manic symptoms in our sample. Children with probable-mania and mania had higher scores on all CBCL subscales and the CBCL-Pediatric Bipolar Disorder (CBCL-PBD) profile (sum of attention, aggression, and anxiety/depression subscales). Logistic regression analysis revealed only thought problems on CBCL that predicted probable-mania and mania. CONCLUSION: Our study shows that mania profile is common in the community sample of Turkish prepubertal children and does not support the thought that mania is rare outside the US. We need further population-based studies that will use diagnostic interviews and multiple informants.

Differentiating bipolar disorder in Turkish prepubertal children with attention-deficit hyperactivity disorder.

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) and bipolar disorder (BPD) in children are frequently comorbid conditions. Because the coexistence of ADHD and mania seriously complicates the course of the condition and the treatment of children, diagnosing or missing this comorbidity has important clinical implications. There are very few systematic studies on the subject in the literature and BPD in children is not recognized or studied in most countries other than the USA. We aimed to differentiate Turkish prepubertal children with ADHD from those with comorbid ADHD and BPD and compare their clinical characteristics. METHODS: A total of 147 treatment- and drug-naïve children, aged 7 to 13 years, who had been consecutively referred to the ADHD clinic, were evaluated using the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version (K-SADS-PL). Parents completed the Child Behavior Checklist (CBCL) 4-18 and the Parent-Young Mania Rating Scale (P-YMRS) prior to the clinical interview. RESULTS: Twelve children (8.2%) had comorbid bipolar disorder (ADHD + BPD). The ADHD + BPD group had significantly higher rates of depressive disorders, oppositional defiant disorder, panic disorder and a family history of bipolar disorder compared with the ADHD group. The ADHD + BPD group had significantly more problems on the CBCL scale (anxiety/depression, social problems, thought problems, aggression, externalization, and total score) and on the P-YMRS (all items except for insight) compared with the ADHD group. CONCLUSIONS: We conclude that ADHD + BPD in Turkish children represents a clinical picture different to that of ADHD alone, in which the clinical characteristics resemble those of children reported in the literature. Further long-term follow-up studies are needed in larger clinical and community samples.

The effect of age, gender and socio-economic factors on perceived dental anxiety determined by a modified scale in children.

PURPOSE: The aim of this study was to examine the validity and reliability of the Com-DAS (combined dental anxiety scale) as an indicator for children's perceived dental anxiety and to investigate the effect of age, gender and socio-economic factors on dental anxiety. MATERIALS AND METHODS: A total of 258 children aged between 8 and 12 years, who had not visited a dentist before, were randomly selected from three different socio-economic status groups. A new scale was developed by combining the C-DAS (Corah's dental anxiety scale) and FIS (facial imaging scale), and named Com-DAS. Original C-DAS was used for validation. RESULTS: There was a high correlation between C-DAS and Com-DAS (r = 0.69). The lowest correlation was in 8-year-old children (r = 0.46), however the mean difference between the scales in this age group was not statistically significant (p > 0.05). The Com-DAS scores showed no statistical difference according to gender, whereas there was a significant difference according to age and socio-economic status (p = 0.001 in both cases). CONCLUSION: The Com-DAS used in this study may be of use in those communities where the children and their families have limited literacy skills and their understanding of modern dental procedures may be influenced by non-qualified dental practice.

Randomized trial of sertraline versus venlafaxine XR in major depression: efficacy and discontinuation symptoms.

BACKGROUND: The comparative efficacy of selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) was recently debated. Meta-analyses, based mainly on fluoxetine comparator data, suggest that the SNRI venlafaxine has superior efficacy to SSRIs in treatment of major depression. OBJECTIVE: To compare quality of life (QOL), efficacy, safety, and tolerability associated with sertraline and venlafaxine extended release (XR) for treatment of DSM-IV major depression. METHOD: This was an 8-week, double-blind, randomized study of sertraline (50-150 mg/day) versus venlafaxine XR (75-225 mg/day), followed by a 2-week taper period. Subjects were recruited from 7 sites in Turkey and 6 sites in Australia between October 2002 and July 2003. The primary outcome measure was the Quality of Life Enjoyment and Satisfaction Questionnaire. Secondary outcome measures included measures of depression (including response and remission), anxiety, pain, safety (e.g., blood pressure), and tolerability (e.g., discontinuation symptoms). RESULTS: A total of 163 subjects received study treatment (women, 69%; mean age, 37.0 [SD = 12.9] years). No significant differences in QOL or efficacy were noted between treatments on the primary or secondary endpoints for the total study population or the anxious depression and severe depression subgroups. A priori analyses of symptoms associated with treatment discontinuation demonstrated no difference between treatment groups. However, in post hoc analyses, sertraline was associated with less burden of moderate to severe discontinuation symptoms. Venlafaxine XR was associated with a relative increase in mean blood pressure (supine diastolic blood pressure, -4.4 mm Hg difference at week 8/last observation carried forward). CONCLUSION: Sertraline and venlafaxine XR demonstrated comparable effects on QOL and efficacy in treatment of major depression, although sertraline may be associated with a lower symptom burden during treatment discontinuation and a reduced risk of blood pressure increase.

Short-term antidepressant treatment of comorbid dental anxiety in patients with panic disorder.

OBJECTIVES: The aims of this study were to determine the frequency of dental anxiety (DA) and dental phobia (DP) in panic disorder, and to follow the changes in DA levels during antidepressant treatment of panic disorder. METHODS: Fifty-three controls and 102 panic disorder patients were assessed using the Structured Clinical Interview (SCID), the Panic-Agoraphobia Scale (PAS), and the Corah Dental Anxiety Scale (DAS). Oral health status was defined by the number of decayed, missing, and filled teeth (DMFT) index. The patients were classified into three groups: (1) those without dental anxiety (WDA), (2) those with dental anxiety (DA), and (3) those with dental phobia (DP). All patients were treated with antidepressants for 3 months and the response rates were assessed. RESULTS: At baseline, DAS was significantly higher in both the DA and the DP groups than in the control group. Ten (9.8%) of the panic disorder patients fulfilled the diagnostic criteria for DP; 31 (30.4%) had severe DA. In the control group, none of the patients was diagnosed as DP, whereas 7 (13.5%) had severe DA. Panic disorder and DA both responded to the antidepressant treatment, but DAS scores remained significantly higher in the DP group than in the DA group and the control group at the end of the third month. CONCLUSIONS: Our data suggest that both DA and DP are more frequent in panic disorder than in healthy controls. Antidepressant treatment may have been helpful in decreasing DA levels in the DA group but not in the DP group.

[Reliability and validity of Turkish form of Endicott Work Productivity Scale]. / Endicott Iste Uretkenlik Olçegi'nin (EIUO) Türk Toplumunda Geçerlilik ve Güvenilirliginin Degerlendirilmesi.

OBJECTIVE: The Endicott Work Productivity Scale (EWPS) is a brief self-report questionnaire designed to enable investigators to obtain a sensitive measure of work productivity. The purpose of the study was to investigate reliability and validity of the Turkish form of EWPS. METHOD: The study was performed with two separate groups; a patient group (n=74) and a community sample (n=107). Through the adaptation process the original form was translated into Turkish, and translated back into English. Statistical tests about construct validity, the concurrent validity, the test re-test reliability and internal consistency were performed. RESULTS: The internal consistency coefficient (Cronbach's alpha) was >.90 for both groups. The correlations of the individual items with the EWPS total scores ranged between.32 and.75. EWPS and HAM-D scores of the patient group was positively correlated (r =.52 and r =.62). The CGI scores correlation was.64 and SF-36 social functioning subscale was correlated negatively (r= -.43). The correlations of the test-retest scores of EWPS were.76. There was a significant mean difference between the total scores of patient and the community groups. CONCLUSION: The Turkish form of EWPS was found to be valid and reliable. The findings concerning the reliability and the validity of the EWPS indicate that this instrument can be used in the studies that will be conducted in Turkey.

[Tobacco, alcohol and substance use prevalence among elementary and secondary school students in nine cities of Turkey]. / Dokuz Ilde Ilk ve Ortaögretim Ogrencilerinde Tütün, Alkol ve Madde Kullanim Yayginligi.

OBJECTIVE: Previous studies in Turkey regarding substance use have failed to take into consideration the elementary school students. The purpose of the present study is to determine prevalence of tobacco, alcohol, and substance use among elementary and secondary school students in Turkey. METHOD: The study was conducted in 9 big cities that were selected from different geographic regions of Turkey. According to the student population size of the cities, a sample of 1250 or 2500 students were selected from each city. The questionnaire was administered to 11.989 elementary school students, and 12.270 secondary school students. In elementary school students' questionnaire, for the substances other than tobacco, alcohol, inhalants and cannabis a general term "drug" was used. RESULTS: Overall, Izmir had the highest rate of substance use. The prevalence of tobacco use at least once in life time was found to be 16.1% in the elementary school. The lifetime prevalence was found to be 15.4% for alcohol use and 1.7% for inhalants and for general term "drug". The prevalence of tobacco use at least once in life time was 55.9%, for alcohol use it was 45.0%, for cannabis use 4.0%, for inhalant use 5.1%, and for heroin and ecstasy use 2.5% among secondary school students. A significant difference was found between males and females in terms of tobacco, alcohol and other drug use both in the elementary and the secondary school. The risk for substance use was found to be greater in private schools than public schools. CONCLUSION: Although the prevalence of substance use among elementary and secondary school students is low when compared to the findings from other countries. It was observed that especially the prevalence of tobacco use was quite high.

Psychosocial factors and sexual dysfunctions: a descriptive study in Turkish males.

The study of human sexuality has dramatically changed in the last decade. The conceptualization of sexual dysfunction developed in the West is now mushrooming in different parts of the world and there is a dearth of research on characteristics of patients seeking treatment for sexual dysfunction in non-Western countries. This paper describes the demographic characteristics, related factors, and clinical symptomatology of 40 male patients with various sexual dysfunctions attending the psychiatric out-patient clinic of Cukurova University, Turkey. Turkey's population is predominantly Muslim and the country unites Europe and Asia, showing the cultural characteristics of both continents. Our results suggest that the patterns of manifestation are similar to those reported elsewhere with the exception of premarital patterns of sexuality.

[Relatives' beliefs and attitudes towards schizophrenia: an epidemiological investigation]. / Sizofrenisi olan hastalarin yakinlarinin sizofreniye yönelik tutumlari.

OBJECTIVE: To examine relatives' beliefs and attitudes towards schizophrenia. METHOD: Data were derived from the demographic and schizophrenia modules of the questionnaire developed for the survey called "Attitudes Towards Mental Disorders". The questionnaire was administered 98 adult relatives of schizophrenic patients who had participated in psychiatric outpatient treatment programs in Istanbul, Izmir and Adana. RESULTS: Although all identified the case described as a mental disorder, only 76.5% determined the term schizophrenia as a mental disorder. Social problems (62.9%) and weakness of will (65.3%) were the most commonly endorsed causes of schizophrenia. Almost all of the respondents preferred medical methods and psychiatrists for the treatment of schizophrenic patients. 72.2% of the sample held the opinion that people with schizophrenia are dangerous and 91.8% believed that these patients could not take responsibility for their own lives. The attitudes of the subjects living in Istanbul and those who stated that "schizophrenia is an illness or a mental disorder" were more negative than the others with respect to social distance characteristics. CONCLUSION: Most of the relatives of schizophrenic patients identified a mental disorder when a schizophrenia case was described, but they had insufficient information about the term schizophrenia. Labeling patients as mentally ill had a negative effect on relatives' attitudes towards schizophrenia. The results of this study underlined the need for education programs for the relatives of patients, and the demands of the relatives concerning treatment modalities with psychosocial components.

[Sociodemographic and clinical characteristics of patients with conversion disorder]. / Konversiyon bozuklugunda sosyodemografik ve klinik ozellikler.

OBJECTIVE: To determine the sociodemographic, and clinical characteristics, and comorbid diagnosis of patients with conversion disorder, and also to evaluate the relationship between the duration of conversion and comorbid diagnosis and personality factors. METHOD: Seventy-two patients who were diagnosed with conversion disorder according to DSM-IV criteria, were included in this study. The Hacettepe Personality Inventor, was administered to all patients, and they were divided into two groups. The first group had conversion symptoms for four years (Group 1), while the other group had conversion symptoms more than four years (Group 2). RESULTS: Sixty-three of patients were female, 9 were males. The average onset age of the disorder was 25.9+/-7.5. Seventy patients (97,2%) had received a maximum of 11 years of education. 40.3% of patients sought treatment because of seizures or convulsions, 40,3% because of sensory symptoms or deficits, 5% because of motor symptoms or deficits, and 12,6% because of mixed presentations. The mean duration of complaints was 4.2+/-1.4 years (min= 1, max= 20). 59.7% of the patients had prominent stress before the onset of the conversion symptoms. There were 12 (28.6%) comorbid psychiatric disorders in Group 1, and 17 (56,7%) in Group 2. Although the mean neurotic trend scores in Group 2 (6.1+/-4.1) were higher than Group 1 (3.1+/-3) (p=.03). The mean emotional resolution scores were lower in Group 2 (4.2+/-3.5) than in Group 1 (7.1+/-3.3) (P=.03). CONCLUSION: Conversion disorder tends to start in early adulthood, and usually follows a stress factor. As the duration of the disorder increases, comorbid psychopathologies, and the level of anxiety, and especially the prevalence of depression increase.