Objective: The posttraumatic stress disorder (PTSD) Checklist is one of the most widely used screening tool in assessing PTSD symptomatology. Several changes to PTSD definition were made in the recent revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The aim of the study was to assess psychometric properties of the Turkish version of the PTSD Checklist for DSM-5 (PCL-5), the revised version conforming to the advances in DSM-5. Method: Psychiatric outpatients with PTSD (n = 29) and major depressive disorder (n = 73) and a community group (n = 360) included in the study. Respondents completed the PCL-5, Trauma Symptom Checklist-40, Life Events Checklist for DSM-5, Dissociative Experiences Scale, Beck Anxiety Inventory, Beck Depression Inventory and Posttraumatic Cognitions Inventory. Results: We found a four-factor solution best fit to the data providing support for the vast array of PTSD research. The PCL-5 demonstrated good reliability with composite reliability coefficients of re-experiencing (.79–.92), avoidance (.73–.91), negative alterations (.85–.90) and hyper-arousal (.81–.88) and temporal reliability with two-week test retest intra-correlation coefficients of .70, .64, .78, and .76, respectively. Strong associations of the total and sub-scale scores of the PCL-5 with other measures of trauma-related symptoms were indicative of construct validity of the screening tool. The current investigation suggested a cut-off score ≥47 for PTSD diagnosis, with .76 sensitivity and .69 specificity. Conclusion: The PCL-5 is a promising screening tool with sound psychometric properties.
Objective: The aims of this study were to determine whether the plasma Indolamine 2,3 dioxygenase and neopterin levels in patients with major depression differ from a healthy control group and to investigate the relationship between previous major depression episodes and plasma indolamine 2,3 dioxygenase and serum neopterin levels. Methods: Thirty eight first episode major depression patients, sixty four recurrent major depression patients and forty one healthy control participant included the study. Plasma indolamine 2,3 dioxygenase and serum neopterin levels compared in these three groups. Results: Plasma indolamine 2,3 dioxygenase and serum neopterin levels in recurrent major depression group were statistically higher than first episode major depression and healthy control group. There was a positive correlation between plasma IDO levels and number of depressive episodes in major depression group (rho=0.36, p<0.001). Conclusion: According to these findings previous major depression episodes can promote response of the immune system associated with proinflamatuar cytokine activity. This sensitizing effect of previous depressive episodes may increase the recurrence risk of depression.
Objective: Autism spectrum disorders (ASDs) is a heterogeneous neuropsychiatric disorder with widespread abnormalities of social interaction and communication, showing severely restricted interests and extreme repetitive behavior. The relationship between aggressive behavior, insensitivity to pain, and ASDs could not be explained completely. Therefore, we aimed to contribute to the etiology by examining the gene expressions of OPRL1, TACR1, and HTR1E in patients with ASDs.Methods: This study was held in the Genome and Stem Cell Research Center of Erciyes University. In this present study, the expressions of OPRL1, TACR1, and HTR1E genes were studied in 22 ASD patients and 14 healthy controls. Quantitative Real-time Polymerase Chain Reaction (qRT-PCR) was used for gene expression studies.Results: There was a statistically significant difference in terms of the expression of the three genes, which we examined between the ASD patient and control groups. Positive and strong correlations were obtained between the three gene expressions in the ASD group and this finding was found to be statistically significant.Conclusions: Considering all these findings, large-scale and new researches are needed for revealing the roles of genes and their pathways which are related to aggression and insensitivity to pain in ASDs. Our results will lead to new research studies in this field.
Objectives: In this study, we aimed to determine the effects of socio-demographic characteristics and the peer groups on the eating attitude and body mass index (BMI) of students at a medical school in Turkey.Methods: This cross-sectional study was conducted with the participation of the students of Gulhane Military Medical Academy (GMMA). Ethical permissions of the study were obtained from the GMMA Ethics Committee. The target population of the study consisted of 703 students, 533 of whom (75.8%) agreed to participate in the study. The Eating Attitudes Test (EAT) was administered to the participants and their BMI was noted. The EAT consists of 10 questions that measure the socio-demographic characteristics of the participants and 40 questions that evaluate eating habits. In order to determine the peer groups of the students, each student was asked to provide the numbers of their three closest friends. Three peer groups were generated for each grade by applying cluster analysis and as a result 18 peer clusters were examined.Results: In this study, the average EAT score was 12.5 +/- 6.9, and the mean BMI was 23.1 +/- 2.4. It was found that the EAT score of 2.4% of the students was equal to or exceeding 30; 0.4% were obese; 21.0% were overweight; and 2.1% were slim. There was a significant difference between the grade level of the students and sport habits (p values respectively; p <.001, p =.015) in terms of the comparison of the EAT score to socio-demographic characteristics. In the analysis of variance between 18 clusters generated according to the cluster analysis, a statistically significant difference was found in terms of both BMI and the EAT (p values <. 001, <. 001, respectively). This suggests that students with similar eating habits and similar BMI levels have a tendency to cluster among similar peer groups. The variables that effect the EAT scores and BMI levels of the students were evaluated by the analysis of covariance. It was found that students' smoking status (p =.039) had a statistically significant effect on BMI after it was adjusted according to peer group and grade. Also, it was found that the grade (p =.011) and peer cluster (p =.021) had a statistically significant effect on eating habits.Conclusions: The peer groups may affect both eating attitudes and BMIs. In medical literature several studies exist that support these findings. But it is a novel approach to identify peer groups by using clustering algorithms and our study has been able to demonstrate the relationship of peer group and eating habits with this method.
Objective: The shortage of cross-culturally validated instruments limits the study and treatment of psychopathology in countries other than English-speaking ones. The Revised Child Anxiety and Depression Scale – Child Version (RCADS-CV) is a self-report questionnaire that assesses dimensions of DSM anxiety and depressive disorders in youths. In this present study, we aimed to examine the psychometric properties of the Turkish version of the RCADS-CV in a clinical sample of children in Turkey. Method: The participants were 483 children aged 8–17 years old. Subjects were recruited from the following centers: Bezmialem University Hospital (55.7%), Kütahya Regional Hospital (17.4%), Istanbul Medical Faculty Hospital of the Istanbul University (16.7%), and Sakarya University Hospital (12.2%). A semi-structured diagnostic interview was carried out and the following measures were used: Children’s Depression Inventory, Screen for Child Anxiety-Related Emotional Disorders (SCARED), and Strengths and Difficulties Questionnaire (SDQ). Results: Inter-scale reliability was strong/excellent with a Cronbach’s α of .95 and coefficients for the RCADS-CV subscales ranging from .75 to .86, demonstrating good internal consistency. Convergent and discriminant validity tests against both a semi-structured clinical interview and self-report measures suggested favorable properties. Confirmatory factor analysis supported the original six-factor model. RCADS-CV showed greater correspondence to specific diagnoses in comparative tests with the existing measures of anxiety and depression. Conclusion: Overall, the study provides satisfactory evidence that the Turkish RCADS-CV yields valid scores for clinical purposes among Turkish children.
Objective: Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that was categorized as a mood disorder in the most recent version of the Diagnostic and Statistical Manual for Mental Disorders. In addition to a history of PMS, a PMDD diagnosis requires prospective symptom assessment for 2 consecutive menstrual periods. Although the effects of some oxidants–antioxidants were previously studied in PMS, their possible effects in PMDD remain unknown. Paraoxonase-1 (PON-1) is a new high-density lipoprotein-associated enzyme with many antioxidative effects. We hypothesized that assessing serum total oxidant–antioxidant and PON-1 levels could clarify the role of oxidant–antioxidant system in PMDD. Methods: All participants (n = 50) were assessed by an experienced psychiatrist for PMDD by using the Diagnostic and Statistical Manual for Mental Disorders-IV (DSM-IV), Premenstrual Assessment Form and Daily Record of Severity of Problems (DRSP)-Short Form or possible psychiatric disorders including depression, anxiety, and sleep disorders. Serum estrogen, progesterone, total oxidant–antioxidant, and paraoxonase-1 (PON-1) levels were measured in the serum of 20 participants with PMDD and 30 asymptomatic controls during the follicular and luteal phases of two consecutive menstrual cycles. Sleep quality, depression, and anxiety symptoms were assessed with the Pittsburg Sleep Quality Index (PSQI), Hamilton Depression Rating Scale (HDRS), and Hamilton Anxiety Rating Scale (HARS), respectively. Results: There were no significant intergroup differences in estrogen, progesterone, oxidant–antioxidant, or PON-1 levels or PSQI scores. However, the mean HDRS and HARS scores were statistically significantly higher for patients with PMDD than for controls. Levels of estrogen, progesterone, and total oxidant–antioxidant were not correlated with HDRS, HARS, or PSQI scores. Conclusions: Considering the lack of differences in hormonal and biochemical levels between the two groups, it may be more efficient and discriminative to longitudinally assess biochemical and cellular stress-related parameters in subjects with PMDD.
Objective: Psoriasis is one of the most common chronic skin diseases, which has a negative impact on the interpersonal relationship and psychosocial well-being. Therefore, psoriasis may lead to a decrease in the self-esteem of the patients. Increased level of anger often accompanies patients with psoriasis. Our aim is to investigate the relationship of anger, anger expression style and level of self-esteem in patients with psoriasis and to determine whether duration and severity of disease affects anger, anger expression style and level of self-esteem. In addition, we aimed to compare the level of self-esteem in patients with early and late onset of psoriasis.Methods: Eighty-five patients with psoriasis and 86 healthy controls were included in the study. Severity of disease was calculated with Psoriasis Area and Severity Index (PASI). The patients were classified as early-onset (age < 20 years) and late-onset psoriasis (age ≥ 20 years). Duration of disease and socio-demographic characteristics were recorded. State-Trait Expression Inventory for Anger (STAXI) and Roserberg Self-esteem Scale (RSES) were used for determining anger, anger expression style and self-esteem.Results: Trait anger, state anger and anger-in scores were statistically significantly higher in patients with psoriasis (p < .05). Anger-out and anger-control scores were similar in both groups. RSES scores were statistically significantly higher in the psoriasis group (p < .05). There was a negative weak statistically significant correlation between RSES and anger-control scores (r = −0.246, p = .027). A positive, weak, statistically significant correlation was found between RSES scores and anger-out scores (r = 0.224, p = .045). A positive, mild, statistically significant correlation between duration of the disease and anger-in scores (r = 0.277, p = .027) was detected in patients with psoriasis whereas no statistically significant correlation between the other parameters and duration and severity of the disease was detected. No significant difference was detected when patients with early- and late-onset psoriasis were compared in terms of self-esteem (p = .722). A positive, mild, statistically significant correlation between duration of the disease and anger-in scores (r = 0.277, p = .027) was detected in patients with psoriasis whereas no statistically significant correlation between the other parameters and duration and severity of the disease was detected.Conclusion: Reduced self-esteem and increased anger levels are remarkable in psoriasis patients. While evaluating and arranging treatment of psoriasis patients, it should be considered that psoriasis is not only a dermatological disease, but also a disease resulting in reduced self-esteem and increased anger level; therefore dermatologic and psychiatric approaches should be taken with the patients.
Objective: The objective of this study is to develop a risk-screening questionnaire appropriate for cultural characteristics in detection of alcohol- and drug-use level through utilization of Addiction Profile Index (API) and perform the reliability and validity work thereof. Methods: The study was carried out on the sample of two previously made separate studies. Both samples were selected from inmates in prisons. API, CAGE Scale, Alcohol Use Disorders Identification Test (AUDIT), Drug Abuse Screening Test (DAST-10), Drug Use Disorders Identification Test (DUDIT) and clinical interview form structured for DSM-IV-TR (SCID-I) were employed in the study. Results: BAPİRT-alcohol and BAPİRT-drug questionnaires evaluating alcohol and drug abuse separately and each of which consisting of six questions were developed. Cronbach's alpha coefficients were found as 0.70 and 0.88 in the internal consistency analysis made with sample 1 data of BAPİRT alcohol and drug scale respectively. BAPİRT alcohol scale consists of two components while BAPİRT drug questionnaire comprises a single component. BAPİRT-alcohol questionnaire was found to correlate with BAPİ (Bağımlılık Profil İndeksi, Addiction Profile Index), AUDIT and CAGE by 0.94, 0.92 and 0.78 respectively. BAPİRT- drug questionnaire was found to correlate with BAPİ, DUDIT and DAST by 0.96, 0.89 and 0.81 respectively. BAPİRT for alcohol had sensitivity and specificity scores of 93.8%, and 72.5%, respectively, when using the cut-off score of 3 while BAPİRT for alcohol had sensitivity and specificity scores of 91.7% and 92.3%, respectively, when using the cut-off score of 4. Conclusions: These findings support that APIRS questionnaires are reliable and valid drug abuse screening instruments in Turkish patients with alcohol and drug use. Further studies need to be done in different clinical populations.
Objective: Pseudocyesis is a rare condition in which a non-pregnant woman has all signs and symptoms of pregnancy, such as abdominal and breast enlargement, cessation of menses and sensation of foetal movement. We hereby present a case of a young woman who presented with pseudocyesis while experiencing anorexia nervosa.Methods: After psychiatric examination, psychopharmacotherapy including cognitive behavioural therapy (CBT) techniques and medication for ongoing depression and eating disorder was provided.Results: After six months of psychopharmacotherapy, depressive mood and belief of being pregnant were diminished; but after two years, she presented to psychiatry for depression and pseudocyesis symptoms again.Conclusions: Etiologic risk factors and treatment approaches including psychotherapy and psychopharmacology are addressed in this case report.
"Priapism Associated with Aripiprazole and Quetiapine in an 8-Year-Old Boy with Autism." Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, 26(2), pp. 212–213Keywords: aripiprazolequetiapinepriapismautismchild
"Risperidone and Lithium for Pathological Laughing." Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, 26(4), pp. 443–444
OBJECTIVE To investigate the effect of Attention Deficit Hyperactivity Disorder (ADHD), antisocial behavior and anxiety/depression ratings of mothers, and child and adolescents' age, gender, ADHD subtype, and comorbidity on one-month drug treatment response to OROS methylphenidate in ADHD in a naturalistic setting. METHODS The analyses included 223 subjects (191 boys, 32 girls; age 6-15 years, mean: 9.4) treated with OROS methylphenidate (18-72 mg/day, mean: 31 mg/d; 0.4-1.4 mg/kg/d) for one-month. Treatment response was defined as larger than 25% or more decrease in pre-treatment the Conners Parent Rating Scale (CPRS) or the Conners Teacher Rating Scale (CTRS) total scores and the Clinical Global Impression improvement with drug treatment 3 (minimally improved) or higher. Maternal ADHD, antisocial behavior and anxiety/depression ratings were obtained by the Adult Self Rating (ASR). Logistic regression analyses were computed in order to calculate the effects of gender; age; ADHD subtype; comorbid anxiety disorder, learning disorder, oppositional defiant/conduct disorder; maternal ASR Anxiety/Depression, ADHD and Antisocial scores. RESULTS 35.2% of subjects had statistically significant 25% or more decrease in pretreatment CPRS total scores and 38.6% of subjects had statistically significant 25% or more decrease in pretreatment CTRS total scores. The subjects with comorbid anxiety disorder had the poorest drug response. Maternal self-reported antisocial and anxiety/depressive symptomatology were statistically significantly associated with worse response to treatment in terms of CPRS (respectively, OR=0.83, 95% CI: 0.75-0.92, p<0.01; OR=0.95, 95% CI: 0.9-0.99, p<0.05) and CTRS total scores (OR=0.9, 95% CI: 0.82-0.99, OR=0.95, 95% CI: 0.91-1, p<0.05). Baseline rating scores were also important predictors of drug treatment response. Effects of age, gender and maternal ADHD were not statistically significant. CONCLUSION ADHD children and adolescents with comorbid anxiety disorders and those whose mothers have more self-reports of antisocial and depressive symptoms showed less favorable short-term response to OROS-MPH. These subjects may require further attention and additional interventions to augment treatment with OROS methylphenidate.
The partial agonist aripiprazole is a novel atypical antipsychotic with a relatively safer side effect profile. Acute unilateral myopia is a very rare condition that is commonly associated with drug use. Here, we present a woman diagnosed with obsessive-compulsive disorder (OCD) and major depressive disorder (MDD) who have been treated for two years in our clinic. She was on fluoxetine (Prozac) 80 mg/day when adding aripiprazole (Abilify) 10 mg/day as an augmentation agent has triggered unilateral myopia. After cessation of aripirazole her myopia has disappeared. Psychiatrists should keep in mind that unilateral myopia as a side effect may develop after combining aripiprazole with fluoxetine in patients with OCD and MDD.
Turner Syndrome (TS) is the most common chromosomal anomaly in women. Its psychiatric manifestations have not been clearly defined. Occurrence of schizophrenia is higher in patients with TS than in the normal population. The literature has reported instances associating stuttering as a side effect of antipsychotic drugs, particularly clozapine-induced stuttering. We found only one case report describing aripiprazole-associated stuttering. In the present case report, we present a female patient with TS-diagnosed schizophrenia who had been treated with aripiprazole because she developed stuttering during treatment with clozapine and then developed dose-dependent stuttering with aripiprazole.
Objective: Juvenile obsessive-compulsive disorder has been increasingly recognized in the literature. However, the developmentally sensitive screening tools for obsessive-compulsive disorder (OCD) in children and adolescents still lag behind psychometric tools developed for adult OCD. The Leyton Obsessional Inventory-Child Version is the most widely utilized screening tool for juvenile OCD assessment. Our aim was to assess psychometric properties of the Leyton Obsessional Inventory-Child Version (LOI-CV) and Obsessive Beliefs Questionnaire-Child Version (OBQ-CV).Method: The sample consisted of 805 children and adolescents, aged from 11 to 17 years. Mean age of the sample was 13.85 (SD +/- 1.40) years. The LOI-CV, OBQ-CV, Obsessive Compulsive Inventory-Revised (OCI-R), State Trait Anxiety Inventory for Children (STAI-C) and Meta-Cognitions Questionnaire for Children (MCQ-C) were completed by respondents. The data were subjected to explanatory and confirmatory factor analyses. Internal consistency and two-week temporal stability of scale scores were computed.Results: Explanatory and confirmatory factor analyses yielded a three-factor solution for the LOI-CV: Compulsions, Obsessions and Mental Neutralizing. Internal reliability was high for the overall scale (alpha=0.86) and sub-scales (Cronbach alphas= 0.76, 0.75, and 0.70, respectively). Factor analyses suggested a new three factor solution for the OBQ-CV: Responsibility/Threat Estimation, Certainty/Control of Thoughts and Perfectionism. Internal consistency was excellent for the total measure (alpha=0.90) and the subscales (alpha=0.84, 0.82 ve 0.71, respectively). Retest reliability was high for the both LOI-CV (r=0.83) and OBQ-CV (r=0.78). Both of the measures revealed good convergent validity with the OCI-R, STAI-C, and MCQ-C.Conclusion: The LOI-CV and OBQ-CV had promising psychometric properties in a community sample of Turkish children and adolescents.
Objective: Combined antipsychotic treatment is frequently used in clinical practice either to improve the symptom control or to reduce the severity of side effects. The expected benefits by combining different antipsychotics include active cross-titration and co-utilization of different administration routes of the therapeutic agents. However, except the add-on therapies to clozapine, there is no objective evidence implying the superiority of combined therapy over monotherapy. Furthermore, there are a number of published case reports of significant side effects accompanying combined antipsychotic usage such as extrapyramidal and metabolic symptoms, seizures, and electrocardiographic abnormalities. It is also argued that switching into a new therapeutic agent might be more beneficial than augmenting the ongoing medication by polypharmacy. Here, we studied on a group of hospitalized schizophrenia patients in a training and research hospital in Turkey whether the Positive and Negative Symptom Scale (PANSS) scores differ between the patients under monotherapy and combined therapy.Methods: Hospital records belonging patients with schizophrenia who were followed up between the years of 2003 and 2013 were retrieved. Schizophrenia diagnoses were re-evaluated and confirmed according to the DSM-IV-TR criteria. All the patients who met the diagnostic criteria and having PANSS subscale scores (n=158) were included in the study. PANSS scores at the time of hospitalization are represented by adding “-before” suffixes, while the ones at the time of discharge by adding “-after”.Results: Our series composed of 158 schizophrenia patients (54 women and 104 men). When the medications were reviewed, we found that 66 patients (41.8%) were treated with a single drug and the atypical antipsychotics were the most commonly used group. Multiple drugs were combined on 92 patients (58.2%) and the most common combination was the “atypical + typical” antipsychotics. PANSS subscales and their comparisons among the groups of monotherapy and combined therapy revealed a slight statistical difference in PANSS negative scores at the time of hospitalization, although we found no significant changes in terms of PANSS scales, in general.Conclusion: In this study, we presented the overall frequency and patterns of our combined antipsychotic therapy in our daily routine work. We only used severity of symptoms in our study, and observed no differences between mono and combined therapy groups in terms of the PANSS evaluation. Further clinical studies with clinical, metabolic, and laboratory data as well as the long follow-ups are needed to uncover if combined therapy proves to be beneficial over monotherapy.
Long term use of antipsychotics, is encountered in many psychiatric disorders, especially in schizophrenia. Eosinophilic myocarditis is a rare form of myocarditis characterized by myocardial inflamation composed of mostly eosinophils. It is known that it may develop at a rate of 0.2-3 % in long term therapies, especially with clozapine use. Standart treatment can not be established because of rarity of disease and difficulties in the determination of the etiology. In this article, three cases, who have been receiving long term drug treatment for schizoaffective disorder and faced sudden death, were presented. Their autopsies were performed in our institution. When myocardial sections were examinated with light microscope, common findings with three cases were, myocyte damage accompanied with patchy distribution of perivascular and interstitial inflamatory infiltrate rich in eosinophils. When the light microscopic findings evaluated with detailed medical history, autopsy findings and toxicological analysis results, we considered these entities may have developed as a result of hypersensitivity reaction due to long term antipsychotic drug use. Eosinophilic myocarditis is encountered as a rare clinical entity and probably it is a subtype of myocarditis that is overlooked. Failure in the clinical diagnosis and delay in treatment may lead to irreversible myocardial damage and death. Endomyocardial biopsy is still the gold standard in the diagnosis of eosinophilic myocarditis. Here, we present these cases since the drug use is the most frequently accused cause, it is rarely seen in acute deaths and the diagnosis can be reached by histopathological examination.
