The study aimed to reveal the awareness of bipolar disorder in society in a Turkish sample and to evaluate the lay theories on bipolar disorder in the Turkish population. The group representing the "academic group" of the sample comprised a total of randomly selected 804(71.5%) participants, including senior and/or graduate students in the field of psychology and university graduates in the field of psychology or health. Regardless of the field of psychology and health, 320 participants (28.5%) were working in other fields, representing the sample’s group of "those working in other fields other than the academic group." Study’s results showed that being interested in mental illnesses plays a more significant role in awareness of both the causes and symptoms of bipolar disorder than being educated and working in the field.The participants who did research to obtain information in the field of psychology/psychiatry knew that the disorder was hereditary and didn’t arise due to psychological reasons more correctly than the participants who didn’t do any research.The study revealed the necessity of education and awareness studies for the overall society and people who haven’t been acquainted with this disorder before regarding the importance of medical and psychological therapy to treat the disease.

Intimate Partner Violence (IPV) is an important public health problem in both developed and developing countries. Violence against women is an important problem all over the world. Violence against women basically takes four forms: physical, emotional, sexual, and economic violence. Exposure of women to this type of violence negatively affects their health both physically and psychologically. Some factors affect women's exposure to IPV, such as education level, economic status, social support. The aim of this study is to determine the factors affecting IPV against women. This research is descriptive. 100 women between the ages of 18-60 in Hakkari participated in the study. Hakkari province, located in the Southeast Anatolian region of Turkey, which is known to have a high representative ability in this regard, was chosen. In the findings; Factors such as low education level, lack of income, early marriage, having children at an early age and lack of support from social and public institutions have been identified as important reasons for IPV. Since these are the Continuity correction (Yates Square Test), the smallest theoretical value is 5

Sexual abuse is a global public health problem that causes many medical, legal, social and economic problems in the short and long term. In this study, it was aimed to evaluate the sociodemographic characteristics and variables of our sexual abuse cases with the literature data. We retrospectively analyzed 175 cases who applied to our department for sexual abuse between January 1, 2013 and December 31, 2018. It was determined that 143 of 175 cases were found under the age of 18. 91,4% of the cases in our study were female and 8,6% were male. It has been observed that victims are frequently abused by people they know. It was found that 17 of the cases were abused by their family members. It was observed that most of those who denied the incident were victims of incest. When the education status of the victims during the incident is examined; 60 (34.3%) cases were found to be at primary school level, 19 (10.9%) cases were found to be at secondary school level, 11 (6.3%) cases were found to be at high school level; It was determined that 78 of all cases (44.6%) still continue their education and 22 cases (12.6%) quit their education. Lesions were detected in the sexual examination of 45(25,7%) of 175 cases; 39 (22,3%) of these cases had acute lesions and 6 (3,4%) of these cases had chronic lesions. Pregnancy occurred in 4 of the victims. Suicide attempts of 8 (4,6%) cases were determined. As a result, sexual abuse is a problem that requires a multi-faceted approach. Common centers should be established to raise the awareness of the society, to prevent sexual abuse, and to support the victims psychologically and socially. Procedural challenges should be reduced, media support should be obtained, and primary protection activities should be organized.

Objective:Electrical injuries are an important cause of mortality and morbidity and they may be prevented by simple precautions in general. The present study aimed to review the death cases due to electric current in Diyarbakır region between 2007 and 2014.Methods:In this study, 6341 forensic death reports were analyzed retrospectively. The study included 239 (3.77%) deceased individuals died because of electrical injury. Age, gender, origin of death, the crime scene, location of electrical entrance and exit points on the body were reviewed.Results:The cases included 147 (61.5%) males and 92 (38.5%) females, and the average age was 23.15+17.1 years [mimum (min): 1, maximum (max): 78]. All deaths due to electric current were accidental. Most of deaths occurred during summer season. The most common contact site was the upper extremity, which was detected in 112 (46.9%) cases. There were 34 cases (14.2%) without any external lesions due to electric current. Seventy-six (46.6%) cases died due to home accidents. The most significant findings of our study were that 114 (47.7%) cases were between 0 and 18 years of age and immersion water heaters were the cause of the incident in 33 (28.9%) cases.Conclusion:Among all forensic death cases of the current study, death rate due to electric shock was found to be higher compared to previous studies. Rate of pediatric deaths due to electric shock was found to be higher in the present study. Therefore, children should be educated to avoid playing with household electric appliances. Furthermore, infrastructure problems should be resolved and safety measures should be taken to prevent such accidents.

INTRODUCTION: Brain tissue continues to develop throughout childhood and during adolescence. Trauma experienced during these periods has been reported to have particularly serious consequences. With a few exceptions, most studies reported elevated cortisol levels in non-stressed circumstances in the child and adolescent victims of sexual abuse compared to controls1 . Prolonged exposure to elevated cortisol levels has been shown to cause an increase in reactive oxygen species (ROS) at the cellular level and increased oxidative stress2 . The aim of the present study was to evaluate cortisol levels, oxidative stress, and DNA damage in child and adolescent victims of sexual abuse versus healthy controls who did not have a history of trauma. MATERIALS AND METHODS: The study was conducted in the Department of Child Psychiatry at Dicle University. Study data were collected between May 2012 and November 2012. The study included a total of 38 children (10 males and 28 females) aged between 9 and 17 years who had experienced childhood sexual abuse and 38 age- and gender-matched children as the control group. Children who reached an intelligence score below 70 points, who had a significant neurological or medical disorder, who received oral contraceptives, had previous or current cortisol therapy or used vitamins, and those who had morbid obesity or active infection were excluded in order to prevent interference with the biochemical parameters. In addition, patients with a history of psychiatric disorder before the latest trauma and those with a history of alcohol or substance abuse were excluded from the CSA group. Parents of all participants signed consent forms regarding their voluntary participation in the study. Approval for the study was obtained from the Non-Interventional Clinical Research Ethics Committee at Dicle University Faculty of Medicine. Sociodemographic features of the participants were obtained and a clinical data form was completed. This was followed by the collection of 2 ml venous blood samples for biochemical tests. The blood samples were obtained in the morning between 10.00 and 12.00 am. Cortisol, glutathione peroxidase (GPx), Coenzyme Q, 8-Hydroxy-2- Deoxyguanosine (8-OHdG), and Superoxide dismutase (SOD) were tested using the ELISA method and commercial kits. The statistical analysis was performed using the SPSS 15.0 software package. RESULTS: The mean age was 13.4±2.5 years (range 9-17 years) among the victims of sexual abuse. In the control group, the mean age was 13.5±2.6 years (range 9-17 years). There were ten males and 28 females in the CSA and control groups. The duration of education was lower in the victims of CSA and their parents compared to the control group. The number of siblings was higher. There was no significant difference between the groups in terms of their family history of psychiatric disorder and smoking/substance abuse. There was also no significant difference between the groups in terms of age at menarche and menstrual cycle. Regarding the parameters related to sexual abuse, 61% (n=23) of the victims experienced sexual abuse involving penetration. Of those victims, 55% (n=21) experienced a single assault and 45% (n=17) experienced multiple assaults. Of the victims, 24% (n=9) experienced familial sexual abuse (incestuous) and 76% experienced sexual abuse committed by non-related persons. Cortisol levels were significantly higher in the CSA group compared to the control group (p<0.01). There was no significant difference between the groups in terms of the levels of oxidative stress parameters (GPx, SOD, and coenzyme Q). Likewise, 8-OHdG levels as an indicator of DNA oxidation were not significantly different between the groups (Table 2). The mean time elapsed since the first sexual abuse until the date of examination was 20.6±22.4 months (3-95 months). The evaluation of the relationship between this time span and cortisol levels revealed that cortisol levels decreased as the time interval increased (r=-0.279, p=0.04). Similarly, 8-OHdG level decreased as the time elapsed since the sexual abuse increased (r=-0.252. p=0.04). In the CSA group, there was no significant relationship between the sexual abuse involving penetration and the levels of GPx, SOD, coenzyme Q, and 8-OHdG. The coenzyme Q level was lower in the victims who sustained multiple assaults than the victims of a single assault (p=0.04). Cortisol and SOD levels were lower in the victims of familial sexual abuse (p=0.03 and p=0.04, respectively). DISCUSSION: Studies conducted during childhood and adolescence on the victims of CSA report elevated cortisol levels; conversely, when studies on CSA victims are conducted after a significant amount of time has elapsed, cortisol levels are reported lower. This decrease in cortisol levels over time is referred to as attenuation hypothesis3 . Consistent with the literature data, the present study reported higher cortisol levels in the CSA group. Furthermore, cortisol levels decreased as time since the sexual abuse increased. In the present study, there was no significant difference between the control group and CSA group in terms of oxidative stress and DNA damage. In a recent study, increased oxidative stress has been shown in rats that were exposed to stress. In another study, oxidative stress was suggested to play a critical role in the development and exacerbation of post-traumatic stress disorder (PTSD). Consistent with the current results, a study conducted on 14 patients with PTSD reported no significant difference in terms of GPx and SOD levels when compared to the control group4 . Both cortisol and 8-OHdG levels were found to be decreased as the time since sexual abuse increased. Although we did not find any difference between the groups in terms of 8-OHdG concentrations, this finding was considered to be a reflection of the relationship between cortisol and DNA damage. In addition, the decrease in cortisol levels over time was suggested to be reflective of an adaptive process preventing harmful effects of prolonged exposure to high cortisol levels on brain structures such as the hippocampus and frontal cortex5 . In conclusion, no significant difference was found in children and adolescents who experienced sexual trauma in terms of oxidative stress level and DNA damage. Furthermore, some factors related to the trauma, such as sexual abuse within the family and multiple assaults, were found to have affected the level of oxidative stress. Because this is the first study that has been conducted in child and adolescent victims of sexual abuse, longitudinal studies on a larger scale are needed to confirm the results of the current study.

Objective: Post-traumatic stress disorder (PTSD) is a psychiatric disorder which develops after exposure to a traumatic event. In recent years, researches on roles of biologic effects in PTSD’s etiology have increased. Prolidase is a manganese-dependent cytosolic exopeptidase that cleaves imidodipeptides containing Cterminal proline or hydroxyproline, and its activity has been documented in plasma and in various organs, such as the heart and the brain. In humans, the deficiency of the enzyme activity causes a rare autosomal recessive inherited disorder with a highly variable clinical phenotype such as chronic recurrent infections, mental retardation, splenomegaly, and skin lesion. The status of prolidase, which has significant biologic effects in PTSD’s etiology, has been assessed. In this study, we aimed to investigate the relationship between PTSD and serum prolidase activity. Methods: Among the survivors of the Van earthquake on 23 October 2011, 25 patients who had been diagnosed with PTSD according to DSM-IV criteria and 26 cases who were traumatized but not diagnosed with PTSD as well as 25 healthy controls who never experienced an earthquake were enrolled in the study. Serum prolidase activity of all participants was measured and compared across groups. All traumatized cases were assessed using the PTSD Check List Civilian Version (PCL-C). Results: The mean prolidase activity of PTSD patients was significantly lower than that of traumatized cases without PTSD diagnosis, which in turn is significantly lower than the prolidase activity of the cases who never experienced an earthquake (p<0.01). Conclusion: Studies have also noted that glutamate and nitric oxide (NO) play a causal role in anxiety-related behaviors. Because of the prominent role of NO in neuronal toxicity, cellular memory processes, and as a neuromodulator, nitrergic pathways may have an important role in stress-related hippocampal degenerative pathology and cognitive defects seen in patients with PTSD. It has been shown that elevated prolin levels activated the NMDA receptor. It has been considered that prolidase has a role of regulation of nitric oxide synthesis. We observed in this research that while prolidase levels decreased, the substance tended to to reduce NO and the neurotoxic effects of glutamate. Therefore, we suggest that Prolidase is a neuroprotective molecule.

Çocuk istismarı, önemli bir halk sağlığı problemi olmaya devam etmektedir. Genellikle çocuğun en yakınları tarafından yapılan, bu nedenle tespit edilmesi ve tedavisi zor olan çocuk istismarı, uzun dönemde ciddi toplumsal problemlere neden olmaktadır. Bu yazıda, fiziksel ve duygusal istismarın bir arada görüldüğü 25 aylık kız çocuğu sunularak, ailede en küçük çocuk olmanın diğer faktörlerle birlikte değerlendirilerek, çocuk istismarı üzerinde etkisi tartışılmıştır. Hastaneye başvuran veya adli makamlarca gönderilen olgularda, çocuk istismarının ortaya çıkarılabilmesi, engellenebilmesi ve mağdur çocukların rehabilitasyonlarının yapılabilmesi için hastane aşamasında yapılması gerekenler, ilgili klinik branşlardan oluşan multidisipliner ekiplerin kurulması ve risk altındaki çocukların iyi tanımlanmasıdır.

INTRODUCTION: Among other effects, oxidative stress also impairs normal brain functions through the inhibition of neurogenesis, altering neuronal transmission, and inducing mitochondrial dysfunction1 . Human and animals studies demonstrated that oxidative stress is related to anxiety. In an animal model of PTSD, inflammation and oxidative stress were reported to play a critical role in the development and exacerbation of PTSD2 . There are also studies that did not report a significant difference between patients with PTSD and the control group in terms of oxidative stress3 . It was reported that oxidative stress could be a critical molecular linkage between the hypothalamic– pituitary–adrenal (HPA) axis dysfunction and mental disorders. It was also reported that the stress-induced increase in cortisol levels accelerates glucose metabolism and production of reactive oxygen species. The aim of the present study is to evaluate children and adolescents who develop PTSD after experiencing sexual abuse versus those who did not develop PTSD in terms of the level of oxidative stress and DNA damage. METHOD: Study Sample: The study was conducted in the Department of Child Psychiatry at Dicle University. The study data were collected between July 2013 and February 2014. A total of 61 children, aged between 5 and 17 years (18 males and 43 females), participated in the study. The patients were divided into two groups, patients with PTSD and patients without PTSD, based on the results of a structured psychiatric interview. Children who achieved an intelligence score below 70 points, those with a significant neurological or medical disorder, those who received oral contraceptives, previous or current cortisol therapy, vitamins, and those with morbid obesity or active infection were excluded from the study in order to prevent interference with the biochemical parameters. The parents provided informed consent in order for their children to participate in the study. Approval was obtained for the study from the Non-interventional Clinical Researches Ethics Committee at Dicle University Faculty of Medicine. Scales: Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL): The schedule (K-SADSPL) was originally developed by Kaufman et al. It was adapted to the Turkish language by Gökler et al. in 2004. K-SADS-PL is administered during an interview with the parents and children, and the final evaluation is performed using input from all data sources. Clinician-Administered Post-Traumatic Stress Disorder Scale for Children and Adolescents (CAPS-CA): CAPS-CA is a semi-structured interview developed to evaluate the frequency and severity of present and past PTSD in children and adolescents according to DSM-III and DSM-4 diagnostic criteria. It was adapted from the Clinician-Administered Post-Traumatic Stress Disorder Scale (CAPS) by Nader et al. in 1996. The scale evaluates 17 symptoms of post-traumatic stress disorder based on DSM-4 and eight items related to PTSD. It was adapted to the Turkish language by Karakaya et al. in 2007. The Children’s Depression Inventory (CDI): The Children’s Depression Inventory developed by Kovacs based on the Beck Depression scale was used in the study. However, questions specific to the childhood period such as school success and relationship with friends were added. The scale was adapted to the Turkish language by Öy and contains 27 items, each of which is scored as 0, 1, or 2 points depending on the severity of the symptom. Biochemical Analysis: The blood samples were obtained in the morning between 10:00 and 12:00 AM. Cortisol, glutathione peroxidase (GPx), superoxide dismutase (SOD), coenzyme Q, 8-Hydroxy-2-Deoxyguanosine (8-OHdG) levels were evaluated using the ELISA method and ready-to-use ELISA kits. Statistical Analysis: The statistical analysis was performed using SPSS 15.0 software package. A p value< 0.05 was considered statistically significant. RESULTS: The mean age was 13.3±2.4 years (range: 5-17 years) among the victims of sexual abuse. Our evaluation revealed a diagnosis of PTSD in 51% (n=31) of victims. There was no significant difference between patients with or without PTSD in terms of gender, smoking status, and menstrual cycle, the latter being assessed for adolescent patients. There was also no significant difference between the groups in terms of age, age of the mother/father, and education level of the parents. Regarding the parameters related to sexual abuse, 48% (n=29) of the victims experienced sexual abuse involving penetration. Of the victims, 46% (n=28) experienced single assault and 54% (n=33) experienced multiple assaults. 21% (n=13) of victims experienced sexual abuse within the family (incestuous), and 79% (n=48) experienced sexual abuse committed by non-related persons. There was no significant difference between patients with or without PTSD in terms of relationship with the abuse and presence of penetration (p=0.34 and p=0.68, respectively). There was no significant difference between the groups with or without PTSD in terms of cortisol, GPx, SOD, coenzyme Q, and 8-OHdG levels (Table 1). Likewise, there was no significant difference between the groups with or without depression in terms of cortisol, GPx, SOD, coenzyme Q, and 8-OHdG levels (p=0.43, p=0.46, p=0.38, p=0.53, and p=0.48, respectively). There was no correlation between CAPS scores and GPx, SOD, coenzyme Q, and 8-OHdG levels between patients with or without PTSD. The mean time that elapsed since the first sexual abuse until the date of examination was 23.9±24.1 months (range: 1-115 months). In the PTSD group, cortisol levels decreased with increasing time after trauma, and there was no significant correlation with the cortisol levels in patients without PTSD (r=-0.46, p=0.01 and r=-0.07, p=0.73, respectively). Similarly, 8-OHdG levels in the PTSD group decreased with increasing time after trauma, and there was no significant correlation with 8-OHdG levels in patients without PTSD (r=-0.42, p=0.03 and r=-0.04, p=0.85, respectively). DISCUSSION: In the present study, there was no significant difference between patients with or without PTSD in terms of oxidative stress and DNA damage. Furthermore, no relationship was found between the severity of the symptoms of PTSD and oxidative stress and DNA damage. In their studies, Tezcan et al. and Čeprnja et al. did not report any association between PTSD and oxidative stress3 . However, healthy volunteers having no past history of trauma were selected as the control group in their study. In addition, the type of trauma in their study was different compared to the present study. In contrast to our findings, human and animal studies showed an association between oxidative stress and anxiety. In an animal model of PTSD, inflammation and oxidative stress were reported to play a critical role in the development and exacerbation of PTSD2 . In the present study, cortisol and 8-OHdG levels decreased with increasing time after trauma in the PTSD group. Although we did not find any difference between the groups in terms of 8-OHdG concentrations, this finding was considered to be a reflection of the relationship between cortisol and DNA damage. In conclusion, there was no significant difference between children and adolescents with or without PTSD after sexual abuse in terms of the level of oxidative stress and DNA damage. However, cortisol and 8-OHdG levels decreased with increasing time after trauma in the PTSD group. Although we did not find any difference between the groups in terms of 8-OHdG concentrations, this finding was considered to be a reflection of the relationship between cortisol and DNA damage. This is the first study conducted in this age group.

INTRODUCTION: Glucocorticoids act through glucocorticoid receptors (GR) found in high concentrations in the amygdala and the hippocampus. In GR-mediated molecular activation, the brain-derived neurotropic factor (BDNF)-mediated signal pathway is required for memory consolidation. BDNF expression in the central nervous system is modified by various brain traumas including stress, ischemia, epileptic seizures, and hypoglycemia. Glucocorticoids play a role in the regulation of BDNF. In the rat hippocampus, stimulation of mineralocorticoid receptors (MR) increases the level of BDNF, while stimulation of glucocorticoid receptors (GR) decreases the BDNF levels1 . As mentioned above, trauma affects growth factors and the HPA axis. There are limited studies in the literature that have investigated the relationship between cortisol and BDNF levels in child and adolescent victims of sexual abuse. The present study compares the levels of BDNF, cortisol, and ACTH between child and adolescent victims of sexual abuse with those who have no trauma history. METHOD: Study Sample: The study was conducted in the Department of Child Psychiatry at Dicle University. The study included a total of 44 children (M/F: 12/32) between the ages of 8 and 17 years who had experienced child sexual abuse and 42 age- and gender-matched children (M/F: 12/30) as control group. The study data were collected between December 2011 and April 2012. Children who achieved an intelligence score below 70 points, who had significant neurological or medical disorders, who received oral contraceptives, had previous or current cortisol therapy, vitamins, and those who showed morbid obesity or active infection were excluded in order to prevent interference with the biochemical parameters. The patients were evaluated by two psychiatrists. The parents provided informed consent in order for their children to participate in the study. Approval for the study was obtained from the Non-Interventional Clinical Research Ethics Committee at Dicle University Faculty of Medicine. Sociodemographic features of the participants were obtained and a clinical data form was completed. This was followed by collection of a 2 ml venous blood sample for biochemical tests. Sociodemographic Data and Clinical Data Form: This form included questions about age, gender, education level, age of the parents, number of siblings, history of psychiatric disorders or substance abuse in the relatives, height, weight, and body mass index (BMI), type of abuse, duration and frequency of abuse, relationship with the abuser, and abuse history. Biochemical Analysis: The blood samples were obtained in the morning between 10:00 and 12:00 AM. Cortisol, ACTH, and BDNF levels were evaluated using the ELISA. Statistical Analysis: The statistical analysis was performed using SPSS 15.0 software package. A p-value below 0.05 was considered statistically significant. RESULTS: The mean age was 13.1±2.7 years (range: 8-17 years) among the victims of sexual abuse. In the control group, the mean age was 13.8±2.9 years (range: 8-17 years). The sexual abuse group consisted of 12 males and 32 females, and the control group consisted of 12 males and 30 females. The duration of education was lower and the mean number of siblings was higher in the victims of sexual abuse and their parents compared to the control group (p=0.02, p0.05). There was no significant difference between the groups in terms of height, weight, and BMI (p>0.05). Regarding the parameters related to sexual abuse, 64% (n=28) of the victims had experienced sexual abuse involving penetration. Of the victims, 52% (n=23) had experienced a single assault and 48% (n=21) multiple assaults. 23% (n=10) had experienced sexual abuse within the family (incestuous) and 77% (n=34) sexual abuse committed by non-related persons. Of all cases, 82% (n=36) were smokers and 18% (n=8) were non-smokers. Cortisol levels were significantly higher in the sexual abuse group compared to the control group (p<0.001). Albeit statistically insignificant, ACTH levels were higher in the sexual abuse group compared to the control group (p=0.10). Consistent with these findings, the ACTH/Cortisol ratio was lower (p<0.001). BDNF levels were significantly lower in the sexual abuse group compared to the control group (p=0.04). The mean time that elapsed from the first sexual abuse until the date of examination was 22.72±21.72 months (range: 2-120 months). The evaluation of the relationship between this time span and cortisol levels revealed that cortisol levels decreased as this time interval increased (r=-0.271, p=0.03). In the sexual abuse group, there was no relationship between the presence of penetration and cortisol, ACTH, and BDNF levels. Cortisol and BDNF levels were lower in the victims of multiple sexual assaults (p=0.03 and p=0.04, respectively). Cortisol and ACTH levels were lower in the victims of sexual abuse within the family; however, BDNF did not show a significant difference (p=0.03, p=0.049, p=0.11). DISCUSSION: One of the most important findings of the present study was that high cortisol levels were observed in the sexual abuse group. Furthermore, cortisol levels decreased as time elapsed, while trauma increased. The majority of the studies conducted on child and adolescent victims of trauma were found to have elevated non-stress cortisol levels. However, a meta-analysis of retrospective studies in patients that experienced chronic stress was found them to have decreased non-stress cortisol levels. This decrease in cortisol levels over time is referred to as the “attenuation hypothesis”. The second most important finding of the present study was lower BDNF levels observed in the sexual abuse group. In human studies, BDNF levels were lower in depressed women who were survivors of childhood physical abuse. BDNF levels were also lower in bipolar patients who had a history of trauma in childhood. The inverse relationship between memory performance and childhood sexual abuse was found to be associated with apolipoprotein E gene alleles. There are studies that implicated BDNF in the relationship between trauma and schizophrenia, bipolar disorder, PTSD, and depression2 . In animal studies, stress was suggested to be associated with changes in the functions and structure of the hippocampus through decreased neurogenesis, increased glucocorticoids, and/or decreased BDNF. In general, studies conducted on patients with PTSD have found lower BDNF levels compared to the control group3 . There are also studies suggesting no change or even an increase in BDNF levels. In the sexual abuse group, the presence of penetration had no effect on cortisol and BDNF levels. However, both cortisol and BDNF levels were lower in victims that experienced multiple sexual assaults. Cortisol levels were lower in victims of sexual abuse within the family. The effects of stress on cognitive functions and psychopathological processes are related to gender, type of stress, frequency, controllability, and predictability. In conclusion, the present study found elevated cortisol levels and decreased BDNF levels in child and adolescent victims of sexual abuse. Interestingly, cortisol levels decreased with increasing time after trauma. Furthermore, some factors related to trauma such as sexual abuse within the family and multiple assaults were found to have affected cortisol and BDNF levels. The results of the present study suggest that cortisol and BDNF could be biological molecular mediators of trauma on biological and psychological systems. While this is the first report on the effects of cortisol and BDNF-induced trauma in child and adolescent victims of sexual abuse, longitudinal studies with larger samples size are required to validate the findings of the current study.

Objective: Earthquakes are among the most destructive life-threatening natural disasters and an important cause of death. Despite the fact that earthquakes are frequently experienced and devastating natural disasters, less attention has been paid to risk factors and psychological effects. PTSD is common and chronic mental disorder is likely to develop in anyone who has been exposed to violent trauma. Oxidative stress has been shown to play an important role in the pathogenesis of post-traumatic stress disorder. Although there are some studies on oxidative stress and post-traumatic stress disorder, no reports are available on the serum total oxidant and antioxidant status in earthquake survivors with PTSD. Therefore, this study aims to investigate the serum total oxidant and antioxidant status in earthquake survivors with chronic PTSD. Methods: This study was consecutively conducted in the Department of Psychiatry at Yuzuncu Yil University (Van, Turkey) between June 2012 and February 2013. In this study, 45 patients with chronic PTSD (15 males, 30 females) and 40 non-PTSD subjects (14 males, 26 females) were enrolled. The control group consisted of 40 healthy earthquake survivors. Patients with PTSD had not received any treatment prior to the study. The oxidative status was determined using a total antioxidant status and total oxidant status measurement and a calculation of the oxidative stress index. Patients were assessed for PTSD by a psychiatrist with the Clinician-Administered PTSD Scale (CAPS) and the Clinical Global Impression (CGI) scale. Results: There were no statistically significant differences between the two groups regarding age, gender, or body mass index. There were no statistically significant differences in the total antioxidant status, total oxidant status, or oxidative stress index when comparing subjects with and without PTSD (all, p>0.05). We found no correlations between Clinician-Administered PTSD Scale scores and oxidant and anti-oxidant stress markers (all, p>0.05). Conclusion: Our results suggest that the total oxidant and antioxidant status may not affect earthquake survivors with PTSD. This is the first study to evaluate the oxidative status in earthquake survivors with PTSD. Further studies are necessary to confirm these findings.

INTRODUCTION: Cortisol levels decrease or show no change in PTSD, although there are some exceptional cases. In the model proposed by Yehuda, PTSD was associated with increased adrenergic response and/or lack of a sufficient amount of cortisol in the circulation following trauma. In general, studies conducted on patients with PTSD have found lower BDNF levels compared to the control groups. A study of patients with PTSD and healthy controls who did not have a history of trauma found lower BDNF levels in patients with PTSD1 . Another study compared BDNF levels between patients with or without PTSD after trauma and reported lower BDNF levels in patients with PTSD2 . To our knowledge, there are no studies in the literature that evaluated cortisol and BDNF levels in adolescent and child victims of sexual abuse. The aim of the present study was to compare BDNF, cortisol, and ACTH levels in a special group of patients comprised of children and adolescent patients with or without PTSD after experiencing sexual assault, which is a catastrophic form of trauma. METHOD: Study Sample: The study was conducted in the Department of Child Psychiatry at Dicle University. The study data were collected between January 2013 and May 2013. The study included 55 children aged between 6 and 17 years, 13 of which were males and 42 were females. The patients were divided into two groups, with or without PTSD, based on the results of a structured psychiatric interview. Children who had mental retardation, history of head trauma, and those who received oral contraceptives, previous or current cortisol therapy or vitamins, and patients who had morbid obesity, chronic systemic disorders, and active infection were excluded in order to prevent interference with biochemical parameters. Two psychiatrists evaluated the patients, and parents provided informed consent in order for their children to participate in the study. Approval was obtained for the study from the Non-Interventional Clinical Research Ethics Committee at Dicle University Faculty of Medicine. Study Procedures: Sociodemographic features of the participants were obtained and a clinical data form was completed. This was followed by a structured psychiatric interview (K-SADS-PL and CAPS-CA) and administration of the self-reported Children’s Depression Inventory (CDI). Finally, a 2 ml venous blood sample was obtained for biochemical tests. Scales: Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL): The schedule (K-SADSPL) was originally developed by Kaufman et al. It was adapted to the Turkish language by Gökler et al. in 2004. K-SADS-PL is administered during an interview with the parents and children, and the final evaluation is performed using input from all data sources. Clinician-Administered Post-Traumatic Stress Disorder Scale for Children and Adolescents (CAPS-CA): CAPS-CA is a semi-structured interview developed to evaluate the frequency and severity of present and past PTSD in children and adolescents according to DSM-III and DSM-4 diagnostic criteria. It was adapted from the Clinician-Administered Post-Traumatic Stress Disorder Scale (CAPS) by Nader et al. in 1996. The scale evaluates 17 symptoms of post-traumatic stress disorder based on DSM-4 and eight tables related to PTSD. It was adapted to the Turkish language by Karakaya et al. in 2007. The Children’s Depression Inventory (CDI): The Children’s Depression Inventory developed by Kovacs based on the Beck Depression scale was used in this study. However, questions specific to the childhood period such as school success and relationship with friends were added. The scale was adapted to the Turkish language by Öy and contains 27 items: Each item is scored as 0, 1, or 2 points depending on the severity of the symptom. Biochemical Analysis: Blood samples were obtained in the morning between 10:00 and 12:00 am. Cortisol, ACTH, and BDNF levels were evaluated using ELISA method and ready-to-use ELISA kits. Statistical Analysis: The statistical analysis was performed using SPSS 15.0 software package. A p-value below 0.05 was considered statistically significant. RESULTS: The mean age was 14.16±2.62 years (range: 6-17 years) among the victims of sexual abuse. Of these victims, 27 (49%) were diagnosed with PTSD. There was no significant difference between patients with or without PTSD in terms of gender, place of living, school success, employment status of the parents, smoking, and menstrual cycle for adolescents. Regarding the parameters related to sexual abuse, 60% (n=33) of the victims experienced sexual abuse involving penetration. Of the victims, 56% (n=31) experienced a single incident of assault and 44% (n=24) experienced multiple assaults. Of the victims, 24% (n=13) experienced sexual abuse within the family (incestuous) and 76% (n=42) experienced sexual abuse committed by non-related persons. There was no significant difference between patients with or without PTSD in terms of relationship with the abuse and presence of penetration (p=0.30 and p=0.70, respectively). However, the rate of PTSD was higher in patients who experienced multiple sexual assaults compared to the victims of a single assault (p<0.001). There was no significant difference between patients with or without PTSD in terms of cortisol, ACTH, and BDNF levels. Likewise, there was no significant difference between patients with or without depression in terms of cortisol, ACTH, and BDNF levels. There were no correlations between CAPS scores and cortisol, ACTH, and BDNF levels between patients with or without PTSD. The mean time that had elapsed since the first sexual abuse until the date of examination was 21.5±22.4 months (3-110 months). In the PTSD group, cortisol levels decreased with increasing time after trauma, and there was no significant correlation with the cortisol levels in patients without PTSD (r=-0.46, p=0.01 and r=-0.07, p=0.73, respectively). There was no correlation between time that had elapsed since trauma and BDNF levels. DISCUSSION: In the current study, the presence of PTSD had no influence on cortisol and ACTH levels in children who had experienced sexual abuse, and cortisol levels decreased with increasing time after trauma in the PTSD group. The studies conducted on patients with PTSD often reported increased levels of CRH in the CSF and a decrease or no change in cortisol levels. Plasma, saliva, and urinary cortisol and plasma ACTH levels were found to be similar between patients with or without PTSD after trauma. Plasma cortisol levels decreased in the two groups, and it was reported that cortisol levels did not predict the development of PTSD. There are findings suggesting that low cortisol levels after exposure to trauma might have increased the risk of developing PTSD. There are also studies suggesting that no relationship between cortisol levels and the development of PTSD exists. In the present study, cortisol levels decreased as the time elapsed since the trauma increased in the PTSD group. It is therefore assumed that these individuals will have lower than normal cortisol levels in adulthood. In the present study, presence of PTSD had no effect on BDNF levels in child victims of sexual abuse, and there was no correlation between BDNF levels and the time that had elapsed since the trauma. In general, studies conducted on patients with PTSD have found lower BDNF levels compared to the control group1,2. BDNF levels were compared between patients with or without PTSD after trauma, and BDNF levels were lower in patients with PTSD (2). In the study by Hauck et al., serum BDNF levels were higher in patients who experienced sexual assault in the last one year compared to the control group; however, BDNF levels did not differ significantly among those who experienced trauma beyond the last one year3 . In conclusion, there was no significant difference between children and adolescents with or without PTSD in terms of cortisol, ACTH, and BDNF levels. However, the decrease in cortisol levels with increasing time after trauma in PTSD group points to the possible role of cortisol in the pathophysiology of the disease. Longitudinal studies on a larger sample are required in order to confirm the findings of the current study that was conducted in children and adolescent patients.

ÖZETAmaç: Ülkemizde hekimlik yapma yetkisine sahip hekimlere, Tababeti Adliye Kanunu’na göre adli olaylarda görev alabilme zorunluluğu; Türk Ceza Kanunu (TCK) 280. Maddesi ile de sağlık personeline adli olguyu bildirim zorunluluğu getirilmiştir. Adli raporlar, adli makamlarca hekimden istenen, kişinin tıbbi durumunun tespit eden ve maruz kalınan travmaya ilişkin adli makamlarca sorulan soruları yanıtlayan, hekim görüş ve kanaatini bildiren belgeleri kapsamaktadır. Bu araştırmada Dicle Üniversitesi Tıp Fakültesi son sınıf öğrencileri (intörn doktor) ve Dicle Üniversitesi Tıp Fakültesi’nde uzmanlık eğitimi almakta olan asistan hekimlerin adli raporlar konusundaki bilgi, tutum ve düşüncelerinin ortaya konması amaçlanmıştır.Yöntem: Kesitsel ve tanımlayıcı tipte olan bu çalışmanın evrenini Dicle Üniversitesi Tıp Fakültesi son sınıf öğrencileri ve Dicle Üniversitesi Hastanesinde uzmanlık eğitimi almakta olan asistan doktorlar oluşturmuştur. Çalışmada veri toplama aracı olarak anket kullanılmıştır. Anket formu sosyodemografik özelliklerin sorgulandığı sekiz ve adli raporlar konusunda bilgi, tutum ve düşüncelerin değerlendirildiği çoktan seçmeli 20 sorudan oluşturulmuştur. Araştırma verilerimizin istatistiksel değerlendirmesinde SPSS 22.0 paket programı kullanılmıştır.Bulgular: Çalışmaya katılanların 175’i (%65) asistan hekim, 94’ü (%35) ise intörn doktordur. Asistan ve intörn doktorların yaş ortalamaları sırası ile 29,4±3,83 yıl ve 24,7±1,62 yıl idi. Asistan ve intörn doktorların sırasıyla 120’si (%69) ve 65’i (%69,1) erkek olup, 54’ü (%31) ve 29’u (%30,9) kadın idi. Katılımcılara adli tıp konusunda kendilerini yeterli görüp görmedikleri sorulmuş; asistan hekim ve intörn doktorların sırasıyla 115’i (%65,7) ve 83’ü (%88,3) yetersiz gördüğünü belirtmiştir. Katılımcılardan asistan hekimlerin ve intörn doktorların sırasıyla 59’u (%33,7) ve 69’u (%73,4) verecekleri adli raporların yargıdaki etkilerini bilmediğini, 39’u (%22,3) ve 2’si (%2,1) bildiğini, 77’si (%44) ve 23’ü (%24,5) ise kısmen bildiğini söylemiştir. Geçici Raporun geçerlilik süresi sorgulanmış, asistan hekimlerin 45’i (%25,7), intörn doktorların ise 66’sı (%70,2) geçici raporu ilk defa duyduğunu söylemiştir.Sonuç: Mahkemelerin verdiği karar ve cezaları adli raporların sonuçları etkilemekte olup, hatalı ya da eksik verilen adli raporlar muayene edilen kişiyi ya da sanığı mağdur edebilmekte, hekimi hukuki ve cezai sorumlulukların altına sokabilmekte, adli makamların iş yükünü arttırarak adli yargı sürecinin uzamasına ve yargının yanlış tecellisine neden olabilmektedir. Bu nedenle gerek hekimlerin gerekse hekim adaylarının adli raporların usulüne uygun ve doğru doldurulması konusunda yeterince bilgi sahibi olmaları, adli raporların kendilerine yükledikleri hukuki sorumluluğun ve yargıdaki etkilerini bilmeleri son derece önemlidir. Şüphesiz bu sorunların çözülmesinin en önemli yolu eğitimdir. Bu nedenle, mezuniyet öncesi adli tıp eğitimleri iyileştirilmeli, mezuniyet sonrasında iller düzeyinde sürekli ve düzenli eğitimler olmalı, adli rapor yazımında kılavuzlardan faydalanılmalıdır.

Objective: Forensic reports are legal documents demanded by judicial authorities, providing information on the medical condition of the forensic cases, encompassing answers to the questions to be probed by judicial authorities regarding the forensic event, and also presenting the remarks and opinions of the physician. The aim of this study was to investigate the knowledge base, attitudes, and views regarding forensic reports in the medical students enrolled in the last grade of medical education and the general practitioners doing specialty training at Dicle University Medical School Hospital.Methods: The universe of this cross-sectional descriptive study included all the students enrolled in the last grade of medical education and the general practitioners doing specialty training at Dicle University Medical School Hospital. The questionnaire consisting of 8 multiple-choice items probing the sociodemographic characteristics of the participants and 20 multiple-choice items probing their knowledge base, attitudes, and views regarding forensic reports. Data were evaluated using SPSS 22.0 for Windows.Results: The participants comprised 175 (65%) general practitioners and 94 (35%) students. Mean age was 29.4 +/- 3.83 years in the general practitioners and 24.7 +/- 1.62 years in the students. The general practitioners included 120 (69%) men and 54 (31%) women and the students included 65 (69.1%) men and 29 (30.9%) women. The results indicated that 115 (65.7%) of the general practitioners and 83 (88.3%) of the students indicated that they felt incompetent in the realm of forensic medicine.Conclusions: Both physicians and physician candidates should prepare forensic reports in due form and should be well acknowledged about how to do prepare them and also should have full knowledge about the legal burden imposed on them by these reports as well as the legal effects of the reports. Therefore, the aspects of forensic medicine within the undergraduate medical education should be enhanced, widespread and regular training activities should be performed in almost all cities, and guidelines for preparing forensic reports should be publicized.

BACKGROUND:Adolescent motherhood is present in many societies worldwide, including Turkey.AIMS:We aimed to determine the demographical and cultural characteristics of adolescent mothers, lifetime domestic violence and history of miscarriage, and whether they suffer from any kind of medically unexplained (psychosomatic) pain in a study in south-eastern Turkey.METHODS:We included 501 mothers in this case-control study. The study group comprised 228 mothers who gave their first deliveries at or before 19 years of age, and the control group consisted of 273 mothers who first delivered after 19 years of age. The case-control study was conducted between February and April 2013 in Diyarbakir, Turkey.RESULTS:Adolescent mothers marry more frequently with their relatives. They have a higher prevalence of culture-bound customary applications such as bride price. They are less likely to be asked for their consent to marry and tend to have more children. They are more frequently victims of domestic violence and more often report medically unexplained psychosomatic pain.CONCLUSIONS:Adolescent motherhood is still a public health problem that seems to be related to certain culture-bound customary practices, continuing domestic violence across generations, increased number of children, and more prevalent psychosomatic pain.

Hekimlik mesleğinin; hastalar arasında sosyal durum, dini inanç, siyasi görüş, milliyet, cinsiyet, yaş ve sosyoekonomik durum farklılıkları gözetmeksizin icra edilmesi gerekmektedir. Ancak tutuklu/hükümlü muayenelerinde Ceza İnfaz Kurumlarının Yönetim, Dış Koruma, Hükümlü ve Tutukluların Sevk ve Nakilleri ile Sağlık Hizmetlerinin Yürütülmesi Hakkındaki Protokolün (3’lü Protokol) yorumlanması ve uygulanmasına bağlı olarak çeşitli sorunlarla karşılaşılmaktadır. Bu çalışmamızda kolluk kuvvetleri eşliğinde cezaevinden Dicle Üniversitesi Tıp Fakültesi Adli Tıp AD’na muayeneye getirilen bir şahsın muayenesi esnasında kolluk kuvvetleri ile hekimler arasında 3’lü protokol nedeniyle yaşanan bir olay ele alınmış olup çözüm önerilerinde bulunulmuştur.

Aim: Child marriage still persists for various reasons in numerous countries and cultures including primarily the underdeveloped or developing countries in South Asia and North Africa. In this study, our aim is to focus on the frequency of child marriage as well as the family characteristics and socio-cultural factors pertaining to marriage, frequency of domestic violence, and somatic symptoms such as pain of unknown origin among the women. Methods: Our study was conducted using a questionnaire presented to 454 women aged 17-65 living in the provincial centre of Diyarbakir. Results: The families of 17.3% of the participants had a history of migration before the marriage. Close-kin marriage was present between the parents of 31.1% of the women. Among the participants, 17.3% were subjected to physical abuse and 1.8% were subjected to sexual abuse before the marriage. Among the women, 33.3% replied that they had chronic pain of unknown origin which the physicians could not diagnose. Conclusions: We have observed that chronic pains of unknown origin pointing to somatisation are more frequent among women who get married before the age of 18. The results of our study point out that underage marriage has an impact not only on sexual and reproductive health, but also on general health. Key Words : Early age marriage, health consequences, pain of unknown origin

In the present study, judicial death cases during childhood were assessed retrospectively for description and discussion of the data obtained in company with the literature were aimed. For the purposes of this study, the postmortem examination and post-mortem records of the cases between the ages of 0-18, who had died between January 2005 and December 2012. The sociodemographic characteristics and origin of the 1113 cases, the type of the incident, the distribution of the causes of death post-mortems were evaluated. The mean age of the 1113 cases was 6.77±0.17 (mean ± SE), and 66.8% cases were male, while 33.1% were female, (Male/Female: 2/1). The greatest part of all the deaths comprised fatal accidents with cases 61.4%, followed by (26.1%) suspicious deaths, 4.3% homicides, and 4.1% suicides the most common cause for death was detected as traffic accident by 33.5% cases among the 48 cases who were homicided, 58.3% were in the 15-18 age group. Consequently, it was observed that child death cases occurred in our territory were frequently accidental and traffic accidents were more common. [Med-Science 2016; 5(4.000): 979-84]