Aslihan Polat

One year outcome in first episode schizophrenia : Predictors of relapse

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

Cigarette smoking among patients with schizophrenia and bipolar disorders

Abstract  The purpose of the present study was to investigate the ratio of smokers and the relationship of cigarette smoking to clinical features in patients with schizophrenia and bipolar disorders. One hundred and forty‐four patients with schizophrenia or bipolar disorder along with 114 healthy controls were evaluated. A total of 57.5% of the patients with schizophrenia, 55.1% of the bipolar patients and 47.3% of the control group were smokers. Daily cigarette consumption among the patients with schizophrenia was higher than that for the bipolar patients, and control group. Among the patients with schizophrenia who were in acute psychotic episode, Scale for the Assessment of Positive Symptoms scores of the smokers were significantly higher.

Attitudes of psychiatrists toward patients with schizophrenia

Abstract  A questionnaire was distributed to psychiatrists to investigate their attitudes toward patients with schizophrenia. A total of 42.7% of 60 respondents never informed patients of the diagnosis of schizophrenia and 40.7% informed on a case‐by‐case basis. The reason that psychiatrists gave for avoiding informing the patients/family members of the diagnosis was the idea that they would not understand the meaning (32.6%) and that they would drop‐out from treatment (28.3%). A total of 88.4% of respondents thought the term ‘schizophrenia’ was used in a pejorative manner in public. The findings revealed that stigmatizing attitudes of society are also shared by some psychiatrists.

Evaluation of regional cerebral blood flow changes in panic disorder with Tc99m-HMPAO SPECT

OBJECTIVE To evaluate the differences in regional cerebral blood flow (rCBF) and rCBF asymmetry index values of panic disorder patients and a control group, using Tc99m-HMPAO SPECT. In addition, the influence of comorbid agoraphobia on the rCBF and rCBF asymmetry index values of the panic disorder patients was also investigated. METHOD The rCBF and rCBF asymmetry index values of 22 panic disorder patients, 9 with agoraphobia and 13 without agoraphobia, and 19 healthy controls were obtained using SPECT. Both (1) the panic disorder and control groups and (2) panic disorder groups with and without agoraphobia were compared in terms of the measured values. RESULTS A decrease in blood perfusion in the bilateral frontal region, a relative increase in blood perfusion in the right medial frontal and right superior frontal regions and a relative blood flow increase in the right medial frontal region according to rCBF asymmetry index values were determined in panic disorder patients. In the patients with agoraphobia, the decrease in blood perfusion in the right occipital region, and the relative increase in the right superior temporal region according to rCBF asymmetry index values were significantly higher than those in subjects without agoraphobia. CONCLUSION The decrease in the rCBF in the bilateral inferior frontal regions in panic patients may be related to the amygdala activation decreasing cerebral blood flow in the frontal region and/or the hyperactivation of the locus ceruleus. The explanations of the etiology of panic disorder are valid only if they are supported with clinical evidence from future studies.

The relation of psychogenic excoriation with psychiatric disorders: a comparative study.

Psychogenic excoriation (PE), characterized by excessive scratching or picking of the skin, is not yet recognized as a symptom of a distinct DSM-IV disorder. It is a chronic disorder with a high rate of psychiatric comorbidity. The purpose of this study was to compare patients diagnosed with PE and patients with another dermatological disease in terms of comorbid psychiatric disorders. Thirty-one consecutive subjects were recruited from an outpatient dermatology clinic. The control group was composed of 31 patients with chronic urticaria. All subjects were interviewed using the Structured Clinical Interview for DSM-III-R (SCID-I), Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HARS), and Yale-Brown Obsession and Compulsion Scale (Y-BOCS) and also completed a semistructured questionnaire. Current major depressive syndrome was the most common psychiatric disorder in the PE group. There was a statistically significant difference between the two groups in terms of current major depressive syndrome (PE group 58.1%, control group 6.5%, P<.01). In the PE group, 45.2% of subjects were diagnosed with obsessive compulsive disorder (OCD), while the rate of OCD was only 3.7% in the control group (P <.01). The PE group scored significantly higher on the BDI, HARS, and Y-BOCS. The results of this study point to the close relationship of PE to depression and OCD.

Unrecognized depression in community-dwelling elderly persons in Istanbul

OBJECTIVE Depression, one of the most prevalent psychiatric disorders, causes disability and reduces quality of life. Rates of clinical depression in community samples of older adults range between 1-16%. Most studies of old age depression have been conducted in developed countries. The present study was conducted to determine the prevalence of depressive disorders among Turkish elderly in an urban community. METHOD This study was carried out in the Kadiköy district of Istanbul. The sample for the cross-sectional part of the study was 1067 individuals age 70 or older, randomly selected from population registries. Geriatric Depression Scale (GDS), Mini-mental State Examination (MMSE) scores and demographic data were obtained by face-to-face home interviews. The data were analyzed using regression analysis for each variable. RESULTS The study group consisted of 623 (61%) females and 395 (39%) males. The mean age was 74.8 years, with 63% of subjects aged 70-74, 29% between 75-84 years old and 8% aged 85 and above. Sixteen percent (n = 163) of the total group scored 14 or higher on the GDS. Only 9% of the depressed group were on antidepressant medication. Logistic regression analysis indicated that significant predictors for higher scores GDS scores were: illiteracy, aged 75-79 yrs, female sex and having 4 or more children. CONCLUSION Depression is a common but unrecognized and thus untreated problem among the elderly population in Turkey. While gender and age are unmodifiable, education level and multiparity can be altered. Education of caregivers and medical staff about old age depression may increase its rate of detection and facilitate improved treatment.

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

Abstract  While external stimuli are given repeatedly, the level of emotional response gradually decreases. This study aims to reveal the neural substrates of such emotional habituation. Fifteen healthy male volunteers were examined using [15O]‐H2O‐PET scanning. Subjects were required to watch two film clips, a horror scene (emotional task) and a calm scene (non‐emotional task). Each film clip was repeatedly presented six times during 12 PET scans. The regional cerebral blood flow (rCBF) in the first two scans of each task was compared with that in the last two scans. On the emotional task, the right retrosplenial cortex (Brodmanns areas 30 and 23) was activated during the former scans, and the bilateral occipital cortices (BA19 and 37) were activated during the latter scans. As for the non‐emotional task, the bilateral occipital cortices (BA19 and 37) were activated during the first two scans, and the bilateral prefrontal cortices (BA10) were activated during the last two scans. The activated cerebral region by emotional experience reciprocally transferred from the paralimbic region (the retrosplenial cortex) to the neocortical region (the bilateral occipital cortices) as the experience was repeated. This finding is consistent with the theory that the process of emotional habituation is promoted by the process of conceptualization.

Controlled lithium discontinuation in bipolar patients with good response to long-term lithium prophylaxis

BACKGROUND This study aims to investigate whether the risk of recurrence following lithium discontinuation is less than reported in discontinuation of a successful, long-term prophylaxis in bipolar patients. METHODS A total of 32 bipolar patients discontinued lithium according to the controlled lithium discontinuation (CLD) protocol following a definite good response to lithium maintenance of at least 5 years. Subjects were followed for up to 9 years. RESULTS The total rate of recurrence was 7% in the first week, 32% in the first month, 62% in the first year, and 81% at the end of the 9th year following discontinuation. Only six of the 32 patients (19%) did not have a recurrence during the follow-up period. CONCLUSIONS Discontinuation of lithium seems to be followed by a high rate of recurrence in bipolar patients even after good response to a long-duration illness-free period. A controlled discontinuation protocol can reduce the risks of morbidity.

Expression of anger and alexithymia in patients with psychogenic excoriation: a preliminary report.

Objective: Psychogenic excoriation (PE), which is characterized by lesions formed by self-picking, has a significant place among the dermatoses related to psychological factors. Emotions, particularly anger that cannot be expressed, may be important in the etiology. The objective of this study was to evaluate the sociodemographic characteristics of patients with PE and with another psychodermatosis, and compare them in terms of anger, manner of anger expression, and alexithymia. Methods: Thirty-one consecutive subjects with PE and thirty-one patients with chronic urticaria were recruited from an outpatient dermatology clinic. All of the subjects completed Toronto Alexithymia Scale and Trait Anger and Anger Expression Scale. Results: PE patients had higher levels of anger (p < .01), tended not to show their anger (p < .05), and were more alexithymic (p < .05). There was also a positive correlation between anger and alexithymia scores (r = .49, p < .05). Discussion: PE, a severe and chronic psychiatric and dermatological problem, may be related to affect-regulation, particularly anger and alexithymia. Due to the fact that it has a different place among psychodermatoses, individuals with PE might benefit from learning how to regulate their affects other than by excoriation.

A late sex reassignment in 5-α reductase deficiency: Case report

The syndrome of male pseudohermaphroditism, caused by a deficiency of the enzyme 5-α reductase, results in a selective decrease in dihyrotestosterone. Culture is an important part of the context in which decisions are made on sex assignment of patients with abnormalities of the external genitalia. In Turkey, patients with ambiguious genitalia are diagnosed very late and corrective surgery is usually performed during or after puberty. Here we present a case with 5-α reductase deficiency who was diagnosed at puberty and followed-up for 10 years.