Aytül Gürsu Hariri

Dissociation in bipolar disorder: Relationships between clinical variables and childhood trauma

OBJECTIVE The dissociative experiences of patients with bipolar disorder (BD) differ from those of patients with other psychiatric disorders with regard to certain features. The primary goal of this study was to evaluate the relationship between the clinical variables of BD and childhood trauma using the factor structure, psychometric features, and potential subdimensions of the Dissociative Experience Scale (DES). METHOD This study included 200 BD patients who were in a remission period and 50 healthy volunteers. The BD patients were recruited from two psychiatry clinic departments in Turkey. The sociodemographic data of the two groups and their scores on the DES and Childhood Trauma Questionnaire (CTQ)-28 were compared. RESULTS The overall DES scores and the scores for each DES item accurately and reliably measured dissociation in the BD patients (item-total correlation r scores: >0.20, Cronbachs alpha: 0.95), and a factor analysis revealed two subdimensions of the DES for BD: identity confusion/alteration (SubDES-1) and amnesia and depersonalization/derealization (SubDES-2). Although age at onset of BD was significantly correlated with both subdimensions, illness duration was significantly correlated only with the SubDES-2. Of all the subjects, 19.5% (39/200 patients) were identified as having dissociative experiences by the DES-Taxon (DES-T), and subjects in this subscale (DES-T-positive) had significantly higher total scores on the CTQ-28 as well as higher scores on each subgroup of this scale. The highest CTQ-28 subgroup score was emotional neglect, which was followed by emotional abuse and physical neglect and then sexual abuse and physical abuse. There was a significant correlation between total scores on the CTQ-28 and SubDES-2 but none of the CTQ-28 subscale scores was significantly correlated with either SubDES-1 or SubDES-2. CONCLUSION The DES sufficiently and reliably identified the experience of dissociative symptoms on the part of BD patients, and a factor analysis revealed two subdimensions of BD on this scale. In particular, DES-T-positive subjects experienced a greater amount of childhood trauma and, as a result, had an earlier age at onset of BD. Additionally, SubDES-2, which was associated with amnesia and depersonalization/derealization, was closely related to illness duration.

Low plasma adiponectin levels in panic disorder

BACKGROUND The present study was performed to evaluate plasma adiponectin levels in the patients with PD. METHOD The study group included a total of 28 patients (17 females, 11 males) and 23 age- and sex-matched healthy comparison subjects (10 females and 13 males). The plasma fasting glucose, total cholesterol, triglyceride, low density lipoprotein (LDL), high density lipoprotein (HDL), and hemoglobin were measured. RESULTS There were no differences in regard to plasma fasting glucose, total cholesterol, triglyceride, LDL, HDL, and hemoglobin levels between groups. However, the mean adiponectin levels were significantly lower in the patient group (26.96 ± 9.92 ng/ml) compared to controls (37.63 ± 23.17 ng/ml) (t=-2.21; p=0.032). As for the ANCOVA analyses, it revealed the main effect of diagnosis on adiponectin levels (F=5.78, p=0.020) after BMI (body mass index) and gender as covariates. CONCLUSIONS Consequently, the findings of our study suggest that there may be an interaction between panic disorder and plasma adiponectin. Moreover, they led us to consider that these patients should be also followed as cardiac problems.

İki Uçlu Bozuklukta Duygudurum Düzenleyici Tedavi Modaliteleri Arasında Cinsel İşlev ve Hormonal Değişkenlerin Karşılaştırılması

INTRODUCTION The aim of this study was to determine the differences between lithium and atypical antipsychotics (quetiapine and olanzapine) with regard to their effects on sexual functions and hormonal variables and to assess the findings in term of gender differences, in patients with bipolar disorder. METHOD 28 female and 29 male patients diagnosed as having bipolar disorder type I according to the DSM-IV, using lithium or quetiapine and quetiapine+lithium or olanzapine and olanzapine+lithium were evaluated consecutively. Being in remission period and given informed consent were set as inclusion criteria in these cases. Interviews with the patients were carried out using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and SKIP-TURK. Sexual functions and satisfaction were evaluated with the Arizona Sexual Experiences Scale (ASEX) and the Golombok Rust Inventory of Sexual Satisfaction (GRISS). Blood samples of the patients were taken in order to determine prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and free testosterone (T) levels. RESULTS GRISS scores in male patients were higher than in female patients (p=.001). The number of manic, depressive and total episodes, and functionality levels were similar between the treatment groups, both in female and male patients. No differences were found between treatment modalities in terms of hormone levels both in female and male patients. Among females, ASEX scores of the patients treated with lithium monotherapy were less than the ones treated with quetiapine and olanzapine. Among patients with quetiapine monotherapy, GRISS scores in male patients were higher than in female patients. CONCLUSION There are some evidences showing gender-based differences in the side effects of atypical antipsychotic drugs. Future studies with a specific focus on this topic are needed in order to have a better understanding of the basic mechanisms of gender differences.

Hamile yatan psikiyatrik hastaların teşhis ve tedavi değerlendirmesi

1Recep Tayyip Erdogan University, Department of Psychiatry, Rize Turkey 2Sisli Hamidiye Etfal Training and Research Hospital, Department of Psychiatry, Istanbul Turkey 3Maltepe University, Department of Psychiatry, Istanbul Turkey 4Sinop State Hospital, Sinop Turkey Letter to the Editor / Editöre Mektup Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2016;29:96-98 DOI: 10.5350/DAJPN2016290112

The effect of structural and functional changes in a psychiatric state hospital on the quality of psychiatric treatment

Objective: The aim of the study is to compare the quality of inpatient psychiatric treatment services offered by the hospital before and after the hospital’s conversion. The main hypothesis of the study is that the quality of the inpatient psychiatric treatment services offered by the hospitals has improved after the conversion. Methods: This study compares the quality of inpatient psychiatric treatment services offered at Erenkoy Psychiatric State Hospital before the conversion between the years 2005-2006 (Period A) and after the conversion between the years 2007-2008 (Period B). The study is completely based upon the files of the inpatients who have been treated in both Period A and Period B (n= 185, 100 male, 85 female), which were reviewed retrospectively. Psychopharmacologic Screening Criteria, duration of hospital stay, number of stay, the duration between the last two stays, the range of diagnosis between entrance and discharge, the types of acceptance into the hospital and the details of the electroconvulsive therapy are some of the parameters used for comparison. Results: It was found that the number of hospital stays within Period A is significantly higher than the number of hospital stays in Period B. In addition the duration between the last two hospital stays was found to be significantly longer in Period B. The usage rate of typical antipsychotics was found to be decreased significantly in Period B. In contrast, the usage rate of atypical antipsychotics was found to be increased in Period B. The usage rate of anticholinergics (AC) accompanied by more than one psychotropic medication was found to be significantly higher in Period A. The ratio of off-label use of antipsychotics (AP) and antidepressants (AD) were found to be higher in the Period A. However, the ratio of off-label use of AD was found to be higher in the Period B. Lack of drug documentation was higher than the minimal acceptable level of 10% in Period A. The unacceptable dosage range of AP, AC and mood stabilizer medications was significantly higher in Period A. Discussion: It is suggested that the quality level of the inpatient psychiatric treatment offered in Period B was higher than in Period A. This can be attributed to intensive clinical workload of the doctors. Thus, the transformation of the psychiatric hospitals into training and research hospitals may contribute to the decrease in the intensive clinical workload and in return increase the quality of inpatient psychiatric treatment. Key words:

Behçet Hastalığı ve Geç Başlayan Hızlı Döngülü İki Uçlu Duygudurum Bozukluğu: Bir Olgu Sunumu

A 48-year old woman who is suffering from Behcet?s disease (BD) for 16 years was diagnosed as having bipolar affective disorder (BAD) at the age of 41. Correlative effects of her both illness have been examined when she has been treated in our hospital because of her new mixed episode. It has known that these kind of illnesses have different correlative effects about each other and therefore they might influence the patient?s quality of life adversely. In our patient, bipolar disorder which developed about 9-10 years after the first physical manifestations of BD has come in to rapidly cycling in last 2 years, the exact opposite of this situation, the BD ameliorated after beginning of bipolar disorder , practically it was in the remission. Rapidly cycling feature of her BP illness deteriorated patient?s life and comprimised her treatment. There are only a few publication in the current literature about comorbidity of Behcet?s Disease and BAD. In this case report, relationship and potential causes of this unusual situation is discussed compared to similar situations in the literature.