Bahadır Bakım

Differentiating Dissociative Disorders from Other Diagnostic Groups Through Somatoform Dissociation in Turkey

Abstract This study aimed to assess the reliability, validity, and psychometric characteristics of the Turkish version of the Somatoform Dissociation Questionnaire (SDQ-20). In this context, it investigated whether somatoform dissociation differentiates dissociative disorders from other diagnostic groups and non-clinical individuals. The Turkish Version of the SDQ-20 was administered to 50 patients with a dissociative disorder, 94 patients with psychiatric disorders other than dissociative disorder, and 175 non-clinical participants. To confirm the clinical diagnosis, all patients in the dissociative disorder group had been evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders. The internal consistency and the test-retest correlation of the SDQ-20 were excellent. The scale had strong correlations with the DES and the DIS-Q. There was a statistically significant difference between dissociative patients and other diagnostic groups on the SDQ-20 total score. The discriminative power of the SDQ-20 was as robust as that of the DES. There was no significant difference between the mean SDQ-20 total scores of Turkish and Dutch patients, but Turkish dissociative patients reported pseudoseizures more frequently than Dutch patients. The specificity of the short version of the scale (SDQ-5) was weak among Turkish patients. Dissociative disorders can be differentiated from other diagnostic groups through somatoform dissociation. The good psychometric characteristics of the SDQ-20 among Turkish participants support its cross-cultural validity.

Prevalence of adult attention deficit hyperactivity disorder in the relatives of patients with bipolar disorder

Objective. We hypothesized that relatives of bipolar patients would have increased rate of attention deficit hyperactivity disorder (ADHD) and subsyndromal manifestations compared to demographically matched relatives of healthy controls. Method. Forty consecutive patients with bipolar disorder were recruited from inpatient and outpatient units of Sisli Etfal Teaching and Research Hospital, Psychiatry Department. Seventy-three first-degree relatives of bipolar disorder group were included. A control group of first-degree relatives of individuals without DSM-IV Axis I psychopathology were also recruited. The Turkish version of the Structural Clinical Interview for DSM-IV, Wender Utah Rating Scale, Turgays Adult ADD/ADHD DSM-IV based Diagnostic and Rating Scale were administered to participants. Results. Overall rate of adult ADHD in RBD group was significantly higher than RC group (9.6 vs. 1.5%; P = 0.04). Participants with adult ADHD in the RBD group had significantly higher rate of alcohol abuse compared to those without adult ADHD (14.3 vs. 1.5%; P = 0.05). Rates of OCD and dysthimia were significantly higher in the subjects with ADHD in the RBD group than the subjects without ADHD (28.6 vs. 4.5%; P = 0.02, 14.3 vs. 1.5%; P = 0.05 respectively). Conclusion. Our findings indicate that relatives of bipolar patients have a risk for suffering from ADHD, and support the hypothesis that relatives of bipolar patients are at a risk for developing attentional and behavioral problems.

Psychiatric Comorbidity in Patients with Conversion Disorder and Prevalence of Dissociative Symptoms

The 1st objective of the current study was to investigate the frequency and types of dissociative symptoms in patients with conversion disorder (CD). The 2nd objective of the current study was to determine psychiatric comorbidity in patients with and without dissociative symptoms. A total of 54 consecutive consenting patients primarily diagnosed with CD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria who were admitted to the psychiatric emergency outpatient clinic of Sisli Etfal Research and Teaching Hospital (Istanbul, Turkey) were included in the study. The Structured Clinical Interview for DSM–IV Axis I Disorders, Structured Interview for DSM–IV Dissociative Disorders, and Dissociative Experiences Scale were administered. Study groups consisted of 20 patients with a dissociative disorder and 34 patients without a diagnosis of any dissociative disorder. A total of 37% of patients with CD had any dissociative diagnosis. The prevalence of dissociative disorders was as follows: 18.5% dissociative disorder not otherwise specified, 14.8% dissociative amnesia, and 3.7% depersonalization disorder. Significant differences were found between the study groups with respect to comorbidity of bipolar disorder, past hypomania, and current and past posttraumatic stress disorder (ps = .001, .028, .015, and .028, respectively). Overall comorbidity of bipolar disorder was 27.8%. Psychiatric comorbidity was higher and age at onset was earlier among dissociative patients compared to patients without dissociative symptoms. The increased psychiatric comorbidity and early onset of conversion disorder found in patients with dissociative symptoms suggest that these patients may have had a more severe form of conversion disorder.

The quality of life and psychiatric morbidity in patients operated for Arnold–Chiari malformation type I

Abstract Background. There are some case reports that highlight the association of Arnold–Chiari malformation (ACM) with psychiatric symptoms. We assessed the association between ACM and psychiatric symptoms and risk factors in terms of psychiatric morbidity and evaluated the quality of life after surgery. Methods. This study consisted of sixteen patients who underwent decompression operation at the Department of Neurosurgery of Sisli Etfal Hospital. The MINI plus, Short-Form McGill Pain Questionnaire and WHOQOL-BREF-TR were administered to patients. Results. About 43.8% of the patients had a psychiatric disorder. About 50% of the patients had co-existing syringomyelia of which 50% with syringomyelia had a psychiatric disorder. Patients with syringomyelia without any psychiatric disorder had significantly lower scores on physical domain of WHOQOL-BREF-TR (p = 0.02) than the patients without syringomyelia and psychiatric disorder. Subjects with a psychiatric disorder had lower scores on four domains of WHOQOL-BREF-TR. The patients with psychiatric diagnoses had significantly higher scores on affective pain index (p = 0.021) and total pain index (p = 0.037) than the patients without any psychiatric disorder. Conclusion. The presence of a psychiatric condition influences not only the physical aspect but also deteriorates the psychological and social relations and environmental aspect. Moreover the presence of a psychiatric disorder increases the perception of pain and causes more discomfort.

Yatarak tedavi gören bipolar bozukluk hastalarında dissosiyatif bozukluk eştanısı olan ve olmayan hasta gruplarının karşılaştırılması

Giris: Bu calismada dissosiyatif bozukluk (DB) estanisi olan ve olmayan bipolar bozukluk (BB) hastalarinin sosyodemografik karakteristiklerinin karsilastirilmasi ve estani varliginin tedaviye etkisinin degerlendirilmesi amaclanmistir. Yontem: BB tanisi ile Şisli Etfal Hastanesi Psikiyatri Klinigi’nde 2010-2011 yillari arasinda yatisi yapilan ardisik 149 hasta calismaya alinmistir. Hastalara SCID-D uygulanarak DB tanisi, SCID-I ile BB tanisi konmus, sosyodemografik karakteristikleri, YMDO, HAM-D, KPDO, DYO puanlari ve hastanede yatis sure ve sayilari incelenmistir. Bulgular: 23 hastada (%15,4) baska turlu adlandirilamayan dissosiyatif bozukluk, 4 hastada (% 2,6) dissosiyatif kimlik bozuklugu, 1 hastada (%0,6) dissosiyatif amnezi tespit edildi. DB estanisi olan BB hastalarinin daha genc ve daha fazla oranda kadin oldugu belirlendi (sirasiyla p=0,002, p=0,015). DB estanili BB hastalarinin DYO toplam puaninin BB hastalarin daha yuksek oldugu tespit edildi (p<0,001). Tum orneklemde DYO toplam puani ile hastanede kalis suresi arasinda korelasyon bulunmustur (p=0,001, Spearman r=0.336). Basvuru sirasinda toplam HDO puani estanili grupta anlamli olarak daha yuksek (p=0,027), intihar maddesi hem basvuru hem taburculukta anlamli olarak yuksek bulunmustur (p<0,001 ve p=0,035). Basvuru esnasinda KPDO puanlarindan, halusinatuar davranis maddesi estanili grupta yuksek bulunmustur (p=0,019). YMDO puanlarindan konusma hiz ve miktari hem basvuru hem taburculukta (sirasiyla p=0,027, p=0,006), icgoru maddesi ise basvuru esnasinda estaninin olmadigi bipolar hasta grubunda yuksek bulunmustur (p=0,018). Sonuc: BB hastalarinda DB estanisi sorgulanmalidir. DB estanili hastalarin daha cok kadin cinsiyette ve daha genc yasta oldugu, daha fazla depresyon puanlarina sahip oldugu; daha uzun sureli hastanede kalis suresine sahip oldugu bulunmustur. Dissosiyasyon estanisi varliginda, intihar girisim sayisi ve halusinatuar davranislarda artis gorulebilir.

Effects of Parental Attitudes Among a Group of High School Students in İstanbul

INTRODUCTION Current study aimed to investigate the possible relations between parental attitudes and depression in a sample of mid-pubertal, high-school students under the light of several sociodemographic variables. METHODS With the permission of Ministry of National Education, a total of 391 students from second and third grades in a state high school and occupational high school in Sisli area included in the study. Sociodemographic Questionnaire, The Parental Bonding Instrument (PBI), and Beck Depression Inventory (BDI) were administered. RESULTS Among the students in the sample, 25.6% (n=100) had significantly higher depression scores and girls had significanltly higher mean BDI scores than boys (p=0.001) reflecting the presence of depression. Adolescents with depression also had higher scores of maternal protection than adolescents without depression (p=0.02). On the other hand, adolescents with depression had lower scores of both maternal and paternal interest than adolescents without depression (p=0.02 and p=0.03, respectively). We also found that boys had higher levels of nicotine - alcohol and substance abuse where girls had higher levels for suicidal attempts and self harming behaviors (p<0.05). CONCLUSION Depression onset was found to be associated with parental attitude which does not promote autonomy and independency. Warm, accepting and concerned parental attitude that promotes secure attachment was found to be protective against depression. Parental attitudes must be of concern when working with adolescents and dealing with the problems seen in this vulnerable phase of the life.

Çanakkale ilinde son 1 yılda hekime yönelik saldırıların değerlendirilmesi

Evaluation of assaults on doctors in Canakkale within the last year Objective: Violence against doctors and health professionals in the healthcare environment is thought to have increased in recent years. Although physical and verbal assaults in the health care system have been evaluated in many different aspects, a limited amount of research has been done in this field in our country. For this reason, we aimed to investigate assaults towards doctors working at the Canakkale State Hospital and Canakkale Onsekiz Mart University in Turkey. Method: A questionnaire was prepared by researchers assessing assaults within the last year on doctors working in the state and university hospitals. Data from 130 doctors who agreed to participation in the study were analysed with SPSS version 16. Descriptive statistics, independent sample T-test for normally distributed variables and Mann-Whitney U test for non-normally distributed variables were used to compare the groups. Results: We found that 59.2% (n=77) of the doctors were verbally and/or physically assaulted at least once during the past year. The majority of attackers consisted of relatives of patients (40.8% verbal attack, n=31). The verbal assaults mostly occurred in outpatient clinics (61.5%), with half of the physical assaults occurring in the emergency department. The vast majority of doctors considered that poor health policies were the most important reason for assaults (83.3%, n=65), and nearly all of them thought that violence towards doctors has increased in recent years (97.4%). Conclusion: The fact that most of the doctors exposed to assaults, regardless of gender, institution, or work position, perceived health policies as being responsible for this violent atmosphere, is very striking. We believe that larger sample-size and comprehensive countrywide studies in this area would help to provide solutions for this problem.

Can obsessive compulsive disorder be detected in adolescent population with three-point scanning?

Obsesif Kompulsif Bozukluk (OKB) ergen toplulugunda yaygin olarak gorulmektedir. OKBsi olan ergenler genellikle islevselligi onemli olcude bozuldugunda tibbi yardim aramaktadir. Bu sebeple ergen toplulugunda OKB taranmasi onemlilik arz etmektedir. Bu calismada kolay, hizli ve ozbildirime dayali uygulanabilen uc maddelik taramanin duyarlilik, ozgulluk ve tahmin edebilme guclerini degerlendirmeyi amacladik. Bu calismanin alan orneklemini 14-17 yaslari arasindaki toplam 177 lise birinci sinif ogrencisi olusturmaktadir. DSM-IV Eksen I Bozukluklari Icin Yapilandirilmis Klinik Gorusme Arastirma Formu OKB modulu sonuclari ile ozbildirime dayali Cocuk Ergen Davranislarini Degerlendirme Olceginden gelistirilen uc maddelik Obsesif Kompulsif Olceginin (CEDDO-OKO) tahmini sonuclari karsilastirilmistir. OKB sikligi (simdiki) yapilandirilmis gorusmeye gore %2.8 olarak saptanmistir. Obsesif Kompulsif Olcegi taramasina gore olasi OKB %46 olarak saptanmistir. Uc maddelik CEDDO-OKO olceginin duyarliligi %60, ozgullugu %54, pozitif prediktif degeri %4 ve negatif prediktif degeri %97 olarak bulunmustur. Sonuc olarak; uc soruluk tarama ile OKB saptama yonteminin duyarliligi ve ozgullugu orta duzeydedir. OKB olmayan ergenleri ayirmasi iyi duzeydedir. Buna karsin pozitif tahmin etme gucunun dusuklugu sebebiyle bu yontemin yeniden gelistirilmesi gereklidir.

Low frequency (1 Hz) rTMS application in the treatment of resistant auditory hallucinations: a case presentation

Low frequency (1 Hz) rTMS application in the treatment of resistant auditory hallucinations: a case presentation Auditory hallucinations are clinically important symptoms which are seen in psychotic disorders. They are associated with low social functionality, increased tendency of violence and suicidality. Some of these cases can just partially respond to medical treatment. Recently, there have been a marked increase in the studies showing an effectiveness of repetitive transcranial magnetic stimulation (rTMS) use in the treatment of auditory hallucinations. In this case presentation, the effect of low frequency rTMS use on resistant auditory hallucinations will be discussed.

OLFACTORY REFERENCE SYNDROME: A CASE REPORT -

Olfactory reference syndrome has been defined as a psychiatric condition characterized by persistent preoccupation about body odor accompanied by shame, self-reproach, avoidance behavior and social isolation. Patients with olfactory reference syndrome are preoccupied with their body odor and they feel themselves responsible for the smell. In DSM-IV, delusions about personal odor are described as an example of the somatic subtypes of delusional disorder.In this article; we present a case of 19 year old male whose delusion of emitting a foul body odor has caused significant depressive symptoms, avoidance behaviors and social isolation.