Başak Yücel

The Efficacy and Safety of Venlafaxine in the Prophylaxis of Migraine

Objective.—To evaluate the efficacy and safety of venlafaxine in the prophylaxis of migraine.

The effect of venlafaxine on ongoing and experimentally induced pain in neuropathic pain patients: a double blind, placebo controlled study

Background and aim The aim of this randomized double blind placebo controlled study was to investigate the effectiveness and the safety of venlafaxine XR 75 and 150 mg on ongoing pain and on quantitative sensory tests in 60 patients with neuropathic pain for 8 weeks.

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.

Assessment of myocardial damage by cardiac MRI in patients with anorexia nervosa

OBJECTIVE Cardiac damage is a major complication of anorexia nervosa (AN). The present study evaluated the prevalence of myocardial damage in patients with AN by cardiac magnetic resonance imaging (CMR). METHOD This study was cross-sectional and observational. Forty consecutive female patients with a diagnosis of AN and 28 healthy female subjects were evaluated from January 2007 to 2011 at the Department of Psychiatry (University of Istanbul, Istanbul, Turkey). Following enrollment in the study, participants underwent a cardiac evaluation, a physical examination, a standard electrocardiogram (ECG), an echocardiography and a CMR. RESULTS Body weight, body mass index and heart rate values were lower in patients with AN than in the control group. When compared with control groups, patients with AN showed reduced left ventricular mass with normal systolic function. Compared to control subjects, patients with AN had higher prevalence of pericardial effusion (30% in the AN group, 4% in the control group, p = .005) and mitral valve prolapses (23% in the AN group, 4% in the control group, p = .03). Myocardial fibrosis (detected as late gadolinium enhancement on CMR) was found in 23% of patients with AN. Myocardial fibrosis was not detected in any control subject (p = .007). CONCLUSION A strong association was found between myocardial fibrosis and AN. Cardiac damage of myocardial fibrosis in asymptomatic patients with AN can be found by CMR examination.

The Turkish version of the eating disorder examination questionnaire: reliability and validity in adolescents.

The Eating Disorder Examination Questionnaire (EDE-Q) is the self-report questionnaire version of the Eating Disorder Examination Interview. The aim of the current study was to validate a Turkish version of the EDE-Q in a sample of Turkish primary and high school students (626 girls and 299 boys) in Istanbul. Subjects also completed the Eating Attitudes Test, the General Health Questionnaire and the Body Image Satisfaction Questionnaire, and they were weighed. Girls had higher scores on all EDE-Q subtests. EDE-Q scores increased as body mass ındex increased. EDE-Q total score and subscales were highly correlated with the Eating Attitudes Test and the Body Image Satisfaction Questionnaire, supporting its validity. A small test-retest reliability study provided satisfactory results. The present study suggests that the Turkish version of EDE-Q is an acceptable, reliable and valid measure in nonclinical adolescent samples. More psychometric studies are needed concerning wider age ranges and various clinical samples.

Honeymoon impotence: psychogenic or organic in origin?

OBJECTIVES Honeymoon impotence is the inability to perform successful sexual intercourse during the initial experience, especially during the first nights of marriage, and it is relatively frequent in Turkey. We investigated the underlying penile vascular abnormalities in patients presenting with honeymoon impotence and sought to differentiate between psychogenic and organic etiologies. METHODS Between 1989 and 1999, 90 patients sought urologic help for honeymoon impotence. Patient age ranged from 18 to 39 years (mean 28.06 +/- 3.4). All patients were given an intracavernous injection of 60 mg papaverine combined with self-manual genital stimulation (CIS test) to assess the degree of tumescence. Patients with a positive response to the CIS test were later evaluated with nocturnal penile tumescence (NPT) monitoring. Patients with a negative response to the CIS test and/or NPT monitoring were evaluated further using penile color Doppler ultrasound. RESULTS A psychogenic etiology was found in 61 patients (67.7%), 50 (55.5%) of whom achieved satisfactory sexual intercourse after intracavernous injection. Twenty-five patients (27.7%) exhibited penile vascular abnormalities by color Doppler ultrasound. Neurogenic erectile dysfunction was considered in the remaining 4 patients (4.4%) with a positive response to the CIS test, abnormal findings on NPT monitoring, and a normal vascular system with color Doppler ultrasound. CONCLUSIONS The present study is the first to report penile vascular abnormalities in patients presenting with honeymoon impotence, which was previously believed to be exclusively psychogenic in origin. The evaluation of the penile vascular system in patients with honeymoon impotence may reveal underlying penile vascular abnormalities, allowing the choice of the appropriate therapeutic option.

Childhood traumatic events and dissociative experiences in patients with chronic headache and low back pain

ObjectiveThe aim of this study was to examine childhood traumatic experiences and dissociative characteristics in women with chronic headache and low back pain. SettingThe patients were evaluated in the multidisciplinary pain clinic of a university hospital. SubjectsThis study included 73 patients: 41 with chronic headache and 32 with chronic low back pain. Outcome MeasuresAll the patients were assessed with use of a semistructured questionnaire, the Dissociative Experiences Scale (DES), the Somatoform Dissociation Questionnaire (SDQ), and the Childhood Abuse and Neglect Questionnaire. Results and ConclusionsThere were no significant differences between the headache and low back pain groups in terms of prevalence of history of neglect; abuse; or sexual, physical, and emotional abuse separately. In addition, no significant differences were found between the groups with respect to the Dissociative Experiences Scale scores. However, analysis of the SDQ scores showed that the neglect rate in the two groups differed significantly. According to our findings, the neglect rate was higher in the headache group, thus warranting further research to investigate the sensitivity of the SDQ for neglect.

A rare case of self-mutilation: self-enucleation of both eyes

Self-enucleation is a very rare self-mutilative behavior deserving attention because of the severity of its results. Self-injurious behavior has been reported to occur in mentally retarded patients, psychotic patients, individuals with personality disorders (primarily borderline personality disorder), malingering, factitious disorder, and in prison populations [l]. Ocular self-mutilation may be associated with chronic schizophrenia, organic disorders such as epilepsy, encephalitis, or LSDinduced psychosis. Other cases of self-inflicted ocular injuries have been associated with major affective disorders, obsessive-compulsive neuroses, and posttraumatic stress disorder (PTSD) [2,3]. In this paper we discuss a psychiatric patient who has been hospitalized in the ophthalmology clinic because of self-enucleation of both of his eyes. This Moslem patient is the first case reported in our country who performed self-enucleation of both eyes with his fingers; his expressed motivation was to not see evil, thereby redeeming sinfulness through his sacrifice and rescuing the people. These statements are very similar to those made in previously reported cases, almost all of whom were Christian.

Correlation of binge eating disorder with level of depression and glycemic control in type 2 diabetes mellitus patients

OBJECTIVE It is reported that eating disorders and depression are more common in patients with type 2 diabetes mellitus (T2DM). In this study, we aimed to determine the prevalence of binge eating disorder (BED) in T2DM patients and examine the correlation of BED with level of depression and glycemic control. METHOD One hundred fifty-two T2DM patients aged between 18 and 75 years (81 females, 71 males) were evaluated via a Structured Clinical Interview for DSM-IV Axis I Disorder, Clinical Version in terms of eating disorders. Disordered eating attitudes were determined using the Eating Attitudes Test (EAT) and level of depression was determined using the Beck Depression Scale. Patients who have BED and patients who do not were compared in terms of age, gender, body mass index, glycosylated hemoglobin (HbA1c) levels, depression and EAT scores. RESULTS Eight of the patients included in the study (5.26%) were diagnosed with BED. In patients diagnosed with BED, depression and EAT scores were significantly high (P<.05). A positive correlation was found between EAT scores and depression scores (r = +0.196, P<.05). No significant difference was found in HbA1c levels between patients with BED and those without (P<.05). CONCLUSIONS T2DM patients should be examined in terms of the presence of BED and disordered eating attitudes. Psychiatric treatments should be organized for patients diagnosed with BED by taking into consideration comorbid depression.

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.