Duru Gündoğar

The relation between affective temperament and resilience in depression: A controlled study

BACKGROUND The aim of this study was to investigate the presence of a relationship between affective temperament and resilience in patients with major depressive disorder (MDD) diagnosis, and to examine whether this relationship, if present, differs from healthy individuals. METHODS In line with this purpose, 100 cases with major depressive disorder diagnosis who were in their remission period were evaluated consecutively in their regular outpatient control interviews. The control group consisted of 100 healthy individuals without any history of psychiatric admission and treatment, matched with the depressive group in terms of age and sex. Diagnostic interviews were conducted with SCID-I, affective temperament and resilience were evaluated with TEMPS-A (Evaluation of Temperament Memphis, Pisa, Paris and San Diego-Auto questionnaire) and The Resilience Scale for Adults (RSA)-Turkish version, respectively. RESULTS We observed a strong relationship between resilience and hyperthymic temperament both in depressive and healthy individuals. There was an inverse relation between psychological resilience and irritable and anxious temperament in both groups. A negative correlation was observed between irritable temperament and family cohesion in depressive disorder group, while in healthy individuals a strong correlation was observed between family cohesion and depressive and anxious temperament, and a weak correlation between family cohesion and hyperthymic temperament. LIMITATIONS The measurements of temperament and resilience were estimated depending on the patients statement. CONCLUSION There is a strong relationship between hyperthymic temperament and psychological resilience in MDD. The relationship between the type of affective temperament and the family cohesion sub-dimension of psychological resilience differs from that of healthy individuals.

Is pica in the spectrum of obsessive-compulsive disorders?

In Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), pica is defined as the persistent eating of nonnutritive substances for at least one month [1]. Although the compulsive nature of this behavior is commented upon frequently in the literature [2,3], there is no single theory accepted universally to explain the phenomenon of pica [4]. The role of the most widely recognized factor, i.e., iron deficiency, is also controversial [2]. On the other hand, the developments in the knowledge of neurobiological factors in obsessive-compulsive disorder (OCD) has led to increased attention to a range of disorders including Tourette’s syndrome [5], kleptomania, and trichotillomania [6] within the notion of an obsessive-compulsive spectrum of disorders. Many disorders within the spectrum respond to selective serotonin re-uptake inhibitors (SSRI), as does OCD [7,8]. However, despite the presence of a compulsive behavior in pica, the link between OCD and pica is not studied much [2]. We report 3 cases of pica that responded to SSRI’s and discussed the possibility of the phenomenon to be involved in the obsessive-compulsive spectrum.

Compulsive buying in bipolar disorder: Is it a comorbidity or a complication?

BACKGROUND The objective of this study was to investigate the frequency of compulsive buying in bipolar disorder (BD), to compare it with healthy controls, and to search if there is a difference between bipolar cases with and without compulsive buying in terms of sociodemographic qualities, temperament, clinical characteristics and comorbid diagnoses. METHODS One-hundred outpatient cases diagnosed as BD according to DSM-IV were evaluated consecutively. Following the diagnosis interview (SCID-I and II) the subjects completed the mood disorders registry form, Compulsive Buying Scale and TEMPS-A. RESULTS Compulsive buying scores were higher in bipolar patients than healthy controls (p<0.001). Cases with compulsive buying revealed higher cyclothymic and irritable temperament scores than other bipolar patients (p=0.029 vs 0.045). Premenstrual syndrome and postpartum onset were more frequent, while psychotic symptoms were less in compulsive buyer bipolar patients (p=0.002, 0.009 vs 0.034). Severity of episode was lower (p=0.01), number of episodes was higher (p=0.009). Acute onset and remission before and after maintenance treatment were more frequent in patients with compulsive buying (p=0.011 and p=0.011). Full remission between episodes was 100%. Cases with axis-1 and axis-2 comorbidities demonstrated higher compulsive buying scores (p=0.025 and 0.005). LIMITATIONS Treatment regimen differences between patients are a limitation of the study. CONCLUSIONS This is the first study to relate compulsive buying with the clinical characteristics of BD. Our results reveal that compulsive buying in BD occurs together with mood episodes which are not very severe, but frequent and with abrupt onset.

Impact of childhood trauma and affective temperament on resilience in bipolar disorder

BackgroundThe aim of this study was to investigate whether childhood trauma (CT) and affective temperament have an impact on resilience in bipolar patients.MethodsOne hundred cases with bipolar disorder (BD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) were evaluated consecutively in their euthymic period during outpatient follow-up interviews. Diagnostic interviews were done with SCID-I, affective temperament was evaluated with the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, and resilience was evaluated with the Resilience Scale for Adults (RSA). The presence of CT was determined and measured with the Childhood Trauma Questionnaire (CTQ).ResultsAmong the bipolar patients, it was found that 35 cases (35%) were CT+. Depressive, cyclothymic, and anxious temperament scores were higher in CT+ cases. However, resilience scores were higher in CT− cases. In bipolar patients with and without childhood trauma, the relationship between temperament and resilience appears to be different. A negative relation between sexual abuse, emotional abuse, emotional neglect, and anxious temperament scores and resilience scores was shown in regression analysis.ConclusionsCT and affective temperament both have an impact on resilience in bipolar patients.

Prevalence and related risk factors of tobacco, alcohol and illicit substance use among university students

Background and Objectives: The objective of this study was to determine the frequency of cigarette, alcohol and substance use and the possible associations between different types of substance use and various risk factors among university students. Methods: A self-assessment questionnaire was administered to 4762 students from Canakkale Onsekiz Mart University. The risk factors associated with cigarette, alcohol and substance use were investigated with logistic regression analysis. Results: The frequencies of regular or occasional tobacco and alcohol use were 38.6% and 46.3% respectively. The frequency of using substance at least once in life time was 6.3% among students. In the present study, male gender was found to be a statistically significant risk factor associated with all of the three dependent variables. The statistically significant risk factors for using alcohol were studying in college and vocational schools, having a parent with high school and above educational level, having a family income of 1226 USD�s and above, having tried tobacco once or a couple of times and using tobacco occasionally or regularly, and having used another substance at least once. Substance use risk was found to be higher in those with higher depression scores, in those who tried tobacco once or a couple of times and who were not using regularly, and who were using tobacco or alcohol occasionally or regularly. Conclusions: The practices and activities of the health center incorporated in the university should be enhanced for the establishment of effective control programs related to tobacco, regular alcohol and substance use.

Is the relationship between affective temperament and resilience different in depression cases with and without childhood trauma

OBJECTIVE The aim of this study was to investigate if the relationship between affective temperament and resilience in major depression is different in cases with and without childhood trauma. METHODS For this purpose 100 cases with major depressive disorder (MDD) diagnosis according to DSM-IV were evaluated consecutively in their regular outpatient clinic follow-up interviews. Diagnostic interviews were done with SCID-I, affective temperament was evaluated with TEMPS-A (Evaluation of Temperament Memphis, Pisa, Paris and SanDiego-Autoquestionnaire) Temperament Questionnaire, resilience was evaluated with The Resilience Scale for Adults (RSA)-Turkish version. The presence of childhood trauma (CT) was determined by Early Trauma Inventory. RESULTS In MDD cases without CT a correlation was present between psychological resilience and hyperthymic temperament, while there was a correlation between psychological resilience and depressive temperament in cases with CT. The relationship between depressive temperament and psychological resilience in cases with CT was observed in the perception of self, family cohesion, and social resources dimensions of psychological resilience. CONCLUSION In depression cases with and without childhood trauma, the relationship between temperament and resilience appears to be different. According to our results psychological resilience was associated with hyperthymic temperament in depressive cases without childhood trauma, while it was associated with depressive temperament in depressive cases with childhood trauma.

Autoerythrocyte sensitization syndrome associated with grief complications

The clinical presentation of a patient with autoerythrocyte sensitization syndrome associated with a complicated grief reaction is reported. A 50‐year‐old female patient presented with recurrent episodes of painful ecchymotic bruising on the lower extremities which started in 1995 after the sudden death of her son and exacerbated almost every year at approximately the same time her son died as an anniversary reaction. No pathological findings were detected in the laboratory examinations. The diagnosis was confirmed by induction of similar lesions by i.d. injection of the patients own washed erythrocytes and whole blood. Psychiatric assessment revealed that the patient was depressed, socially introverted, overly defensive and avoidant in interpersonal relationships. Antidepressant treatment and psychotherapy for major depression and grief complications were started with the patient. Having an awareness of this rare condition will assist in the prevention of unnecessary investigations in such cases and will allow early referral for appropriate psychological counseling.

How should we inform patients about antidepressants? A study comparing verbal and written information

Objective. To compare the efficacy of verbal, written and, combined verbal and written information about selective serotonin reuptake inhibitors in patients with depression. Method. Patients with a diagnosis of major depression who were prescribed selective serotonin reuptake inhibitors (n=104) were randomly allocated to verbal (n=34, 18F 16M), written (n=38, 19F 19 M) and verbal and written information (n=32, 18F 14M) groups, the content of the verbal and written information being exactly the same. Beck depression inventory was used to evaluate the depressive symptoms. Patients were called back after 10–14 days and their retention of the knowledge was measured. Results. The total retention scores of the verbal group, written group and the combined written and verbal group were 12.85±2.19, 7.39±2.85, and 13.19±2.12, respectively. The total scores of the verbal and the combined verbal and written information groups were significantly higher than those of the written group. The information scores had a significant positive correlation with education level. Conclusion. The retention of verbal information given to patients with low levels of depression concerning the effects and side effects of serotonin reuptake inhibitors is higher than written information. Further studies with more severely depressed patients, comparing the basal information level and the information level after the intervention and the effect of information on compliance are needed.