Halis Ulas

The epidemiology of major depressive disorder and subthreshold depression in Izmir, Turkey: Prevalence, socioeconomic differences, impairment and help-seeking.

BACKGROUND Subclinical and clinical depression is common, widely distributed in the general population, and usually associated with role impairment and help-seeking. Reliable information at the population level is needed to estimate the disease burden of depression and associated care needs in Turkey. METHOD The cross-sectional study aimed to assess the prevalence of subthreshold (SubD) and clinical major depressive disorder (MDD) in Izmir, Turkey. In the 5242 eligible households, a total of 4011 individuals were successfully interviewed, yielding a response rate of 76.5%. Prevalence estimates of MDD and SubD depression were formed by using the responses to the questions of the CIDI section E. Short Form 36 (SF-36) to assess health status and functional impairments in eight scaled scores during the last four weeks. All respondents were questioned about receiving 12-month treatment for any psychological complaints, the route of help-seeking, as well as prescribed medicines and any hospitalization. RESULTS The one year prevalence estimate for CIDI/DSM IV MDD was 8.2% (95% CI, 7.4-9.1). Less educated, low income, uninsured, low SES, unemployed/disabled and housewives, slum area residents had higher one year MDD prevalence. Determined prevalence of help seeking from mental health services of SubD and MDD cases were 23.6%, 30.6% respectively. Only 24.8% of clinically depressive patients received minimally adequate treatment. LIMITATIONS Cross sectional design. CONCLUSION Higher MDD prevalence correlates with younger ages, female gender, unemployment, less education, lower monthly income, lower SES and uninsurance. Help seeking from mental health services were low. There are treatment gap and impairment in depressive group.

Panic symptoms in schizophrenia: Comorbidity and clinical correlates

Abstract  The aim of the present study was to investigate the prevalence of panic attack (PA) and panic disorder (PD) in patients with schizophrenia and detect the clinical features. Forty‐nine patients with schizophrenia were included in the study. Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI), Extrapyramidal Symptom Rating Scale (ESRS) and Bandelow Panic and Agoraphobia Rating Scale were administered. Fifteen patients were found to have PA and seven patients had PD. Patients with panic symptoms had higher scores of PANSS, HDRS, CGI and ESRS. Comorbid panic symptoms in schizophrenia may be related to positive symptoms, extrapyramidal side‐effects and depression.

Impact of panic attacks on quality of life among patients with schizophrenia.

OBJECTIVE Schizophrenia patients had decreased levels of quality of life compared to normal population. The aim of this study was to investigate the impact of panic attacks on quality of life in patients with schizophrenia. METHODS Eighty-eight patients with schizophrenia and 85 healthy subjects were included in the study. World Health Organization Quality of Life Instrument-Short Form (WHOQOL-Bref) was given to patients and healthy subjects to assess quality of life. Panic module of Structured Clinical Interview for DSM-IV (SCID) was administered to patients for diagnosis of panic attacks and panic disorder. Positive and Negative Syndrome Scale (PANSS) for symptom severity and Calgary Depression Scale (CDS) for depressive symptoms were administered to the patients. RESULTS Patients with schizophrenia demonstrated significantly lower scores compared to healthy controls in all domains of WHOQOL-Bref. Twenty-five patients (28.4%) with schizophrenia had panic attacks (PA) and 10 patients (11.4%) met criteria for panic disorder (PD). Schizophrenia patients with PA had significantly lower scores on psychological domain of WHOQOL-Bref compared to the patients without PA. Schizophrenic patients with panic attacks had higher CDS scores than patients without PA. In the multivariate regression analyses the variance in psychological domain of WHOQOL-Bref was explained by depression rather than panic attack. CONCLUSION In patients with schizophrenia comorbid panic attacks may have a negative impact on quality of life, which is associated with depression significantly. Panic attacks and depressive symptomatology must be examined comprehensively in order to improve quality of life in patients with schizophrenia.

Formal thought disorder in schizophrenia and bipolar disorder: A systematic review and meta-analysis

Historically, formal thought disorder has been considered as one of the distinctive symptoms of schizophrenia. However, research in last few decades suggested that there is a considerable clinical and neurobiological overlap between schizophrenia and bipolar disorder (BP). We conducted a meta-analysis of studies comparing positive (PTD) and negative formal thought disorder (NTD) in schizophrenia and BP. We included 19 studies comparing 715 schizophrenia and 474 BP patients. In the acute inpatient samples, there was no significant difference in the severity of PTD (d=-0.07, CI=-0.22-0.09) between schizophrenia and BP. In stable patients, schizophrenia was associated with increased PTD compared to BP (d=1.02, CI=0.35-1.70). NTD was significantly more severe (d=0.80, CI=0.52-0.1.08) in schizophrenia compared to BP. Our findings suggest that PTD is a shared feature of both schizophrenia and BP but persistent PTD or NTD can distinguish subgroups of schizophrenia from BP and schizophrenia patients with better clinical outcomes.

Formal thought disorder in first-episode psychosis.

Formal thought disorder (FTD) is one of the fundamental symptom clusters of schizophrenia and it was found to be the strongest predictor determining conversion from first-episode acute transient psychotic disorder to schizophrenia. Our goal in the present study was to compare a first-episode psychosis (FEP) sample to a healthy control group in relation to subtypes of FTD. Fifty six patients aged between 15 and 45years with FEP and forty five control subjects were included in the study. All the patients were under medication for less than six weeks or drug-naive. FTD was assessed using the Thought and Language Index (TLI), which is composed of impoverishment of thought and disorganization of thought subscales. FEP patients showed significantly higher scores on the items of poverty of speech, weakening of goal, perseveration, looseness, peculiar word use, peculiar sentence construction and peculiar logic compared to controls. Poverty of speech, perseveration and peculiar word use were the significant factors differentiating FEP patients from controls when controlling for years of education, family history of psychosis and drug abuse.

Electroconvulsive therapy in an adolescent pregnant patient

Electroconvulsive therapy (ECT) has been increasingly used in both children and adolescents and case reports demonstrated its efficacy with minimal negative consequences (Rey andWalter, 1997). ECT may be considered in adolescents with severe mood disorders, high suicide risk and when other somatic treatment modalities are presumed risky (i.e. during pregnancy) as parallel to ECT indications in adults (Taieb and Cohen, 2000; American Academy of Child and Adolescent Psychiatry, 2004). Adolescents are not believed to be at additional risk from ECT (American Academy of Child and Adolescent Psychiatry, 2004). In a study on the long term effects of ECT on cognitive functions in adolescents, no measurable anterograd memory deficit was found 3.5 years after the ECT treatment. Also no differerence was found on the MMSE scores, attention section of the Weschler Memory Scale—Revised scores and the California Verbal Learning Test scores between the ECT and the comparison group (Cohen and Taieb, 2000). ECT treatment did not affect school and social functioning of adolescents (Taieb et al., 2002). ECT is an effective treatment method throughout the pregnancy and during the postpartum period with a low level of risk (Rabheru, 2001; American Psychiatric Association, 2006). In ECT during pregnancy both the babys and the mothers health should be considered. Here, we report an adolescent pregnant patient who was treated safely with ECT for major depression with psychotic features.

Relation of formal thought disorder to symptomatic remission and social functioning in schizophrenia

OBJECTIVE The aim of this cross-sectional study is to examine the relation of formal thought disorder (FTD) with symptomatic remission (SR) and social functioning in patients with schizophrenia. METHOD The study was carried out with a sample consisting of 117 patients diagnosed with schizophrenia according to DSM-IV. The patients were assessed with the Positive and Negative Syndrome Scale (PANSS), the Thought and Language Index (TLI), and the Personal and Social Performance Scale (PSP). We used logistic regression in order to determine the relation between FTD and SR and linear regression to identify the strength of association between FTD and social functioning. RESULTS Logistic regression analysis revealed that poverty of speech (odds ratio: 1.47, p<0.01) and peculiar logic (odds ratio: 1.66, p=0.01) differentiated the remitted patients from the non-remitted ones. Linear regression analysis showed that the PSP total score was associated with poverty of speech and peculiar logic items of the TLI (B=-0.23, p<0.01, B=-0.24, p=0.01, respectively). CONCLUSION Our findings suggest that poverty of speech and peculiar logic are the specific domains of FTD which are related to both SR status and social functioning in patients with schizophrenia.

Manic Episodes Associated With Tramadol A Case Report

insomnia. There are anecdotal reports of efficacy of topiramate, but our patient took topiramate for months without any benefit. Sertraline is to date the only selective serotonin reuptake inhibitor successfully used in the treatment of NES: 3 clinical trials report a decrease in evening hyperphagia, mean body weight, and frequency of awakenings. Because central modulation of serotonin seems to be promising, trazodone may represent an effectual alternative. Trials demonstrate similar results to those obtained with tricyclics and selective serotonin reuptake inhibitors in patients with bulimia nervosa and atypical eating disorders. It also increases slow-wave sleep when given as a monotherapy and this can be helpful in restoring circadian rhythm. The woman’s night eating symptoms improved after 2 weeks of treatment and the NEQ score dropped by 29 points (70.7%) at 6-month follow-up with Nocturnal Ingestion scale achieving remission. At the same time, her body mass index decreased by 3 points, approximately 10% of her body weight. These results overlap with that obtained with sertraline in term of remission in night eating symptoms, weight loss, and speed of response. The patient has also been monitored for a longer time than the other studies available on literature and positive results have been stable for 10 months after remission. The antidepressive dose of trazodone (>150 mg/d) seems to be the most suitable, although results seem dose-independent. Trazodone was also well tolerated: the patient did not report any adverse effect, except for daytime sleepiness that could have been avoided through a slower titration. Lastly, we recommended psychotherapy, as well as for other eating and feeding disorders, to consolidate the results achieved and support the patients in remission. Limitation of this case is the relevant depressive symptoms, as assessed with the HRSD-29 (score > 20), which does not allow to deduce in a definitive way that change in depressive symptoms was not the principal driver of changes in night eating symptoms. However, MinnesotaMultiphasic Personality Inventory-2 profile assesses for a depressive temperament and not for a full-blown depression. These observations are promising but further investigations are needed.

Rationale, Component Description and Pilot Evaluation of a Physical Health Promotion Measure for People with Mental Disorders across

Introduction: The HELPS project aimed at developing a toolkit for the promotion of physical health in people with mental disorders to reduce the substantial excess morbidity and mortality in the target group. Methods: The HELPS toolkit was developed by means of national and international literature reviews, Delphi rounds with mental health experts and focus groups with mental health experts and patients/ residents in 14 European countries. The toolkit was translated into the languages of all participating countries, and usability of toolkit modules was tested. Results: The toolkit consists of several modules addressing diverse somatic health problems, lifestyle, environment issues, patient goals and motivation for health-promotion measures. It aims at empowering people with mental illness and staff to identify physical health risks in their specific contexts and to select the most appropriate modules from a range of health promotion tools. Discussion: The HELPS project used an integrative approach to the development of simple tools for the target population and is available online in 14 European languages. Preliminary evidence suggests that the toolkit can be used in routine care settings and should be put to test in controlled trials to reveal its potential impact.

Legal Aspects of Gender Reassignment Surgery in Turkey A Case Report

The gender reassignment process has ethical, social and legal dimensions. However, European Union countries have recommended certain principles for such reassignment. The lack of special legislation regulating legal conditions and effects of gender reassignment creates a difficult situation for transsexuals. A new civil law was implemented in 2001 in Turkey recognising gender identity reassignment which has set new standards for procedures. According to the law, court permission is compulsory for gender reassignment surgery. Courts require expert analyses in a health council report which must include a psychiatric examination of the individual, who must also be permanently unreproductive as defined by the law. Although the new Civil Law arranges new standards for gender reassignment surgery procedures, there are several problems in reassigning the civil status of transsexuals in Turkey.