Kemal Kuscu

Mothers’ postpartum psychological adjustment and infantile colic

Background: Infantile colic is a common problem of early infancy. There is limited data on the relation between postpartum maternal psychological problems and colic. Aim:: To investigate whether infantile colic is associated with postpartum mood disorders or insecure adult attachment style of the mother. Methods: Seventy eight mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened with Edinburgh Postpartum Depression Score (EPDS) and maternal anxiety was assessed with State-Trait Anxiety Inventory (STAI). The Adult Attachment Scale was used to determine the attachment style of the mother. Infantile colic was defined according to Wessel criteria. Results: Infantile colic was present in 17 infants (21.7%); 12.9% of the mothers had an EPDS ⩾13. The mean EPDS of the mothers whose infants had infantile colic (10.2±6.0) was significantly higher than that of the mothers of infants without colic (6.3±4.0). Among infants with infantile colic, 62.5% had mothers who had insecure attachment style, whereas only 31.1% of mothers had insecure attachment when the infant did not have infantile colic. Conclusion: Postpartum maternal depressive symptoms and insecure attachment style are associated with infantile colic. Screening and early intervention of postpartum depression might promote the health of both the mother and infant.

The effects of psychiatric treatment on depression, anxiety, quality of life, and sexual dysfunction in patients with inflammatory bowel disease

Objective Depression and anxiety are common disorders in inflammatory bowel disease (IBD). Our aim is to prospectively determine the effect of psychiatric treatment on scores for depression, anxiety, quality of life (QoL), and sexual dysfunction in an outpatient population diagnosed with IBD and also anxiety and/or depression disorder. Patients and methods Patients who scored higher than the cutoff point on the Hospital Anxiety Depression Scale were referred for further structured psychiatric evaluation and determination of the need for psychiatric drug treatment. Patients who underwent drug therapy completed Short Form-36 (SF-36) and the Arizona Sexual Experience Scale at baseline and after 6 months of follow-up. Results Major depressive disorder and generalized anxiety disorder were the most common diagnoses. After 6 months, 47 patients had completely adhered to drug treatment (group A), whereas 20 were nonadherent (group B). In group A, all domains of SF-36, Arizona Sexual Experience Scale, depression/anxiety scores, and Crohn’s disease activity index were statistically improved after treatment when compared with the baseline. In group B, the three domains of SF-36, platelet count, and mean corpuscular volume were worse between baseline and at 6 months. Conclusion In IBD patients having any psychiatric disorder, 6 months of antidepressant drug treatment is associated with an improvement in depression, anxiety, QoL, and sexual functioning scores, as well as an improvement in Crohn’s disease activity index. On the other hand, insufficient psychiatric treatment seems to be related to a poor QoL.

Postoperative psychiatric disorders in general thoracic surgery: incidence, risk factors and outcomes

OBJECTIVE Postoperative psychiatric disorders (PPDs) may complicate the post-surgical outcome. We analysed the types, incidences, risk factors and outcomes of the PPDs in non-cardiac thoracic surgery patients. METHODS All patients (n=100) undergoing major non-cardiac thoracic surgery from January 2004 to March 2005 were investigated prospectively. The diagnosis of PPD was made based on the Diagnosis and Statistical Manual of Mental Disorders. The patients were grouped into two according to the presence (group I) or absence (group II) of PPD. Data on pre-, per- and postoperative factors, and the adverse outcomes were analysed. RESULTS Eighteen patients (18%) developed PPD, including delirium in 44%, adjustment disorders in 22%, panic attack in 17%, minor depression in 11% and psychosis in 6%. The patients who developed PPD were older (58+/-17 vs 50+/-15 years, p=0.05), had a longer operation time (6+/-1 vs 5+/-2h, p=0.015) and hospital stay (13+/-9 vs 8+/-5 days, p=0.019). The morbidity and mortality rates were not significantly different between the groups (67% vs 46%; 11% vs 1%, respectively). The causative factors in the development of PPD were older age, longer operation time, abnormal serum chemistry values of sodium, potassium, calcium and glucose, hypoalbuminaemia, the presence of the postoperative respiratory distress and infection and blood transfusion (p<0.05). CONCLUSIONS PPDs are associated with adverse outcomes including a longer hospital stay, and increased morbidity and mortality rates. The identification, detection and elimination of these risk factors are recommended.

Mother-Child Interactions of Preterm Toddlers

INTRODUCTION We aimed to investigate the mother-toddler relationship in preterm toddlers. METHODS The sample consisted of 18 mothers and their preterm toddlers (group 1) and 20 mothers and their fullterm toddlers (group 2). Anxiety and depressive symptom levels, attachment pattern, and parental attitudes of mothers and social-emotional problems and developmental level of the toddlers were explored to assess possible confounding factors in the mother-toddler relationship. Two researchers rated the Parent Infant Relationship Global Assessment Scales (PIRGAS). RESULTS Both the mothers in group 1 and group 2 had similar Beck Depression Inventory (BDI) and State and Trait Anxiety Inventory (STAI) scores. However, the mothers who gave birth before 32 weeks of gestation had higher trait anxiety scores than others (46±2.4 vs. 42.3±5.4, p=0.01). The groups had similar Brief Infant Toddler Social Emotional Assessment Scale (BITSEA) problem and competency scores. The parenting style of group 1 revealed that they had higher scores on the Parenting Attitude Research Instrument (PARI) subscale 5 (excessive discipline) (39.6 vs. 32.1; p=0.02). CONCLUSION Mother-toddler interaction and attachment security were found to be similar in fullterm and moderately preterm healthy toddlers. Our findings suggest that not the preterm birth itself but the medical, developmental, and/or neurological consequences of prematurity may affect the mother-toddler interaction. To explore the independent effect of prematurity in mother-toddler dyadic relationship, longitudinally designed studies are warranted.

PSYCHOTIC DEPRESSION: A PECULIAR PRESENTATION FOR MULTIPLE SCLEROSIS

Multiple sclerosis (MS) is frequently associated with a number of different psychiatric syndromes. Solely psychiatric syndrome may be the first clinical presentation of multiple sclerosis. We report a patient whose first attack was psychotic depression. The present case emphasizes that psychiatric symptoms can occur at any time during the course of the disease and, moreover, may be the presenting feature.

Evaluation of depression, anxiety, alexithymia, attachment, social support and somatization in functional dyspepsia

ABSTRACT AIM: The psychiatric and psychosocial aetiology of Functional dyspepsia is not well known. In the present study, our aim is to determine the relative contributions of psychiatric predictors – i.e. depression, anxiety, somatization, alexithymia – in relation with socio-psychological factors, specifically their personal characteristics (i.e. emotional attachment) and perceived social support, in distinguishing FD from organic dyspepsia and healthy samples. MATERIAL AND METHODS: An estimated 30 functional dyspepsia, 29 organic dyspepsia patients who were admitted to our gastroenterology outpatient clinic and 27 healthy controls were enrolled to our study. Beck Depression Inventory, Toronto Alexithymia Scale, Adult Attachment Scale, State-Trait Anxiety Inventory, Multidimensional Scale of Perceived Social Support and somatization sub-scale of Symptom Checklist-90 were provided to all patients and healthy controls. All participants were examined by a gastroenterologist and a psychiatrist. RESULTS: Healthy controls were younger than organic dyspepsia group and women/men rate was lower in organic dyspepsia than other two groups. Depression score was higher in functional dyspepsia group than in healthy controls and functional dyspepsia group’s attachment syle was more secure than that of the healthy control group. Somatization rate was seen higher in functional dyspepsia group with psychiatric examination. There was no significant difference seen in anxiety, alexithymia and social support between the three groups. DISCUSSION: Anxious-avoidant attachment profile as well as the higher propensity to have depressive and anxiety symptoms might be critical psychiatric and psychosocial factors underlying FD’s aetiology. A multidisciplinary approach is needed in the follow up of functional dyspepsia patients. Psychological evaluation and treatment would increase the life quality of dyspepsia patients.

P137 Sexual dysfunction in inflammatory bowel disease patients

whose SES-CD was 3 whereas it was 88% in patients whose SES-CD was 2 (p < 0.01). This tendency was observed both in patients who were treated with/without biologics. Cox regression analysis after adjustment of possible confounding factors revealed that SES-CD 2 was found to be independent determinants of non-relapse (HR 0.17; 95%CI 0.06 0.48). Conclusions: The present study demonstrated that endoscopic remission (SES-CD 2) predicted long-term prognosis even in patients with clinical remission.