Mehmet Z. Sungur

A comparison of DSM-IV-TR and DSM-5 definitions for sexual dysfunctions: critiques and challenges.

INTRODUCTION The diagnostic criteria of sexual dysfunctions (SDs) are paramount for the development of sexual medicine as reliable diagnoses are essential to guide treatment plans. Prior Diagnostic and Statistical Manual of Mental Disorders (DSM) classifications based definitions of SD mostly on expert opinions and included imprecise terms. The validity of diagnoses of SD has only recently been challenged, and efforts are made to make more operational definitions. AIM This paper aims to compare and contrast the recently released Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) diagnostic criteria of SD with that of Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Text Revision (DSM-IV-TR) and explains the rationale for making changes in the new DSM-5. It also aims to address some issues to be considered further for the future. METHODS Online proposed American Psychiatric Association website DSM-5, the new released DSM-5, and DSM-IV-TR diagnostic criteria for SD were thoroughly inspected, and an extensive literature search was performed for comparative reasons. MAIN OUTCOME MEASURES Changes in diagnostic criteria of DSM-5 were detected, and DSM-IV-TR and DSM-5 diagnostic criteria for SD were compared and contrasted. RESULTS Diagnostic criteria were more operationalized, and explicit duration and frequency criteria were set up in DSM-5 for purposes of good clinical research. Classifications based on simple linear sexual response were abandoned, and diagnostic classifications were separately made for males and females. Desire and arousal disorders in women were merged. CONCLUSIONS Drifting apart from linear sexual response cycle may be an advancement in establishing specific diagnostic criteria for different genders. However, it is still a question of debate whether there is enough evidence to lump sexual interest and arousal disorders in females. Making more precise definitions is important to differentiate disorders from other transient conditions. However, there is still room to improve our definitions and find a way to include gay and lesbian individuals. Further discussions and debates are expected to be continued in the future.

Identifying an optimal treatment for schizophrenia: A 2-year randomized controlled trial comparing integrated care to a high-quality routine treatment

Abstract Objective. This study used repeated outcome measures over a 2-year period to compare the clinical and social benefits of routine schizophrenia treatment with those of evidence-based pharmacological and psychosocial treatment strategies. Method. One hundred patients who were diagnosed with schizophrenia according to DSM-IV criteria were randomly assigned to 24 months of either optimal case management (OCM) or routine case management (RCM). OCM involved minimally effective doses of antipsychotic medication with compliance training, an identical treatment programme with the addition of manual-based communication and problem solving training to help patients and caregivers manage stress, social skills training, supported employment, cognitive-behavioural strategies for residual psychotic and non-psychotic symptoms, as well as anger management and substance use counselling. RCM involved minimally effective doses of antipsychotic medication with compliance training, the monitoring of side effects, education about schizophrenia and its optimal treatment, detection of early warning signs and supportive psychotherapy to address practical problems. The symptoms, impairment, disability, unmet needs, quality of life of the patients were examined by blinded researchers every 6 months. Results. Statistically and clinically significant advantages were observed for OCM versus RCM on all measures. Most of these advantages increased throughout the 24-month period. Conclusions. This study helps demonstrate the importance of psychosocial interventions in the treatment of schizophrenia. Recent advances in evidence-based psychosocial strategies can be implemented into routine clinical practice with additional clinical and social benefits.

Internet Addiction and Its Cognitive Behavioral Therapy

Internet addiction or problematic internet use is one of the newest areas of interest in psychiatry. The internet which was developed to increase communication and facilitate information exchange has grown beyond expectations making some users unable to control their internet use and thus experience problems in their functioning at work and in social and private spheres (Young 1999). The reasons for the internet becoming so widespread in such a short time have been the subject of many studies. To explain the increase in internet use for sexual pursuits, Cooper has defined a ‘Triple A Engine’ (Access, Affordability and Anonymity). Access is the ease of having access to the internet anywhere and anytime and finding whatever is sought in the internet where there is no refusal. Affordability is the ease of having access to the rich content of the internet especially in on-line sexuality in return for an affordable price. Anonymity is the secrecy of an individual’s both real and perceived identity (Cooper 1998). These popularizing and facilitating factors may enable us to understand the increase in using the internet in all other areas.

Cultural Factors in the Treatment of Sexual Dysfunction in Muslim Clients

Religion is an important cultural factor that may have a significant impact on the presentation of mental health problems and sexual dysfunction. Although there is increasing empirical evidence of the relationship between religion, sexual dysfunction, and sex therapy, it is difficult to predict how these factors influence one another among Islamic populations. In Islam, discussing sexual issues outside marriage is prohibited, which can make it difficult for clients to seek help; however, this may be allowed for treatment purposes. Any sexual activity outside marriage is also banned in Islam, while religion encourages the enjoyment of sex and sensitivity to the needs of the spouse in heterosexual marriages. The restrictive nature of Islamic rules regarding sexual issues may give rise to contextual sexual problems. Alongside these factors, personal interpretations of Islamic principles and their impact on daily practice vary among different Muslim populations. Therefore, unique, couple-tailored treatment programs that are person-centered and sensitive to couples’ cultural and religious norms are more likely to be successful than standard package-type treatments.

Heart rate variability response to affective pictures processed in and outside of conscious awareness: Three consecutive studies on emotional regulation

Previous research has increased understanding of the neurobiological basis of emotional regulation. However, less is known concerning the unconscious processing of affective information. Three experiments were performed to investigate the extent to which complex affective stimuli can be processed outside of consciousness and demonstrate possible mechanisms for regulation of resulting emotional responses. In Experiment 1, participants were either instructed to passively observe blocked-picture cues (neutral and negative) or to downregulate their emotions by distancing. Resulting emotional regulation activity was assessed with 0.1-Hz heart rate variability (HRV) indices. In Experiment 2, participants were presented with affective pictures that were rendered consciously invisible by means of continuous flash suppression (CFS). In Experiment 3, two equivalent sets of negative affective pictures were covertly presented and the effect of a cognitive task on emotional regulation was evaluated. Our findings revealed that 0.1-Hz HRV indices exhibited greater change over baseline in response to negative compared to neutral stimuli for both presentation conditions (consciously perceived or not). The implementation of distancing and the cognitive task were both associated with higher 0.1-Hz HRV change scores. These results indicate that even complex affective stimuli can be processed without awareness, resulting in a congruent emotional response that is physiologically detectable. Cognitive strategies can help more effectively regulate this response, implying that conscious perception of a triggering stimulus may not be essential for cognitive regulation.

Sosyal Anksiyete Bozukluğunda Bilişsel Davranışçı Terapi: Güncel Kavramlar

Ozet Bilissel davranisci terapiler halen sosyal anksiyete bozuklugunda yuksek kanit duzeyine sahip en onemli tedavi yontemlerindendir. Ancak buna ragmen bazi hastalarin tedaviden yeterince fayda gormemesi yeni arayislari surdurmektedir. Bu yazida yapilan sosyal anksiyete bozuklugunda bilissel davranisci terapiler konusunda yapilan calismalar gozden gecirilmis guncel kavramlar tartisilmistir. Guncel calismalarin bilgisayar teknolojisini cokca kullanmasi dikkat cekicidir. Son yillarda calismalar sosyal anksiyete bozuklugunda dikkat yanliligi, yanli bilgi isleme, dikkat egitimi, yargi yanliliklari, internet tabanli bilissel davranisci terapiler ve sosyal aksiliklere alistirma tedavisi uzerinde yogun- lasmaktadir. Internet tabanli bilissel davranisci terapiler ozellikle tedaviye ulasma olanagi olmayan kisiler icin iyi bir secenek gibi durmaktadir. Anahtar sozcukler: Sosyal anksiyete bozuklugu, bilissel davranisci terapiler. Abstract Cognitive behavioral therapy is still one of the most important treatment modalities in social anxiety disorder with a high level of evidence. However, some patients do not fully benefit from these therapies and this fact leads to ongoing search for new approaches. This paper reviews use of cognitive behavioral therapy in social anxiety disorder studies and discusses related updated concepts. The frequent use of computer-assisted therapy for most of recent studies was found noteworthy. Recent studies regarding social anxiety disorder focused on concepts such as attention bias, biased information processing, attention training, judgment biases, internet-based cognitive behavioral therapies and social mishap exposure. Internet-based cognitive-behavioral therapy seemed to be a good option for people who were unable to access face to face treatment.

Vajinusmuslu Kadınlarda Cinsel İşlev Ve Doyum / Sexual Function And Satisfaction of Women With Vaginismus

Sexual function and satisfaction of women with vaginismus Objective: Vaginismus is one of the sexual dysfunctions that affects couples’ sexual life. There is a common opinion that women with vaginismus have a satisfied sexual life even there is no vaginal entry. But contrary to this opinion, several studies reported that sexual function and satisfaction of women with vaginismus were impaired. In our study, our purpose was to evaluate sexual function and satisfaction in women with vaginismus and to compare the findings with that of healty women’s. Method: Forty women with vaginismus who referred to Sexual Dysfunction Therapy Outpatient Unit and fifty healthy voluntary women who had no sexual complaint participated in the study. Questionnaire regarding demographic characteristics, Symptom Check List (SCL-90 R), Cloninger’s Temperament and Character Inventory (TCI), Golombok-Rust Inventory of Sexual Satisfaction (GRISS) were evaluated. Results: It was found that women with vaginismus avoided sexual intercourse, were more emotional and needed approval more frequently. Also, vaginismus history was more frequent in their family and among close relatives. They found inadequate their and their partners’ level of sexual knowledge. They had typical fears and they had problems in all other domains of sexual function as well as the vaginal entry. There were statistically significant differences in GRISS vaginismus, avoidance, satisfaction, frequency, lack of orgasm subscales and total GRISS score between vaginismus and control groups. Conclusions: Unlike general opinion, women with vaginismus have problems in many domains of sexual function. We think that it would be inadequate if vaginismus is considered only a problem of vaginal entry, that all domains of sexual function, avoidance and enviromental factors should be evaluated together.

Turkish validity and reliability of the Sexual Complaints Screener for Women

ABSTRACT OBJECTIVE: The Sexual Complaints Screener for Women (SCS-W) is a brief, practical and up-to-date scale which assesses sexual problems parallel with the current diagnostic manuals. The SCS-W consists of 10 questions which assess a variety of sexual dysfunctions and potential distress experienced at the time of and the last six months leading to the evaluation. This study aims to assess the validity and reliability parameters of the Turkish version of the SCS-W. METHODS: Cross-sectional study included 352 women between the ages of 18 and 25 who voluntarily completed the survey, 316 of which were included in the analysis. Data was collected through specific questionnaires including the Female Sexual Function Index, the Short Form Health Survey (SF-36), the Turkish translation of SCS-W, and a sociodemographic form. The Cronbach Alpha Test was used to calculate the internal consistency and the Pearson Correlation Test was used for total score correlations as well as to determine cross-validity. An explanatory factor analysis was applied to identify the validity of the scale. RESULTS: The average age of participants in the study was 21.17 ± 1.87. The Cronbach alpha internal consistency coefficient of the scale was 0.895, and the correlation coefficient for most of the items was found to be higher than 0.50. Correlation analysis between the SCS-W and the FSFI total score and subscales were statistically significant. CONCLUSION: The SCS-W has credible psychometric values for validity and reliability to screen and evaluate sexual complaints. To sum up, the SCS-W is a practical assessment tool with the considerable advantages of delivering cost-effective evaluation of female sexual problems in clinical settings, research, and daily practice.

Sociotropic personality traits positively correlate with the severity of social anxiety

Sociotropy can be seen as the opposite of autonomy, as those with high levels of sociotropy are overly concerned with interpersonal relationships, whereas those with high levels of autonomy are mostly concerned with independence and do not prioritise social interactions and how they are evaluated by others. Both of these personality dimensions may be associated with increased susceptibility for depression, first suggested in 1999.

The Relationship Between Dysfunctional Attitudes, Rumination Response Styles and Depression

The relationship between dysfunctional attitudes, rumination response styles and depression Objective: In our study we aimed to investigate the relationship between rumination response styles, dysfunctional attitudes and depression. Methods: 60 patients diagnosed with depression according to the DSM-IV-TR diagnostic criteria in the Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery outpatient clinics are involved in our study. All participants were administered a sociodemographic questionnaire, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Beck Depression Inventory (BDI), Dysfunctional Attitude Scale (DAS) and Ruminative Responses Scale (RRS-short version). Results: In our study, there was mild-moderate negative correlation between depression and the perfectionist attitudes, need for approval, independent attitudes subscores. The RRS-short version brooding subscore was highly positively correlated with depression. Depression and RRS-short version reflecting score was moderately and positively correlated. As predictors of depression, high subscores of RRS-short version brooding and RRS-short version reflected increased risk for depression, whereas high subscores of DAS perfectionist attitudes are evaluated to be protective for depression. Conclusions: In our study, in contrast to the literature, it was shown that dysfunctional attitudes are not positively correlated with depression nor are they predictors of depression. However, it may not be appropriate to make such comment based on a single study. Factors that can lead to this conclusion are discussed in the study. On the other hand, our study emphasizes the key role of rumination in depression. In practice of cognitive behavioral therapy of which efficacy in treatment of patients with depression has been know, assessment of ruminative responses, treatment techniques for reducing ruminative responses should be targeted.