Nazan Aydin

Validation of the Turkish version of the Edinburgh Postnatal Depression Scale among women within their first postpartum year

Abstract.Background:The aim of the study was to find out the validity and reliability of the Turkish version of the Edinburgh Postnatal Depression Scale (EPDS) and to determine the optimum cut-off value for postnatal depression.Method:Validation of the Turkish version of the EPDS was conducted on a sample of 341 women who were within their first postpartum year. Structured Diagnostic Interview for DSM-IV Axis I Disorders was used as the gold standard test, and receiver operating characteristic analysis was used to evaluate test performance of the EPDS.Results:The study of sensitivity, specificity and predictive values versus SCID-I indicated a cut-off score of 12.5 as the best (sensitivity: 75.5, specificity: 71.5). Positive predictive value was 30.3% and negative predictive value was 94.5%. Cronbach’s alpha value was calculated as 0.72.Conclusions:It was concluded that: (1) values for the validity were respectable, but not excellent; (2) the scale needs to be improved for use in the Turkish population; and (3) the high prevalence of postnatal depression found in this study may be a function of the low validity of the test.

Cognitive functions and serum levels of brain-derived neurotrophic factor in patients with major depressive disorder.

OBJECTIVE We assessed major cognitive domains in major depressive disorder (MDD) compared to a healthy control group using neurocognitive tests. We hypothesized that lower serum brain-derived neurotrophic factor (BDNF) levels would be associated with poorer neurocognitive performance in patients with major depression and that these associations would be shown in healthy controls as well. METHOD Executive functions, sustaining and focusing of attention, memory functions, and verbal fluency were assessed in this study using the Trail-Making Test (TMT), Stroop Color Word Interference Test-TBAG Form (SCWT), Wisconsin Card Sorting Test (WCST), Test of Variables of Attention (TOVA), Auditory Consonant Trigram test (ACTT), Digit Span subtest of the Wechsler Memory Scale (DST), Rey Auditory Verbal Learning Test (RAVLT), and Controlled Oral Word Association Test (COWAT). RESULTS The MDD group showed significantly poorer performance than the control group in cognitive functions; they also had lower levels of BDNF than the control group. However, there was no correlation between cognitive performances and BDNF levels except in the TMT, Part B. CONCLUSIONS The current understanding of the importance of neurocognitive assessment and related biological markers in depression is improving. Further studies with larger sample sizes evaluating neurocognitive functions with molecular analyses of BDNF levels may reveal a novel marker for predicting and monitoring neurocognitive deficits in depression.

Normative data and factorial structure of the Turkish version of the Temperament and Character Inventory

Cloningers dimensional psychobiological model of personality accounts for both normal and abnormal variation in 2 major personality components: temperament and character. Here, we examined the psychometric properties of the Turkish version of the Temperament and Character Inventory (TCI) in a healthy Turkish population, obtaining normative data for the Turkish TCI. The study was conducted in healthy volunteers at both Karadeniz Technical University School of Medicine and Atatürk University School of Medicine (n = 683). The Turkish sample had significantly lower mean scores on Novelty Seeking and Reward Dependence and higher mean scores on Harm Avoidance than the American sample. The Turkish sample had significantly lower scores on Self-Directedness, Cooperativeness, and Self-Transcendence. Self-Directedness and Harm Avoidance, Cooperativeness and Reward Dependence, and Cooperativeness and Self-Directedness were intercorrelated. The Cronbach coeficients were between 0.60 and 0.85 on temperament dimensions, and between 0.82 and 0.83 on character dimensions. The lowest Cronbach coefficients were found in Reward Dependence (0.60) and Persistence (0.62). A principal axis factor analysis with a 4-factor solution revealed the highest loadings on Novelty Seeking and Harm Avoidance and relatively weaker loadings on Reward Dependence and Persistence. A 3-factor solution for character subscales indicated the highest loadings on Cooperativeness and Self-Transcendence. The factorial structure was consistent with Cloningers 7-factor model of personality, and test-retest indicated a good stability of scores over time. The reliability and factorial validity of the Turkish version of the TCI are therefore supported.

Depression and Associated Factors Among Women Within Their First Postnatal Year in Erzurum Province in Eastern Turkey

AbSTRACT Objectives: The aims of the study were to identify associated factors with depression, to estimate prevalence of depression among women in the postnatal first year in Eastern Turkey, and to compare the results with those obtained from western societies. Methods: We randomly selected 728 women in their postnatal first year. The data were collected in 2003 by using a structured questionnaire and the Edinburgh Postnatal Depression Scale. Results: The percentage of the women who had scores ≥ 13 was 34.6%. Having an unemployed husband, premenstrual symptoms, lack of husbands support, any stressful life event during the pregnancy, infant with a health problem, a temperamentally difficult child, and history of psychiatric condition were found to be associated factors with depression in women in this region. Conclusion: The percentage of women with high scores in Eastern Turkey was higher than the reported prevalence in many western countries, and significant relations were identified between depression and social factors.

Toward Changing of the Pathophysiologic Basis of Acute Hydrocephalus After Subarachnoid Hemorrhage: A Preliminary Experimental Study

BACKGROUND Acute hydrocephalus (ventricular enlargement within 72 hours) is a common complication in patients with aneurysmal subarachnoid hemorrhage (SAH). Cerebrospinal fluid (CSF) secretion may be increased in the early phases of SAH, but it has not been proved definitively. We studied the histologic features of choroid plexus (CP) in the early and late phases of SAH. METHODS This study was conducted on 20 rabbits, with 5 rabbits in the control group, 5 rabbits in the sham group, and 10 rabbits in the SAH group. In the SAH group, five of the animals were decapitated after 2 days of cisternal blood injections, and the other five animals were decapitated after 14 days of injections. The CP of lateral ventricles were obtained from coronary sections of brains at the level of the temporal horns of the lateral ventricles. Sections were stained with hematoxylin and eosin and Masson trichrome for SAH-related damage and examined stereologically to discern water-filled vesicles, which were counted. Sections were compared statistically. RESULTS The mean numbers of water vesicles were different after SAH between the early decapitated group (group III) and the late decapitated group (group IV). The mean numbers of water vesicles were 2.80 (± 0.05) in the control group (group I), 2.76 (± 0.02) in the sham group (group II), 14.68 (± 0.06) in the early decapitated group (group III), and 4.78 (± 0.13) in the late decapitated group (group IV). Total number of fluid-filled vesicles of CP was also assessed stereologically; the total numbers were 840 (± 16) in group I, 828 (± 7) in group II, 4404 (± 19) in group III, and 1434 (± 41) in group IV. The numbers of water-filled cisterns were significantly increased in the early phases of SAH (P < 0.05). CONCLUSIONS In SAH with aneurysm rupture, increased CSF secretion seems to be triggered by hemorrhage in the early phase, but it is not possible in the late phase because of CP degeneration. In the early phase of hemorrhage, CSF secretion may be stimulated by the irritant receptor glossopharyngeal and vagal nerve endings, which innervate the healthy CP epithelium and arteries. Our findings may be accepted as being causative. It is likewise possible that CSF blockage per se leads to hydrocephalus, and the morphologic changes are sequelae that occur later in the course of disease. This is the first study to show the water vesicles of CP as a causative factor in the development of acute hydrocephalus after SAH.

Handedness, eyedness, and hand–eye crossed dominance in patients with schizophrenia: Sex-related lateralisation abnormalities

Schizophrenia is referred to as cerebral lateralisation abnormality. In this study the possible relationships among handedness, eye dominance, and crossed and non-congruent hand–eye dominance in patients with schizophrenia are investigated. A total of 88 patients with schizophrenia and 118 controls were included in the study. The patient group included 60 men and 28 women who ranged in age from 17 to 63 years. Diagnoses were made on the basis of information provided from clinical interviews and Structured Clinical Interview for DSM-IV. Handedness was ascertained by using the Edinburgh Handedness Inventory. Eye dominance was measured only by the near–far alignment test. Patients with schizophrenia had a significantly increased frequency of mixed-handedness and decreased frequency of both right- and left-handedness in comparison with controls. Also, the male patients with schizophrenia had significantly increased frequencies of left eye dominance, crossed hand–eye dominance, and non-congruent hand–eye dominance compared to controls, but not the female patients. Cerebral lateralisation abnormalities in schizophrenia may be associated with sex-related hormonal factors.

Untreated depression in the first trimester of pregnancy leads to postpartum depression: high rates from a natural follow-up study

Background This is a natural follow-up study that presents the postpartum results of women who experienced depression during pregnancy. Methods This study involved 78 women diagnosed with depression in the first trimester of pregnancy. All patients were diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) in the first trimester and all were referred to a psychiatric center for treatment. Of the 78, 73 were contacted postpartum and reassessed by SCID-I. Treatment anamnesis was evaluated retrospectively. Results The women were divided into two groups at the postpartum evaluation according to anamnesis of psychiatric treatment. Twenty-one of the 73 (28.7%) had received treatment during pregnancy (treated group). Fifty-two women had not been treated (untreated group). In the treated group, no postpartum depression was determined (0%). In the untreated group, 92% (n=48) of women had a depressive disorder postpartum (P<0.01). In addition, scores regarding depression, functionality, and perceived social support were worse postpartum for the untreated group. Conclusion Untreated depression during pregnancy is an important predictor of postpartum depression. This natural follow-up study is important because it presents very striking rates of postpartum depression. Referral of patients with depression during pregnancy to psychiatric treatment should be provided and is strongly encouraged.

Left Ear (Right Temporal Hemisphere) Advantage and Left Temporal Hemispheric Dysfunction in Schizophrenia

In this study, to investigate the right or left ear advantages in psychiatric patients, the durations of hearing for right and left ears were assessed in 61 psychiatric patients, 26 with schizophrenia, 17 with depressive disorder, 13 with bipolar affective disorder, and 5 with brief psychotic disorder, plus 24 controls. Diagnoses were made on the basis of information provided from clinical interviews and the Structured Clinical Interview for DSM-IV (SCID). Schizophrenia was associated with a left ear advantage, and both depressive disorder and brief psychotic disorder were associated with right ear advantage as well as controls. These results suggest that their schizophrenia may be associated with a left temporal lobe dysfunction.

The depression in women in pregnancy and postpartum period: A follow-up study

Aim: This was a follow-up study to determine postpartum depression (PPD) and its causes in a population previously evaluated in the first trimester of pregnancy. Methods: The study sample consisted of pregnant women who were evaluated in the first trimester and 360 women who were re-evaluated in the postpartum period. Detailed sociodemographic data were obtained from the women, and depression was assessed with the Edinburgh Postpartum Depression scale (EPDS) and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I Disorders (SCID-I). Results: In this follow-up study, the prevalence of PPD was 35% (n = 126). A depressive disorder in the first trimester of pregnancy, previous mental disorder, somatic disorder, exposure to domestic violence during pregnancy, baby’s staying in the incubator and not breastfeeding were predictors of PPD. Exposure to violence and a history of previous depression predicted depression both in pregnancy and in the postpartum period. Conclusion: Depression rates are high in Eastern Turkey. Exposure to violence during pregnancy and the existence of a previous mental disorder were risk factors for perinatal depression in this study. Performing screening tests can identify women at risk of pregnancy-related depression. Prevention programs should be established in areas where the prevalence of depression is high.

Disappearance of phantom limb pain during cauda equina compression by spinal meningioma and gradual reactivation after decompression

UNLABELLED We describe a 65-yr-old woman, whose right lower limb had been amputated at the mid-femoral level because of complicated femur fracture sustained at the age of 5 yr. After amputation, she experienced phantom limb pain (PLP), which gradually decreased in intensity but persisted for 60 yr. At this point the pain diminished progressively, in parallel with the evolution of cauda equina compression caused by an intraspinal tumor. The PLP gradually reappeared over 3 mo after surgical removal of the tumor. IMPLICATIONS We present a case in which phantom limb pain (PLP) in an amputated leg disappeared during cauda equina compression by meningioma and reactivated after surgical decompression. This case suggests that complete compression or blockade of nerves, a nerve plexus, the cauda equina, or the medullary cord may result in suppression of PLP, and decompression of or recovery from the block may cause reactivation.