Necla Keskin

Impulse control disorders in elderly patients

OBJECTIVE There is no epidemiological study on the prevalence of impulse control disorders (ICDs) in the elderly population. The studies on ICDs in elderly patients are limited and some of them are case reports about pathological gambling and kleptomania. The comorbidity of other psychiatric disorders makes diagnosis difficult and has negative effects on both treatment and the prognosis of ICDs. The aim of this study was to determine the prevalence of ICDs among elderly patients and to evaluate the related sociodemographic and clinical features. METHOD A total of 76 patients aged 60 and over who have been referred to our outpatient clinics in a one-year period were included in the study. A demographic data form was completed. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) was used to determine axis I psychiatric disorders. The prevalence of ICDs was investigated by using the modified version of the Minnesota Impulse Disorders Interview (MIDI). Impulsivity was measured with the Barratt Impulsiveness Scale Version 11 (BIS-11). The Mini-Mental State Examination (MMSE) test was performed to evaluate the cognitive status of patients and to exclude the diagnosis of dementia. In addition, all patients completed Symptom Check List-90 (SCL-90). RESULTS The prevalence rate of at least one comorbid ICD in our sample was 17%. When patients with a diagnosis of ICDs not otherwise specified (ICD-NOS) were included, the prevalence rate increased to 22.4%. The most common ICD was intermittent explosive disorder (15.8%), followed by pathological gambling (9.2%). The majority of the sample was men (54%), married (80%), had a high school education (51%), and mid-level socioeconomic status (79%). The only statistically significant difference between the sociodemographic characteristics of patients with or without ICDs was gender. The lifetime prevalence of ICDs was 34.1% in men and 8.6% in women. The prevalence of childhood conduct disorder was significantly higher in the group with ICD. There was no statistically significant difference in the number of suicide attempts, history of physical illness and family history of psychiatric disorders between the groups with or without ICDs. Comorbidity of alcohol/substance abuse was found to be 17.6% in patients with ICD whereas no cases were found in the group without ICD. CONCLUSION The result of this study has shown that approximately one fifth of patients over 60years had at least one lifetime ICD comorbidity. The prevalence rates of ICDs seem to decrease with aging. The male gender and childhood conduct disorder are related with higher prevalence rates of ICDs in elderly.

Assessment of sleep quality in bipolar euthymic patients

OBJECTIVE Sleep quality is affected in bipolar disorder even in euthymic episodes. The aim of this study was to assess sleep quality in bipolar euthymic patients, determine related clinical characteristics and evaluate its effects on functionality. METHODS A total of 122 outpatients were included. Scales were used to confirm that patients were euthymic. Mini Mental Test was performed to exclude patients with a diagnosis of dementia. A data form for socio-demographic features and clinical characteristics of bipolar disorder have been completed. SCID-I and SCID II were used. The general features of sleep were investigated by General Sleep Questionnaire. All patients completed Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Bipolar Disorder Functioning Questionnaire. RESULTS 56.5% of our sample had poor sleep quality. Patients with poor sleep had a longer time to fall asleep and more frequent waking after sleep onset. Caffeine use and smoking, history of suicide attempts, seasonality, comorbidity of lifetime anxiety, somatoform and impulse control disorders, using antidepressant medication and administration of electroconvulsive therapy were significantly higher; emotional and intellectual functioning, household relations, taking initiative, self-sufficiency and total functionality were lower in bipolar patients with poor sleep quality (p<0.05). The strongest predictor of sleep quality problem was seasonality, recording an odds ratio of 3.91. CONCLUSIONS Sleep quality is closely related with clinical features of bipolar disorder. Sleep quality is affected negatively in euthymic episodes of bipolar disorder and poor sleep quality cause loss in functionality. Assessment of sleep disturbances routinely in psychiatric interviews and dealing with sleep problems regardless mood episodes may improve sleep quality, thereby functionality and quality of life.

Assessment of co-morbidity of adult separation anxiety in patients with bipolar disorder

Objective: The aim of this study was to assess the co-morbidity of adult separation anxiety in bipolar patients and evaluate its effects on the course of disorder and functionality. Method: A total of 70 patients who have been regularly followed in the Bipolar Disorder Unit were included in the study. The Structured Clinical Interview for DSM-IV – Axis I and Axis II disorders and demographic form were used. Separation anxiety was investigated by the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS) and the Hamilton Anxiety Rating Scale (HAM-A) was filled out by an interviewer. In addition, all patients completed the Bipolar Disorder Functioning Questionnaire (BDFQ), Separation Anxiety Symptom Inventory (SASI) and Adult Separation Anxiety Questionnaire (ASA). Results: The prevalence rate of co-morbid adult separation anxiety disorder (A-SepAD) was 54% (n = 38) in our sample. Age of onset was in adulthood among 36% of patients with a diagnosis of A-SepAD and the others (64%) were childhood-onset. Co-morbidity of personality disorders was more common in bipolar patients with childhood-onset separation anxiety disorder (C-SepAD). The lifetime prevalence of co-morbidity of specific phobias and number of suicide attempts were significantly higher in the group with A-SepAD. Functionality loss due to feeling of stigmatization was higher, and total functionality as measured by the BDFQ was found to be lower in bipolar patients with A-SepAD. Conclusion: The results of this study have shown that 54% of bipolar patients had a diagnosis of A-SepAD. A-SepAD seems to increase the number of suicide attempts and have negative effects on functionality. A-SepAD should be assessed in regular interviews of patients with bipolar disorder.

Uyku Bozuklukları: Sınıflama ve Tedavi

Farkli bir bilinclilik durumu olarak tanimlanabilecek uyku, insan vucudunun normal ve saglikli islemesi icin gereklidir. Islevsellikte bozulmaya ve yasam kalitesinde dusmeye yol actigi bilinen uyku sorunlari baska bir bedensel ya da ruhsal hastaligin bir belirtisi olarak ortaya cikabilecegi gibi basli basina bir hastalik olarak da gorulebilir. Bu yazida uyku bozukluklarinin yeni siniflandirma sistemleri ve guncel tedavi algoritmalari isiginda gozden gecirilmesi amaclanmistir.

Paliperidone-related gynecomastia and treatment: a case report

Hyperprolactinemia is a frequent adverse effect of typical antipsychotics and atypical antipsychotics such as risperidone, amisulpride, and paliperidone. Side effects due to hyperprolactinemia are less frequent in males and sometimes these symptoms are overlooked. The management of a patient with antipsychotic-induced hyperprolactinemia must be patient specific. The recommended treatments include reducing dose of the offending antipsychotic, switching to another antipsychotic, using dopamine receptor agonist, adding sex steroids or aripiprazole to the treatment. In this report, a case that developed gynecomastia in the second month of the paliperidone treatment is presented, and its treatment is discussed.

Bipolar Bozuklukta Uyku

Bipolar bozuklukta hastaligin kendisiyle, kullanilan ilaclarla, ek tibbi durumlarla iliskili olarak ortaya cikan ya da birincil olarak gorulen uyku bozukluklari, yineleme ve depresmelere yol acmakta, artmis tedavi direnci ile iliskilendirilmektedir. Bipolar bozuklukta uyku kalitesi otimik donemler de dahil hastaligin her doneminde etkilenmistir. Bipolar bozuklukta yapilan uyku calismalarinda, diger ruhsal bozukluklarda oldugu gibi ozgul bir bulgu saptanmamistir. Bipolar hastalarda uyku bozukluklari kotu hastalik gidisi, azalmis islevsellik ve yasam kalitesi ile iliskilendirilmistir

Transsexualism: Clinical Features and Legal Issues -

Yapilan epidemiyolojik calisma verileri daha cok cinsiyet degistirme ameliyatlari icin basvuran kisilerden elde edilen transseksualitenin gecmiste dusunuldugu kadar nadir olmadigi ve gerek psikolojik gerekse toplumsal sonuclari nedeniyle uzerinde onemle durulmasi gerektigi bilinmektedir. Etiyolojisi tam olarak aydinlatilamamis olup biyolojik ve psikososyal faktorlerin etiyolojide birlikte rol oynadigi dusunulmektedir. 3-4 yas civarinda yerlesen cinsel kimligin bu yastan sonra degistirilmesi olanaksizdir. Bu nedenle uygulanacak tedavilerde amac cinsel kimligi degistirmek degil kisinin kimligine ve yasantisina uyumunu arttirmak olmalidir. Dunya Profesyonel Transseksuel Sagligi Birligi (The World Professional Association for Transgender Health [WPATH]) bakim standartlarini (Standards of Care [SOC]) iceren bir kilavuz yayinlamistir ve bu kilavuz transseksuel bireylerin takip ve tedavilerine dair oneriler sunmaktadir. Medeni kanunda cinsiyet degistirme ile ilgili madde oldukca ayrintili olmakla birlikte maddeye siki sikiya bagli kalindiginda kullanim alani oldukca dardir ve bu konuda yeni bir duzenlemeye ihtiyac duyuldugu aciktir.