Oğuz Karamustafalıoğlu

Fighting stigma of mental illness in midsize European countries.

PurposeStigma is the most powerful obstacle to the development of mental health care. Numerous activities aiming to reduce the stigma of mental illness and the consequent negative discrimination of the mentally ill and their families have been conducted in Europe. Descriptions of many of these activities are not easily available, either because there are no publications that describe them, or because descriptions exist only in local languages. This supplement aims to help in overcoming this imbalance by providing a description of anti-stigma activities in 14 countries in Europe regardless of the language in which they were published and regardless whether they were previously published.MethodsThe review was undertaken by experts who were invited to describe anti-stigma activities in the countries in which they reside. It was suggested that they use all the available evidence and that they consult others in their country to obtain a description of anti-stigma activities that is as complete as possible.ResultsThe anti-stigma activities undertaken in the countries involved are presented in a tabular form. The texts contributed by the authors focus on their perception of the stigma of mental illness and of activities undertaken to combat it in their country.ConclusionsAlthough much has been done against the stigmatization and discrimination of the mentally ill, fighting stigma remains an essential task for mental health programs and for society. The descriptions summarized in this volume might serve as an inspiration for anti-stigma work and as an indication of potential collaborators in anti-stigma programs.

Pharmacological treatment strategies in obsessive compulsive disorder: A cross-sectional view in nine international OCD centers

Objective: It is unknown what next-step strategies are being used in clinical practice for patients with obsessive–compulsive disorder (OCD) who do not respond to first-line treatment. As part of a cross-sectional study of OCD, treatment and symptom information was collected. Method: Consecutive OCD out-patients in nine international centers were evaluated by self-report measures and clinical/structured interviews. OCD symptom severity was evaluated by the Yale Brown Obsessive Compulsive Scale (YBOCS) and Clinical Global Impression–Severity Scale (CGI-S). Clinical response to current treatment was evaluated by the CGI-Improvement Scale (CGI-I ≤ 2). Results: In total, 361 participants reported taking medication; 77.6% were taking a selective serotonin reuptake inhibitor; 50% reported use of at least one augmentation strategy. Antipsychotics were most often prescribed as augmenters (30.3%), followed by benzodiazepines (24.9%) and antidepressants (21.9%). No differences in OCD symptom severity were found between patients taking different classes of augmentation agents. Conclusions: Results from this international cross-sectional study indicate that current OCD treatment is in line with evidence-based treatment guidelines. Although augmentation strategies are widely used, no significant differences in OCD symptom severity were found between monotherapy and augmentation or between different therapeutic agents.

Experience of stigma and discrimination reported by people experiencing the first episode of schizophrenia and those with a first episode of depression: The FEDORA project

Aim: To record and measure the nature and severity of stigma and discrimination experienced by people during a first episode of schizophrenia and those with a first episode of major depressive disorder. Methods: The Discrimination and Stigma Scale (DISC-12) was used in a cross-sectional survey to elicit service user reports of anticipated and experienced discrimination by 150 people with a diagnosis of first-episode schizophrenia and 176 with a diagnosis of first-episode major depressive disorder in seven countries (Austria, Croatia, Czech Republic, Poland, Romania, Sweden and Turkey). Results: Participants with a diagnosis of major depressive disorder reported discrimination in a greater number of life areas than those with schizophrenia, as rated by the total DISC-12 score (p = .03). With regard to specific life areas, participants with depression reported more discrimination in regard to neighbours, dating, education, marriage, religious activities, physical health and acting as a parent than participants with schizophrenia. Participants with schizophrenia reported more discrimination with regard to the police compared to participants with depression. Conclusion: Stigma and discrimination because of mental illness change in the course of the mental diseases. Future research may take a longitudinal perspective to better understand the beginnings of stigmatisation and its trajectory through the life course and to identify critical periods at which anti-stigma interventions can most effectively be applied.

Sexual dysfunction in female patients with panic disorder alone or with accompanying depression

Objective. The aim of this study was to evaluate sexual dysfunction in female patients with panic disorder and to investigate the impact of accompanying depression with regard to sexual dysfunction. Method. Twelve patients who met the diagnostic criteria for panic disorder without depression (P) and 28 patients who met the diagnostic criteria for panic disorder with depression (PD) were compared to 13 control cases (C). Arizona Sexual Experience Scale (ASEX) was used to measure sexual experience. Results. ASEX scores were significantly different between the three groups (P=0.001). In two group comparisons sexual desire and aversion subscores of ASEX were significantly decreased in group PD when compared with groups P and C (P=0.01). Also, our results show that the difference of orgasmic experience subscore of ASEX in groups PD and C was found to be statistically significant (P=0.01). On the other hand, there was no statistical difference between P and PD groups in terms of orgasmic experience (P=0.16). Conclusion. These results suggest that decreased sexual desire and high sexual aversion may be presenting symptoms of depression in patients with panic disorder. If there is no depression, patients with panic disorder should be questioned especially for orgasmic problems.

The relationship of psychological trauma with trichotillomania and skin picking.

Objective Interactions between psychological, biological and environmental factors are important in development of trichotillomania and skin picking. The aim of this study is to determine the relationship of traumatic life events, symptoms of post-traumatic stress disorder and dissociation in patients with diagnoses of trichotillomania and skin picking disorder. Methods The study included patients who was diagnosed with trichotillomania (n=23) or skin picking disorder (n=44), and healthy controls (n=37). Beck Depression Inventory, Traumatic Stress Symptoms Scale and Dissociative Experiences Scale were administered. All groups checked a list of traumatic life events to determine the exposed traumatic events. Results There was no statistical significance between three groups in terms of Dissociative Experiences Scale scores (P=0.07). But Beck Depression Inventory and Traumatic Stress Symptoms Scale scores of trichotillomania and skin picking groups were significantly higher than the control group. Subjects with a diagnosis of trichotillomania and skin picking reported statistically significantly higher numbers of traumatic and negative events in childhood compared to healthy subjects. Conclusion We can conclude that trauma may play a role in development of both trichotillomania and skin picking. Increased duration of trichotillomania or skin picking was correlated with decreased presence of post-traumatic stress symptoms. The reason for the negatively correlation of severity of post-traumatic stress symptoms and self-harming behavior may be speculated as developing trichotillomania or skin picking symptoms helps the patient to cope with intrusive thoughts related to trauma. Future longitudinal research must focus on whether trauma and post-traumatic stress or trichotillomania and skin picking precede the development of mental disorder.

Prevalence of adult attention deficit hyperactivity disorder in the relatives of patients with bipolar disorder

Objective. We hypothesized that relatives of bipolar patients would have increased rate of attention deficit hyperactivity disorder (ADHD) and subsyndromal manifestations compared to demographically matched relatives of healthy controls. Method. Forty consecutive patients with bipolar disorder were recruited from inpatient and outpatient units of Sisli Etfal Teaching and Research Hospital, Psychiatry Department. Seventy-three first-degree relatives of bipolar disorder group were included. A control group of first-degree relatives of individuals without DSM-IV Axis I psychopathology were also recruited. The Turkish version of the Structural Clinical Interview for DSM-IV, Wender Utah Rating Scale, Turgays Adult ADD/ADHD DSM-IV based Diagnostic and Rating Scale were administered to participants. Results. Overall rate of adult ADHD in RBD group was significantly higher than RC group (9.6 vs. 1.5%; P = 0.04). Participants with adult ADHD in the RBD group had significantly higher rate of alcohol abuse compared to those without adult ADHD (14.3 vs. 1.5%; P = 0.05). Rates of OCD and dysthimia were significantly higher in the subjects with ADHD in the RBD group than the subjects without ADHD (28.6 vs. 4.5%; P = 0.02, 14.3 vs. 1.5%; P = 0.05 respectively). Conclusion. Our findings indicate that relatives of bipolar patients have a risk for suffering from ADHD, and support the hypothesis that relatives of bipolar patients are at a risk for developing attentional and behavioral problems.

Aripirazole augmentation in clozapine-associated obsessive-compulsive symptoms in schizophrenia.

ObjectivePatients with schizophrenia often experience comorbid obsessive-compulsive symptoms. Within these patients, a significant subgroup developed secondary obsessive-compulsive symptoms during treatment with clozapine.MethodIn this paper, we report on four cases in which adjunctive therapy with aripiprazole was tested to alleviate obsessive-compulsive symptoms in schizophrenia.ResultsAll four patients had a significant improvement in obsessive-compulsive symptoms. The combination of clozapine and aripiprazole was well tolerated.ConclusionThis case series demonstrates the clinical efficacy of aripiprazole adjunctive therapy with clozapine in schizophrenic patients with comorbid obsessive-compulsive symptoms. Larger-sampled and controlled studies are required in order to test and confirm these observations.

Childhood, adolescent and adult age at onset and related clinical correlates in obsessive–compulsive disorder: a report from the International College of Obsessive–Compulsive Spectrum Disorders (ICOCS)

Abstract Objective: Many studies suggest that age at onset (AAO) is an important factor for clinically differentiating patients with juvenile and adult onset of obsessive–compulsive disorder (OCD). The present international study aimed to assess the prevalence of different AAO groups and compare related socio-demographic and clinical features in a large sample of OCD patients. Methods: A total of 431 OCD outpatients, participating in the ICOCS network, were first categorised in groups with childhood (≤12 years), adolescent (13–17 years) and adult-onset (≥18 years), then in pre-adult and adult onset (≥18 years) and their socio-demographic and clinical features compared. Results: Twenty-one percent (n = 92) of the sample reported childhood onset, 36% (n = 155) adolescent onset, and 43% (n = 184) adult onset. Patients with adult onset showed a significantly higher proportion of females compared with the other subgroups (χ2 = 10.9, p< 0.05). Childhood- and adolescent-onset patients had been more frequently treated with cognitive behavioural therapy (CBT), compared to adult-onset patients (χ2 = 11.5; p < 0.05). The pre-adult- versus adult-onset analysis did not show any additional significant difference. Conclusions: The present international multicentre study confirms that OCD onset occurs more frequently before adult age, with approximately one out of five patients showing childhood onset. Pre-adult onset was associated with higher rate of CBT, while adult onset was more prevalent in females.

Major Depressive Disorder, Mental Health Care, and the Use of Guidelines in the Middle East

A large gap exists between the number of people needing treatment and the number of people receiving treatment for depression in the Middle East. Barriers to mental health care in the region have included the lack of education for primary health care providers about mental illnesses, the scarcity of trained mental health care specialists, the lack of resources in developing countries, and the stigmatization of mental illness in Middle Eastern cultures. Guidelines for the treatment of depression have not been developed in most countries of the region. Guidelines have been published for both general practitioners and for psychiatrists in Turkey, and they are similar to guidelines published in the West. These guidelines are assessed using the AGREE instrument. Although guidelines recommend antidepressants as a first-line treatment for depression, many physicians in Middle Eastern countries prescribe benzodiazepines. One reason for this treatment gap may be that patients with depression often seek treatment from primary care providers and report somatic symptoms. Primary care providers may not be as knowledgeable about the diagnosis of depression or its treatment as psychiatrists and may not have access to certain classes of medications. More education for both physicians and patients in the Middle East is needed to decrease the stigma associated with depression.

The relationship between childhood sexual/physical abuse and sexual dysfunction in patients with social anxiety disorder

Abstract Background: Childhood traumatic events are known as developmental factors for various psychiatric disorders. Objective: The aim of this study was to investigate the effects of childhood sexual and physical abuse (CSA/CPA), and co-morbid depression on sexual functions in patients with social anxiety disorder (SAD). Method: Data obtained from 113 SAD patients was analysed. Childhood traumatic experiences were evaluated using the Childhood Trauma Questionnaire, and the Arizona Sexual Experience Scale was used for the evaluation of the sexual functions. The data from interviews performed with SCID-I were used for determination of Axis I diagnosis. The Beck Anxiety Scale, Beck Depression Scale and Liebowitz Social Anxiety Scale were administered to each patient. Results: History of childhood physical abuse (CPA) was present in 45.1% of the SAD patients, and 14.2% had a history of childhood sexual abuse (CSA). Depression co-diagnosis was present in 30.1% of SAD patients and 36.3% had sexual dysfunction. History of CSA and depression co-diagnosis were determined as two strong predictors in SAD patients (odds ratio (OR) for CSA, 7.83; 95% CI, 1.97–31.11; p = 0.003 and OR for depression, 3.66; 95% CI, 1.47–9.13; p = 0.005). Conclusions: CSA and depression should be considered and questioned as an important factor for SAD patients who suffer from sexual dysfunction.