Ömer Şenormancı

Attachment and family functioning in patients with Internet addiction

OBJECTIVE Although the Internet is used effectively in many areas of life, some users experience problems because of over-use due to a lack of control. The diagnostic criteria for Internet addiction include disruptions in family relationships, but adequate data on the attachment styles and family functioning associated with this condition are limited. This study aimed to investigate the attachment styles and family functioning of patients with Internet addiction. METHOD The sample included 30 male patients consecutively admitted to the Bakırköy Mental Health and Research Hospital Internet Addiction Outpatient Clinic, who were diagnosed in clinical interviews as having Internet addiction according to Youngs (1998) criteria. Thirty healthy males who were matched with the experimental group in terms of sociodemographic characteristics were included as control subjects. Both groups provided sociodemographic data and completed the Beck Depression Inventory (BDI), the Experiences in Close Relationships Questionnaire-r (ECR-r) and the Family Assessment Device (FAD). RESULTS Patients with Internet addiction had higher BDI scores (P<.001) and higher attachment anxiety subscores on ECR-r (P<.001) compared with those in the control group. Patients with Internet addiction evaluated their family functioning as more negative and reported problems in every aspect addressed by the FAD. Scores on the FAD behaviour control, affective responsiveness, and problem-solving subscales (P<.05) and on the FAD communication, roles, and general functioning subscales (P<.001) were significantly higher in the patient compared with the control group. CONCLUSION Patients with Internet addiction have more anxious attachment styles as well as prominent disruptions in family functioning. Thus, it may be important to evaluate the attachment styles and family functioning of patients with Internet addiction. Indeed, comprehensive treatment approaches including other family members may make important contributions to treatment success.

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.

The Relationship between Quality of Life and Cognitive Functions, Anxiety and Depression among Hospitalized Elderly Patients.

Objective Older people seek not only a longer life, but also a better quality of life (QOL). Our aim was to find out the relationship between QOL and socio-demographic factors, social activities, cognitive status, depression and anxiety symptoms among medically ill and hospitalized elderly people in Turkey. Methods Two hundred forty three patients age 65 years or older were examined. The Socio-demographic Data Survey, the Mini Mental State Examination (MMSE), the Geriatric Depression Scale-short form (GDS-15), the Beck Anxiety Inventory (BAI) and the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) were applied to participants. The independent samples t-test and analysis of variance (ANOVA) were used to analyze quantitative data. Pearson’s correlation and linear regression analysis were performed. Results The total score for QOL was significantly higher for those who saw their family members and relatives frequently rather than rarely (p=0.002), who were always busy with social activities rather than rarely or never (p<0.001), who had more years of education (p=0.003), and who were frequently exercising (p=0.023). According to linear regression analysis, the WHOQOL-OLD total score increased by 0.295 and −0.936 units, while MMSE and GDS-15 scale scores increased one unit respectively (β=0.295, t=1.979, p=0.04; β=−0.936, t=−4.881, p<0.001). Conclusion Cognitive disabilities, depression, and other psychiatric problems along with medical disease negatively affect the QOL of elderly patients. While performing medical assessment regarding elders, detecting and treating cognitive disabilities and depression is very valuable in improving the QOL of elderly patients.

The mediator role of ruminative thinking style in the relationship between dysfunctional attitudes and depression

BACKGROUND The main aim of the present study was to examine whether ruminative thinking styles (brooding and reflection) mediate the effects of dysfunctional attitudes on depressive symptoms. METHODS 120 psychotropic drug-naive first episode depression patients recruited from Bulent Ecevit University School of Medicine psychiatry department and Zonguldak State Hospital psychiatry department outpatient clinics were involved in the study. Participants completed 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). Regression analyses together with the Sobel tests were performed for testing the mediator hypothesis. RESULTS According to the path model, the level of brooding fully mediated the relationship between dysfunctional attitudes and depressive symptomatology but reflection did not play a mediator role in the relationship between dysfunctional attitudes and depressive symptoms. CONCLUSIONS Assessment of brooding with both mental status examination and specific measurements and focusing on brooding as an intervention strategy would be beneficial components for an effective treatment of depression.

Childhood trauma and suicide risk in the population living in Zonguldak Province.

No previous study has investigated the association between early trauma and suicidal behavior in Zonguldak. The aim of this study was to investigate the incidence of childhood abuse and neglect in the general population living in Zonguldak province and the relationship between childhood trauma and suicidal ideations and attempts.

Phenomenological subtypes of mania and their relationships with substance use disorders

OBJECTIVE The aim of the present study was to determine the distinct clusters of subtypes among patients with bipolar disorder (BD) and the relationship between the clinical features of BD patients, particularly substance use disorders (SUDs) and the clusters. METHOD The present study initially assessed 96 inpatients who were hospitalized in the psychiatric clinic of Bakırköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology, for a BD manic episode. All patients were evaluated during the initial 3 days of their admission using the Young Mania Rating Scale (YMRS), the Montgomery-Asberg Depression Rating Scale (MADRS),the Scale for the Assessment of Positive Symptoms (SAPS), the Michigan Alcoholism Screening Test (MAST) and a sociodemographic questionnaire. The factor structures of the psychopathological scale items were determined with factor analyses and based on the factor loadings, cluster analyses were performed. The relationships among the clusters and the clinical variables were then evaluated. RESULTS The factor analyses generated three factors: increased psychomotor activity, dysphoria, and psychosis. A hierarchical cluster analysis was applied to the three factor loadings, and revealed that factor 1 (increased psychomotor activity) was high in cluster 1 and that the effects of factors 2 (dysphoria) and 3 (psychosis) were high in cluster 2. Within cluster 1 (Psychomotor elevation), 39% of patients were diagnosed with an alcohol use disorder while 31.6% of patients in the cluster 2 (dysphoric-psychotic) were diagnosed with both alcohol and cannabis use disorders. Within cluster 2 (dysphoric-psychotic), 47.4% of patients had one suicide attempt and 21.1% of patients had two or more attempts during their lifetime. CONCLUSION There was a significant difference in the presence of SUDs between patients with psychomotor elevation and patients in dysphoric-psychotic cluster. This may be point out that pure manic patients with BD self-medicate using the sedative effects of alcohol and the causal relationship between cannabis and psychosis. Using a dimensional approach to study BD may enhance detection of the biological correlates of BD and improve the treatment and outcomes of the disorder.

Compulsive modafinil use in a patient with a history of alcohol use disorder

To the Editor,The mechanism of action of modafinil, a nonamphetamine stimu-lant, remains unknown [1,2].Modafinil is prescribed for a variety ofmedical conditions including narcolepsy, obstructive sleep apnea, shiftwork sleep disorder and bipolar depression [3,4].Modafinil is a dopamine transporter inhibitor [5] with low abuseliability; its efficacy has been investigated for the treatment of cocaine,methylphenidate and alcohol addiction [6–8]. However, few studieshave been conducted on the addictive potential of modafinil, althoughit has been suggested that modafinil should be used with caution[2,3,8]. An association between modafinil use and pathological gam-blinghasbeenreported,possiblyduetothepotentiationofthedopami-nergic system [9]. To the best of our knowledge, the case describedherein represents the first report of compulsive modafinil use, whichoccurred following 2 years of modafinil treatment.A 34-year-old male presented with a history of recurrent depressionandalcoholaddictionfor11years.Hewasadmittedtoourclinicanddiag-nosed with major depression with psychotic features 3 years previously;psychiatric outpatient follow-up was irregular. The patient was treatedwith various psychotropic medications (e.g., Selective serotonin reuptakeinhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs)and Tricyclic antidepressants (TCAs) antidepressants, benzodiazepinesand carbamazepine). Due to abuse, benzodiazepine treatment wasdiscontinued 2 years previously. The patient complained of oversleep-ing,fatigueandanhedonianotrelievedbymedication.Laboratoryanal-ysisrevealednoabnormalities,andneurologicalevaluationwasnormal.Two years previously, modafinil was added to his treatment regimen,which comprised duloxetine at 60 mg/day, bupropion at 150 mg/day,modafinil at 200 mg/day and amisulpride at 400 mg/day. This regimenwas maintained for 1.5 years; the patient reported that it increased hisenergy levels.Followinga6-monthabsence,thepatientreportedtoourclinicstatingthat he had increased the dose of modafinil to 35 tablets per day(3500 mg/day),usingtabletsprescribe datnonpsychiatricandpsychiatricoutpatientclinicsorpurchasedwithoutprescription.Weofferedhospi-talizationoroutpatientfollow-up;thepatientdeclinedtobehospitalized.No signs of modafinil addiction were detected, and we altered his treat-ment regimen as follows: modafinil dose was gradually decreased;duloxetine was increased to 90 mg/day; bupropion and amisulpridedoses were maintained at current le vels; and carbamazepine was addedat 600 mg/day,Modafinildopaminereceptoraffinityissimilartothatofmethylphe-nidate, suggesting possible abuse liability [2,10]. In the present case,modafinil was used for treatment-resistant depression, and it amelio-ratedoversleeping,fatigueandanhedonia.However,thepatientreportedthat dose escalation was necessary to maintain his improved mood. Wesuggested that the duloxetine dose be increased instead and that thedose of modafinil be decreased gradually, given its stimulant action. Toreduce impulsivity, we suggested carbamazepine as more appropriatecompared with modafinil dose escalation because modafinil sharesstructuralsimilaritieswithcocaine [11].Accordingtothemostrecentpsy-chiatric records obtained from another hospital, the patient applied toother psychiatricclinicsand decreased hismoda finildosageto vetab-lets per day (500 mg/day) in accordance with our suggested treatmentregimen. At the most recent psychiatric follow-up, also at another clinic,amisulpride was ceased following consultation with our unit.During sensitization, behavioral and neurochemical responses aftersubstance abuse are potentiated [12], a process that can underlie addic-tive behavior. D1 receptors represent one possible mediator of sensitiza-tion [13].Amisulprideexhibitsonlymarginalaf finityforthepostsynapticD1 receptor [14], but this would be exacerbated by the dopamine re-uptake inhibitory effects of bupropion [15] and modafinil. Compulsivemodafinil use may beassociated withthe increase insynaptic dopaminetransmission that preferentially st imulates postsynaptic D1 receptors.Modafinil may exertdifferenteffectsin accordance withpersonalityprofile [16]; no personality measurement instruments were applied inthe present case, which represents a limitation to the study.In conclusion, in patients with a history of addiction and low treat-ment compliance, dopamine-enhancing medication should be usedwithcaution;potentialinteractionswith other prescribeddrugs shouldbe considered to reduce the likelihood of compulsive use.Melek Cengiz Mete MDOmer Şenormanci MDOzge Saracli MDNuray Atasoy MDLevent Atik MDProfessor, Bulent Ecevit University School of Medicine, PsychiatryZonguldak, TurkeyE-mail address: senorman_7@hotmail.comAvailable online xxxxReferences

Hastanede Yatan Yaşlılarda Bilişsel İşlevlerin Günlük Yaşam Aktiviteleri, Depresyon, Anksiyete ve Klinik Değişkenlerle İlişkisi

INTRODUCTION Cognitive impairment in elderly patients, which may be a sign of dementia, depression, anxiety or medical diseases, has been determined as a risk factor for functional loss. In this study, we aimed to investigate the frequency of cognitive impairment and to investigate the relationship of cognitive status with sociodemographic variables, daily living activities, anxiety and depression in elderly inpatients. METHOD The sample of this cross-sectional and descriptive study consists of 243 patients aged 65 years and older who were hospitalized in Bülent Ecevit University Hospital. A sociodemographic questionnaire,, the Mini-Mental State Examination (MMSE), Activities of Daily Living Scale, Lawton-Brody Instrumental Daily Activities Scale, Geriatric Depression Scale (GDS) and the Beck Anxiety Inventory were used for data collection. RESULTS One hundred and six (43.6%) patients were female and 137 (56.4%) were male. The patients were divided into two groups according to the Mini-Mental State Examination (MMSE) 23/24 cut-off score. The cognitive decline was statistically significantly more frequent in patients who were older, female, less educated, low socioeconomic status, and living in rural areas. There were more problems in the basic and instrumental activities of daily living and nutrition in patients with cognitive decline. Anxiety and depression scores were higher in this group. In our study, although the frequency of cognitive decline and depression according to GDS were 56% and 48%, respectively; we found that only 10.5% of patients applied to the psychiatrist, and 9.3% of patients received psychiatric treatment. CONCLUSION Cognitive decline may cause deterioration in the daily living activities, nutrition and capacity for independent functioning. Older age, female, low education, low socioeconomic status and living in rural area are important risk factors for cognitive impairment. Cognitive decline in older age may be associated with depression and anxiety. We assume that when cognitive decline, depression and other psychiatric problems are unidentified, it may contribute to deterioration of mental health in medically ill elderly.

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.

Gender differences in romantic jealousy and attachment styles

ABSTRACT Objective: We examined the gender differences and attachment styles with regard to the phenomenology of jealousy among married individuals. Method: The study included 86 married couples who presented to the Marriage Counselling Centre at the Bakırköy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery. Subjects were evaluated in terms of sociodemographic data, the Romantic Jealousy Questionnaire, and the Adult Attachment Style Scale. Results: In our population, 79% of males and 66% of females defined themselves as jealous. Females had higher emotional and cognitive scores than male participants. Females had higher scores on the negative effects of jealousy. Female commitment scores were higher than those of males. Ambivalent attachment was positively correlated with physical, emotional, and behavioural responses to jealousy and inadequacy as a reason for jealousy. Conclusions: We suggest that a multidimensional approach permits to identify and guide responses to the challenge of romantic jealousy.