Orhan Doğan

Childhood Trauma, Dissociation, and Psychiatric Comorbidity in Patients With Conversion Disorder

OBJECTIVE The aim of this study was to evaluate dissociative disorder and overall psychiatric comorbidity in patients with conversion disorder. METHOD Thirty-eight consecutive patients previously diagnosed with conversion disorder were evaluated in two follow-up interviews. The Structured Clinical Interview for DSM-III-R, the Dissociation Questionnaire, the Somatoform Dissociation Questionnaire, and the Childhood Trauma Questionnaire were administered during the first follow-up interview. The Structured Clinical Interview for DSM-IV Dissociative Disorders was conducted in a separate evaluation. RESULTS At least one psychiatric diagnosis was found in 89.5% of the patients during the follow-up evaluation. Undifferentiated somatoform disorder, generalized anxiety disorder, dysthymic disorder, simple phobia, obsessive-compulsive disorder, major depression, and dissociative disorder not otherwise specified were the most prevalent psychiatric disorders. A dissociative disorder was seen in 47.4% of the patients. These patients had dysthymic disorder, major depression, somatization disorder, and borderline personality disorder more frequently than the remaining subjects. They also reported childhood emotional and sexual abuse, physical neglect, self-mutilative behavior, and suicide attempts more frequently. CONCLUSIONS Comorbid dissociative disorder should alert clinicians for a more chronic and severe psychopathology among patients with conversion disorder.

Prevalence of dissociative disorders among women in the general population

This study sought to determine the prevalence of dissociative disorders among women in the general population, as assessed in a representative sample of a city in central Turkey. The Dissociative Disorders Interview Schedule (DDIS), the Borderline Personality Disorder section of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II), and the PTSD-Module of the Structured Clinical Interview for DSM-III-R (SCID) were administered to 628 women in 500 homes. The mean age of participants was 34.8 (S.D.=11.5, range: 18-65); 18.3% of participants (n=115) had a lifetime diagnosis of a dissociative disorder. Dissociative disorder not otherwise specified (DDNOS) was the most prevalent diagnosis (8.3%); 1.1% of the population was diagnosed as having dissociative identity disorder (DID). Participants with a dissociative disorder had borderline personality disorder, somatization disorder, major depression, PTSD, and history of suicide attempt more frequently than did participants without a dissociative disorder. Childhood sexual abuse, physical neglect, and emotional abuse were significant predictors of a dissociative disorder diagnosis. Only 28.7% of the dissociative participants had received psychiatric treatment previously. Because dissociative disorders are trauma-related, significant part of the adult clinical consequences of childhood trauma remains obscure in the minds of mental health professionals and of the overall community. Revisions in diagnostic criteria of dissociative disorders in the DSM-IV are recommended.

Social Phobia Among University Students and Its Relation to Self-Esteem and Body Image.

Objective: To demonstrate the prevalence of social phobia and its relation to body image and self-esteem. Method: Study participants were 1003 students recruited from Cumhuriyet University as a randomized sample. Subjects were administered the Diagnostic Interview Schedule-III-Revised (DIS-III-R) Social Phobia Scale, the Rosenberg Self-Esteem Scale, and the Multidimensional Body–Self Relations Questionnaire (MBSRQ). We analyzed the data, using Fishers exact chi-square test. Results: Lifetime prevalence of social phobia among university students was 9.6% and past-year prevalence was 7.9%. Self-esteem was lower (P < 0.05) among those with social phobia than among those without social phobia. Students with social phobia had lower scores on the MBSRQ than did those without social phobia (P < 0.0001). Conclusions: The results show that persons with social phobia have lower self-esteem and more distorted body image than do those without social phobia.

The distribution of symptoms of attention- deficit/hyperactivity disorder and oppositional defiant disorder in school age children in Turkey

ObjectiveThe aim of this study was to determine the prevalence of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in school age children in Sivas province centre and to examine the distribution of symptoms according to subtypes.MethodThe study population was made up of 1425 children between the ages of 6 and 15 from eight primary schools selected by random sampling method in Sivas province centre. All students were given a questionnaire prepared according to DSMIV criteria that was completed by their parents or teachers. This form includes 18 symptoms of ADHD and eight symptoms of ODD. Student’s t-test and variance analysis were used for statistical evaluation.ResultsA prevalence of 8.1% was found for ADHD in our study. According to subtypes, 32.2% of these were “inattentive”, 40% were “hyperactive” and 27.8% were combined type. A prevalence of 11.5% was found for ODD. The boy/girl ratio was > 1 for both ADHD and ODD, and 52.2% of those with ADHD were established as having ODD at the same time.ConclusionsThe prevalence of ADHD and ODD in primary school children was not considered to be small. Studies concerning the distribution of symptoms in different societies, cultures, and viewpoints and identification of children with this type of problem are beneficial for early diagnosis and prophylactic treatment.

Examination of free radical metabolism and antioxidant defence system elements in patients with obsessive–compulsive disorder

Free radicals and oxidative stress are involved in the pathogenesis of various diseases. Malondialdehyde (MDA) is a natural product of lipid peroxidation in all mammalian cells. Vitamins C and E are nonenzymatic antioxidant structures. Our study investigated the role of free radicals in the obsessive-compulsive disorder (OCD). The participants were 30 patients with OCD that were drug-free at least for a month and a control group of 30 healthy subjects, matched with respect to age and sex. In both groups, the levels of erythrocyte malondialdehyde and the plasma vitamin C and E concentrations were measured. The levels of malondialdehyde were significantly higher in the patient group than in the control group (p<.01). The levels of plasma vitamin E were significantly lower in the patient than in the control group (p<.02). Although our patient group had slightly lower concentrations of plasma vitamin C compared to our control group, the difference between these two groups was not statistically significant. There was a significant correlation between increasing malondialdehyde levels and decreasing vitamin E concentrations. This study shows the presence of a significant relationship of OCD and oxidative stress, and consequently, an involvement of free radicals and of the antioxidant defence. Biochemical studies may contribute to the understanding of OCD and its treatment.

Prevalence of anxiety disorders among elderly people

The objectives of this study are to determine current and lifetime prevalence of anxiety disorders and also to explore the relationship, if any, between possible risk factors and anxiety disorders, amongst elderly people living in the Sivas province of Turkey.

Serum cortisol and dehydroepiandrosterone‐sulfate levels in schizophrenic patients and their first‐degree relatives

Aims:  Alterations in cortisol and dehydroepiandrosterone sulfate (DHEA‐S) levels are thought to play a role in the pathophysiology of neuropsychiatric disorders, including schizophrenia. The aim of this study was to investigate the role of serum cortisol and DHEA‐S in the pathophysiology of schizophrenia.

Psychosocial approaches in outpatients with schizophrenia.

The objective of this study was to determine how psychosocial approaches to people with schizophrenia, in addition to treatment with psychotropic drugs, affect the course of the illness and family interactions. The project included people who were diagnosed with schizophrenia and hospitalized at least once. Twenty-three people completed the study. Brief Psychiatric Rating Scale (BPRS), WHO Quality of Life (WHOQOL-BREF-TR), Family Assessment Device (FAD), Specific Level of Functioning Scale (SLFS) and Multidimensional Scale of Perceived Social Support (MSPSS) were applied both at the beginning and at the end of the study. Two study teams visited the participants six times in their homes once per two weeks. At the end of the third month, improvements in social interactions and in family relationships were observed. According to the average score at baseline, BPRS average score was found to be significantly lower (p < 0.02); WHOQOL-BREF, SLFS and MSPSS average scores were found to be significantly higher (respectively p < 0.02, p < 0.0001, p < 0.05). The results of this study show that psychosocial approaches are beneficial especially in social skills and family relationships.

Evaluation of Laser Treatment on Reline-Base Composites

The effects of different laser treatments on some mechanical properties of acrylic resin and soft liner were investigated. A total of 60 test specimens were fabricated according to test requirements. The specimens were roughened with Potassium-ticanyl-Phosphate (KTP), Er:YAG, and Nd:YAG lasers before application of soft liner. The flexural, peel, and tensile bond strengths were measured using a universal testing machine. Fourier transform infrared spectroscopy with attenuated total reflectance (FTIR-ATR) spectra of surfaces were also obtained to evaluate changes on the lased surfaces. No significant difference was apparent between the tensile bond strength values of the groups. Although peel strength values obtained for each of the laser types were lower than those of the control group, flexural strength values were higher than those of the control specimens. The spectra of specimens showed that lasing led to some chemical changes on the resin surfaces. Physical changes on the treated surfaces were visualized by scanning electron microscopy (SEM) analysis. Results of this study suggest that such treatments may be warranted because of the increase in flexural strength.

Peel bond strength of two silicone soft liners to a heat-cured denture base resin.

PURPOSE This study investigated the peel strength of two different soft liners to a polymethylmethacrylate (PMMA) denture base resin before and after thermocycling. MATERIALS AND METHODS The silicone-based soft liner materials tested were Molloplast B and Permaflex; the denture base material was a heat-cured acrylic resin, Meliodent. A total of 40 specimens was prepared using rectangular molds with dimensions of 100 x 10 x 2 mm for PMMA and 150 x 10 x 2 mm for soft liners, as described in ASTM-D903-93. For each of the liner materials, 10 specimens were packed against a cured PMMA denture base surface as recommended by the manufacturers. The other 10 specimens were packed against PMMA denture base dough and processed together. In each group, 5 of the specimens were tested directly, while the other 5 were thermocycled in a water bath (5°C to 55°C; 3000 cycles) before testing. Peel testing was performed using an Instron testing machine. RESULTS The results revealed that peel strength values of the Permaflex specimens prepared according to the manufacturers recommendations were significantly higher than those of Molloplast B (p < 0.05). However, when packing was done against uncured PMMA dough, the difference between the specimens of two liners was not significant. Thermocycling led to significant decreases in the peel strength of both Permaflex liner specimens packed against cured/uncured PMMA resin surfaces (p < 0.05), whereas this process did not affect the strength of Molloplast B specimens. CONCLUSION Results indicated that the material Molloplast B was superior to the material Permaflex in terms of peel strength when the specimens were simultaneously polymerized with PMMA and thermocycled.