Taner Oznur

Assessment of dissociation among combat-exposed soldiers with and without posttraumatic stress disorder

Background Dissociation is a disruption of and/or discontinuity in the normal, subjective integration of one or more aspects of psychological functioning, including memory, identity, consciousness, perception, and motor control. A limited number of studies investigated combat-related dissociation. Objective The primary aim of this study was to evaluate the relationship between dissociative symptoms and combat-related trauma. Method This study included 184 individuals, including 84 patients who were exposed to combat and diagnosed with posttraumatic stress disorder (PTSD) (Group I), 50 subjects who were exposed to combat but were not diagnosed with PTSD (Group II), and 50 healthy subjects without combat exposure (Group III). The participants were evaluated using the Dissociative Experiences Scale (DES) to determine their total and sub-factor (i.e., amnesia, depersonalization/derealization, and absorption) dissociative symptom levels. In addition, Group I and Group II were compared with respect to the relationship between physical injury and DES scores. Results The mean DES scores (i.e., total and sub-factors) of Group I were higher than those of Group II (p<0.001), and Group IIs mean DES scores (i.e., total and sub-factors) were higher than those of Group III (p<0.001). Similarly, the number of subjects with high total DES scores (i.e.,>30) was highest in Group I, followed by Group II and Group III. When we compared combat-exposed subjects with high total DES scores, Group I had higher scores than Group II. In contrast, no relationship between the presence of bodily injury and total DES scores could be demonstrated. In addition, our results demonstrated that high depersonalization/derealization factor scores were correlated with bodily injury in PTSD patients. A similar relationship was found between high absorption factor scores and bodily injury for Group II. Conclusions Our results demonstrated that the level of dissociation was significantly higher in subjects with combat-related PTSD than in subjects without combat-related PTSD. In addition, combat-exposed subjects without PTSD also had higher dissociation levels than healthy subjects without combat experience.

The ratios of 2nd to 4th digit may be a predictor of schizophrenia in male patients

The production of androgens (mostly testosterone) during the early fetal stage is essential for the differentiation of the male brain. Some authors have suggested a relationship between androgen exposure during the prenatal period and schizophrenia. These two separate relationships suggest that digit length ratios are associated with schizophrenia in males. The study was performed in a university hospital between October 2012 and May 2013. One hundred and three male patients diagnosed with schizophrenia according to DSM‐IV using SCID‐I, and 100 matched healthy males, were admitted to the study. Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS) and Brief Psychiatric Rating Scale (BPRS) were used to assess schizophrenia symptoms. The second digit (2D) and fourth digit (4D) asymmetry index (AI), and the right‐ and left‐hand 2D:4D ratios were calculated. All parametric data in the groups were compared using an independent t‐test. The predictive power of the AI was estimated by receiver operating characteristics analysis. The 2D:4D AI was statistically significantly lower in the patient group than the healthy control comparison group. There were significant differences between the schizophrenia and the control groups in respect of left 2D:4D and right 2D:4D. There was no correlation between AI, left, or right 2D:4D, BPRS, or SAPS in the schizophrenia group. However, there was a negative correlation between left 2nd digit (L2D):4D and the SANS score. Our findings support the view that the 2D:4D AI can be used as a moderate indicator of schizophrenia. Even more simply, the right or left 2D:4D can be used as an indicator. L2D:4D could indicate the severity of negative symptoms. Clin. Anat. 28:551–556, 2015.

A rare symptom in posttraumatic stress disorder: Spontaneous ejaculation

Patient: Male, 25 Final Diagnosis: Post Traumatic Stress Disorder Symptoms: Insomnia • nightmares • spontaneous ejaculation Medication: Paroxentine Clinical Procedure: — Specialty: Psychiatry Objective: Unusual clinical course Background: Sexual dysfunction is reported to occur more frequently in posttraumatic stress disorder (PTSD) patients than in the general population. Herein, we present the case of a patient with spontaneous ejaculation that developed when severity of PTSD symptoms increased. Case Report: Our patient was a 25-year-old single man admitted to a psychiatric polyclinic because of PTSD symptoms and concurrent spontaneous ejaculations. He was diagnosed with PTSD after clinical interviews. Organic pathology to explain spontaneous ejaculations was not detected. Paroxetine treatment was initiated and PTSD symptoms and frequency of spontaneous ejaculations were decreased at the clinical follow-up. Conclusions: Assessment of the presented case in the light of the literature indicates that his re-experiencing (flashbacks, nightmare) and hyperarousal (symptoms of anxiety specific to PTSD) led to an increase in adrenergic system activation and, consequently, spontaneous ejaculation without sexual stimulus. The effect of Paroxetine in decreasing the frequency of spontaneous erection and ejaculation in the presented case is thought to have occurred via control of PTSD symptoms and their adverse effects on ejaculation. Treatment based on a consideration of PTSD symptoms and autonomic instability might increase the positive outcome rate in such patients.

Low-dose Clozapine-induced Seizure: A Case Report

Seizures are believed to be a dose-dependent side effect of clozapine. In this case report, we describe a patient who had tonic-clonic seizures after using a low dose clozapine who did not have any seizure risk. The 29-year-old male patient had been followed-up with a diagnosis of schizophrenia for about 5 years. When using clozapine 200 mg/day he had a tonic-clonic seizure with bilateral diffuse epileptic activity in electroencephalography (EEG). In the literature, there are a few case reports about low-dose clozapine-induced seizure. Seizures were observed in our case with a low dose of clozapine (200 mg/day) making this case remarkable. EEG monitoring at regular intervals and examination of plasma levels of clozapine could be useful in preventing the development of seizures.

The Effect of Stress and Depression on Gastrointestinal Diseases

TO THE EDITOR: In a recent issue of the Journal of Neurogastroenterology and Motility, we were very interested in the article by Lee et al1 entitled “The Effect of emotional stress and depression on the prevalence of digestive diseases” in which the investigators reported that stress and depression are related to various digestive diseases and may be predisposing factors for functional dyspepsia and irritable bowel syndrome, and that depression may be a predisposing factor for gastric cancer. This study is well designed but we would like to comment on some of the factors that can affect depression and stress as these may shed new light on the author’s interpretations. Large-scale studies that aim to determine psychological processes such as depression and stress levels in psychosomatic diseases such as gastrointestinal diseases should meticulously consider the risk factors that affect these processes. At the same time, the inclusion and exclusion criteria should be well structured. For example, the main factors that affect stress and depression levels are psychotropic medication and regular exercise. We know that both psychotropic medication2 and regular exercise3 decrease levels of depression and stress. The study by Lee et al1 did not specify whether or not participitants used psychotropic medication or exercised regularly, nor did it specify if these factors were used as exclusion or inclusion criteria. In addition, most women begin to experience emotional changes before and during menstruation period which are known as premenstrual syndrome (PMS).4 Symptoms of PMS include affective, physical, cognitive, and behavioral changes. Affective symptoms include irritability (ie, a cardinal symptom), mood swings, anxiety, and depression.5–6 These psychological symptoms do not only occur during PMS but can also be seen during and after menopause. Upon entering menopause, women may experience a wide range of feelings, from anxiety and discomfort to release and relief.7–8 Thus, stress and depression levels show fluctuations during the menstrual cycle and menopausal period. In this study, the authors did not state the menstrual status of female individuals which could cause unnaturally lower or higher stress and depression levels. We think that it is highly important to examine these issues in order to reliably interpret the study results. Clarifying these 2 concerns will provide a clearer picture when interpreting stress and depression levels among participants.

Posttraumatic Stress Disorder Patients and Results of Violent Behavior

AIM: High levels of anger and aggression in post-traumatic stress disorder lead to unfavorable social, legal, physical and economic results to family members and the other social layers as much as patients. In this study, it is aimed to investigate the relation between both alcohol-cigarette consumption ratios and anger levels, characteristics of aggressive behaviors and the judicial outcome in cases diagnosed post-traumatic stress disorder due to armed conflict. METHODS: 38 cases diagnosed as post-traumatic stress disorder were included to the study. Pre- and post-traumatic alcohol/cigarette consumption amounts and aggressive behaviors are determined. Impact of Events Scale (Revised) (IES-R) was used for evaluating post-traumatic stress disorder symptom patterns and severity, Buss Perry Aggression Questionnaire was used for measuring anger and aggression levels, and Taylor’s Violence Rating Scale was used for evaluating the judicial outcome of aggression. RESULTS: 23 of cases (60.6%) were married with children, 13 of cases (34.25) were single and 2 of cases (5.2%) were divorced.18 of cases (47.4%) were graduate. IES-R total score was 66,9 ± 12,7, Buss Perry total score was 111,3 ± 20,5, and Taylor’s Violence Rate was 2,5 ± 1,0. When the pre- and post-traumatic aggressive behaviors were compared; physical violence to the partner was increased more than ten times, Physical and verbal violence to social individuals were increased more than four and seven times, respectively. And also it is observed that inflicting damage to property was increased 17 times, reckless driving was increased 11 times, and self-mutilation was increased 5 times. Alcohol consumption was determined as 0 (0 - 126) g/day for pre-trauma cases and 16.5 (0 - 294) g/day for post-trauma cases. Cigarette smoking was determined as 5 (0 – 40) cigarette/day for pre-trauma cases and 30 (0 -60) cigarette/day for post-trauma cases. CONCLUSION: Post-traumatic stress disorder associated with high levels of anger and aggression and alcohol can cause familial-marital problems, breaking up a family, increase in judicial problems and arrest, increase in ratios of self-mutilation and severe bodily injuries, physical violence to patterns and children, progressing of post-traumatic stress disorder, severe mental situations such as depression and suicide. For these reasons, careful detecting of alcohol-drug abuse and overstimulation symptoms as anger/aggression in post-traumatic stress disorder, and rapid target-driven psychopharmacologic and psychotherapeutic interventions Become more of an issue.

Low-dose clozapine-induced retrograde ejaculation: Letters to the Editor

Retrograde ejaculation (RE) is the absence of ejaculation despite presence of orgasm. The reason for a large number of RE cases is medications used in treatments. Number of RE developed secondary to use of clozapine is very limited. In the following case a clozapine induced RE is reported.

Depression and Cytokines; a different perspective

no summary.

Possible relationship between amino acids, aggression and psychopathy.

Abstract Objective: Aggressive behaviour is associated with reduced serotonin metabolism in the brain, but there is not enough knowledge on potential changes of the serotonin precursor levels among violent offenders. In this study, we aimed to evaluate the relationships among the tendency of psychopathy, anger and the basic amino acids. Methods: Fifty-two young adult male patients with antisocial personality disorder (APD) and 30 healthy men included the study. Serum amino acid levels were measured by HPLC method. Aggression questionnaire and Hare Psychopathology Scale were used for all participants. Results: Blood levels of phosphoserine, aspartic acid, glutamic acid, aminoadipic acid and 1-methylhistidine in group of patients with APD were significantly higher than the control group. Blood levels of TRP, asparagine, citrulline, cystine, isoleucine, tyrosine, histidine, hydroxylysine, lysine, ethanolamine and arginine in the group of patients were found lower than the control group. A significant positive correlation between anger scores and histidine, methionine and GABA was found. GABA and methionine showed a significant correlation with the indirect aggression score. Conclusion: Our study showed a relationship between serum amino acid levels and the scores of aggression and psychopathy. We think that this is a productive research area for understanding the relationship among biochemical factors, aggression and psychopathy.

The relationship between the level of aggression and the sleep quality in patients with posttraumatic stress disorder

Subject: Sleep disorders are common problems in post-traumatic stress disorder (PTSD) patients. The main symptoms associated with sleep disorders were reported as a reduction in total sleep time, prolonged sleep latency, increase in the number wakefulness, low sleep efficiency and a reduction in the percentage of deep sleep stages. A relation between sleep disorders and increased levels of aggression was determined. In this study, we aimed to examine the relationship between the quality of sleep and the level of aggression in patients with Post Traumatic Stress Disorder. Method: The study was included 48 patients with a diagnosis of PTSD who were hospitalized. Data were collected using post-traumatic stress disorder questionnaire scale, Pittsburgh sleep quality scale and the Buss-Perry Aggression Scale applied by the clinician. Data analysis was made using SPSS 15.0 package program. Descriptive statistics and Pearson’s correlation test were used in statistical analysis. Results: The average age of the cases was 32.33 ± 7.93, the average of the symptoms of post-traumatic stress disorder was 56.23 ± 11.14, the average of sleep quality was 22.08 ± 6.67 and the average of aggression levels was 51.67 ± 7.48. There was a high level deterioration in sleep quality and aggression levels were medium/medium-high levels. It was determined that Buss-Perry Aggression Scale scores were positively correlated with Pittsburgh sleep quality and posttraumatic stress disorder total and hyper arousal subscale scores. Conclusion: In this study, it is stated that increase in overstimulation symptoms and degradation of sleep in PTSD patients cause increase in agression levels. Degradation of sleep is determined as an indicator of agression that is observed in TSSB patients. Associatively, in PTSD patients, use of interventions to improve the quality of sleep oriented agressive behaviours gain value