This study assesses childhood trauma history, dissociative symptoms, and dissociative disorders c... more This study assesses childhood trauma history, dissociative symptoms, and dissociative disorders comorbidity in patients with Panic Disorder (PD). Ninety two psychotropic drug-naive patients with PD, recruited from outpatient clinics in the psychiatry department of a Turkish hospital were involved in the study. Participants were assessed with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), Dissociation Questionnaire (DIS-Q), Panic and Agoraphobia Scale (PAS), Panic Disorder Severity Scale (PDSS) and the Childhood Trauma Questionnaire (CTQ). Eighteen (19 %) of the patients with PD had comorbid dissociative disorder diagnosis upon screening with SCID-D. The most prevalent disorders were dissociative disorder not otherwise specified (DDNOS), dissociative amnesia, and depersonalization disorders. Patients with a high degree of dissociation symptoms and dissociative disorder comorbidity had more severe PD than those without (P<0.05). All of the childhood trauma subscales used were correlated with the severity of symptoms of dissociation and PD. Among all subscales, the strongest relationship was associated with childhood emotional abuse. Logistic regression analysis showed that emotional abuse and severity of PD were independently associated with dissociative disorder. In our study, a significant proportion of the patients with PD had concurrent diagnoses of dissociative disorder. We conclude that the predominance of PD symptoms in admission should not lead the clinician to overlook the underlying dissociative process, and associated traumatic experiences among these patients.
Türk psikiyatri dergisi = Turkish journal of psychiatry, 2012
The aim of this study is to examine the population targeted by the violent behavior of psychotic ... more The aim of this study is to examine the population targeted by the violent behavior of psychotic patients and to provide data on the treatment and therapeutic support of psychiatric professionals based on our results. Eighty-one psychotic patients lacking criminal responsibility and under observation or mandatory treatment due to violent crime were compared with a control group of 31 persons with criminal responsibility. The sociodemographic features of the two groups' victims and descriptive data about the crimes and the target populations were examined and analyzed with SPSS 11. Patient and control groups were compared according to their relationships to their victims. Of psychotic patients' victims, 36.9% percent were family members, while in the non-psychotic group the proportion was 10%, a statistically significant difference (p<0.01). We also found a statistically significant difference between the two groups in the mean ages of their victims and in the proportions ...
Abstract
The relationship between Panic Disorder (PD) and dissociation is well known. In this st... more Abstract
The relationship between Panic Disorder (PD) and dissociation is well known. In this study we aimed to investigate whether or not dissociative experiences affect the response to PD drug treatment. For this purpose, standart dose of venlafaxine was preferred for treatment. 63 patients with PD were included in the study. Venlafaxine treatment with increasing dose was administered to each patient during a 10-week period. The Panic Disorder Severity Scale (PDSS) and the Dissociation Questionnaire (DIS-Q) were applied to the patients at the
beginning of the study. Patients were divided into two groups based on DIS-Q scores. PDSS was applied again to both groups at the end of 10-week treatment. No difference between sociodemographic data and PDSS scores of two groups – patients with low DIS-Q scores (b2.5) and high DIS-Q scores (N2.5) – was found at the beginning. At the end of the study, a significant decrease in PDSS scores measured in both groups was detected. However, the decrease in PDSS score for the group with lower DIS-Q score was at a higher percentage (z = −3.822, p = 0.0001). These results depict that dissociative symptoms accompanying PD affect psychopharmacological treatment in a negative way. Reevaluation of dissociative symptoms at the beginning and end of treatment would help in planning personal therapy.
Türk psikiyatri dergisi = Turkish journal of psychiatry, 2013
The aim of this study is to investigate the patterns of offense and treatment outcomes in patient... more The aim of this study is to investigate the patterns of offense and treatment outcomes in patients with schizophrenia who have exhibited violent behavior and to provide data for mental health professionals to aid in the treatment and therapeutic support of schizophrenia patients. The subjects included in this study include a total of 52 patients with schizophrenia who had committed violent crime and who were under observation or mandatory treatment, and a control group of 31 subjects who assumed full responsibility for the crime they were accused of. Patients with schizophrenia and control subjects were examined based on the assumption that prior exhibition of violent behavior may be a determining factor for socio-demographic characteristics and the early identification of violent crime. Life-long aggressive behavior was also examined using the Overt Aggression Scale (OAS). A total of 80.7% of the patients with schizophrenia were found to be paranoid subtype. The mean age of schizop...
The present study attempted to assess the dissociative symptoms and overall dissociative disorder... more The present study attempted to assess the dissociative symptoms and overall dissociative disorder comorbidity in patients with obsessivecompulsive disorder (OCD). In addition, we examined the relationship between the severity of obsessive-compulsive symptoms and dissociative symptoms.
All patients admitted for the first time to the psychiatric outpatient unit were included in the study. Seventy-eight patients had been diagnosed as having OCD during the 2-year study period. Patients had to meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD. Most (76.9%; n = 60) of the patients were female, and 23.1% (n = 18) of the patients were male. Dissociation Questionnaire was used to measure dissociative symptoms. The Structured Clinical Interview for Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition Dissociative Disorders interviews and Yale-Brown Obsessive Compulsive Checklist and Severity Scale were used. Eleven (14%) of the patients with OCD had comorbid dissociative disorder. The most prevalent disorder in our study was dissociative depersonalization disorder. Dissociative amnesia and dissociative identity disorder were common as
well. The mean Yale-Brown score was 23.37 ± 7.27 points. Dissociation Questionnaire scores were between 0.40 and 3.87 points, and the mean was 2.23 ± 0.76 points. There was a statistically significant positive correlation between Yale-Brown points and Dissociation Questionnaire points. We conclude that dissociative symptoms among patients with OCD should alert clinicians for the presence of a chronic and complex
dissociative disorder. Clinicians may overlook an underlying dissociative process in patients who have severe symptoms of OCD. However, a lack of adequate response to cognitive-behavioral and drug therapy may be a consequence of dissociative process.
The purpose of the study was to examine psychopathological traits and psychiatric co-morbidities ... more The purpose of the study was to examine psychopathological traits and psychiatric co-morbidities in seekers of cosmetic rhinoplasty. Fifty persons seeking cosmetic rhinoplasty and 50 control subjects were admitted to the study. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Symptom Checklist-90 [Revised] (SCL-90-R) were administered to people who requested cosmetic rhinoplasty and control subjects. All participants were also screened by the Structured Clinical Interview for DSM-IV-(SCIDI/CV, SCID-II). Thirteen cosmetic rhinoplasty seekers [CRS] (26%) and three control subjects (6%) had at least one psychiatric diagnosis. There was a significant difference between the two groups (p = 0.006). Beck depression inventory (p = 0.002) and BAI (p = 0.046) levels above the cut-off point were significantly higher in the CRS group than in the normal control. Somatoform disorders were statistically higher in the CRS than control group (p = 0.007). Nine CRS (18%) and two control subjects (4%) had at least one personality disorder. There were differences between the two groups (p = 0.025). The average of SCL-90-R was significantly higher in the CRS than in the control subjects (p < 0.001). The most prevalent somatoform disorders of the CRS were six with body dysmorphic disorder [BDD] (12%). The most prevalent personality disorders of the CRS were three with avoidant (6%) and three with narcissistic (6%) personality.
CONCLUSION:
Assessment of detailed psychopathological aspects and psychiatric co-morbidities could help to define the clinical profile of people requesting cosmetic rhinoplasty in cosmetic surgery settings. Research into these factors may be important as it is essential to detect crucial problems such as personality disorders and BDD before surgery.
The goal of this review is to discuss possible underlying psychopathological situations in patien... more The goal of this review is to discuss possible underlying psychopathological situations in patients requesting surgical cosmetic rhinoplasty operation and to examine potential problems that might arise. An extensive search was conducted through PubMed, Ambase and PsychInfo by using related keywords in English, like “rhinoplasty and psychiatric comorbidities”, “rhinoplasty and psychopathology”. Patients who demand cosmetic rhinoplasty operation appealed to the surgeon since they wanted to feel better about themselves after the surgery. Indeed, some long-term studies determined that such a situation can take place at high rates. However, some studies reported the possibility of serious psychological disorders after such surgical operations. Studies relating to the analysis of psychopathologic symptoms are quite limited. Research has shown that psychopathologic evaluation conducted preoperatively is especially important to identify serious psychopathologies such as personality disorders and body dysmorphic disorder (BDD). Conclusions: Exclusion of patients possessing serious psychopathologies from operations provides better results in the long term. The lack of sufficient research in this area necessitates new and comprehensive studies.
ABSTRACT – Background and Objectives: This study was designed to investigate the association of t... more ABSTRACT – Background and Objectives: This study was designed to investigate the association of the gender and subtype diagnosis with the onset age of the disease, marriage, reproductive rates in the schizophrenic inpatients. Methods: Total of 463 patients (329 males and 134 females) hospitalized with the diagnosis of schizophrenia according to DSM-IV criteria and who were between 15-65 years of age were included in the study. We evaluated the age, gender, marital status, number of children, onset of the disease and subtype of schizophrenia. Results: Mean of onset of the disease score was higher statistically in the females (27.6 ± 4.3) than the males (23.7 ± 3.9) (p < 0.05) in our study. The paranoid subtype was the commonest, while women were more likely to be married than men, men had more children than women; and the paranoid subtype were more likely to be married than the other groups. Conclusions: Onset age of schizophrenia was four years higher in the women than in men and that the rates of the schizophrenia subtypes were consistent with those detected in the other studies demonstrates that these rates were determined by neurobiological mechanisms rather than socio-cultural factors.
Background and objective: This review article aims to discuss and evaluate the risk factors for t... more Background and objective: This review article aims to discuss and evaluate the risk factors for the development of violence and homicidal behaviour and the effectiveness and outcomes of the preferred atypical antipsychotics in patients diagnosed with schizophrenia. Method: For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the articles in the international databases covering the period between 1970 and 2010 was performed. Results: Although the risk of homicidal behaviours is higher in patients with schizophrenia compared to the overall population, little is known about the relevant conditions triggering acts of violence among the patients with schizophrenia. The available results suggest that certain factors including some sociodemographic characteristics, young age, alcoholism, substance abuse, noncompliance with treatment, fulfillment of the criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts and history of frequent hospitalization increase the potential for violent episodes. Available data show clozapine to be the most rational therapeutic choice in preventing violent behaviour in patients with schizophrenia. There is evidence from randomized controlled trials in support of the specific anti-aggressive effect of clozapine. Conclusion: In clinical practice, patients with a risk of committing homicide should be detected and monitored closely. There are many trials showing the efficacy of clozapine on violent and aggressive behaviour.
ABSTRACT
Schizophrenia, violence and homicidal act: assessing the risks, preventive measures and
... more ABSTRACT Schizophrenia, violence and homicidal act: assessing the risks, preventive measures and place of clozapine in the treatment Objective: This review is designed to analyze the potential risk factors and preventive measures involved in homicidal behaviors in schizophrenic individuals and investigate the efficacy of clozapine in preventing these violence behaviors and evaluate the results. Method: For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the articles in the international and national databases, covering the period between 1979 and 2010 was performed. Trials that have contributed to this field were also utilized. Results: Although the risk of homicidal behaviors is higher in the schizophrenic individuals compared to the overall population, little is known about the relevant conditions triggering this act of violence among criminals. The available results suggest that certain factors, including some socio-demographic characteristics, male gender, young age, alcoholism, substance abuse, incompliance with the treatment, fulfillment of the criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts, and history of frequent hospitalization increase the probability for occurrence of violent episodes. Conclusion: In the clinical practice, the patients with a risk of committing homicide should be detected and monitored closely. The available data show clozapine to be the most rational therapeutic choice in preventing the acts of violence in schizophrenics. Key words: Schizophrenia, violence, homicide, risk factors, preventive measures, clozapine
Purpose: This review article is aimed to discuss and evaluate the causative risk factors of the d... more Purpose: This review article is aimed to discuss and evaluate the causative risk factors of the development of a suicidal behavior and the effectiveness and outcomes of the preferred atypical antipsychotics in patients diagnosed with schizophrenia. Method: Psychiatric literature was scanned for this purpose. All articles written 1970 to 2010 in the scientific database were reviewed. Discussion: It has been already known for a long time that completed or triled suicide attempt rates are high among patients having a diagnosis of schizophrenia. High risk is associated with male sex, previous suicide attempts, depressive symptoms, early stages of disease, high frequency of hospitalization, premorbid social malfunction, abuse and traumatic experiences in childhood and a family history of suicide. These are predisposing factors which should be regarded. It is also known that the period following discharge from hospital is particularly risky, since frequency of suicide attempts are increased in this period. Present data shows that clozapine is the best choice of treatment to prevent suicide directed behavior in schizophrenics. However other atypical antipsychotics like olanzapine, risperidone, amisulpride, ziprasidone and aripiprazole are also known to be a choice of treatment. Conclusion: Patients with a suicide risk should be determined and followed closely and frequently in clinical practice.
Aim: To determine the psychiatric symptom assesment of patients seeking treatment for irritable b... more Aim: To determine the psychiatric symptom assesment of patients seeking treatment for irritable bowel syndrome (IBS) and to demonstrate the presence of more complicated psychiatric disorders. Subjects and Method: The participants were recruited from patients who were attending internal medicine and gastroenterology clinics and who fullfilled the Rome III criteria for IBS. Fifty patients with IBS (IBS group) and 50 patients with complaints other than gastrointestinal symptoms (control group) were randomly selected. All participants were screened by the Structured Clinical Interview for DSM-IV (SCID-I), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Check list – 90 (Revised) [SCL-90-R]. Results: Seventeen patients (34%) and three control subjects (6%) had at least one psychiatric diagnosis (p = 0.001). Global severity index (GSI) total scores and SCL-90-R items were significantly higher in the IBS group than the control group (0.92 ± 0.46 vs 0.358 ± 0.19, p < 0.001). Beck anxiety inventory and BDI scores were higher in the IBS group than the control group (p < 0.001). Axis-I psychiatric disorders diagnosed with SCID-I were significantly higher in the IBS group (34% vs 6%) [p = 0.001]. Among the Axis-I disorders, somatoform and anxiety disorders were higher in the patient group than in the control subjects (p = 0.002 and p = 0.0057) whereas there was no difference for mood disorders (p = 0.204). Seven (14%) of the patients and two (4%) of the control subjects had at least one Axis-II psychiatric disorder diagnosed with SCID-II without any significance (p = 0.159). Conclusion: These findings suggest that except for mood and personality disorders, almost all psychiatric symptoms and disease co-morbities with IBS are higher than in the sample without IBS. We can easily use SCL-90-R, BAI and BDI in internal medicine and gastroenterology clinics to detect psychiatric symptom levels and then to refer patients to a psychiatrist for further evaluation and treatment.
In this article, it is aimed to review the efficacies of mood stabilizers and atypical antipsycho... more In this article, it is aimed to review the efficacies of mood stabilizers and atypical antipsychotics, which are used commonly in psychopharmacological treatments of bipolar and borderline personality disorders. In this context, common phenomenology between borderline personality and bipolar disorders and differential features of clinical diagnosis will be reviewed in line with the literature. Both disorders can demonstrate common features in the diagnostic aspect, and can overlap phenomenologically. Concomitance rate of both disorders is quite high. In order to differentiate these two disorders from each other, quality of mood fluctuations, impulsivity types and linear progression of disorders should be carefully considered. There are various studies in mood stabilizer use, like lithium, carbamazepine, oxcarbazepine, sodium valproate and lamotrigine, in the treatment of borderline personality disorder. Moreover, there are also studies, which have revealed efficacies of risperidone,...
Objective: In our research, we aimed to attract attention whether internal migration has an effec... more Objective: In our research, we aimed to attract attention whether internal migration has an effect on criminal behavior of schizophrenic patients. Method: Schizophrenic (according to DSM-IV) patients (66 from the general psychiatry units and 69 from forensic psychiatry clinics) participated in the research from a regional hospital in the northwest of Turkey. Forensic psychiatric patients are divided into two subgroups, namely those who migrated (n=30) within the country and not (n=39), with those who are repetitive offenders (n=29) and not (n=40); then groups were compared in the point of parameters of crime and migration. Results: Most of the patients who have not committed a crime were from cities. Even though there was no significant difference, with those who have committed a crime, the age of internal migration was younger. Migration raised the possibility of the recidivism of the criminal acts up to 5 fold whereas, having already been prisoned before raised this possibility up to 17 fold and childhood within the criminal group. Conclusions: Although our data indicated the internal migration not to affect the rate of the criminal acts among the patients with schizophrenia meaningfully, it significantly affected repetition of crime within the criminal group. The need to focus on internal migration and urbanization as disruptive environmental conditions effecting schizophrenia and crime in countries like Turkey where the urbanization process is still ongoing, is obvious. Key words: Crime, internal migration, schizophrenia
Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2013
This article aims to review the effectiveness of mood stabilizers used in the psychopharmacologic... more This article aims to review the effectiveness of mood stabilizers used in the psychopharmacologic treatment of both bipolar disorder and borderline personality disorder. In this context, the overlapping phenomenology of borderline personality disorder and bipolar disorder and the differential diagnosis of clinical features will be also reviewed with the literature.
Both disorders can show common features in terms of diagnosis and overlap in phenomenological perspective. Coexistence of both disorders is quite frequent. The nature of mood shifts, types of impulsivity and the longitudinal course of the disorders should be considered to differenciate them. There are findings on the effectiveness of mood stabilizers such as lithium, carbamazepine, oxcarbazepine, sodium valproate or lamotrigine in the treatment of the borderline personality disorder. The differentiation of borderline personality disorder from bipolar disorder is not easy. A very careful evaluation is required. This differentiation may also be useful in terms of treatment. A greater number of research results are available on the effectiveness of valproate and lamotrigine in the treatment of borderline personality disorder. Findings related to other mood stabilizers are insufficient. In
the treatment of borderline personality disorder, there is not any drug approved by the official authorities. Psychotherapeutic approaches still retain their important place in the treatment. However, symptombased approach is proposed in the use of mood stabilizers.
This study assesses childhood trauma history, dissociative symptoms, and dissociative disorders c... more This study assesses childhood trauma history, dissociative symptoms, and dissociative disorders comorbidity in patients with Panic Disorder (PD). Ninety two psychotropic drug-naive patients with PD, recruited from outpatient clinics in the psychiatry department of a Turkish hospital were involved in the study. Participants were assessed with the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), Dissociation Questionnaire (DIS-Q), Panic and Agoraphobia Scale (PAS), Panic Disorder Severity Scale (PDSS) and the Childhood Trauma Questionnaire (CTQ). Eighteen (19 %) of the patients with PD had comorbid dissociative disorder diagnosis upon screening with SCID-D. The most prevalent disorders were dissociative disorder not otherwise specified (DDNOS), dissociative amnesia, and depersonalization disorders. Patients with a high degree of dissociation symptoms and dissociative disorder comorbidity had more severe PD than those without (P<0.05). All of the childhood trauma subscales used were correlated with the severity of symptoms of dissociation and PD. Among all subscales, the strongest relationship was associated with childhood emotional abuse. Logistic regression analysis showed that emotional abuse and severity of PD were independently associated with dissociative disorder. In our study, a significant proportion of the patients with PD had concurrent diagnoses of dissociative disorder. We conclude that the predominance of PD symptoms in admission should not lead the clinician to overlook the underlying dissociative process, and associated traumatic experiences among these patients.
Türk psikiyatri dergisi = Turkish journal of psychiatry, 2012
The aim of this study is to examine the population targeted by the violent behavior of psychotic ... more The aim of this study is to examine the population targeted by the violent behavior of psychotic patients and to provide data on the treatment and therapeutic support of psychiatric professionals based on our results. Eighty-one psychotic patients lacking criminal responsibility and under observation or mandatory treatment due to violent crime were compared with a control group of 31 persons with criminal responsibility. The sociodemographic features of the two groups' victims and descriptive data about the crimes and the target populations were examined and analyzed with SPSS 11. Patient and control groups were compared according to their relationships to their victims. Of psychotic patients' victims, 36.9% percent were family members, while in the non-psychotic group the proportion was 10%, a statistically significant difference (p<0.01). We also found a statistically significant difference between the two groups in the mean ages of their victims and in the proportions ...
Abstract
The relationship between Panic Disorder (PD) and dissociation is well known. In this st... more Abstract
The relationship between Panic Disorder (PD) and dissociation is well known. In this study we aimed to investigate whether or not dissociative experiences affect the response to PD drug treatment. For this purpose, standart dose of venlafaxine was preferred for treatment. 63 patients with PD were included in the study. Venlafaxine treatment with increasing dose was administered to each patient during a 10-week period. The Panic Disorder Severity Scale (PDSS) and the Dissociation Questionnaire (DIS-Q) were applied to the patients at the
beginning of the study. Patients were divided into two groups based on DIS-Q scores. PDSS was applied again to both groups at the end of 10-week treatment. No difference between sociodemographic data and PDSS scores of two groups – patients with low DIS-Q scores (b2.5) and high DIS-Q scores (N2.5) – was found at the beginning. At the end of the study, a significant decrease in PDSS scores measured in both groups was detected. However, the decrease in PDSS score for the group with lower DIS-Q score was at a higher percentage (z = −3.822, p = 0.0001). These results depict that dissociative symptoms accompanying PD affect psychopharmacological treatment in a negative way. Reevaluation of dissociative symptoms at the beginning and end of treatment would help in planning personal therapy.
Türk psikiyatri dergisi = Turkish journal of psychiatry, 2013
The aim of this study is to investigate the patterns of offense and treatment outcomes in patient... more The aim of this study is to investigate the patterns of offense and treatment outcomes in patients with schizophrenia who have exhibited violent behavior and to provide data for mental health professionals to aid in the treatment and therapeutic support of schizophrenia patients. The subjects included in this study include a total of 52 patients with schizophrenia who had committed violent crime and who were under observation or mandatory treatment, and a control group of 31 subjects who assumed full responsibility for the crime they were accused of. Patients with schizophrenia and control subjects were examined based on the assumption that prior exhibition of violent behavior may be a determining factor for socio-demographic characteristics and the early identification of violent crime. Life-long aggressive behavior was also examined using the Overt Aggression Scale (OAS). A total of 80.7% of the patients with schizophrenia were found to be paranoid subtype. The mean age of schizop...
The present study attempted to assess the dissociative symptoms and overall dissociative disorder... more The present study attempted to assess the dissociative symptoms and overall dissociative disorder comorbidity in patients with obsessivecompulsive disorder (OCD). In addition, we examined the relationship between the severity of obsessive-compulsive symptoms and dissociative symptoms.
All patients admitted for the first time to the psychiatric outpatient unit were included in the study. Seventy-eight patients had been diagnosed as having OCD during the 2-year study period. Patients had to meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD. Most (76.9%; n = 60) of the patients were female, and 23.1% (n = 18) of the patients were male. Dissociation Questionnaire was used to measure dissociative symptoms. The Structured Clinical Interview for Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition Dissociative Disorders interviews and Yale-Brown Obsessive Compulsive Checklist and Severity Scale were used. Eleven (14%) of the patients with OCD had comorbid dissociative disorder. The most prevalent disorder in our study was dissociative depersonalization disorder. Dissociative amnesia and dissociative identity disorder were common as
well. The mean Yale-Brown score was 23.37 ± 7.27 points. Dissociation Questionnaire scores were between 0.40 and 3.87 points, and the mean was 2.23 ± 0.76 points. There was a statistically significant positive correlation between Yale-Brown points and Dissociation Questionnaire points. We conclude that dissociative symptoms among patients with OCD should alert clinicians for the presence of a chronic and complex
dissociative disorder. Clinicians may overlook an underlying dissociative process in patients who have severe symptoms of OCD. However, a lack of adequate response to cognitive-behavioral and drug therapy may be a consequence of dissociative process.
The purpose of the study was to examine psychopathological traits and psychiatric co-morbidities ... more The purpose of the study was to examine psychopathological traits and psychiatric co-morbidities in seekers of cosmetic rhinoplasty. Fifty persons seeking cosmetic rhinoplasty and 50 control subjects were admitted to the study. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Symptom Checklist-90 [Revised] (SCL-90-R) were administered to people who requested cosmetic rhinoplasty and control subjects. All participants were also screened by the Structured Clinical Interview for DSM-IV-(SCIDI/CV, SCID-II). Thirteen cosmetic rhinoplasty seekers [CRS] (26%) and three control subjects (6%) had at least one psychiatric diagnosis. There was a significant difference between the two groups (p = 0.006). Beck depression inventory (p = 0.002) and BAI (p = 0.046) levels above the cut-off point were significantly higher in the CRS group than in the normal control. Somatoform disorders were statistically higher in the CRS than control group (p = 0.007). Nine CRS (18%) and two control subjects (4%) had at least one personality disorder. There were differences between the two groups (p = 0.025). The average of SCL-90-R was significantly higher in the CRS than in the control subjects (p < 0.001). The most prevalent somatoform disorders of the CRS were six with body dysmorphic disorder [BDD] (12%). The most prevalent personality disorders of the CRS were three with avoidant (6%) and three with narcissistic (6%) personality.
CONCLUSION:
Assessment of detailed psychopathological aspects and psychiatric co-morbidities could help to define the clinical profile of people requesting cosmetic rhinoplasty in cosmetic surgery settings. Research into these factors may be important as it is essential to detect crucial problems such as personality disorders and BDD before surgery.
The goal of this review is to discuss possible underlying psychopathological situations in patien... more The goal of this review is to discuss possible underlying psychopathological situations in patients requesting surgical cosmetic rhinoplasty operation and to examine potential problems that might arise. An extensive search was conducted through PubMed, Ambase and PsychInfo by using related keywords in English, like “rhinoplasty and psychiatric comorbidities”, “rhinoplasty and psychopathology”. Patients who demand cosmetic rhinoplasty operation appealed to the surgeon since they wanted to feel better about themselves after the surgery. Indeed, some long-term studies determined that such a situation can take place at high rates. However, some studies reported the possibility of serious psychological disorders after such surgical operations. Studies relating to the analysis of psychopathologic symptoms are quite limited. Research has shown that psychopathologic evaluation conducted preoperatively is especially important to identify serious psychopathologies such as personality disorders and body dysmorphic disorder (BDD). Conclusions: Exclusion of patients possessing serious psychopathologies from operations provides better results in the long term. The lack of sufficient research in this area necessitates new and comprehensive studies.
ABSTRACT – Background and Objectives: This study was designed to investigate the association of t... more ABSTRACT – Background and Objectives: This study was designed to investigate the association of the gender and subtype diagnosis with the onset age of the disease, marriage, reproductive rates in the schizophrenic inpatients. Methods: Total of 463 patients (329 males and 134 females) hospitalized with the diagnosis of schizophrenia according to DSM-IV criteria and who were between 15-65 years of age were included in the study. We evaluated the age, gender, marital status, number of children, onset of the disease and subtype of schizophrenia. Results: Mean of onset of the disease score was higher statistically in the females (27.6 ± 4.3) than the males (23.7 ± 3.9) (p < 0.05) in our study. The paranoid subtype was the commonest, while women were more likely to be married than men, men had more children than women; and the paranoid subtype were more likely to be married than the other groups. Conclusions: Onset age of schizophrenia was four years higher in the women than in men and that the rates of the schizophrenia subtypes were consistent with those detected in the other studies demonstrates that these rates were determined by neurobiological mechanisms rather than socio-cultural factors.
Background and objective: This review article aims to discuss and evaluate the risk factors for t... more Background and objective: This review article aims to discuss and evaluate the risk factors for the development of violence and homicidal behaviour and the effectiveness and outcomes of the preferred atypical antipsychotics in patients diagnosed with schizophrenia. Method: For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the articles in the international databases covering the period between 1970 and 2010 was performed. Results: Although the risk of homicidal behaviours is higher in patients with schizophrenia compared to the overall population, little is known about the relevant conditions triggering acts of violence among the patients with schizophrenia. The available results suggest that certain factors including some sociodemographic characteristics, young age, alcoholism, substance abuse, noncompliance with treatment, fulfillment of the criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts and history of frequent hospitalization increase the potential for violent episodes. Available data show clozapine to be the most rational therapeutic choice in preventing violent behaviour in patients with schizophrenia. There is evidence from randomized controlled trials in support of the specific anti-aggressive effect of clozapine. Conclusion: In clinical practice, patients with a risk of committing homicide should be detected and monitored closely. There are many trials showing the efficacy of clozapine on violent and aggressive behaviour.
ABSTRACT
Schizophrenia, violence and homicidal act: assessing the risks, preventive measures and
... more ABSTRACT Schizophrenia, violence and homicidal act: assessing the risks, preventive measures and place of clozapine in the treatment Objective: This review is designed to analyze the potential risk factors and preventive measures involved in homicidal behaviors in schizophrenic individuals and investigate the efficacy of clozapine in preventing these violence behaviors and evaluate the results. Method: For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the articles in the international and national databases, covering the period between 1979 and 2010 was performed. Trials that have contributed to this field were also utilized. Results: Although the risk of homicidal behaviors is higher in the schizophrenic individuals compared to the overall population, little is known about the relevant conditions triggering this act of violence among criminals. The available results suggest that certain factors, including some socio-demographic characteristics, male gender, young age, alcoholism, substance abuse, incompliance with the treatment, fulfillment of the criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts, and history of frequent hospitalization increase the probability for occurrence of violent episodes. Conclusion: In the clinical practice, the patients with a risk of committing homicide should be detected and monitored closely. The available data show clozapine to be the most rational therapeutic choice in preventing the acts of violence in schizophrenics. Key words: Schizophrenia, violence, homicide, risk factors, preventive measures, clozapine
Purpose: This review article is aimed to discuss and evaluate the causative risk factors of the d... more Purpose: This review article is aimed to discuss and evaluate the causative risk factors of the development of a suicidal behavior and the effectiveness and outcomes of the preferred atypical antipsychotics in patients diagnosed with schizophrenia. Method: Psychiatric literature was scanned for this purpose. All articles written 1970 to 2010 in the scientific database were reviewed. Discussion: It has been already known for a long time that completed or triled suicide attempt rates are high among patients having a diagnosis of schizophrenia. High risk is associated with male sex, previous suicide attempts, depressive symptoms, early stages of disease, high frequency of hospitalization, premorbid social malfunction, abuse and traumatic experiences in childhood and a family history of suicide. These are predisposing factors which should be regarded. It is also known that the period following discharge from hospital is particularly risky, since frequency of suicide attempts are increased in this period. Present data shows that clozapine is the best choice of treatment to prevent suicide directed behavior in schizophrenics. However other atypical antipsychotics like olanzapine, risperidone, amisulpride, ziprasidone and aripiprazole are also known to be a choice of treatment. Conclusion: Patients with a suicide risk should be determined and followed closely and frequently in clinical practice.
Aim: To determine the psychiatric symptom assesment of patients seeking treatment for irritable b... more Aim: To determine the psychiatric symptom assesment of patients seeking treatment for irritable bowel syndrome (IBS) and to demonstrate the presence of more complicated psychiatric disorders. Subjects and Method: The participants were recruited from patients who were attending internal medicine and gastroenterology clinics and who fullfilled the Rome III criteria for IBS. Fifty patients with IBS (IBS group) and 50 patients with complaints other than gastrointestinal symptoms (control group) were randomly selected. All participants were screened by the Structured Clinical Interview for DSM-IV (SCID-I), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Check list – 90 (Revised) [SCL-90-R]. Results: Seventeen patients (34%) and three control subjects (6%) had at least one psychiatric diagnosis (p = 0.001). Global severity index (GSI) total scores and SCL-90-R items were significantly higher in the IBS group than the control group (0.92 ± 0.46 vs 0.358 ± 0.19, p < 0.001). Beck anxiety inventory and BDI scores were higher in the IBS group than the control group (p < 0.001). Axis-I psychiatric disorders diagnosed with SCID-I were significantly higher in the IBS group (34% vs 6%) [p = 0.001]. Among the Axis-I disorders, somatoform and anxiety disorders were higher in the patient group than in the control subjects (p = 0.002 and p = 0.0057) whereas there was no difference for mood disorders (p = 0.204). Seven (14%) of the patients and two (4%) of the control subjects had at least one Axis-II psychiatric disorder diagnosed with SCID-II without any significance (p = 0.159). Conclusion: These findings suggest that except for mood and personality disorders, almost all psychiatric symptoms and disease co-morbities with IBS are higher than in the sample without IBS. We can easily use SCL-90-R, BAI and BDI in internal medicine and gastroenterology clinics to detect psychiatric symptom levels and then to refer patients to a psychiatrist for further evaluation and treatment.
In this article, it is aimed to review the efficacies of mood stabilizers and atypical antipsycho... more In this article, it is aimed to review the efficacies of mood stabilizers and atypical antipsychotics, which are used commonly in psychopharmacological treatments of bipolar and borderline personality disorders. In this context, common phenomenology between borderline personality and bipolar disorders and differential features of clinical diagnosis will be reviewed in line with the literature. Both disorders can demonstrate common features in the diagnostic aspect, and can overlap phenomenologically. Concomitance rate of both disorders is quite high. In order to differentiate these two disorders from each other, quality of mood fluctuations, impulsivity types and linear progression of disorders should be carefully considered. There are various studies in mood stabilizer use, like lithium, carbamazepine, oxcarbazepine, sodium valproate and lamotrigine, in the treatment of borderline personality disorder. Moreover, there are also studies, which have revealed efficacies of risperidone,...
Objective: In our research, we aimed to attract attention whether internal migration has an effec... more Objective: In our research, we aimed to attract attention whether internal migration has an effect on criminal behavior of schizophrenic patients. Method: Schizophrenic (according to DSM-IV) patients (66 from the general psychiatry units and 69 from forensic psychiatry clinics) participated in the research from a regional hospital in the northwest of Turkey. Forensic psychiatric patients are divided into two subgroups, namely those who migrated (n=30) within the country and not (n=39), with those who are repetitive offenders (n=29) and not (n=40); then groups were compared in the point of parameters of crime and migration. Results: Most of the patients who have not committed a crime were from cities. Even though there was no significant difference, with those who have committed a crime, the age of internal migration was younger. Migration raised the possibility of the recidivism of the criminal acts up to 5 fold whereas, having already been prisoned before raised this possibility up to 17 fold and childhood within the criminal group. Conclusions: Although our data indicated the internal migration not to affect the rate of the criminal acts among the patients with schizophrenia meaningfully, it significantly affected repetition of crime within the criminal group. The need to focus on internal migration and urbanization as disruptive environmental conditions effecting schizophrenia and crime in countries like Turkey where the urbanization process is still ongoing, is obvious. Key words: Crime, internal migration, schizophrenia
Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2013
This article aims to review the effectiveness of mood stabilizers used in the psychopharmacologic... more This article aims to review the effectiveness of mood stabilizers used in the psychopharmacologic treatment of both bipolar disorder and borderline personality disorder. In this context, the overlapping phenomenology of borderline personality disorder and bipolar disorder and the differential diagnosis of clinical features will be also reviewed with the literature.
Both disorders can show common features in terms of diagnosis and overlap in phenomenological perspective. Coexistence of both disorders is quite frequent. The nature of mood shifts, types of impulsivity and the longitudinal course of the disorders should be considered to differenciate them. There are findings on the effectiveness of mood stabilizers such as lithium, carbamazepine, oxcarbazepine, sodium valproate or lamotrigine in the treatment of the borderline personality disorder. The differentiation of borderline personality disorder from bipolar disorder is not easy. A very careful evaluation is required. This differentiation may also be useful in terms of treatment. A greater number of research results are available on the effectiveness of valproate and lamotrigine in the treatment of borderline personality disorder. Findings related to other mood stabilizers are insufficient. In
the treatment of borderline personality disorder, there is not any drug approved by the official authorities. Psychotherapeutic approaches still retain their important place in the treatment. However, symptombased approach is proposed in the use of mood stabilizers.
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Papers by Cenk Ural
The relationship between Panic Disorder (PD) and dissociation is well known. In this study we aimed to investigate whether or not dissociative experiences affect the response to PD drug treatment. For this purpose, standart dose of venlafaxine was preferred for treatment. 63 patients with PD were included in the study. Venlafaxine treatment with increasing dose was administered to each patient during a 10-week period. The Panic Disorder Severity Scale (PDSS) and the Dissociation Questionnaire (DIS-Q) were applied to the patients at the
beginning of the study. Patients were divided into two groups based on DIS-Q scores. PDSS was applied again to both groups at the end of 10-week treatment. No difference between sociodemographic data and PDSS scores of two groups – patients with low DIS-Q scores (b2.5) and high DIS-Q scores (N2.5) – was found at the beginning. At the end of the study, a significant decrease in PDSS scores measured in both groups was detected. However, the decrease in PDSS score for the group with lower DIS-Q score was at a higher percentage (z = −3.822, p = 0.0001). These results depict that dissociative symptoms accompanying PD affect psychopharmacological treatment in a negative way. Reevaluation of dissociative symptoms at the beginning and end of treatment would help in planning personal therapy.
All patients admitted for the first time to the psychiatric outpatient unit were included in the study. Seventy-eight patients had been diagnosed as having OCD during the 2-year study period. Patients had to meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD. Most (76.9%; n = 60) of the patients were female, and 23.1% (n = 18) of the patients were male. Dissociation Questionnaire was used to measure dissociative symptoms. The Structured Clinical Interview for Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition Dissociative Disorders interviews and Yale-Brown Obsessive Compulsive Checklist and Severity Scale were used. Eleven (14%) of the patients with OCD had comorbid dissociative disorder. The most prevalent disorder in our study was dissociative depersonalization disorder. Dissociative amnesia and dissociative identity disorder were common as
well. The mean Yale-Brown score was 23.37 ± 7.27 points. Dissociation Questionnaire scores were between 0.40 and 3.87 points, and the mean was 2.23 ± 0.76 points. There was a statistically significant positive correlation between Yale-Brown points and Dissociation Questionnaire points. We conclude that dissociative symptoms among patients with OCD should alert clinicians for the presence of a chronic and complex
dissociative disorder. Clinicians may overlook an underlying dissociative process in patients who have severe symptoms of OCD. However, a lack of adequate response to cognitive-behavioral and drug therapy may be a consequence of dissociative process.
CONCLUSION:
Assessment of detailed psychopathological aspects and psychiatric co-morbidities could help to define the clinical profile of people requesting cosmetic rhinoplasty in cosmetic surgery settings. Research into these factors may be important as it is essential to detect crucial problems such as personality disorders and BDD before surgery.
psychopathologic symptoms are quite limited. Research has shown that psychopathologic evaluation conducted preoperatively is especially important to identify serious psychopathologies such as personality disorders and body dysmorphic disorder (BDD).
Conclusions: Exclusion of patients possessing serious psychopathologies from operations provides better results in the long term. The lack of sufficient research in this area necessitates new and comprehensive studies.
Methods: Total of 463 patients (329 males and 134 females) hospitalized with the diagnosis of schizophrenia according to DSM-IV criteria and who were between 15-65 years of age were included in the study. We evaluated the age, gender, marital status, number of children, onset of the disease and subtype of schizophrenia.
Results: Mean of onset of the disease score was higher statistically in the females (27.6 ± 4.3) than the males (23.7 ± 3.9) (p < 0.05) in our study. The paranoid subtype was the commonest, while women were more likely to be married than men, men had more children than women; and the paranoid subtype were more likely to be married than the other groups.
Conclusions: Onset age of schizophrenia was four years higher in the women than in men and that the rates of the schizophrenia subtypes were consistent with those detected in the other studies demonstrates that these rates were determined by neurobiological mechanisms rather than socio-cultural factors.
Method: For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the articles in the international databases covering the period between 1970 and 2010 was performed.
Results: Although the risk of homicidal behaviours is higher in patients with schizophrenia compared to the overall population, little is known about the relevant conditions triggering acts of violence among the patients with schizophrenia. The available results suggest that certain factors including some sociodemographic characteristics, young age, alcoholism, substance abuse, noncompliance with treatment, fulfillment of the criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts and history of frequent hospitalization increase the potential for violent episodes.
Available data show clozapine to be the most rational therapeutic choice in preventing violent behaviour in patients with schizophrenia. There is evidence from randomized controlled trials in support of the specific anti-aggressive effect of clozapine.
Conclusion: In clinical practice, patients with a risk of committing homicide should be detected and monitored closely. There are many trials showing the efficacy of clozapine on violent and aggressive behaviour.
Schizophrenia, violence and homicidal act: assessing the risks, preventive measures and
place of clozapine in the treatment
Objective: This review is designed to analyze the potential risk factors and preventive measures involved
in homicidal behaviors in schizophrenic individuals and investigate the efficacy of clozapine in preventing
these violence behaviors and evaluate the results.
Method: For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the
articles in the international and national databases, covering the period between 1979 and 2010 was
performed. Trials that have contributed to this field were also utilized.
Results: Although the risk of homicidal behaviors is higher in the schizophrenic individuals compared to the
overall population, little is known about the relevant conditions triggering this act of violence among
criminals. The available results suggest that certain factors, including some socio-demographic characteristics,
male gender, young age, alcoholism, substance abuse, incompliance with the treatment, fulfillment of the
criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts,
and history of frequent hospitalization increase the probability for occurrence of violent episodes.
Conclusion: In the clinical practice, the patients with a risk of committing homicide should be detected and
monitored closely. The available data show clozapine to be the most rational therapeutic choice in
preventing the acts of violence in schizophrenics.
Key words: Schizophrenia, violence, homicide, risk factors, preventive measures, clozapine
Method: Psychiatric literature was scanned for this purpose. All articles written 1970 to 2010 in the scientific database were reviewed.
Discussion: It has been already known for a long time that completed or triled suicide attempt rates are high among patients having a diagnosis of schizophrenia. High risk is associated with male sex, previous suicide attempts, depressive symptoms, early stages of disease, high frequency of hospitalization, premorbid social malfunction, abuse and traumatic experiences in childhood and a family history of suicide. These are predisposing factors which should be regarded. It is also known that the period following discharge from hospital is particularly risky, since frequency of suicide attempts are increased in this period. Present data shows that clozapine is the best choice of treatment to prevent suicide directed behavior in schizophrenics.
However other atypical antipsychotics like olanzapine, risperidone, amisulpride, ziprasidone and aripiprazole are also known to be a choice of treatment.
Conclusion: Patients with a suicide risk should be determined and followed closely and frequently in clinical practice.
Subjects and Method: The participants were recruited from patients who were attending internal medicine and gastroenterology clinics and who fullfilled the Rome III criteria for IBS. Fifty patients with IBS (IBS group) and 50 patients with complaints other than gastrointestinal symptoms (control
group) were randomly selected. All participants were screened by the Structured Clinical Interview for DSM-IV (SCID-I), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Check list – 90 (Revised) [SCL-90-R].
Results: Seventeen patients (34%) and three control subjects (6%) had at least one psychiatric diagnosis (p = 0.001). Global severity index (GSI) total scores and SCL-90-R items were significantly higher in the IBS group than the control group (0.92 ± 0.46 vs 0.358 ± 0.19, p < 0.001). Beck anxiety inventory and BDI scores were higher in the IBS group than the control group (p < 0.001). Axis-I psychiatric disorders diagnosed with SCID-I were significantly higher in the IBS group (34% vs 6%) [p = 0.001].
Among the Axis-I disorders, somatoform and anxiety disorders were higher in the patient group than in the control subjects (p = 0.002 and p = 0.0057) whereas there was no difference for mood disorders (p = 0.204). Seven (14%) of the patients and two (4%) of the control subjects had at least one Axis-II psychiatric disorder diagnosed with SCID-II without any significance (p = 0.159).
Conclusion: These findings suggest that except for mood and personality disorders, almost all psychiatric symptoms and disease co-morbities with IBS are higher than in the sample without IBS. We can easily use SCL-90-R, BAI and BDI in internal medicine and gastroenterology clinics to detect psychiatric symptom levels and then to refer patients to a psychiatrist for further evaluation and treatment.
criminal behavior of schizophrenic patients.
Method: Schizophrenic (according to DSM-IV) patients (66 from the general psychiatry units and 69 from
forensic psychiatry clinics) participated in the research from a regional hospital in the northwest of Turkey.
Forensic psychiatric patients are divided into two subgroups, namely those who migrated (n=30) within the
country and not (n=39), with those who are repetitive offenders (n=29) and not (n=40); then groups were
compared in the point of parameters of crime and migration.
Results: Most of the patients who have not committed a crime were from cities. Even though there was
no significant difference, with those who have committed a crime, the age of internal migration was
younger. Migration raised the possibility of the recidivism of the criminal acts up to 5 fold whereas, having
already been prisoned before raised this possibility up to 17 fold and childhood within the criminal group.
Conclusions: Although our data indicated the internal migration not to affect the rate of the criminal acts
among the patients with schizophrenia meaningfully, it significantly affected repetition of crime within the
criminal group. The need to focus on internal migration and urbanization as disruptive environmental
conditions effecting schizophrenia and crime in countries like Turkey where the urbanization process is still
ongoing, is obvious.
Key words: Crime, internal migration, schizophrenia
Both disorders can show common features in terms of diagnosis and overlap in phenomenological perspective. Coexistence of both disorders is quite frequent. The nature of mood shifts, types of impulsivity and the longitudinal course of the disorders should be considered to differenciate them. There are findings on the effectiveness of mood stabilizers such as lithium, carbamazepine, oxcarbazepine, sodium valproate or lamotrigine in the treatment of the borderline personality disorder. The differentiation of borderline personality disorder from bipolar disorder is not easy. A very careful evaluation is required. This differentiation may also be useful in terms of treatment. A greater number of research results are available on the effectiveness of valproate and lamotrigine in the treatment of borderline personality disorder. Findings related to other mood stabilizers are insufficient. In
the treatment of borderline personality disorder, there is not any drug approved by the official authorities. Psychotherapeutic approaches still retain their important place in the treatment. However, symptombased approach is proposed in the use of mood stabilizers.
The relationship between Panic Disorder (PD) and dissociation is well known. In this study we aimed to investigate whether or not dissociative experiences affect the response to PD drug treatment. For this purpose, standart dose of venlafaxine was preferred for treatment. 63 patients with PD were included in the study. Venlafaxine treatment with increasing dose was administered to each patient during a 10-week period. The Panic Disorder Severity Scale (PDSS) and the Dissociation Questionnaire (DIS-Q) were applied to the patients at the
beginning of the study. Patients were divided into two groups based on DIS-Q scores. PDSS was applied again to both groups at the end of 10-week treatment. No difference between sociodemographic data and PDSS scores of two groups – patients with low DIS-Q scores (b2.5) and high DIS-Q scores (N2.5) – was found at the beginning. At the end of the study, a significant decrease in PDSS scores measured in both groups was detected. However, the decrease in PDSS score for the group with lower DIS-Q score was at a higher percentage (z = −3.822, p = 0.0001). These results depict that dissociative symptoms accompanying PD affect psychopharmacological treatment in a negative way. Reevaluation of dissociative symptoms at the beginning and end of treatment would help in planning personal therapy.
All patients admitted for the first time to the psychiatric outpatient unit were included in the study. Seventy-eight patients had been diagnosed as having OCD during the 2-year study period. Patients had to meet the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD. Most (76.9%; n = 60) of the patients were female, and 23.1% (n = 18) of the patients were male. Dissociation Questionnaire was used to measure dissociative symptoms. The Structured Clinical Interview for Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition Dissociative Disorders interviews and Yale-Brown Obsessive Compulsive Checklist and Severity Scale were used. Eleven (14%) of the patients with OCD had comorbid dissociative disorder. The most prevalent disorder in our study was dissociative depersonalization disorder. Dissociative amnesia and dissociative identity disorder were common as
well. The mean Yale-Brown score was 23.37 ± 7.27 points. Dissociation Questionnaire scores were between 0.40 and 3.87 points, and the mean was 2.23 ± 0.76 points. There was a statistically significant positive correlation between Yale-Brown points and Dissociation Questionnaire points. We conclude that dissociative symptoms among patients with OCD should alert clinicians for the presence of a chronic and complex
dissociative disorder. Clinicians may overlook an underlying dissociative process in patients who have severe symptoms of OCD. However, a lack of adequate response to cognitive-behavioral and drug therapy may be a consequence of dissociative process.
CONCLUSION:
Assessment of detailed psychopathological aspects and psychiatric co-morbidities could help to define the clinical profile of people requesting cosmetic rhinoplasty in cosmetic surgery settings. Research into these factors may be important as it is essential to detect crucial problems such as personality disorders and BDD before surgery.
psychopathologic symptoms are quite limited. Research has shown that psychopathologic evaluation conducted preoperatively is especially important to identify serious psychopathologies such as personality disorders and body dysmorphic disorder (BDD).
Conclusions: Exclusion of patients possessing serious psychopathologies from operations provides better results in the long term. The lack of sufficient research in this area necessitates new and comprehensive studies.
Methods: Total of 463 patients (329 males and 134 females) hospitalized with the diagnosis of schizophrenia according to DSM-IV criteria and who were between 15-65 years of age were included in the study. We evaluated the age, gender, marital status, number of children, onset of the disease and subtype of schizophrenia.
Results: Mean of onset of the disease score was higher statistically in the females (27.6 ± 4.3) than the males (23.7 ± 3.9) (p < 0.05) in our study. The paranoid subtype was the commonest, while women were more likely to be married than men, men had more children than women; and the paranoid subtype were more likely to be married than the other groups.
Conclusions: Onset age of schizophrenia was four years higher in the women than in men and that the rates of the schizophrenia subtypes were consistent with those detected in the other studies demonstrates that these rates were determined by neurobiological mechanisms rather than socio-cultural factors.
Method: For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the articles in the international databases covering the period between 1970 and 2010 was performed.
Results: Although the risk of homicidal behaviours is higher in patients with schizophrenia compared to the overall population, little is known about the relevant conditions triggering acts of violence among the patients with schizophrenia. The available results suggest that certain factors including some sociodemographic characteristics, young age, alcoholism, substance abuse, noncompliance with treatment, fulfillment of the criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts and history of frequent hospitalization increase the potential for violent episodes.
Available data show clozapine to be the most rational therapeutic choice in preventing violent behaviour in patients with schizophrenia. There is evidence from randomized controlled trials in support of the specific anti-aggressive effect of clozapine.
Conclusion: In clinical practice, patients with a risk of committing homicide should be detected and monitored closely. There are many trials showing the efficacy of clozapine on violent and aggressive behaviour.
Schizophrenia, violence and homicidal act: assessing the risks, preventive measures and
place of clozapine in the treatment
Objective: This review is designed to analyze the potential risk factors and preventive measures involved
in homicidal behaviors in schizophrenic individuals and investigate the efficacy of clozapine in preventing
these violence behaviors and evaluate the results.
Method: For this purpose, the psychiatry literature was comprehensively reviewed. A screening of the
articles in the international and national databases, covering the period between 1979 and 2010 was
performed. Trials that have contributed to this field were also utilized.
Results: Although the risk of homicidal behaviors is higher in the schizophrenic individuals compared to the
overall population, little is known about the relevant conditions triggering this act of violence among
criminals. The available results suggest that certain factors, including some socio-demographic characteristics,
male gender, young age, alcoholism, substance abuse, incompliance with the treatment, fulfillment of the
criteria for antisocial personality disorder and paranoid subtype, history of suicidal ideation and attempts,
and history of frequent hospitalization increase the probability for occurrence of violent episodes.
Conclusion: In the clinical practice, the patients with a risk of committing homicide should be detected and
monitored closely. The available data show clozapine to be the most rational therapeutic choice in
preventing the acts of violence in schizophrenics.
Key words: Schizophrenia, violence, homicide, risk factors, preventive measures, clozapine
Method: Psychiatric literature was scanned for this purpose. All articles written 1970 to 2010 in the scientific database were reviewed.
Discussion: It has been already known for a long time that completed or triled suicide attempt rates are high among patients having a diagnosis of schizophrenia. High risk is associated with male sex, previous suicide attempts, depressive symptoms, early stages of disease, high frequency of hospitalization, premorbid social malfunction, abuse and traumatic experiences in childhood and a family history of suicide. These are predisposing factors which should be regarded. It is also known that the period following discharge from hospital is particularly risky, since frequency of suicide attempts are increased in this period. Present data shows that clozapine is the best choice of treatment to prevent suicide directed behavior in schizophrenics.
However other atypical antipsychotics like olanzapine, risperidone, amisulpride, ziprasidone and aripiprazole are also known to be a choice of treatment.
Conclusion: Patients with a suicide risk should be determined and followed closely and frequently in clinical practice.
Subjects and Method: The participants were recruited from patients who were attending internal medicine and gastroenterology clinics and who fullfilled the Rome III criteria for IBS. Fifty patients with IBS (IBS group) and 50 patients with complaints other than gastrointestinal symptoms (control
group) were randomly selected. All participants were screened by the Structured Clinical Interview for DSM-IV (SCID-I), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Check list – 90 (Revised) [SCL-90-R].
Results: Seventeen patients (34%) and three control subjects (6%) had at least one psychiatric diagnosis (p = 0.001). Global severity index (GSI) total scores and SCL-90-R items were significantly higher in the IBS group than the control group (0.92 ± 0.46 vs 0.358 ± 0.19, p < 0.001). Beck anxiety inventory and BDI scores were higher in the IBS group than the control group (p < 0.001). Axis-I psychiatric disorders diagnosed with SCID-I were significantly higher in the IBS group (34% vs 6%) [p = 0.001].
Among the Axis-I disorders, somatoform and anxiety disorders were higher in the patient group than in the control subjects (p = 0.002 and p = 0.0057) whereas there was no difference for mood disorders (p = 0.204). Seven (14%) of the patients and two (4%) of the control subjects had at least one Axis-II psychiatric disorder diagnosed with SCID-II without any significance (p = 0.159).
Conclusion: These findings suggest that except for mood and personality disorders, almost all psychiatric symptoms and disease co-morbities with IBS are higher than in the sample without IBS. We can easily use SCL-90-R, BAI and BDI in internal medicine and gastroenterology clinics to detect psychiatric symptom levels and then to refer patients to a psychiatrist for further evaluation and treatment.
criminal behavior of schizophrenic patients.
Method: Schizophrenic (according to DSM-IV) patients (66 from the general psychiatry units and 69 from
forensic psychiatry clinics) participated in the research from a regional hospital in the northwest of Turkey.
Forensic psychiatric patients are divided into two subgroups, namely those who migrated (n=30) within the
country and not (n=39), with those who are repetitive offenders (n=29) and not (n=40); then groups were
compared in the point of parameters of crime and migration.
Results: Most of the patients who have not committed a crime were from cities. Even though there was
no significant difference, with those who have committed a crime, the age of internal migration was
younger. Migration raised the possibility of the recidivism of the criminal acts up to 5 fold whereas, having
already been prisoned before raised this possibility up to 17 fold and childhood within the criminal group.
Conclusions: Although our data indicated the internal migration not to affect the rate of the criminal acts
among the patients with schizophrenia meaningfully, it significantly affected repetition of crime within the
criminal group. The need to focus on internal migration and urbanization as disruptive environmental
conditions effecting schizophrenia and crime in countries like Turkey where the urbanization process is still
ongoing, is obvious.
Key words: Crime, internal migration, schizophrenia
Both disorders can show common features in terms of diagnosis and overlap in phenomenological perspective. Coexistence of both disorders is quite frequent. The nature of mood shifts, types of impulsivity and the longitudinal course of the disorders should be considered to differenciate them. There are findings on the effectiveness of mood stabilizers such as lithium, carbamazepine, oxcarbazepine, sodium valproate or lamotrigine in the treatment of the borderline personality disorder. The differentiation of borderline personality disorder from bipolar disorder is not easy. A very careful evaluation is required. This differentiation may also be useful in terms of treatment. A greater number of research results are available on the effectiveness of valproate and lamotrigine in the treatment of borderline personality disorder. Findings related to other mood stabilizers are insufficient. In
the treatment of borderline personality disorder, there is not any drug approved by the official authorities. Psychotherapeutic approaches still retain their important place in the treatment. However, symptombased approach is proposed in the use of mood stabilizers.