An Evaluation of Psychogenic Predictors of Non-Organic Erectile Dysfunction.

Background and Objectives: Erectile dysfunction is a significant problem, which diminishes the quality of life. The aim of this study was to investigate the relationship of childhood trauma and attachment styles in the aetiology of psychogenic erectile dysfunction. Materials and Methods: The study included 80 participants (40 patients who presented with the complaint of erectile dysfunction, were not determined with an organic pathology, and were diagnosed with erectile dysfunction according to the DSM-5 criteria; and a control group of 40 healthy subjects.) The structured clinical interview form for DSM-5 (SCID-5) was applied to all the participants, together with the International Erectile Function Index (IIEF), the Childhood Trauma Questionnaire (CTQ), the Relationship Scale Questionnaire (RSQ), and the Beck Depression Inventory (BDI). Results: The emotional abuse (p = 0.002), physical abuse (p = 0.049), emotional neglect (p = 0.004), physical neglect (p = 0.002), and total scale points of the CTQ were determined to be significantly higher in the patient group than in the control group. Secure (p = 0.022) and dismissive (p = 0.009) attachment styles were found to be higher in the control group. As the time together with the current sexual partner increased, so the severity of erectile dysfunction increased, and sexual function, orgasmic function, sexual satisfaction, and general satisfaction decreased. As emotional abuse, sexual abuse, and physical neglect increased, the severity of erectile dysfunction increased. Childhood trauma (ß = -0.275, t (73) = -2.704, p = 0.009) and the duration together with the partner (ß = -0.249, t (73) = -2.512, p = 0.014) were found to be predictive of erectile dysfunction. Conclusions: The results of this study demonstrated that childhood trauma and the time elapsed without treatment are predictors of psychogenic erectile dysfunction severity, and secure attachment style and self-esteem play an important role in the aetiology of psychogenic erectile dysfunction.

Cognitive outcomes of transcranial magnetic stimulation in treatment-resistant depression: a randomized controlled study.

BACKGROUND: Major depressive disorder (MDD) is a significant cause of workforce loss, and is associated with cognitive impairments which can continue even after the elimination of mood and behavioural symptoms. The aim of this study was to investigate the benefit of transcranial magnetic stimulation (TMS) on cognitive functions in treatment resistant depression. METHODS: This randomised controlled clinical trial was conducted at a university hospital, department of psychiatry (tertiary centre) between October 2019 and July 2020. The study included 30 patients with depressive disorder, aged 18-50 years, who did not respond to at least two antidepressant medications for at least 8 weeks (one drug used was serotonin norepinephrine reuptake inhibitor [SNRI]; and 15 healthy control subjects. The patients were separated into two equal groups in a double-blind, random manner, and 20 sessions of repeated TMS was applied to one group, and 20 sessions of sham TMS to the other. The Montgomery Asberg Depression Scale (MADRS), Hamilton Depression Rating Scale (HAM-D), Stroop test, Wisconsin Card Sorting Test (WCST), Digit Span Test (DST), Trail Making Test A-B, and Verbal Memory Processes Test (VMPT) were applied to the patients before and after the TMS procedure. RESULTS: The decrease in the HAM-D score was greater in the active magnetic stimulation (25 trains, 10 Hz, 110% motor threshold intensity) group, and with the exception of verbal memory processes, better performance was obtained by the active magnetic stimulation group than the sham group in the cognitive function tests. DISCUSSION: TMS was seen toimprove the cognitive defects present in the active phase of treatment-resistant depression, and therefore TMS could provide early improvement in cognitive functions in clinical use. Key words: Depression, transcranial magnetic stimulation, neurocognitive functi.

Efficacy of transcranial magnetic stimulation in treatment-resistant depression.

BACKGROUND: The use of Transcranial Magnetic Stimulation (TMS) in the add-on treatment of patients with treatment-resistant depression (TRD) is becoming more common. This study aims to investigate the efficacy of TMS on depression and accompanying anxiety symptoms among patients with TRD. METHODS: The current study was conducted with 38 patients diagnosed with TRD. The patients were randomly divided into two groups and received 20 sessions of high-frequency (10Hz) TMS and 20 sessions of sham TMS to the left dorsolateral prefrontal cortex in a double-blind and cross-over fashion without a change in their pharmacotherapy. In the clinical evaluation, Hamilton Depression Rating Scale (HAM-D) and Hamilton Anxiety Rating Scale (HAM-A) were carried out three times in total: before, crossover phase, and at the end of the treatment. RESULTS: A statistically significant decrease was found in the HAM-D and HAM-A in the group who were actively stimulated in the cross-over phase of the study. While there was a significant decrease in the HAM-A in the group who received sham stimulation, the decrease in the HAM-D was not statistically significant. Group comparisons revealed a statistically significant decrease in HAM-D in the group who were actively stimulated compared to the group receiving sham stimulation. At the end of the study, 63% of 38 patients responded to treatment, 15% partially responded, and 42% reached remission. DISCUSSION: This randomized, double-blind, sham-controlled, cross-over study revealed that TMS is superior to sham-TMS, provides clinically significant improvement when implemented besides pharmacotherapy among patients with treatment-resistant depression, and is beneficial for accompanying anxiety symptoms.

Effect of Psychodrama Group Therapy on Remission and Relapse in Opioid Dependence.

INTRODUCTION: Relapse is one of the most common problems in the addiction treatment. The aim of this study was to increase the remission rates, reduce relapse rates and investigate the effect of psychodrama on depression, anxiety and locus of control after treatment in a group of inpatients diagnosed with opioid use disorder (OUD). METHOD: The study was started with 13 inpatients diagnosed with OUD and completed with six members. In addition to psychoeducation, the psychodrama study of 13 sessions lasted. The control group consisted of six individuals with the same diagnosis and characteristics, who had only undergone psychoeducation. Hamilton Depression-Anxiety and Rotter Locus of Control Scales were applied to the participants before and after the group. RESULTS: Anxiety rates decreased in both groups according to pre-test and post-test results. In the outpatient part of the study, five patients in the patient group remained in treatment and clean at the end of the fifth month and four at the end of the sixth month. In the control group only two people could remain in treatment and clean at the end of the sixth month. The most effective psychodrama techniques were empty chair, doubling and mirroring. DISCUSSION: Both psychodrama techniques and SAMBA program are applications that reduce anxiety levels of patients. It was concluded that psychodrama applications aimed at increasing the internal control belief may be beneficial in terms of increasing the motivation of the patients and coping with relapse.

Sympathetic Skin Response in Social Anxiety Disorder and Its Relationship with Empathy Skills, Alexithymia.

INTRODUCTION: Psycho-behavioral studies have shown that sympathetic skin response (SSR), which is an indicator of sympathetic function, is associated with emotional responses. It has been reported that SSR, which is claimed to be a biological indicator of empathy, has increased in Social Anxiety Disorder (SAD) patients. The aim of this study was to evaluate the relationship between SSR and alexithymia, empathy in patients with SAD. METHOD: SAD patients and control group were applied Liebowitz Social Anxiety Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Toronto Alexithymia Scale, Empathy Quotient, Facial Emotion Identification and Discrimination tests (FID, FDSC); during the application FID, SSR were measured. The relationship between alexithymia and empathy levels were investigated. RESULTS: The number of SSR was higher in all visual stimuli of SAD patients (11.13±3.01) compared to the control group (7.4±3.57). More autonomous activity to negative stimuli (SAD: 10.55±2.82, control: 6.36±3.64), sensitivity to positive stimuli (SAD: 0.58±0.69, control: 1.03±0.8) was less than control group. While 41.7% of SAD patients had alexithymic features, 36.1% were diagnosed with depressive disorder. CONCLUSION: It was thought that depressive and alexithymic features may have contributed to increased sympathetic sensitivity to negative stimuli in SAD patients. Further studies are needed to examine the effects of this situation on the selection and creation of the treatment modalities.

[Prefrontal cortex neurochemical metabolite levels in major depression and the effects of treatment: an HMRS study]. / Major depresyonda prefrontal korteks nörokimyasal metabolit düzeyleri ve sagaltimin etkileri: bir HMRS çalismasi.

OBJECTIVE: Neuronal degeneration in the prefrontal cortex during depression results in altered production of neurochemical metabolites. The aim of the present study is to examine changes in neurochemical metabolites in the prefrontal cortex and evaluate the effects of psychodrama group therapy and pharmacotherapy on neurochemical metabolism in the first episode depression using 1HMRS methodology. METHOD: Eighteen drug-free female patients with diagnosed first-episode major depression according to DSM-IV criteria and 10 healthy female subjects were enrolled in the study. The Hamilton Rating of Depression Scale (HAM-D) was used to asses the severity of depression in each of the study participants. Proton magnetic resonance spectroscopy (1HMRS) was applied to the right prefrontal cortex both before and after treatment and the concentration of N-Asetil Aspartate (NAA), choline (Cho), and creatine (Cr) were measured. All patients were prescribed ant-depressant medication at the time of the evaluation (essitalopram 10-20 mg/g). In addition, a psychodrama group therapy session was conducted in which 10 patients participated in one 3-hour session each week. HAM-D and 1HMRS were repeated after 16 weeks. RESULTS: Prior to treatment, the HAM-D score in the patient group was 14.55±4.55 while the HAM-D score was 3.88±2.47 after 16 weeks of treatment. The severity of symptoms among the patient group was determined to be mild/moderate. No neurochemical abnormalities were identified in the right prefrontal cortex of depressed patients compared to the healthy subjects in the baseline measurements and no significant change was observed in neurochemical metabolites following treatment with pharmacotherapy or pharmacotherapy with group psychotherapy. CONCLUSION: Our results identified no neurodegeneration, cell membrane dysfunction, alterations in energy metabolism, or altered neurochemical metabolite levels in patients undergoing a first episode of mild/moderate depression. Further studies will be needed to evaluate the effects of alternate treatments and the presence or absence of neuronal damage during follow-up of patients with depression.

Involuntary social cue integration in patients with obsessive compulsive disorder.

OBJECTIVE: Patients with obsessive compulsive disorder (OCD) have inferior social functioning compared to healthy controls, but the exact nature of these social deficits, and the underpinning mechanisms, are unknown. We sought to investigate social functioning in patients with OCD by measuring their involuntary/spontaneous processing of social cues using a specifically designed test, which might reveal deficits in these patients that explicit voluntary tasks do not detect. METHODS: The sample of the study consisted of an OCD group (n = 25) and a control group (n = 26). Both groups performed an adaptation of the Social Distance Judgment Task (SDJT; Jellema et al., 2009), in which participants have to judge the geometrical distance between two human cartoon figures presented on a computer screen. Head/gaze direction and body direction were manipulated to be either compatible, i.e. both directed to the left or to the right (Compatible condition) or incompatible, i.e. body directed toward the observer (frontal view) and head/gaze directed to the left or right (Incompatible condition). RESULTS: In the Compatible condition, controls nor OCD patients were influenced by the social cues in their judgments of the geometrical distances. However, in the Incompatible condition, where the attentional cue was more conspicuous, both groups were influenced by the cues, but the controls to a significantly larger extent than the OCD patients. CONCLUSIONS: This study showed that patients with OCD are less likely, compared to controls, to automatically/spontaneously integrate the other's direction of attention into their visual percept. This may have resulted in their judgments of the geometrical distances between the agents to be more accurate than those of controls. The suggested impairment in automatically integrating social cues may have important repercussions for the social functioning of OCD patients.

Psychopathology in thalassemia major.

BACKGROUND: Thalassemia major (TM) is a chronic disease with adverse emotional effects on both the child and the family. The aim of this study was to investigate the psychiatric state and behavioral problems of children with TM. METHODS: Twenty children diagnosed with TM and 34 healthy children were enrolled in this study carried out by the Pamukkale University Faculty of Medicine, Department of Pediatrics. Mothers of the children of both the groups were handed a child behavior check-list for 4-18-year-old children and adolescents as well as a short questionnaire requesting demographic information. RESULTS: The psychiatric diagnosis was significantly higher in the children with TM (55.0%) as compared to the control group (14.7%). The thalassemic children showed an anxiety disorder frequency of 30.0% and a depressive disorder frequency of 15.0%. T scores of the indicators of internalizing problems, externalizing problems, attention problems and social problems contained in the child behavior check-list were shown to be higher in children with TM than in the control group. The TM group demonstrated significantly higher problems in peer relationships and educational success in comparison with the controls. CONCLUSION: Children with TM are posed with an increased risk of psychopathology.

Cognitive functions in euthymic patients with bipolar disorder.

BACKGROUND: Recent studies have focused on the nature of cognitive dysfunction in bipolar patients. The purpose of the current study was to investigate cognitive performance of individuals with bipolar disorder compared to healthy control subjects during a well-established euthymic period. METHODS: The sample consisted of 27 bipolar euthymic patients and 21 control subjects. Verbal and visual memory performance, attention, executive functions and psychosocial functions were evaluated for each participant. RESULTS: Bipolar patients showed significant attentional deficit and executive dysfunction and also poor performance on verbal and visual memory tasks compared to the controls. Illness duration and lifetime total episode number and previous episode with psychotic features was associated with worsened performance on attention, executive and memory tasks. Psychosocial functioning was not associated with cognitive deficit. CONCLUSIONS: The present study showed persistent cognitive impairment on inhibitory control and selective attention as well as poor performance on verbal and visual memory tests in a group of bipolar euthymic patients. The impaired neuropsychological performance was associated with duration of illness, total number of episodes per lifetime, and previous episodes with psychotic features. Attentional dysfunction seemed to be a trait abnormality for the sample studied.

Does corticosteroid usage in rhinoplasty cause mood changes?

In this study, the psychological effects of single-dose corticosteroids administered to patients who had undergone rhinoplasty were assessed. A total of 30 rhinoplasty patients were included in the study and were randomly assigned to 1 of 2 groups. Preoperatively, patients completed the Bech Rafaelsen Mania Scale and the Beck Depression Inventory. Dexamethasone 10 mg was given intravenously just before surgery to the first group, but no medication was administered to the second group. On the first postoperative day, patients were seen again, and the Bech Rafaelsen Mania Scale and the Beck Depression Inventory were again completed. Periorbital edema and ecchymosis were graded, and psychological well-being was measured on a standard visual analog scale. All patients and physicians were blinded to treatment until the end of the study. Results show that administration of a single-dose of dexamethasone 10 mg caused neither euphoria nor depression. No significant differences were observed between steroid and control groups in terms of patients' psychological well-being. With single-dose dexamethasone, periorbital edema was significantly reduced on the first 2 postoperative days, and upper eyelid ecchymosis was significantly decreased only on the first postoperative day. However, reoperative steroid administration had no influence on ecchymosis of the lower eyelid. The authors conclude that single-dose dexamethasone 10 mg can be used safely to reduce periorbital edema and ecchymosis in rhinoplasty patients.

OCD symptoms in a sample of Turkish patients: a phenomenological picture.

This study aimed to investigate the clinical features of obsessive-compulsive disorder (OCD) and the possible association between obsessive-compulsive symptoms and culture-related characteristics in a sample of Turkish patients with OCD. We studied 141 patients with OCD (according to DSM-IV criteria) consecutively admitted to our outpatient clinic during the period from February 1998 to December 2003. We used the Turkish version of the Structured Clinical Interview for DSM-IV (SCID) to interview all patients, and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to assess obsessive-compulsive symptoms and severity. The onset of OCD symptoms was earlier in males. Major depression was the most common comorbid disorder (30.5%). The most commonly occurring obsessions were contamination (56.7%), aggression (48.9%), and somatic (24.1%), followed by religious (19.9%), symmetry (18.4%), and sexual imagery (15.6%). Symmetry and sexual obsessions, and checking compulsions and rituals, tended to be more common in male patients. Dirt and contamination obsessions and washing compulsions were slightly more common in females. The vast majority of patients with religious obsessions (83%) and half of the patients with sexual obsessions had compulsions that included religious practices. Also, patients with sexual and religious obsessions had delayed seeking professional help.

Depressive symptomatology among university students in Denizli, Turkey: prevalence and sociodemographic correlates.

AIM: To determine overall and subgroup prevalence of depressive symptomatology among university students in Denizli, Turkey during the 1999-2000 academic year, and to investigate whether sociodemographic factors were associated with depressive symptoms in university students. METHODS: A stratified probability sample of 504 Turkish university students (296 male, 208 female) was used in a cross-sectional study. Data were obtained by self-administered questionnaire, including questions on sociodemographic characteristics and problem areas. The revised Beck Depression Inventory (BDI) was used to determine depressive symptoms of the participants. BDI scores 17 or higher were categorized as depressive for logistic regression analysis. Student t-test and linear regression were used for continuous data analysis. RESULTS: Out of all participants, 26.2% had a BDI score 17 or higher. The prevalence of depressive symptoms increased to 32.1% among older students, 34.7% among students with low socioeconomic status, 31.2% among seniors, and 62.9% among students with poor school performance. The odds ratio of depressive symptoms was 1.84 (95% confidence interval [CI], 1.03-3.28) in students with low socioeconomic status and 7.34 (95% CI, 3.36-16.1) in students with poor school performance in the multivariate logistic model. The participants identified several problem areas: lack of social activities and shortage of facilities on the campus (69.0%), poor quality of the educational system (54.8%), economic problems (49.3%), disappointment with the university (43.2%), and friendship problems (25.9%). CONCLUSIONS: Considering the high frequency of depressive symptoms among Turkish university students, a student counseling service offering mental health assistance is necessary. This service should especially find the way to reach out to poor students and students with poor school performance.

Psychiatric morbidity among cancer patients and awareness of illness.

A significant proportion of cancer patients experience psychiatric morbidity. Potential predictors of psychiatric morbidity include patient disease-related factors and factors relating to the patient's environment. The aim of this study was to investigate the prevalence of psychiatric morbidity and the relationship between the clinical or personal factors, especially psychiatric morbidity, and awareness of cancer diagnosis among a group of Turkish cancer patients. A total of 117 cancer patients were assessed using the Structured Clinical Interview for DSM-IV (SCID), the Hospital and Anxiety Depression Scale (HADS) and the General Health Questionnaire (GHQ). Of these patients, 30% had a psychiatric diagnosis. Adjustment disorders comprised most of the psychiatric diagnoses. Awareness of the diagnosis of cancer, history of previous psychiatric disorders, pain and stress factors were correlated with psychiatric morbidity. Of the 117 patients, 64 (54.7%) were unaware of the diagnosis of cancer. Most of the patients (67.9%) who were considered to be aware of the cancer diagnosis stated that they had guessed their illness from the treatment process or drug adverse effects. Psychiatric morbidity was significantly higher in the patients who knew that they had a cancer diagnosis (P=0.03). These findings suggest that the awareness of cancer diagnosis is related to the presence of psychiatric morbidity. In particular, the understanding of the diagnosis indirectly may be stressful to the patient because it arouses suspicion about the cancer and treatment, and consequently can lead to psychiatric disturbance. In Turkey honest disclosure of the true diagnosis is still not common for cancer patients and it seems to be essential to improve this situation.

Quantitative EEG analysis in obsessive compulsive disorder.

Quantitative analysis of the EEG (q-EEG) in patients with obsessive compulsive disorder (OCD) showed a decreased beta and an increased theta power at frontotemporal regions. The patients who had higher scores in doubting test (Maudsley Obsessive Compulsive Questionnaire) and more severely ill patients shared similar q-EEG features. The relative theta powers were significantly increased and alpha powers were significantly decreased in these patients, particularly in the frontotemporal region. It was suggested that the q-EEG may be useful in investigating the OCD patients with heterogeneous characteristics.