Levels of childhood traumatic experiences and dissociative symptoms in extremely obese patients with and without binge eating disorder.

Background: It has been suggested that obese patients with binge eating disorder (BED) show higher levels of dissociation and childhood trauma. Aim: This study assesses childhood trauma history and dissociative symptoms in obese patients with BED compared to obese patients without BED. Methods: The 241 patients participating in the study had to meet obesity criteria. These patients were applicants for bariatric surgery and were consulted by a psychiatry service. Patients were separated into two groups that were accompanied by BED diagnoses according to structured clinical interviews administered according to the DSM-IV (SCID-I). Patients were assessed using the Dissociation Questionnaire (DIS-Q) and the Childhood Trauma Questionnaire (CTQ). The two groups of patients were compared. Results: A total of 75 (31.1%) of the 241 obese patients were diagnosed with BED. The study showed that obese patients with BED had higher dissociative scores than those without BED (p < .05). The results showed higher total scores and two different types of childhood trauma (physical abuse and emotional abuse) in BED patients compared to non-BED patients (p < .05). Conclusions: Clinicians should be fully aware of BED, dissociative symptoms and childhood traumatic experiences. These results show that, for at least a sub-group of obese patients, BED is associated with obesity and may be connected with dissociative symptoms and childhood physical abuse and emotional abuse.

Relation of binge eating disorder with impulsiveness in obese individuals.

AIM: To investigate the levels of impulsiveness, and the relationship between the binge eating disorder (BED) and the levels of impulsiveness in obese individuals. METHODS: Two hundred and forty-one obese patients who were included in the study and candidate for bariatric surgery (weight loss surgery) were clinically interviewed to identify the BED group, and patients were divided into two groups: Those with BED and those without BED. The comorbidity rate of groups was determined by using structured clinical interview for DSM-IV (SCID-I). A sociodemographic data form including the story of previous psychiatric treatment, structured clinical interview for DSM-IV (SCID-I), Beck Anxiety Inventory, Beck Depression Inventory (BDI) and Barratt Impulsiveness Scale-11 were applied to both of the groups. RESULTS: In regard to 241 obese individuals included in the study, total score and score of attention subscale for BED (+) group were significantly high (P < 0.05). In addition, suicide attempt, story of psychiatric consultation, and score for BDI were again significantly high in the BED (+) group (P < 0.05). CONCLUSION: In assessment of obese individuals, assessment of associated psychopathology such as impulsive characteristics and suicide attempt in addition to disrupted eating behaviors will allow to have a more extensive view.

Is there a complex relation between social anxiety disorder, childhood traumatic experiences and dissociation?

BACKGROUND: A possible relationship has been suggested between social anxiety and dissociation. Traumatic experiences, especially childhood abuse, play an important role in the aetiology of dissociation. AIM: This study assesses childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with social anxiety disorder (SAD). METHOD: The 94 psychotropic drug-naive patients participating in the study had to meet DSM-IV criteria for SAD. Participants were assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), the Dissociation Questionnaire (DIS-Q), the Liebowitz Social Anxiety Scale (LSAS), and the Childhood Trauma Questionnaire (CTQ). Patients were divided into two groups using the DIS-Q, and the two groups were compared. RESULTS: The evaluation found evidence of at least one dissociative disorder in 31.91% of participating patients. The most prevalent disorders were dissociative disorder not otherwise specified (DDNOS), dissociative amnesia, and depersonalization disorders. Average scores on LSAS and fear and avoidance sub-scale averages were significantly higher among the high DIS-Q group (p < .05). In a logistic regression taking average LSAS scores as the dependent variable, the five independent variables DIS-Q, CTQ-53 total score, emotional abuse, sexual abuse, and emotional neglect were associated with average LSAS scores among patients with SAD (p < .05). CONCLUSIONS: It is concluded that, on detecting SAD symptoms during hospitalization, the clinician should not neglect underlying dissociative processes and traumatic experiences among these patients.

Childhood Traumatic Experiences, Dissociative Symptoms, and Dissociative Disorder Comorbidity Among Patients With Panic Disorder: A Preliminary Study.

This study assessed childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with panic disorder (PD). A total of 92 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 using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), Dissociation Questionnaire, Panic and Agoraphobia Scale, Panic Disorder Severity Scale, and Childhood Trauma Questionnaire. Of the patients with PD, 18 (19%) had a comorbid dissociative disorder diagnosis on screening with the SCID-D. The most prevalent disorders were dissociative disorder not otherwise specified, 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 < .05). All of the childhood trauma subscales used were correlated with the severity of symptoms of dissociation and PD. Among all of the subscales, the strongest relationship was 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 at admission should not lead the clinician to overlook the underlying dissociative process and associated traumatic experiences among these patients.

Open-longitudinal study of the effect of dissociative symptoms on the response of patients with panic disorder to venlafaxine.

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 (<2.5) and high DIS-Q scores (>2.5) - 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.

[Violent behavior variables among patients with schizophrenia under forensic psychiatric process: a case-control study]. / Adli Psikiyatrik Süreç Içindeki Sizofreni Hastalarinin Siddet Davranisi Degiskenleri: Bir Olgu Kontrol Çalismasi

OBJECTIVE: 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. METHODS: 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). RESULTS: A total of 80.7% of the patients with schizophrenia were found to be paranoid subtype. The mean age of schizophrenia, the age for the first criminal behavior and the mean age at the time of crime were significantly higher in the schizophrenic group, compared to controls. Previous criminal history, self-injurious behavior before the violent crime, and alcohol and substance use at the time of crime were found to be significantly lower in the schizophrenia group. It was found that more crimes were committed during the daytime in the schizophrenia group, in comparison to the control group. It was also observed that patients with schizophrenia primarily targeted the people around them. CONCLUSION: Investigation into the behavior patterns of patients with schizophrenia exhibiting violent behavior and taking measures to manage the potential risks in these individuals may help to reduce the incidence of future violent behavior. Studies such as this one can aid in improving a patient's social measures and in protecting the people around these individuals.

Borderline personality disorder: bipolarity, mood stabilizers and atypical antipsychotics in treatment.

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, olanzapine and quetiapine as atypical antipsychotics. It is not easy to differentiate borderline personality disorder from the bipolar disorders. An intensively careful evaluation should be performed. This differentiation may be helpful also for the treatment. There are many studies about efficacy of valproate and lamotrigine in treatment of borderline personality disorder. However, findings related to other mood stabilizers are inadequate. Olanzapine and quetiapine are reported to be more effective among atypical antipsychotics. No drug is approved for the treatment of borderline personality disorder by the entitled authorities, yet. Psychotherapeutic approaches have preserved their significant places in treatment of borderline personality disorder. Moreover, symptom based approach is recommended in use of mood stabilizers and atypical antipsychotics.

Dissociative symptoms and dissociative disorder comorbidity in patients with obsessive-compulsive disorder.

The present study attempted to assess the dissociative symptoms and overall dissociative disorder comorbidity in patients with obsessive-compulsive 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.

[Profile of population targeted by violent behavior of psychotic patients]. / Psikotik Hastalarin Siddet Davranislarinda Hedef Kitle Profili.

OBJECTIVE: 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. METHOD: 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. RESULTS: 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 who victimized married people, had previously met with their victims or who lived with their victims prior to the homicidal act. CONCLUSION: This study concludes that violent psychotic patients mostly choose their victims from among their family members. Psychotic patients were three times more likely to choose a relative compared to the control group. Recognizing the risk factors and the population most often targeted by homicidal behavior is essential for protecting patients and the community.

Psychopathological dimensions of tinnitus and psychopharmacologic approaches in its treatment.

BACKGROUND: The aim of this review to investigate presence of psychopathological states and efficacy of psychopharmacological drugs in the treatment of tinnitus. MATERIALS AND METHODS: An extensive Internet search has been performed for this aim through PubMed by using related key words in English. RESULTS: Higher anxiety and depression levels and somatoform disorder clusters are defined in patients with tinnitus. Additionally, impulsivity, hostility, demanding, physical discomfort, anxiety for health, emotionality and suicidal tendency are also defined in these people. Personality characteristics in these patients are depression, hysteria and hypochondriac features. Besides these symptom clusters, more severe psychopathologies like personality disorders may be encountered in these patients. Sertraline, paroxetine and nortriptyline can be considered as the first-line antidepressants in the psychopharmacological treatment of tinnitus. There are studies which have reported the efficacy of sulpiride. Carbamazepine, valproate and gabapentin can be effective as mood stabilizers. Short-acting benzodiazepines like alprazolam and midazolam are effective in signs of anxiety. Clonazepam and diazepam can be evaluated as other options. However, some glutamate receptor antagonists also can be used in the treatment of tinnitus. Disturbed sleep is frequently associated with tinnitus. Sleep disturbance can disrupt the quality of life in the patients with tinnitus. These patients might benefit from cognitive-behavioral therapy, which offers the promise of relief from tinnitus-related distress and insomnia. CONCLUSION: When pathophysiologic reasons are excluded, it should be at least considered that tinnitus is exaggerated by psychopathological symptoms. Life quality of patients can be increased by treating these symptoms.

[The impact of socioeconomic and sociodemographic factors on the criminal behavior of patients with a psychotic disorder]. / Sosyoekonomik Etmenlerin ve Sosyodemografik Ozelliklerin Psikotik Olgularin Suç Islemesinde Etkisi.

INTRODUCTION: The impact of socioeconomic and demographic factors on the criminal behavior of patients with a psychotic disorder was evaluated. METHOD: The study included 70 psychotic men hospitalized in the forensic psychiatry unit of the Bakirköy State Hospital for Psychiatric and Neurological Diseases for compulsory treatment who were compared to 70 psychotic disorder cases with no criminal history hospitalized in the acute wards in the same hospital. Socioeconomic and sociodemographic data were collected and statistical evaluations were made. RESULTS: The vast majority of all the patients (90.7%) in both groups were diagnosed with schizophrenia. The forensic group was significantly less educated than the control group (7.99+/-3.81 years vs. 9.37+/-3.62 years, P<0.05). More than 50% of the cases in both groups were never married ; when considering divorced and widowed patients together with these unmarried patients, the percentage rose to 83%. Fewer forensic cases lived in urban areas than did control cases (50% vs. 84.3%). Logistic regression analysis highlighted a relationship between unemployment and the lack of social insurance to the criminal behaviour of the forensic group. Of those in the forensic group, 48.6% had no social insurance, whereas only 15.7% of the control group had none. CONCLUSION: The data suggested that unemployment and the lack of social insurance are 2 independent variables that may contribute to the probability that patients with a psychotic disorder will engage in criminal behavior.