Analysis of Forensic Death Statistics From 2013 to 2022 and Autopsy Practices in Türkiye

Background: Autopsy rates are significantly lower that what they should be worldwide. Additionally, autopsy practices vary between countries. Aims: To examine the autopsy rates, the distribution and temporal changes of forensic autopsy cases, so as to identify the areas in the death investigation system that require improvement in Türkiye. Study Design: Cross-sectional study. Methods: "Forensic Death Examination Statistics" of the Council of Forensic Medicine (CFM) and "Death Statistics" of the Turkish Statistical Institute were compared and analyzed for the years 2013-2022 in Türkiye. Results: The number of forensic death cases sent to the CFM has increased over time. For all causes of deaths, the autopsy rate is approximately 3.6-4.8%. The cause-specific mortality rates for deaths due to sharp instrument trauma, blunt trauma, occupational accident, undetermined, and poisoning have increased over the years. "The percentage of "undetermined" deaths, which are important to demonstrate negative autopsies, was 14.2% in 2021. Conclusion: Although the autopsy rates have slightly increased in a volatile trend over time in Türkiye, they are still not at the desired level. Thus, it is essential to further raise awareness among all professionals involved in death investigations about the importance of autopsies.

Medicolegal aspect of loss of smell and olfactory event-related potentials.

Background: It is not straightforward to objectively evaluate the olfactory dysfunction that occurs following forensic incidents. The olfactory event-related potentials method, based on electrophysiological records, may provide objective data in the evaluation of posttraumatic anosmia cases from the medicolegal perspective. This study, where a quantitative evaluation of the cases with the complaints of olfactory sensation disorder was performed using the olfactory event-related potentials test, aims to identify the factors that should be considered in the evaluation of olfactory dysfunction from the medicolegal perspective. Results: This study first evaluated the complaints of 98 patients admitted because of posttraumatic impaired smell and then administered electrophysiological odor tests on the patients. Because of this, the relationship between the EEG responses of the cases and the olfactory disorder was examined. Of the 98 cases that participated in the study, 68 (69.4%) were male and 30 (30.6%) were female. Of all cases, 53 (54.1%) had complaints of not being able to smell at all, 14 (14.3%) had complaints of reduced smell, whereas, in addition to the existing complaints of olfactory dysfunction, 44 (44.9%) of them had complaints of taste perception and 18 (18.3%) reported having vision disorders. 21 of 37 cases who reported being unable to smell during the test turned out to be anosmic. Furthermore, 16 cases stated that, though having had a response in the odor test, they had no sense of smell following the test. Conclusions: Although it seems possible to prove that there is a relationship between the olfactory event-related potential test and the diagnosis of anosmia, there is still ongoing research on its use in clinical practice. Performing both subjective and electrophysiological tests together to detect olfactory dysfunctions that occur after a forensic incident enable provide more reliable results in diagnosis.

Brain-derived neurotrophic factor levels and psychopathology scores in drug-naïve first-episode psychosis.

INTRODUCTION: Brain-derived neurotrophic factor (BDNF) is involved in the regulation of many neuronal processes, including neurogenesis. Therefore, it is thought to be closely associated with many psychopathologies with a neurodevelopmental basis, for example, schizophrenia. METHODS: The patients admitted to the Psychiatry Department of the Faculty of Medicine with a diagnosis of non-affective drug-naïve first-episode psychosis (FEP) were included in the study. The relationship between laboratory and clinical findings and psychometric data (Positive and Negative Syndrome Scale) was examined. RESULTS: The study population consisted of 34 FEP and 34 healthy control (HC) volunteers. Mean BNDF levels of FEP and HC groups were 14.95 ± 6.13 and 17.89 ± 4.84 pg/ml, respectively. The difference between the groups was statistically significant (t = 2.197; p = .032). There was a negative correlation between mean BDNF levels and PANSS general psychopathology subscale scores (r = .358; p = .038), and total PANSS scores (r = .356; p = .039). DISCUSSION: There is a consensus on low serum BDNF levels both in FEP and in schizophrenia. However, it is still not clear which clinical findings are associated with lower serum BDNF levels. The relationship between BDNF levels and psychopathologies in schizophrenia has to be investigated.

Effect of N-acetylcysteine on clozapine-induced sialorrhea in schizophrenic patients: a case series.

Clozapine is an atypical antipsychotic demonstrated to be superior in the treatment of refractory schizophrenia. Despite all this effectiveness, it has side effects that can be serious and bothersome. Sialorrhea is the most common adverse drug reaction that occurs during clozapine treatment. It is usually persistent, may impair the patient's quality of life and reduce treatment compliance. However, there is limited evidence to guide possible treatment strategies for sialorrhea. N-Acetylcysteine (NAC) is a powerful antioxidant. It acts directly as a scavenger of free radicals, in particular oxygen radicals. The antioxidant NAC also modulates glutamatergic, neurotrophic and inflammatory pathways. The first time we examined and reported the effect of NAC (1200-2400 mg/day) on clozapine-induced sialorrhea in a patient group of five patients. After four weeks of follow-up, the severity of sialorrhea decreased significantly with NAC augmentation. There were no significant side effects of NAC as measured by the UKU scale.

Serum Levels of High Sensitivity C-reactive Protein in Drug-naÏve First-episode Psychosis and Acute Exacerbation of Schizophrenia.

OBJECTIVE: Findings about inflammatory processes in schizophrenia are increasing day by day. Inflammatory processes in schizophrenia are associated with both its etiology and clinical symptoms. Serum high-sensitivity C-reactive protein (hsCRP) is also one of these inflammatory processes. Particularly, it is thought to be closely related to clinical findings of patients with schizophrenia. METHODS: In this study, the relationship between clinical findings of hsCRP levels of patients with drug-naÏve first-episode psychosis (FEP) and patients with schizophrenia in acute exacerbation phase is investigated. Clinical findings, psychometric properties (the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, Brief Psychiatric Rating Scale), and hsCRP levels of patients were compared. RESULTS: Forty-eight patients with FEP, 74 patients with schizophrenia in acute exacerbation phase and 54 healthy controlled volunteers are included in the study. The most substantial finding in the study is that there is a positive correlation between hsCRP levels and severity of positive symptoms of both patient groups, with FEP and with schizophrenia. The second most substantial finding is there is no significant difference between patients with FEP and schizophrenia, in terms of hsCRP. CONCLUSION: The relationship between hsCRP and positive symptom severity in two groups of patients supports the inflammatory hypothesis in the etiopathogenesis of schizophrenia. This finding is supportive of close relation between inflammatory processes and clinical findings of patient with schizophrenia.

Changes in Pre- and Post-Electroconvulsive Therapy Serum Myostatin Levels in Patients with Treatment Resistant Depression.

OBJECTIVE: Myostatin is a growth factor which is investigated regarding musculoskeletal system. Albeit its effect on muscle mass is known, it is considered likely having other unknown effects as well, particularly on central nervous system. With this study, it is aimed to find out that what type of effect electroconvulsive therapy (ECT) does on myostatin in patients with treatment resistant depression. METHODS: Twenty-nine patients with treatment resistant major depression and thirty healthy volunteers were included in the study. Pre- and post-ECT levels of myostatine were compared; also this results were compared to healthy controls. RESULTS: For 29 patients with treatment-resistant major depression, the pre-treatment mean myostatin level was 0.95±0.32 ng/ml and post-therapy myostatin level was 11.05±6.97 ng/ml. As a result of this study, it is found that ECT affects serum myostatin levels to a significant degree (t=4.17, p＜0.05). It is also found that there was a significant relation between serum myostatin levels and depression scores (r=0.392, p＜0.05). CONCLUSION: With the present study and similar ones, it can be understood that how ECT achieves its effectiveness biologically.

Evaluation of potential novel variations and their interactions related to bipolar disorders: analysis of genome-wide association study data.

BACKGROUND: Multifactor dimensionality reduction (MDR) is a nonparametric approach that can be used to detect relevant interactions between single-nucleotide polymorphisms (SNPs). The aim of this study was to build the best genomic model based on SNP associations and to identify candidate polymorphisms that are the underlying molecular basis of the bipolar disorders. METHODS: This study was performed on Whole-Genome Association Study of Bipolar Disorder (dbGaP [database of Genotypes and Phenotypes] study accession number: phs000017.v3.p1) data. After preprocessing of the genotyping data, three classification-based data mining methods (ie, random forest, naïve Bayes, and k-nearest neighbor) were performed. Additionally, as a nonparametric, model-free approach, the MDR method was used to evaluate the SNP profiles. The validity of these methods was evaluated using true classification rate, recall (sensitivity), precision (positive predictive value), and F-measure. RESULTS: Random forests, naïve Bayes, and k-nearest neighbors identified 16, 13, and ten candidate SNPs, respectively. Surprisingly, the top six SNPs were reported by all three methods. Random forests and k-nearest neighbors were more successful than naïve Bayes, with recall values >0.95. On the other hand, MDR generated a model with comparable predictive performance based on five SNPs. Although different SNP profiles were identified in MDR compared to the classification-based models, all models mapped SNPs to the DOCK10 gene. CONCLUSION: Three classification-based data mining approaches, random forests, naïve Bayes, and k-nearest neighbors, have prioritized similar SNP profiles as predictors of bipolar disorders, in contrast to MDR, which has found different SNPs through analysis of two-way and three-way interactions. The reduced number of associated SNPs discovered by MDR, without loss in the classification performance, would facilitate validation studies and decision support models, and would reduce the cost to develop predictive and diagnostic tests. Nevertheless, we need to emphasize that translation of genomic models to the clinical setting requires models with higher classification performance.

Letter to Editor. Depression and cytokines - a different perspective. / List do Redakcji. Depresja i cytokiny ­ inne spojrzenie.

no summary.

Seropositivity of neurotropic infectious agents in first-episode schizophrenia patients and the relationship with positive and negative symptoms.

BACKGROUND: According to the neurodevelopmental model, schizophrenia is a disorder that occurs as a result of different etiologic factors during brain development, including viral infections. However, it is unclear whether these infections are related to the disease or whether they affect the symptom pattern. We investigated the presence of four herpes viruses (EBV, CMV, HSV-1 and HSV-2) in first-episode schizophrenia patients and compared seropositive with seronegative patients and healthy volunteers to reveal the etiological role of viral agents on schizophrenia symptoms. SUBJECTS AND METHODS: Ninety-two first-episode patients who met the DSM-IV diagnostic criteria for schizophreniform disorder were included the study, along with 88 healthy volunteers. The presence of the four herpes viruses was investigated with serological methods (ELISA) in both groups. Positive and negative symptoms were evaluated with Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS). RESULTS: There was no difference between the patient and control groups in terms of seropositivity of the four viruses. We found that SANS scores of HSV-1 and CMV seropositive schizophrenia patients were significantly higher than the scores of patients with seronegative schizophrenia. No difference was found in SAPS scores. CONCLUSIONS: The results suggest a role of HSV and CMV infections in negative symptoms. This supports the hypothesis that viruses do not directly give rise to schizophrenia, but patients who were previously been infected with these viral agents may be prone to schizophrenia, and some of the symptom patterns may be related to different agents.

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

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