Sexual dysfunction in women with human papilloma virus infection in the Turkish population.

Human papilloma virus infection (HPV) is the most common sexually transmitted disease. It may increase the risk of several cancers, including those of the cervix, vulva, vagina, head and neck. HPV is usually transmitted during sexual intercourse; there are limited data about sexual dysfunction (SD) after infection with this virus. We aimed to measure the incidence of SD in women with HPV. In this study, we evaluated 67 HPV-infected female patients and 66 healthy controls. The Arizona Sexual Experience Scale (ASEX), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Socio Demographic Form were used for evaluation. Gynaecologists and psychiatrists evaluated the participants. Women with HPV were found to have significantly higher Arizona Sexual Experience Scale (ASEX) total scores and ASEX sub scores than the control group in the domains of sexual desire, arousal, genital response, orgasmic experience and their satisfaction from orgasm (p ≤ .05). The study group shows a statistically significant difference in the Beck Depression Inventory (BDI), but Beck Anxiety Inventory (BAI) scores show no significant differences between the experimental and control groups. Our study shows that HPV positivity in female patients is associated with a significant impairment in sexual function and that this impairment is not related to depression or anxiety. Impact statement What is already known on this subject? There are only a few studies concerned with sexual dysfunction in HPV patients. These studies have methodological problems, as they do not rule out the effect of depression on sexual dysfunction. It is very difficult to perform studies on sexual dysfunction and sexually transmitted diseases, because both physicians and patients are reluctant to talk about sexual problems. In the present study, only 6 out of 15 physicians accepted to contribute to the study. Although the physicians gave a questionnaire to more than 400 patients, only 133 of them completed that questionnaire. The most important difficulties in this study was to find enough patients. What do the results of this study add? Depression and sexual dysfunction are frequently seen in HPV patients. Although depression is one of the most common causes of sexual dysfunction, an HPV infection may lead to sexual dysfunction even in the patients without depression. What are the implications of these findings for clinical practice and/or further research? HPV infections may be associated with mental health problems and sexual dysfunction. The gynaecologists and other clinicians working with HPV patients should also evaluate patients psychologically and refer patients to psychiatry if required. The psychiatric problems associated with an HPV infection do not only impair sexual functions, but also may lead to difficulties in social life.

Sexual dysfunction in men suffering from genital warts.

INTRODUCTION: Human papillomavirus (HPV) infection can present clinically as genital warts (GWs) in both males and females. Much less is known about the psychosexual consequences of GW, and the studies on patients in this group are still quite limited. AIMS: The aim of this study was to test two hypotheses: (i) sexual dysfunction (SD) is likely to occur in male patients suffering from GWs; (ii) if male SD exists, it may be associated with depression or anxiety. METHODS: This was a pilot study with a prospective cross-sectional design. Male patients with GW (N for patient group = 116) were compared with male control cases (N for control group = 71) using the Arizona Sexual Experience Scale (ASEX), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). The participants were evaluated by a dermatologist and a psychiatrist, respectively. MAIN OUTCOME MEASURES: The associations between sexual dysfunction, depression, and anxiety among the participants were examined. RESULTS: There was no difference between the groups in terms of sociodemographic changes. Sexual dysfunction was found to be significantly more common in the patients than controls (P = 0.000 < 0.001). When the subscores of ASEX were evaluated, they were found to be statistically significant between the two groups (P = 0.000 < 0.001). BDI and BAI scores were statistically higher in the patient group than in controls, and there was a positive correlation between BDI and BAI scores with ASEX total and subscores (P = 0.000 < 0.001). CONCLUSIONS: Male patients with GW have higher rates of sexual dysfunction, depression, and anxiety when compared with the normal population. Men suffering from GW should be evaluated for possible sexual problems, besides depression and anxiety.

Can We Benefit from the Preoperative Psychometric Test with Symptom Checklist-90-Revised (SCL-90-R) to Predict Weight Loss After Sleeve Gastrectomy?

BACKGROUND: The psychological assessment is crucial before bariatric surgery. Derogatis' Symptom Checklist-90-Revised (SCL-90-R) is one of the most widely used measures of psychological symptoms and distress in both clinical and research settings. We aimed to investigate the predictive value of SCL-90-R subscale scores on postoperative excess weight loss percentage (EWLP) after laparoscopic sleeve gastrectomy (LSG). METHODS: Patients who underwent primary LSG for morbid obesity and fully completed preoperative SCL-90-R between January 2016 and July 2019 were retrospectively examined. A multiple linear regression analysis was performed to investigate the relationship between descriptive and psychological variables associated with EWLP percentage at the 12th-month. RESULTS: One hundred six patients who met the inclusion criteria were analyzed. The adequate weight loss (EWLP ˃ 50%) was achieved in 90% of patients after 12 months. The multiple linear regression analysis indicated that younger patients (ß = - 0.695; 95% CI - 1.056, - 0.333; p < 0.001), and patients with preoperative lower BMI (ß = - 1.524; 95% CI - 1.974, - 1.075; p < 0.001) achieved higher EWLP at 12th-month. High somatization score (ß = 11.975; 95% CI 3.653, 20.296; p = 0.005) and a low Global Severity Index (GSI) score (ß = - 24.276; 95% CI - 41.457, - 7.095; p = 0.006) had a positive effect on EWLP at 12th-month. CONCLUSIONS: Preoperative psychological testing can help predict surgical outcomes in the bariatric population. More intense lifestyle and behavioral support can be applied by targeting patients who are expected to lose less weight after surgery, and patients' weight loss potential can be increased.

Regulation of tyrosine phosphatases in the adventitia during vascular remodelling.

Protein tyrosine phosphatases (PTPs) are regulators of growth factor signalling in vascular remodelling. The aim of this study was to evaluate PTP expression in the context of PDGF-signalling in the adventitia after angioplasty. Utilising a rat carotid artery model, the adventitial layers of injured and non-injured vessels were laser microdissected. The mRNA expression of the PDGF beta-receptor, the ligands PDGF-A/B/C/D and the receptor-antagonising PTPs (DEP-1, TC-PTP, SHP-2, PTP1B) were determined and correlated to vascular morphometrics, proliferation markers and PDGF beta-receptor phosphorylation. The levels of the PDGF beta-receptor, PDGF-C and PDGF-D were upregulated concurrently with the antagonising PTPs DEP-1 and TC-PTP at day 8, and normalised at day 14 after vessel injury. Although the proliferation parameters were time-dependently altered in the adventitial layer, the phosphorylation of the PDGF beta-receptor remained unchanged. The expression dynamics of specific PTPs indicate a regulatory role of PDGF-signalling also in the adventitia during vascular remodelling.

Sexual dysfunctions in patients with neurodermatitis and psoriasis.

We investigated sexual dysfunction and accompanying depression in patients with neurodermatitis and psoriasis. Patients with neurodermatitis (n = 31) and psoriasis (n = 24) were compared to control cases (n = 33) with Beck depression scale (BDS) and Arizona Sexual Experience Scale (ASEX). Beck Depression Scale and ASEX scores varied between three groups. In two group comparisons, the neurodermatitis group had more sexual problems than the psoriasis group and the control group. Patients with neurodermatitis and psoriasis have sexual dysfunction and depression in the course of these chronic diseases and the higher frequency of sexual problems was seen in patients with neurodermatitis.

[Psychodermatology: a collaboration between psychiatry and dermatology]. / Psikiyatri ve Dermatolojinin Ortak Calisma Alani: Psikodermatoloji.

Dermatology is of special importance in consultation-liaison practice. The brain and the skin originate from the same germ layer, the ectoderm, in the embryo. In later periods of life, the various ways these two organs influence each other has been the subject of many studies published in this field. These studies are divided into three groups: 1- studies about stress and dermatologic diseases, 2- psychoanalytic and psychodynamic approaches to psychodermatologic diseases, and 3- clinical research and treatment of psychodermatologic diseases. Recently, in some countries which are aware of the importance of the subject, in the psychodermatology section psychiatrists, dermatologists, psychologists and residents work together as a team. In fact, it has been already accepted that there is a need for association between psychiatry and dermatology in many cases. This association between the two disciplines aims to enhance the success of therapy and psychiatric support for patients who primarily have psychiatric disease, but project that as a dermatologic disease, on the one hand. On the other hand, it provides a more holistic, and satisfying approach for both doctors and patients having primarily dermatologic disease, but who develop psychiatric problems secondarily. In this article, psychodermatology investigations and the relationship between the skin and psyche, diseases discussed in this context, and overlapping areas of psychiatry and dermatology are reviewed, and it is aimed to attract attention to this topic.

Psychopathology and personality features in orthopedic patients with boxer's fractures.

A boxer's fracture (BF) is the most common type of metacarpal fracture and is usually an intentional injury. This study aims to investigate the severity of depressive and anxiety symptoms and evaluate the personality features of patients with BF in comparison with patients with fractures other than boxer's fractures [other fractures (OFs)] and a group of healthy controls (C). The study group was comprised of 14 patients who were diagnosed to have BF, 13 patients who were assessed due to OF and 11 C. Patients and controls were assessed with Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-2) was used to screen axis II, personality disorders' symptoms. The results showed that patients with BF had more anxiety as a trait and had higher mean scores for self-defeating, borderline and antisocial personality disorders than both the group of OF and C. Additionally, BF group had higher scores on the anger and cynicism subscales of MMPI-2. These results suggest that maladaptive personality traits and anxiety symptoms are common in patients with BF. Psychiatric assessment of patients who apply to orthopedy clinics with BF should be a part of their treatment plan.

[The psychometric properties of MMPI-2 addiction related supplementary scales on alcoholic patients]. / Alkol bagimlilarinda MMPI-2 bagimlilik alt olçeklerinin psikometrik ozellikleri.

OBJECTIVE: The aim of the study was to investigate criterion-related validity, internal-consistency and diagnostic efficiency statistics of the three MMPI-2 addiction related supplementary scales i.e., MacAndrew Alcoholism Scale (MAC-R), Addiction Potential Scale (APS) and Addiction Acknowledgment Scale (AAS). METHOD: Sixty-nine male chronic alcoholic patients and 51 male healthy control subjects were recruited for the study. All patients satisfied the diagnostic criteria of ICD-10 for alcohol dependence. Alcohol and drug modules of Schedules for Clinical Assessment in Neuropsychiatry (SCAN) were administered to each patient in order to give the diagnosis of alcohol dependency. The lifetime severity of drinking problems was assessed by the Michigan Alcoholism Screening Test (MAST). RESULTS: The comparison of the MMPI-2 results of the study groups revealed that chronic alcoholic patients had higher scores on MAC-R, APS and AAS. The investigation of the diagnostic efficiency statistics showed that MAC-R and AAS had satisfactory sensitivity and specificity for alcoholic patients. As a measure of internal-consistency, Kuder-Richardson coefficients were found to be satisfactorily high for each scale. CONCLUSION: The results of this study indicates that MMPI-2 based MAC-R and AAS scales are effective at differentiating between chronic alcoholic and control subjects. However, low specificity values of APS seemed to be damaging its diagnostic efficiency. Uniformly high Kuder-Richardson coefficients suggest that the items that comprise the MAC-R, APS and AAS are satisfactorily homogenous.

Variable clinical presentations of secondary delusional infestation: an experience of six cases from a psychodermatology clinic.

OBJECTIVE: Delusional Infestation (DI) is a relatively rare condition with a fixed belief of being infested with living organisms, despite a lack of medical evidence of such infestation. Although it seems to be a psychiatric disease, patients commonly are admitted to dermatology clinics because of skin findings. Psychiatrists can underestimate its prevalance, whereas dermatologists can miss the diagnosis. It should be managed as a psychodermatological disease. Our aim in the study was to evaluate six patients with different clinical presentations of DI and to emphasize some clinical features. METHOD: All patients were internalized in the psychodermatology clinic for this study. Medical history and clinical data from dermatologic and psychiatric examinations were noted; Mini International Neuropsychiatric Interview (MINI-Plus) and laboratory investigations including blood and urine analyses, microscopic analysis of so-called pathogens, and skin biopsy if needed, were performed. The diagnosis was made based on detailed history, dermatologic and psychiatric examinations, and laboratory investigations. RESULTS: All patients had symptoms of itching, burning, or crawling sensations dermatologically and thus were admitted to dermatology clinic. They were all considered secondary DI to another medical condition or to psychiatric illness. Vitamin B12 deficiency, diabetes, and hypothyroidism were the underlying medical conditions. Related psychiatric illnesses were trichotillomania and schizoaffective disorder, schizophrenia, shared pychotic disorder, and brief psychotic disorder. Two patients had delusions of inanimate materials; four patients had partial and complete remissions; and two patients have dropped out. CONCLUSION: Each patient had different clinical characteristics creating diagnostic challenges. All complaints were related to the infestation of the skin. The presence of different psychiatric comorbidities is remarkable. It seems that both psychiatrists and dermatologists can face diagnostic and therapeutic challenges of this complex disease in clinical settings, particularly if there are unusual clinical features of DI. Therefore, both psychiatrists and dermatologists should be well aware of DI.

Atypical antipsychotic drugs in the treatment of delusional parasitosis.

INTRODUCTION: Delusional parasitosis (DP) is a rare delusional disorder in which patients believe that they are infected with parasites, worms, insects, or bacteria. Antipsychotics are the preferred treatment in these patients. METHOD: Case series in which we summarize six patients with DP treated with atypical antipsychotic medications including amisulpride, olanzapine, and risperidone. RESULTS: One patient had a myocardial infarction after being given amisulpride, and several patients did not adjust well. Parenterally administered antipsychotics, particularly risperidone, were the most effective treatment in this series of patients with DP. CONCLUSION: Patients with DP can be difficult to treat; however, parenterally administered antipsychotics appear to produce better results in these patients.

Sexual dysfunction in female patients with panic disorder alone or with accompanying depression.

Objective. The aim of this study was to evaluate sexual dysfunction in female patients with panic disorder and to investigate the impact of accompanying depression with regard to sexual dysfunction. Method. Twelve patients who met the diagnostic criteria for panic disorder without depression (P) and 28 patients who met the diagnostic criteria for panic disorder with depression (PD) were compared to 13 control cases (C). Arizona Sexual Experience Scale (ASEX) was used to measure sexual experience. Results. ASEX scores were significantly different between the three groups (P=0.001). In two group comparisons sexual desire and aversion subscores of ASEX were significantly decreased in group PD when compared with groups P and C (P=0.01). Also, our results show that the difference of orgasmic experience subscore of ASEX in groups PD and C was found to be statistically significant (P=0.01). On the other hand, there was no statistical difference between P and PD groups in terms of orgasmic experience (P=0.16). Conclusion. These results suggest that decreased sexual desire and high sexual aversion may be presenting symptoms of depression in patients with panic disorder. If there is no depression, patients with panic disorder should be questioned especially for orgasmic problems.

Case report: delirium associated with ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is one of the most important complications of assisted reproductive technologies. Mild OHSS is characterized by ovarian enlargement and abdominal discomfort. In severe cases anasarca, hepatic dysfunction, reduced blood volume, electrolyte imbalance, organ failure and thromboembolic phenomena may be observed. Delirium is a syndrome, not a disease, and has many causes, all of which result in a similar pattern of signs and symptoms relating to a patient's level of consciousness and cognitive impairment. Delirium remains an under-recognized and under-diagnosed clinical disorder. The case is presented of a 30-year-old woman with OHSS and delirium. She underwent intracytoplasmic sperm injection (ICSI) for severe male factor infertility. Five days after oocyte retrieval, ascite formation was observed in ultrasonographic evaluation, and embryo transfer was cancelled. Twelve days after retrieval she came to the emergency clinic with abdominal distension and pain. She was hospitalized and paracentesis was performed every other day three times. She had altered consciousness and psychomotor hypoactivity 1 h after the last paracentesis. Psychiatric consultation revealed that she was in a state of delirium, and haloperidol was administered for treatment. Her symptoms disappeared within a week. Her medication was stopped when symptoms resolved and she was still asymptomatic in psychiatric evaluation 1 week later.

Bupropion is effective in depression in narcolepsy.

Narcolepsy is a rare disorder characterised by sleep disturbances, cataplexy, sleep paralysis and hypnagogic, hypnopompic hallucinations. Although several treatment modalities, such as tricyclic antidepressants or selective serotonin reuptake inhibitors, have been used to treat different symptoms, there is no definite treatment for narcolepsy. Modafinil or amphetamine-like stimulants, such as dexamphetamine or methylphenidate, are used to treat sleepiness. Our case was a 58-year-old woman who was diagnosed as narcolepsy cataplexy syndrome. Her Epworth Sleepiness Scale (ESS) score was 14 and Beck Depression Inventory (BDI) score was 29 in the first evaluation. Imipramine and modafinil were begun for the treatment, but there was no improvement in her symptoms. Subsequently, bupropion was started at 150 mg/day and then dosage was increased to 300 mg/day. She was asymptomatic at the end of 3 months. To our knowledge, this is the second depressive narcoleptic patient who has responded to 300 mg/day of bupropion.