Post-traumatic stress disorder and related factors among female victims of sexual assault required to attend a University Hospital in Turkey: A cross-sectional cohort study.

BACKGROUND: Post-traumatic stress disorder (PTSD) is one of the most common consequences of sexual assault, but it is not invariable. AIM: Our aim was to investigate pre-, peri- and post-traumatic factors associated with post-traumatic stress disorder among adult women who had been sexually assaulted. METHODS: All women attending a specialist university clinic for victims of sexual assault referred by the courts for a mental health assessment were invited to participate. At the time, the Turkish penal code required such referral (the year up to September 2015). Consenting women completed a sociodemographic information form, the Traumatic Stress Symptom Checklist, the Multidimensional Scale of Perceived Social Support, the Short Form-36 reflecting perceived quality of life, the Beck Depression Scale and the Beck Anxiety Scale. RESULTS: Sixty women were eligible and agreed to participate. Two-thirds of them (41, 68%) reported features of PTSD. In bivariate analyses, the women with PTSD also rated themselves as having a wide range of health and social disadvantages. Self-perceived poverty of social support and having suicidal thoughts were independently associated with PTSD. CONCLUSIONS: Although the rate of mental health and social problems among the women with PTSD were high, less than a third had actually sought help for their difficulties. While a requirement in the penal code that such women should have a psychiatric assessment seems over-intrusive and has since been dropped, our findings suggest that more efforts should be made to ensure that such women have help available if they want it.

Executive function in parents of patients with familial versus sporadic bipolar disorder.

OBJECTIVE: Studies investigating the cognitive function of healthy relatives of patients with bipolar disorder are conflicting, and the neurocognitive profile of relatives of bipolar disorder probands is still unclear. We aimed to evaluate executive function in unaffected parents of familial and sporadic patients with bipolar disorder. METHODS: The study included 24 unaffected familial parents (FP) of patients with bipolar disorder, 26 unaffected sporadic parents (SP) of patients with bipolar disorder and 26 controls matched with the parents for gender, age and duration of education (76 subjects in total). All of the subjects were interviewed with the Structured Clinical Interview for DSM-IV-Axis I. Executive function was assessed using the California Verbal Learning Test (CVLT), the Trail Making Test (TMT), the Wisconsin Card Sorting Test (WCST) and the Stroop test. RESULTS: In comparison to their respective matched controls, FP performed significantly worse on the CVLT, TMT, WCST and Stroop test, whereas SP performed significantly worse only on WCST perseverative errors and Stroop color test. FP performed significantly worse than SP on the CVLT, TMT, and WCST. CONCLUSION: The present study investigated relatives with and without a family history of bipolar disorder separately and found that executive function was impaired in parents with a positive family history of bipolar disorder. These findings bring more evidence suggesting that deficits in prefrontal executive function and verbal memory are associated with familial vulnerability to bipolar disorder and that executive function and verbal memory impairments may represent a potential endophenotype of bipolar disorder.

The relationship between insight and the level of expressed emotion in patients with obsessive-compulsive disorder.

AIM: The aim of this study is firstly to compare the obsessive-compulsive disorder (OCD) patients with good insight and OCD patients with poor insight in terms of socio-demographic and clinical features; to investigate the relation between insight and the level of the expressed emotion (EE) in the patients; and lastly to specify the factors that predict level of insight. METHODS: OCD patients with good insight and patients with poor insight were compared in terms of clinical features and the perceived EE level of the patients and the individuals that they live with in order to specify the factors that predict the insight level, and to investigate the relationship between insight level and EE. RESULTS: It was found that the total Expressed Emotion Scale, total Level of Expressed Emotion (LEE), LEE-Emotional Response and LEE-Tolerance/Expectation subscale scores of the group comprised of patients with poor insight are higher than the other group. The results also show that the duration of illness and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score predict insight level. CONCLUSIONS: This study shows that the level of EE perceived by the patients with poor insight and the person that he/she lives with, is higher than the group with good insight. The studies that investigate the relationship between the factors of insight level and EE level, which are indicated to determine the level of the illness severity and its chronicity, will enable the researchers to understand the importance of the role of the family on the treatment processes of OCD.

Persistent genital arousal disorder misdiagnosed because of Islamic religious bathing rituals: a report of three cases.

Persistent genital arousal disorder is not well known or adequately understood by physicians. The disorder is characterized by a persistent and highly unwanted state of genital arousal and orgasm-like feelings. Ghusl is an ablution in Islamic culture, which is an obligatory ritual wherein the body is washed thoroughly after exposure to religious contaminants such as sexual intercourse, menstruation, and childbirth. Muslim women suffering from the disorder may bathe frequently because of their religious beliefs. The authors summarize the case histories of 3 patients with persistent genital arousal disorder who were initially misdiagnosed with obsessive-compulsive disorder. All 3 patients presented with complaints of unwanted, persistent orgasms or orgasm-like arousals, and as a result, they performed ghusl several times a day. At previous interviews, the genital arousal was diagnosed as a sexual and somatic obsession, and repeatedly performing ghusl was considered a cleansing compulsion. Physicians' lack of awareness or knowledge of persistent genital arousal disorder, combined with the unwillingness of patients to discuss sexual problems, can lead to a focus on the repetitive bathing, and thus, a misdiagnosis of the problem as obsessive-compulsive disorder. These cases are presented to highlight the possible pitfalls in the diagnosis of persistent genital arousal disorder cases in Islamic countries where ghusl is common.

Are there differences in oxidative stress and inflammatory processes between the autogenous and reactive subtypes of obsessive-compulsive disorder? A controlled cross-sectional study.

OBJECTIVE: To date, no study has investigated whether autogenous and reactive obsessive-compulsive disorder (OCD) types are different entities in terms of oxidative stress and inflammatory processes. The aim of this study is to compare them in terms of these features. METHODS: The study was conducted in subjects with reactive OCD (n=19), autogenous OCD (n=14), and a control group (n=17). All participants were non-smokers. Sociodemographic data were collected and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Obsessive Beliefs Questionnaire (OBQ), and Overvalued Ideas Scale (OVIS) were administered. High-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), paraoxonase (PON1), total oxidant status (TOS), and total antioxidant status (TAS) were measured. RESULTS: There were no significant differences in TAS, TOS, or oxidative stress index (OSI) between the OCD and control groups. PON1 and hs-CRP levels were higher in the OCD group, whereas IL-6 and IL-10 levels were lower. Comparison across the three groups revealed no differences in TAS, TOS, OSI, or PON1 levels; however, hs-CRP was significantly higher while IL-6 and IL-10 were significantly lower in the reactive group compared to controls. CONCLUSION: Our results show that, although inflammatory processes may play a role in OCD, the autogenous and reactive subtypes do not differ from each other in these respects. The classification of OCD into autogenous and reactive subtypes should be reevaluated.

Risky sexual behavior among patients in Turkey with bipolar disorder, schizophrenia, and heroin addiction.

AIM: Risky sexual behavior associated with such sexually transmitted infections (STIs) as hepatitis B and C, herpes, Treponema pallidum, and Neisseria gonorrhoeae, is more frequent among psychiatric patients and parenteral drug abusers than the general population. The aim of this study was to investigate risky sexual behavior in psychiatric outpatients diagnosed with schizophrenia (SCH), bipolar disorder, and heroin addiction (HA), and to compare them with those observed in healthy controls. METHODS: The study group (N = 485; 234 females and 251 males) consisted of patients that consecutively presented to Bakirkoy State and Training Hospital for Psychiatric and Neurological Diseases in Istanbul and normal healthy controls. MAIN OUTCOME MEASURES: The chi-squared test was used for comparisons between groups and categorical variables. One-way analysis of variance (post-hoc Bonferroni test) was used for demographic data. A 22-item questionnaire for collecting demographic, illness history, and sexual activity data, and a structured 23-item form for collecting data on risky sexually behavior were administered to the participants. RESULTS: In all, 10% of the participants had a positive history for STIs. The majority of risky sexual behaviors was observed among the HA patients. The frequency of being sexually assaulted and having homosexual acts among the SCH group were higher. None of the patients had a positive human immunodeficiency virus (HIV) test result. The frequency of positivity for hepatitis B and C markers was highest among the HA patients. CONCLUSIONS: The provision of information and training about all STIs and risky sexual behavior should become routine in the treatment of mentally ill patients, especially those that abuse drugs.

Double standard for traditional value of virginity and premarital sexuality in Turkey: a university students case.

This study investigates the prevalence of myths regarding virginity and the hymen and their associations with sexuality prior to marriage. This study was conducted with 534 single, heterosexual male and female students from various faculties of Dicle University in Turkey. The findings demonstrated that the rates of masturbation (11.1%) and premarital sexual intercourse (4.3%) were much lower in women than in men (87.7% and 44.2% respectively) who were traditionally expected to maintain their virginity until marriage. A higher degree of commitment to religious faith was associated with a lower rate of masturbation and sexual contact experience. Also, the myth that the hymen symbolized virginity was slightly more prevalent among male students (74.2% vs. 72.1%). Female virginity was significantly more important among male students (76.7%) than females (11.1%), and male students more frequently (30.1% vs. 11.1%) stated that "the blood-stained bed sheet" should be displayed to the family on the day of marriage. Although some myths about virginity were frequently reported by females, less significance was attributed to virginity by females than by males. In conclusion, the traditional social structure that incites sexual double standards still prevails over the sexual attitudes and behaviors of university students in Turkey.

Quality of life, depression and anxiety in young male patients with silicosis due to denim sandblasting.

The aim of this study was to estimate the quality of life, depression and anxiety in patients with silicosis due to denim sandblasting. This study was conducted on 50 young male patients with silicosis and 30 controls. A socio-demographic data form, Short Form-36 (SF-36), the Beck depression inventory (BDI) and the Beck anxiety inventory (BAI) were used to determine quality of life, depression and anxiety. The mean scores of SF-36, BDI and BAI were higher in the patients than in the controls. Correlation analysis revealed a strong negative correlation between all scales of SF-36 and BDI scores. Additionally, there was strong negative correlation between five scales of SF-36 and BAI scores. We suggest that silicosis might be detrimental to the quality of life and increase depression and anxiety in patients with silicosis due to denim sandblasting.

Association of Nicotine Use Disorder with Neurexin 3 Gene Polymorphisms. / Nikotin Kullanim Bozuklugunun Neurexin 3 Gen Polimorfizmi ile Iliskisi.

OBJECTIVE: In this study, we aimed to investigate the Neurexin 3 gene (NRXN3) polymorphisms in the rs 221473, rs 221497, rs1004212 and rs11624704 regions in relation to nicotine use disorder (NUD) in the Turkish population. METHOD: Power analysis indicated that the NUD group and the control group of this study should each comprise 200 participants in the 18-65 year age range. The NUD group consisted of individuals without a psychiatric first axis disorder except for NUD, mental retardation, past head trauma or a neurological disorder, who had smoked minimally10 cigarettes per day for at least 1 year. The control group included individuals without a serious chronic physical illness, a previous psychiatric disorder or mental retardation and who responded "no" to the question "have you ever smoked?" A sociodemographic questionnaire and the Fageström nicotine dependence scale (FNDS) for the NUD group were utilized. Venous blood samples of all participants were taken into tubes containing EDTA (ethylene daimine tetra acetic acid) for DNA extraction. Duplex fluorescence melting curve analysis was used for genotype detection and differentiation. RESULTS: The individuals carrying the AC allele and the AG allele at the rs11624704 and the rs1004212 regions respectively had a high risk of being addicted to cigarettes. CONCLUSION: This is first study investigating the relationship of the NRXN3 gene and nicotine addiction in the Turkish population. It was observed that the risk of NUD in the Turkish population may be related to the Neurexin gene.

Association of Nicotine Use Disorder with Neurexin 3 Gene Polymorphisms. / Nikotin Kullanim Bozuklugunun Neurexin 3 Gen Polimorfizmi ile Iliskisi.

OBJECTIVE: In this study, we aimed to investigate the Neurexin 3 gene (NRXN3) polymorphisms in the rs 221473, rs 221497, rs1004212 and rs11624704 regions in relation to nicotine use disorder (NUD) in the Turkish population. METHOD: Power analysis indicated that the NUD group and the control group of this study should each comprise 200 participants in the 18-65 year age range. The NUD group consisted of individuals without a psychiatric first axis disorder except for NUD, mental retardation, past head trauma or a neurological disorder, who had smoked minimally10 cigarettes per day for at least 1 year. The control group included individuals without a serious chronic physical illness, a previous psychiatric disorder or mental retardation and who responded "no" to the question "have you ever smoked?" A sociodemographic questionnaire and the Fageström nicotine dependence scale (FNDS) for the NUD group were utilized. Venous blood samples of all participants were taken into tubes containing EDTA (ethylene daimine tetra acetic acid) for DNA extraction. Duplex fluorescence melting curve analysis was used for genotype detection and differentiation. RESULTS: The individuals carrying the AC allele and the AG allele at the rs11624704 and the rs1004212 regions respectively had a high risk of being addicted to cigarettes. CONCLUSION: This is first study investigating the relationship of the NRXN3 gene and nicotine addiction in the Turkish population. It was observed that the risk of NUD in the Turkish population may be related to the Neurexin gene.

Inflammation and Oxidative Stress in Deficit Schizophrenia.

INTRODUCTION: Differences in parameters related to inflammatory and oxidative stress in deficit (DS) and nondeficit schizophrenia (non-DS) may support the DS/non-DS categorization of schizophrenia. For DS patients, non-DS patients, and for healthy controls, this study aims to evaluate the serum levels of: proinflammatory cytokines of interleukin (IL) 1ß, tumor necrosis factor (TNF) α, Interferon (IFN) γ, IL-12, and IL-17; anti-inflammatory cytokines of IL-10, IFN-α, and transforming growth factor (TGF) ß; and antioxidant biomarkers of paraoxonase1 (PON1) and Total Antioxidant Capacity (TAOC). METHOD: Serum IL-1ß, TNF-α, IFN-γ, IL-12, IL-17, IL-10, IFN-α, TGF-ß, PON1 and TAOC levels were measured and performed in DS (n=26), non-DS (n=28), and healthy control (n=28) groups. RESULTS: Patients in the DS group had higher IL-17 levels than the non-DS group did. TGF-ß values for both patient groups were significantly higher than those of the controls. PON1 and TAOC values for both patient groups were significantly lower than those of the controls. CONCLUSION: Our findings may be evidence for the consideration that DS reflects a coherent entity within schizophrenia. Increased levels of IL-17 from pro-inflammatory cytokines may be related with DS.

The relationship between separation anxiety and intolerance of uncertainty in pregnant women.

Background and aim: Pregnancy is a risky period to develop Adult Separation Anxiety Disorder (ASAD). The aim of this study was to investigate the frequency of separation anxiety in pregnant women, and the relationship of separation anxiety with sociodemographic variables and intolerance of uncertainty.Methods: This study included 310 pregnant women and used the Adult Separation Anxiety Questionnaire (ASAQ) and Intolerance of Uncertainty Scale-Short Form (IUS-12).Results: The average age in pregnant women with ASAD was lower. IUS-12 total score, prospective anxiety, and inhibitory anxiety subscale scores were significantly higher in the ASAD group. There were moderate and statistically significant positive correlations between the ASAD score and the IUS-12 total, prospective anxiety and inhibitory anxiety subscale scores.Conclusion: Intolerance of uncertainty may be an important factor in the mental processes of individuals with separation anxiety. Pregnancy period can be a risky period for developing ASAD. Cognitive behavioral treatments including intolerance of uncertainty may be effective in the treatment of ASAD. There is a need for follow-up studies on the effects of separation anxiety during pregnancy on maternal-fetal health.

[Factors affecting the diagnosis of post-traumatic stress disorder after a terrorist attack]. / Bir Terörist Saldiri Sonrasinda Travma Sonrasi Stres Bozuklugu Gelisimini Etkileyen Risk Faktörleri.

OBJECTIVE: On 3 January 2008 explosives placed in an automobile on a thoroughfare in Diyarbakir, southeastern Turkey exploded in a terrorist attack. The aim of this study was to determine the risk factors for the diagnosis of and the rate of post-traumatic stress disorder (PTSD) among individuals who were eye- or earwitnesses to the explosion 1 and 3 months after the explosion. METHODS: Among the residents and workers in close proximity to the explosion site, 216 individuals who were eye- or earwitnesses to the explosion were included in the study. A sociodemographic data form and a traumatic stress symptom scale were administered to the participants 1 and 3 months following the explosion. RESULTS: In all, 12.5% of the participants were diagnosed with PTSD 1 month post-explosion versus 9.6% 3 months post-explosion. While history of psychiatric disorder and physical injury were risk factors for PTSD 1 month post-explosion, risk factors 3 months post-explosion was history of psychiatric disorder. CONCLUSIONS: PTSD occurs at high rates in individuals exposed to terrorist attacks. More studies following such events are required in Turkey. In light of these results it is advised that individuals at risk of PTSD receive therapeutic and preventive interventions provided by mental health professionals.

[Chronic manganese intoxication due to methcathinone (ephedron) abuse: a case report]. / Metkatinon (Efedron) Kötüye Kullanimina Bagli Kronik Manganez Entoksikasyonu: Bir Olgu Sunumu.

Known as an occupational disease, chronic manganese intoxication is recently being observed among abusers of psychoactive substances. Methcathinone hydrochloride is obtained by combining ephedrine/pseudoephedrine and potassium permanganate. Various neuropsychiatric symptoms have been reported among Efedron users. Our patient is a 29 year old male, who was referred to our hospital from a state general hospital with a diagnosis of Conversion Disorder. He was hospitalized and preliminary diagnoses of Facititous Disorder, Conversion Disorder, Psychiatric Disorder due to a General Medical Condition and Antisocial Personality Disorder. He was abstinent from any substance for five years upon referral to our hospital and had a history of methcathinone abuse for 4.5 years. The backache dated back to 6 years ago and a disturbance of gait was added to the clinical picture. A speech disturbance, falling while walking downhill and walking on tiptoe were added in the last 2-3 years. In the neurological examination, extrapyramidal system findings, gait disturbance and the report on use of manganese compunds were found. The setting was changed from psychiatric ward to neuorology ward and evaluated by consultant neurologist. The case was diagnosed as ?Manganese Intoxication'. The aim of this report is to demonstrate and emphasize the importance of questioning the presence of manganese compounds in case of history of substance abuse. Other areas of interest are the shortage of data on the intravenous use of manganese and the cases reported in the literature coming from the former Soviet Union.

No Interaction Between Childhood Maltreatment and Serotonin Transporter Gene in Recurrent Major Depressive Disorder: A Clinical Sample.

INTRODUCTION: There is inconsistent evidence of interaction between childhood adversities and a serotonin transporter promoter polymorphism (5-HTTLPR) in depression. It is hypothesized that genetic sensitivity to stress could be more specific to recurrent major depressive disorder (MDD). The aim of the study is to replicate a recent study which provided preliminary evidence of interaction between severity of childhood maltreatment and the 5-HTTLPR polymorphism in recurrent MDD. METHODS: Participants included a well-characterized clinical sample of 70 recurrent MDD cases and 67 never psychiatrically ill controls, aged 18 years or over. Socio-demographic and clinical information form, Composite International Diagnostic Interview (CIDI), Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI) were applied to both groups, along with genotyping. RESULTS: There was no interaction between childhood maltreatment and the 5-HTTLPR in relation to recurrent MDD. All forms of childhood maltreatment were reported as more severe by cases than controls, and there was an independent association between maltreatment and recurrent MDD. CONCLUSION: The path forward to detect genetic risk loci for depression remains challenging. Taking childhood maltreatment history into account could lead to a richer understanding of differences in biological correlates, genetic underpinnings, and outcomes.

The Relationship Between Obsessive Belief Level and Cognitive Flexibility in Patients with Obsessive Compulsive Disorder.

INTRODUCTION: It is known that dysfunctional beliefs are important in the onset and maintenance of symptoms of Obsessive Compulsive Disorder (OCD) according to the cognitive model of OCD. OCD patients with higher obsessive beliefs would be expected to have greater deficits in cognitive flexibility. In this study, we aimed to examine the relationship between obsessive belief levels and cognitive flexibility in OCD patients. METHODS: Patients with OCD (50) and Panic Disorder (30) as a control group were evaluated and diagnosed using Structured Clinical Interview for DSM-IV Axis I Disorders. A socio-demographic data form, Beck Depression Inventory, Beck Anxiety Inventory and Wisconsin Card Sorting Test (WCST) were administered to all the patients. The Yale-Brown Obsessive Compulsive Scale and Obsessive Beliefs Questionnaire-44 (OBQ-44) were administered to the OCD group. The OCD group was divided into two subgroups as higher obsessive beliefs (OCD-H) (n=29) and lower obsessive beliefs (OCD-L) (n=21) according to a cluster analytic approach. RESULTS: When the subgroups were compared according to WCST; the number of completed categories was statistically significantly lower, and the numbers of total errors, perseverative errors and non-perseverative errors were significantly higher in the OCD-H group. CONCLUSION: The results of our study show that cognitive flexibility is impaired in OCD patients with higher obsessive beliefs.

Evaluation of the Decision-making Capacity of Two Cases Planning to Undergo Uterine Evacuation.

Psychiatric disorders in the perinatal period can lead to a deterioration in one's judgment and decision-making ability. These disorders may cause sensitive and complex legal and ethical issues relating to psychiatric, obstetric, and neonatal care. Clinicians should ethically respect the autonomy of the individual, but at the same time, they must assess the individual's decision-making process with the use of forensic psychiatric and consultation-liaison psychiatric practice. While the literature related to mental disorders in pregnancy has been increasing, there is limited information regarding the medico-legal and ethical aspects of this topic. Herein, we present two cases who are pregnant and have psychiatric disorders, and we aim to discuss their evaluation process of uterine evacuation.

Femicide: Psychosocial Characteristics of the Perpetrators in Turkey.

Female homicides are widely prevalent in Turkey with rising trend. The aim of this study is to identify gender role attitudes, childhood trauma histories, and individual characteristics of men who have been involved in the femicide, and to compare them with men who do not exercise violence against women. Participants completed a Sociodemographic and Clinical Information form, Semistructured Interview form, and the Childhood Trauma Questionnaire. Case group was not significantly different than the control group in terms of any measured individual characteristics including childhood traumas, psychopathology, and gender attitudes. Our data indicate that only migration history may be linked to femicide. A unique psychopathology that could be related to being a femicide perpetrator was not identified. Migration and perception of gender roles stand out as factors that separate men who exercise violence from men who do not.

[The Effect of Chronic Cigarette Use on Cognitive Function]. / Kronik Sigara Kullaniminin Bilissel Islevler Üzerine Etkisi.

OBJECTIVE: In this study, we aimed to investigate the effect of chronic cigarette smoking on the cognitive function in people who have no other mental or physical illness other than tobacco use disorder. METHOD: The study was carried out on three groups: smokers (n = 71), former smokers (n = 39), and non-smokers (n = 49). The Wisconsin Card Sorting Test (WCST), Stroop Color and Word Test (ST), Trail Making Test (TMT), Auditory Verbal Learning Test (AVLT), and Serial Digit Learning Test (SDLT) were applied to the 3 groups participating in the study. Groups were compared with the Three-Factor Covariance Analysis. RESULTS: Stroop test 4th card time score which determined the basic level of color discourse in the smoker group was significantly higher than the non-smoker group. The Trail Making Test-B time scores were significantly higher in the smoker group than the non-smoker group. And Trail Making Test-B time points were significantly higher in the former smoker group than nonsmoker group. Auditory Verbal Learning Test - verbal learning scores were lower in the smoker group than the non-smoker and former smoker group. There was no significant difference in verbal learning scores between the non-smoking and former smoker groups. The neurocognitive deficits in smokers appear to be related to dose and duration. CONCLUSION: This study suggests that auditory verbal memory, visualspatial processing, and attention areas may be a selective area of disability in smokers. A major limitation is the fact that general cognitive performance levels of participants was not assessed by a general criteria such as Wechsler Adult Intelligence Scale (WAIS).