Two-year clinical follow-up enhances the diagnosis of early-stage hip osteoarthritis: data from check cohort.

OBJECTIVE: To provide a set of diagnostic criteria for early-stage hip osteoarthritis (OA) in primary care, using signs and symptoms monitored over 2 years in individuals with hip pain and/or stiffness. Additionally, the study aimed to see whether these factors were additive to factors based on baseline signs and symptoms only. METHODS: Data of the 543 persons with 735 symptomatic hips were collected from the prospective Cohort Hip and Cohort Knee cohort study. Using data from 5 to 10 years of follow-up, 24 experts (13 general practitioners, 11 secondary care physicians (6 rheumatologists and 5 orthopaedic surgeons)) inspected individuals' medical data on the presence of clinically relevant hip OA. Their diagnoses are used as reference standards. Backward selection method was used to provide models using the factors from baseline to 2 years of follow-up. Additionally, new models were combined with previously published models, using same selection method. Area under the curve (AUC) was calculated after each removal of factors in the final combined models. RESULTS: Radiographic factors and high-sensitive C reactive protein did not end up in any model with change factors only. AUC value (SD) of the final obtained model of change factors was 0.70 (0.01). Adding newly defined factors to previously published models significantly (p<0.0001) increased the AUC value to 0.75 (0.01). CONCLUSION: Final diagnostic criteria, consisting only of the factors obtained through history taking and physical examination, were able to detect early-stage hip OA associated with clinically relevant hip OA 5-10 years later, with 'moderate' precision.

Association between clinical findings and the presence of lumbar spine osteoarthritis imaging features: A systematic review.

OBJECTIVE: Spinal osteoarthritis is difficult to study and diagnose, partly due to the lack of agreed diagnostic criteria. This systematic review aims to give an overview of the associations between clinical and imaging findings suggestive of spinal osteoarthritis in patients with low back pain to make a step towards agreed diagnostic criteria. DESIGN: We searched MEDLINE, Embase, Web of Science, and CINAHL from inception to April 29, 2021 to identify observational studies in adults that assessed the association between selected clinical and imaging findings suggestive of spinal osteoarthritis. Risk of bias was assessed using the Newcastle Ottawa Scale and the quality of evidence was graded using an adaptation of the GRADE approach. RESULTS: After screening 7902 studies, 30 met the inclusion criteria. High-quality evidence was found for the longitudinal association between low back pain (LBP) intensity, and both disc space narrowing and osteophytes, as well as for the association between LBP-related physical functioning and lumbar disc degeneration, the presence of spinal morning stiffness and disc space narrowing and for the lack of association between physical functioning and Schmorl's nodes. CONCLUSIONS: There is high- and moderate-quality evidence of associations between clinical and imaging findings suggestive of spinal osteoarthritis. However, the majority of the studied outcomes had low or very low-quality of evidence. Furthermore, clinical and methodological heterogeneity was a serious limitation, adding to the need and importance of agreed criteria for spinal osteoarthritis, which should be the scope of future research.

Diagnostic criteria for early hip osteoarthritis: first steps, based on the CHECK study.

OBJECTIVES: Although there is a general focus on early diagnosis and treatment of hip OA, there are no validated diagnostic criteria for early-stage hip OA. The current study aimed to take the first steps in developing diagnostic criteria for early-stage hip OA, using factors obtained through history taking, physical examination, radiography and blood testing at the first consultation in individuals presenting with hip pain, suspicious for hip OA, in primary care. METHODS: Data of the 543 individuals with 735 symptomatic hips at baseline who had any follow-up data available from the prospective CHECK cohort study were used. A group of 26 clinical experts [general practitioners (GPs), rheumatologists and orthopaedic surgeons] evaluated standardized clinical assessment forms of all subjects on the presence of clinically relevant hip OA 5-10 years after baseline. Using the expert-based diagnoses as reference standard, a backward selection method was used to create predictive models based on pre-defined baseline factors from history taking, physical examination, radiography and blood testing. RESULTS: Prevalence of clinically relevant hip OA during follow-up was 22%. Created models contained four to eight baseline factors (mainly WOMAC pain items, painful/restricted movements and radiographic features) and obtained area under the curve between 0.62 (0.002) and 0.71 (0.002). CONCLUSION: Based on clinical and radiographic features of hip OA obtained at first consultation at a GP for pain/stiffness of the hip, the prediction of clinically relevant hip OA within 5-10 years was 'poor' to 'fair'.

Frequency of body dysmorphic disorder among patients with complaints of hair loss.

BACKGROUND: Body dysmorphic disorder (BDD) is a psychiatric condition in which a disabling preoccupation with a non-existent or slight defect in appearance is the main symptom. Hair concerns are frequent in patients with BDD. OBJECTIVES: The purpose of this study was to determine the prevalence of BDD among patients with complaints of hair loss. METHODS: A validated BDD questionnaire (BDDQ) was administered to 150 patients with complaints of hair loss and 150 control subjects who were selected from among general dermatology (GD) patients. Standard statistical tests were performed (descriptive analysis, chi-squared tests, non-parametric tests). Differences that achieved a P-value of <0.05 were considered statistically significant. RESULTS: Among patients with complaints of hair loss, 42 of 142 subjects retained in the study (29.6%; 31 females and 11 males) were diagnosed with BDD. Furthermore, 25.6% of female patients and 52.4% of male patients were diagnosed with BDD (P = 0.013). Hair concerns were more common in males than in females (P < 0.05). In the GD group, four control subjects (2.7%, all female) were diagnosed with BDD; all of their concerns focused on the body and acne. CONCLUSIONS: The incidence of BDD is about 10 times higher in patients with complaints of hair loss than it is in GD patients and is higher in males. Awareness of the condition and the referral of selected patients to mental health professionals is crucial.

Evaluation of physical fitness parameters in patients with schizophrenia.

The aims of this study were to compare aerobic and anaerobic exercise capacities, pulmonary functions, body composition and fat distribution parameters in patients with schizophrenia and healthy controls and to investigate the associations among these parameters. Sixty (30 male, 30 female) patients with schizophrenia and 60 (30 male, 30 female) healthy controls were included in the study. Maximal aerobic capacity was estimated with the Astrand submaximal exercise protocol, and anaerobic performance was determined with a Wingate test. Body composition was established with a bioelectrical impedance analyzer. Pulmonary function tests, skinfold thickness and body circumference measurements were also carried out. Maximal aerobic capacity, maximal anaerobic power, anaerobic capacity and pulmonary function tests (forced vital capacity and maximal voluntary ventilation) were found to be lower in male and female schizophrenic groups as compared to the controls. Body fat percentage, waist and abdomen circumferences, and waist to hip ratio were found to be higher in female schizophrenic patients than in controls. We suggest that maximal aerobic capacity, maximal anaerobic power, and anaerobic capacity are poor in the schizophrenia patients as compared to healthy controls. Low cardiorespiratory fitness is related to reduced pulmonary function and impaired body composition in schizophrenia patients.

Association analyses of depression, anxiety, and physical fitness parameters in Turkish obese adults.

OBJECTIVE: This study aims to investigate the associations among depression, anxiety, aerobic exercise capacity, body fat percentage, sum of skinfolds, abdomen circumference, and waist to hip ratio on the basis of body mass index (BMI) in adults. METHODS: The subjects of the study were 60 obese participants (30 women, 30 men) with BMIs over 30 kg/m{2}and 60 healthy controls (30 women, 30 men) with BMIs of 18-25 kg/m{2}. Body fat percentage was calculated from the skinfold thicknesses using the formula. Body circumference measurements were performed using a tape measure. Maximal aerobic capacity (VO(2)max) was determined by Astrand submaximal exercise protocol. Two self-reported questionnaires, Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), were administered to all participants. RESULTS: BMI, body fat percentage, sum of skinfolds, abdomen circumference, and waist to hip ratio were found to be higher in obese groups as compared to the controls, while VO(2)max (ml/kg/min) values were lower in both genders. In males, BAI scores and mild-level anxiety percentage values were higher in the obese group than in the control group. There was no significant difference for BDI scores and levels between the obese and control groups in both genders. There was also no significant difference in BAI scores and levels between the obese and control groups in women. CONCLUSION: The fact that physical fitness being found poor in obese shows the existence of a condition that might constitute an increased tendency for obesity-related disorders. In addition, it was suggested that, in Turkey, attitudes toward obesity change depending on gender.

Efficacy of transcutaneous electrical nerve stimulation for pain relief in women undergoing office endometrial biopsy.

AIM: To evaluate the efficacy of transcutaneous electrical nerve stimulation (TENS) for decreasing pain related with office endometrial biopsy. METHODS: In this prospective study, 65 women undergoing office endometrial biopsy were randomly allocated to receive 550 mg oral naproxen sodium plus active TENS (Group I, n = 33) or 550 mg oral naproxen sodium plus placebo TENS (Group II, n = 32). The intensity of pain perceived by the patients was measured using a 10-cm visual analog scale (VAS) before insertion of the speculum, when the cervix grasped, immediately after biopsy, and 15 min after the procedure. The effect of anxiety (Spielberger's state anxiety inventory) on pain scores was also investigated. RESULTS: There were no statistical significant differences between groups in age, weight, body mass index, gravidity, parity, education, and menopausal status (p > 0.05). The pain scores before insertion of the speculum, when the cervix grasped, and immediately after biopsy were similar in both groups (p > 0.05). But at 15 min after the procedure, there was a significant reduction of the mean VAS pain score in naproxen sodium plus TENS group, compared with the naproxen sodium plus placebo TENS group (0.14 ± 0.47, 1.44 ± 1.37, respectively, p < 0.0001). The mean anxiety scores were 48.19 ± 6.71 and 45.85 ± 6.22 in Group I and Group II, respectively. We did not find any significant correlation between anxiety and VAS pain scores (p > 0.05). CONCLUSIONS: TENS appears to be successful in decreasing pain only after the procedure undergoing office endometrial biopsy. It can be used as a simple, cheap, safe, and effective pain relief method.

Temperament and character traits of women admitted for breast reduction and comparison with body perception.

BACKGROUND: Reduction mammaplasty improves self-esteem and low body perception. Previous reports comprise either retrospective data or sectional analysis in which women were evaluated postoperatively. Furthermore, temperament and character properties of women applying for breast reduction have not been investigated. This study aimed to compare the temperament and character traits of women admitted for breast reduction surgery with those of healthy volunteers and to investigate the interaction of body perception with temperament and character. METHODS: The study enrolled 24 patients admitted for reduction mammaplasty and 24 healthy women. The study participants received the Temperament and Character Inventory (TCI) and the Rosenberg Self-Esteem Scale (RSE) questionnaires. The RSE questionnaire was completed again by the patients 6 months after the operation. RESULTS: Of the temperament scales, the persistence scale was significantly lower for the patients. Only the reward dependence subscale of the temperament scale was significantly higher for the patients. Self-esteem (RSE) was significantly lower for the patients than for the control subjects preoperatively, whereas, it rose significantly after the operation. The RSE showed a negative correlation with self-directedness and its subscales of being responsible and resourceful. A significant negative correlation also was found between RSE and empathy. CONCLUSIONS: Women with large breasts try to develop adaptable character properties against chronic troubles. However, the temperament scale of persistence decreases in this process. Similar temperament and character traits of women with and those without large breasts suggest that patients desire breast reduction for functional rather than cosmetic purposes.

The prevalence of panic disorder in pregnant women during the third trimester of pregnancy.

OBJECTIVE: The principal aim of this study was to assess the current prevalence rate of panic disorder (PD) in pregnant women during the third trimester of pregnancy. The second aim of the present study was to investigate the clinical characteristics of PD in pregnant and nonpregnant women. METHOD: The study data were gathered from 512 consecutive women in the third trimester of pregnancy who were admitted to the obstetric outpatient clinics of 2 university research centers. The diagnosis of PD was determined by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I disorders in the third trimester of pregnancy. Within the same period, the Panic and Agoraphobia Scale was used to determine the severity of PD. In addition, we compared the clinical characteristics of PD in gravid subjects (n = 13) with their control group. A control group was composed of 19 consecutive nonpregnant female outpatients diagnosed with PD who presented to the psychiatric outpatient clinics of the same hospitals. RESULTS: The prevalence rate of PD was found to be 2.5% (n = 13) among the subjects in the third trimester of pregnancy. Of these 13 pregnant, 7 subjects reported that PD developed during the 6th to 28th weeks of their gestation, and the number of subjects who experienced PD symptoms before pregnancy was 6. In addition, there was no statistically difference between gravid and nongravid PD cases with regard to the severity of panic symptoms. CONCLUSION: Our study suggests that PD may be common among pregnant females during the third trimester of pregnancy and seems to be associated with similar clinical features during gestation and nongestation.

The impact of obsessive-compulsive disorder in pregnancy on quality of life.

Aim. To examine the effects of obsessive-compulsive disorder (OCD) on quality of life in pregnant women. Material and method. Twenty-five pregnant women diagnosed as OCD in two university outpatient clinics were included for the study. Twenty-five pregnant women with no mental disorders and the same sociodemographic properties were taken as the control group. The diagnosis of OCD was confirmed with the DSM-IV Axis-I Disorders Structured Clinic Interview Diagnosis/Clinic Version (SCID-I/CV). In order to measure the severity of OCD Yale-Brown Obsession and Compulsion Scale was performed. Quality of life was evaluated by WHO (World Health Organisation) Life Quality Scale - Short Form (WHOQOL-Brief). Results. The whole subgroup of points of WHOQOL-Brief was significantly lower in OCD patients compared to control group (in all subgroups P<0.01). There was a negative correlation between the Y-BOCS obsession and compulsion subpoints and total points with the physical health (P <0.05), psychological health (P <0.001) and social relationship (P <0.01) of WHOQOL-Brief. No significant association was found with enviromental areas. Besides, there was a negative correlation between the duration of OCD and WHOQOL-Brief psychological health subarea (P <0.05). Conclusion. OCD negatively effects the quality of life in pregnant women and is correlated with the severity of the disorder.

Course of panic disorder during the early postpartum period: a prospective analysis.

PURPOSE: Most of the studies about course of panic disorder (PD) after childbirth have a retrospective nature. The aim of the current study was to examine prospectively the clinical course of 13 pregnant women with a diagnosis of PD across pregnancy and the early postpartum period. METHOD: The diagnosis of PD was determined by means of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders in the third trimester of pregnancy. Within the same period, the Panic and Agoraphobia Scale was used to determine the severity of PD. The last assessment with both instruments was performed at 6 weeks postnatally. RESULTS: Of these 13 women, 6 (group 1) reported that PD developed during the 6th to the 28th week of their gestation, and the number of women who experienced PD symptoms before pregnancy (group 2) was 7. It was found that the severity of panic symptoms considerably decreased in the total sample, group 1, and group 2 from the basal levels to 6 weeks postnatally. CONCLUSION: Our study results suggest that pregnant women with PD may experience a marked improvement in PD symptoms in the early postpartum period.

Course of obsessive-compulsive disorder during early postpartum period: a prospective analysis of 16 cases.

OBJECTIVE: The aim of the current study was to prospectively examine a course of obsessive-compulsive disorder (OCD) during the early postpartum period. METHOD: The study data were collected from 16 pregnant women with a diagnosis of OCD according to the Structured Clinical Interview for DSM-IV (SCID-I). Obsessive-compulsive disorder symptoms were assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) before and after childbirth. Psychopharmacologic or psychotherapeutic treatments were not administered over the study period. RESULTS: Scores of the mean Y-BOCS-total and Y-BOCS-obsession were significantly reduced from the basal levels to 6 weeks postnatally. No significant difference was found in terms of Y-BOCS-compulsion between 2 interviews. During the study period, whereas the Y-BOCS-total scores were decreased by at least 25% in 8 (50.0%) of 16 patients, only 1 (6.2%) of 16 patients experienced at least a 25% increase in the same scores. CONCLUSION: The results from a small patient group suggest that some patients may experience a marked improvement in preexisting OCD symptoms after childbirth.

The effects of electroconvulsive therapy on ghrelin, leptin and cholesterol levels in patients with mood disorders.

The effects of electroconvulsive therapy (ECT), which is a widely used treatment for psychiatric disorders, have not yet been established. Therefore, we aimed to explore whether the patients' serum ghrelin and leptin levels are associated with the action of ECT treatment. In the case of the mood disorders, which occurred in 16 patients with major depressive episode (MDE) and 12 patients with bipolar disorder-manic episode (BD-me) and 25 healthy controls, we have determined the serum levels of ghrelin, leptin and cholesterol before ECT and 2 days after ECT. The BMI was also calculated in all subjects. Although ECT treatment did not change mean the BMI and serum leptin level, the mean serum ghrelin level decreased and the total cholesterol level increased after ECT compared with before ECT. While the leptin levels in the patient group were significantly lower than the controls before and after ECT, the mean serum ghrelin and total cholesterol levels differed statistically only before ECT, but not after ECT than those in controls. The ghrelin levels have decreased significantly after ECT in both sub-groups MDE and BB-me. However, the mean serum total cholesterol level increased statistically after ECT only in the MDE sub-group, and the leptin levels did not differ in both sub-groups after ECT compared with before ECT. In conclusion, ECT treatment seems to be associated with decreased ghrelin levels and increased cholesterol levels but not leptin levels. However, more comprehensive and detailed studies are needed to decipher the exact role of ECT on ghrelin, leptin and total cholesterol in mood disorders.

Obsessive-compulsive disorder in pregnant women during the third trimester of pregnancy.

OBJECTIVE: The principal aims of this study were to examine the current prevalence rate, clinical characteristics, and related factors of obsessive-compulsive disorder (OCD) in pregnant women during the third trimester of pregnancy. METHOD: The study data were gathered from 434 consecutive women in the third trimester of pregnancy who presented to the obstetric outpatient clinics of 2 university research centers and from 58 consecutive nonpregnant women with diagnosed with OCD who presented to the psychiatric outpatient clinics of the same centers. Obsessive-compulsive disorder was diagnosed by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The Yale-Brown Obsessive-Compulsive Scale was used to determine the severity and types of obsessions and compulsions. RESULTS: The prevalence rate of OCD was found to be 3.5% among the women in the third trimester of pregnancy. Two (0.5%) women reported that OCD developed during the second trimester (16th and 24th gestational weeks) of pregnancy. The most common obsessions were contamination (80.0%) and symmetry/exactness (60.0%), whereas the most common compulsions were cleaning/washing (86.7%) and checking (60.0%). Women with pregnancy-onset OCD and some women with previous diagnoses of OCD had obsessions and compulsions with themes focused on the fetus or newborn. Pregnant women with OCD had higher frequencies of family history of OCD compared with women without this disorder. Age, educational level, employment status, number of gestations and live births, history of abortion, frequency of primigravida, and the existence of gestational complications were unrelated to OCD in the pregnant women. Pregnant and nonpregnant women with OCD had similar characteristics of obsessive-compulsive symptoms. CONCLUSION: Our study suggests that OCD is present relatively frequently among pregnant women during the third trimester of pregnancy, and it has similar clinical features during gestation and nongestation.

Ghrelin and leptin levels in patients with obsessive-compulsive disorder.

To examine the importance of ghrelin and leptin in the pathogenesis of obsessive-compulsive disorder (OCD), we measured serum ghrelin and leptin levels, lipid profile and body mass index (BMI) in 43 patients with OCD and 20 healthy controls. The patients were divided into two subgroups according to whether DSM-IV OCD was accompanied with major depressive disorder (MDD) (OCD+MDD) or not (OCD-MDD). There was no statistically significant difference in ghrelin and leptin levels between groups. The OCD+MDD group had a trend of higher ghrelin levels and lower leptin levels than the OCD-MDD and control groups. There was a negative correlation between change in serum ghrelin and leptin levels only in the OCD+MDD group. Neither ghrelin nor leptin showed any correlation with severity of MDD and OCD. In conclusion, our results suggest that OCD is not associated with leptin or ghrelin levels. More comprehensive and detailed studies are needed to decipher the exact role of ghrelin and leptin in OCD.

Temperament and character profile in patients with essential hyperhidrosis.

BACKGROUND/AIMS: The main debates on hyperhidrosis are whether there are some personality features such as anxiety or stress, or whether the psychological symptoms are due to negative social feedback from early life. We aimed to investigate the temperament and character dimensions with a psychobiological inventory. METHODS: We recruited patients with hyperhidrosis (n=26) and chronic renal failure (n=44) as well as healthy subjects (n=22) from dermatology and nephrology clinics and the general population in Afyonkarahisar. All subjects were required to perform a temperament and character inventory. RESULTS: The total novelty seeking score in hyperhidrosis was significantly lower than in controls. There was no significance in total harm avoidance scores between hyperhidrosis patients and controls. The total reward dependence and persistence scores were significantly higher in hyperhidrosis patients. The fear of uncertainty in the harm avoidance scale was found to be significantly greater in hyperhidrosis patients. Regarding character dimensions, the total score in each of the subscales self-directedness, cooperativeness and self-transcendence was found to be higher in hyperhidrosis patients. CONCLUSION: The higher scores of all subscales of character dimensions in hyperhidrosis patients suggest that hyperhidrosis is not related with social phobia or personality disorder.

Paradoxical therapy in conversion reaction.

Paradoxical therapy consists of suggesting that the patient intentionally engages in the unwanted behaviour such as performing compulsive ritual or wanting a conversion attack. In this study, the subjects were selected by the emergency unit psychiatrist from patients who were admitted to the emergency unit with pseudoseizure. The diagnoses was based on DSM-IV criteria. Paradoxical intention was applied to half of the 30 patients with conversion disorders; the other half were treated with diazepam in order to examine the efficiency of the paradoxical intention versus diazepam. In both groups the differences of the anxiety scores at the beginning of the study were found to be insignificant (z=1.08, p=0.28). Of the 15 patients who completed paradoxical intention treatment, 14 (93.3%) responded favorably to paradoxical intention. On the other hand of 15 patients who completed diazepam therapy, 9 (60%) responded well to therapy and 6 patients carried on their conversion symptoms at the end of 6 weeks. Paradoxical intention-treated patients appeared to have greater improvements in anxiety scores (z=2.43, p<0.015) and conversion symptoms (t=2.27, p=0.034) than the diazepam-treated patients. The results of the present study are encouraging in that paradoxical intention can be effective in the treatment of conversion disorder.