Psychopathology in Violent Offenders Against Healthcare Workers.

Workplace violence in healthcare is gradually becoming a major concern in many countries around the world and research has usually been focused on the victims of violence. The aim of this study was to investigate the psychopathology of individuals who commit violence against healthcare workers. The study included 50 subjects (patient or relative of patient) aged 18-65 years who had committed violence against a healthcare worker (study group) and a control group of 55 subjects with no history of violence. A Sociodemographic Questionnaire, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Barratt Impulsiveness Scale (BIS-11), State-Trait Anger Expression Inventory (STAXI), and Eysenck Personality Questionnaire-Revised Short Form (EPQ-RSF) were administered to both the study group and the control group. A psychiatric disorder was diagnosed in 50% of the violent offenders group and in 16.4% of the control group. It was determined that 54.8% of the patient relatives and 44.4% of the patients themselves who committed a violent act against healthcare workers had at least one psychiatric diagnosis and these rates did not differ between the patients and their relatives (χ2 = 0.492, p = 0.483). Comparisons of the scale scores between the groups revealed that the STAXI scores (p < .001), BIS-11 total scores (p < .001), BDI, and BAI scores were statistically significantly higher in the violent offenders group. Considering the higher rates of psychiatric disorders and higher levels of anger and impulsivity among people who commit violent acts against healthcare workers, psychotherapeutic interventions such as stress and anger management interventions, improvement of interaction and communication between patients, their relatives and healthcare workers, and the implementation of rehabilitating punitive programs for violent offenders may be beneficial to reduce the rates of violent behavior against healthcare workers.

Fear of Circumcision in Boys Considerably Vanishes within Ten Days of Procedure.

PURPOSE: To compare fear of circumcision, before, immediately after, and ten days after the operation. MATERIALS AND METHODS: This was a case-control study in which participants in the operation group consisted of children admitted for circumcision at the outpatient clinics of a hospital. The Children's Fear Scale and the Venham Picture Test were administered by face-to-face interviews. RESULTS: The sample consisted of 100 boys who were circumcised and 99 who have not been circumcised yet. Children's Fear Scale scores measured before (P = .000) and immediately after the operation (P = .000) were significantly different from scores obtained on the 10th day after the operation. Total fear scores of the Venham Picture Test of boys whose families were in the higher economic level were higher than those of boys from low-income families (P < .05). The primary reason for admission for circumcision was religious, and the reason for the remaining boys was a combination of religious and hygienic factors. The boys who came to have circumcision solely because of religious reasons were found to be less fearful compared with the boys who were brought to surgery for both religious and medical reasons (P < .05). The lowest fear scores were obtained for boys who were six years of age or older. Boys who knew what the circumcision meant were less afraid of circumcision compared with those who were unaware of the procedure. CONCLUSION: Fear from circumcision does not persist; it considerably vanishes within ten days. It seems reasonable to recommend circumcision for boys six years of age or older. Pre-operative education may help boys to overcome fear originated from circumcision.

Weight gain and associated factors in patients using newer antidepressant drugs.

OBJECTIVE: The aim of the present study was to examine weight gain and its association with clinical and sociodemographic characteristics in patients using newer antidepressants. METHODS: The study had a cross-sectional design. A total of 362 consecutive psychiatric patients taking antidepressant drugs for 6 to 36 months were included in the study. RESULTS: The prevalence rate of weight gain was 55.2%; 40.6% of the patients had a weight gain of 7% or more compared to the baseline. Overall, antidepressant use was significantly related to increased body weight. Specifically, citalopram, escitalopram, sertraline, paroxetine, venlafaxine, duloxetine and mirtazapine, but not fluoxetine, were associated with significant weight gain. Multivariate logistic regression analysis indicated that lower education status, lower body mass index at the onset of antidepressant use and family history of obesity were independent predictors of weight gain ≥7% compared to the baseline. CONCLUSIONS: The study results suggest that patients who take newer antidepressants might have significant problems related to body weight.

Low-dose imipramine for treatment of panic disorder during pregnancy: a retrospective chart review.

Although imipramine is one of the antidepressants that could be effective in the treatment of panic disorder, data on its usage for this diagnosis in the pregnancy period are limited. This report presents the results of 16 pregnant women with panic disorder without comorbid diagnosis who underwent low-dose imipramine (10-40 mg/d) treatment. According to the Clinical Global Impression-Improvement Scale, 12 (75%) of 16 women responded to the treatment. The results suggest that low-dose imipramine may be useful for the treatment of panic disorder during pregnancy.

The prevalence of depression and anxiety disorders in patients with euthyroid Hashimoto's thyroiditis: a comparative study.

OBJECTIVE: The aim of this study was to examine the current prevalence of major depression and anxiety disorders in patients with euthyroid Hashimoto's thyroiditis (HT) and euthyroid goiter. METHOD: The study sample was formed by consecutive 51 and 45 patients who were admitted to the endocrinology outpatient clinic and diagnosed with euthyroid HT and endemic/nonendemic goiter, respectively, and 68 healthy controls. Current diagnoses of psychiatric disorders were determined using the Structured Clinical Interview for DSM-IV. Beck Depression Inventory and Beck Anxiety Inventory were applied to the participants. RESULTS: There was a statistically significant difference among the three groups in terms of major depression (P=.001), any mood or anxiety disorder (P=.000), any depressive disorder (P=.020), any anxiety disorder (P=.016) and obsessive-compulsive disorder (OCD) (P=.013). In the HT group, the prevalence of depression (P=.000), OCD (P=.005) and panic disorder (P=.041) was significantly higher than that in the control group. In the goiter group, depression (P=.006), any depressive disorder (P=.03), and any mood or anxiety disorder (P=.000) were significantly common in comparison to the control group. No significant difference was found between the HT and goiter groups. CONCLUSIONS: Euthyroid HT and euthyroid goiter increase predisposition to major depression and anxiety disorders, and thyroid autoimmunity and other thyroid pathologies should be investigated in euthyroid patients with chronic and treatment-resistant complaints.

Antidepressants and menstruation disorders in women: a cross-sectional study in three centers.

OBJECTIVE: The relationship between menstruation disorders and antidepressant drugs usage in women remains unclear. In this study, we aimed to investigate the incidence rate of antidepressant-related menstruation disorders and to examine whether or not antidepressant use is associated with menstrual disorders in women. METHODS: The study sample was gathered from three centers and four hospitals. A total of 1432 women who met the criteria of inclusion were included in the study. The sample was divided into two groups: the antidepressant group (n=793) and the control group (n=639). The menstruation disorders were established with reports from the study participants on the basis of related gynecological descriptions. RESULTS: The prevalence of menstrual disorders was significantly higher in the antidepressant group (24.6%) than the control group (12.2%). The incidence of antidepressant-induced menstruation disorder was 14.5%. The antidepressants most associated with menstrual disorders were paroxetine, venlafaxine, sertraline and their combination with mirtazapine. Overall, the incidence rate was similar in women receiving selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors. CONCLUSIONS: The results of the present study suggest that menstruation disorders are frequently observed in women taking antidepressants and that it appears to be associated with antidepressant use at least in some women.

[Psychopharmacological treatment and quality of life in obsessive compulsive disorder]. / Obsesif kompulsif bozuklukta psikofarmakolojik tedavinin yasam kalitesine etkisi.

OBJECTIVE: Obsessive compulsive disorder (OCD) is an illness that considerably influences the family, academic, occupational and social functioning of patients. In this study, we aimed to investigate the impact of psychopharmacological treatment on quality of life in patients with OCD. METHOD: Using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS) and the World Health Organization Quality of Life Measurement Instrument Short Form, Turkish Version (WHOQOL-Bref TR) we assessed 53 patients who met the DSM-IV criteria for OCD to establish baseline values. The patients were consecutively assigned to receive either sertraline (100-200 mg/day), fluvoxamine (200-300 mg/day) or paroxetine (40-80 mg/day). We reassessed 36 (68%) of the initial group after 12 weeks. RESULTS: The scores of obsession, compulsion and depression severity at follow-up were significantly lower than those of baseline scores. There is no significant difference between the pre and post-treatment quality of life domain scores. While psychological health scores at follow-up was significantly associated with baseline HDRS scores (r=-0.35, p<0.05), social relationship scores at follow-up was significantly associated with baseline social relationship scores (r=0.63, p<0.001) and compulsion scores (r=-0.37, p<0.05). Regression analyses revealed that social relationship scores at follow-up was associated with baseline compulsion severity whereas other follow-up quality of life domain scores were not predicted by any baseline variable. CONCLUSIONS: Clinical viewpoint and objective evaluations should be essential in the evaluation of treatment outcome, and quality of life researches may be important complement to clinical researches.

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.

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.

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 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.

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.

Longitudinal assessment of symptom and subtype categories in obsessive-compulsive disorder.

Although it has been postulated that symptom subtypes are potential predictors of treatment response, few data exist on the longitudinal course of symptom and subtype categories in obsessive-compulsive disorder (OCD). Putative subtypes of OCD have gradually gained more recognition, but as yet there is no generally accepted subtype discrimination. Subtypes, it has been suggested, could perhaps be discriminated based on autogenous versus reactive obsessions stemming from different cognitive processes. In this study, our aim was to assess whether symptom and subtype categories change over time. Using the Yale-Brown Obsessive Compulsive Symptom Checklist (Y-BOCS-SC), we assessed 109 patients who met DSM-IV criteria for OCD to establish baseline values, then reassessed 91 (83%) of the initial group after 36+/-8.2 months. Upon reassessment, we found significant changes from baseline within aggressive, contamination, religious, symmetry and miscellaneous obsessions and within checking, washing, repeating, counting and ordering compulsion categories. Sexual, hoarding, and somatic obsessions, and hoarding and miscellaneous compulsions, did not change significantly. In accordance with the relevant literature, we also assigned patients to one of three subtypes--autogenous, reactive, or mixed groups. Though some changes in subtype categories were found, no subtype shifts (e.g., autogenous to reactive or reactive to autogenous) were observed during the course of the study. Significantly more patients in the autogenous group did not meet OCD criteria at follow-up than did patients in the other groups. Our results suggest that the discrimination between these two types of obsession might be highly valid, because autogenous and reactive obsessions are quite different, both in the development and maintenance of their cognitive mechanisms, and in their outcome.

Comparison of treatment responses and clinical characteristics of early-onset and late-onset obsessive-compulsive disorder.

Objective. The clinical characteristics and response to pharmacotherapy of adult patients with early-onset and late-onset obsessive-compulsive disorder (OCD) were compared in this study. Methods. A total of 50 outpatients with OCD diagnosed according to DSM-IV criteria (early-onset: 20; late-onset: 30) were included in the study. After initial clinical evaluation with The Structured Clinical Interview for DSM-IV/Clinical Version (SCID-I/CV), The Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), all patients were treated with fluvoxamine, sertraline or paroxetine for 12 weeks. Treatment response was defined as a ≥35% reduction in the Y-BOCS-total scores from baseline in a 12-week follow-up period. Results. Forty-three patients (early-onset: 16; late-onset: 27) completed the study. The early-onset group had higher frequencies of symmetry/exactness obsessions and ordering/arranging compulsions, and the late-onset group had higher mean age at assessment. Nine (56.3%) patients with early-onset and 18 (66.7%) with late-onset responded to pharmacotherapy. The difference between response rates was not statistically significant. Conclusions. Our study suggests that although there are some phenomenological differences between patients with early-onset OCD and late-onset OCD, these patients have similar responses to pharmacotherapy.

Twelve-month prevalence of obsessive-compulsive disorder in Konya, Turkey.

We conducted a household survey of 3,012 adults aged 18 and over in order to estimate the prevalence of DSM-IV obsessive-compulsive disorder (OCD) in urban areas in Konya, Turkey. Trained psychiatry interns administered the 2.1 version of the OCD section of the Composite International Diagnostic Interview (CIDI). The 12-month period prevalence rate of OCD was 3.0%. The mean age of onset of OCD was 25.9 +/- 12.5 (range, 7 to 63) years. The prevalence rate of OCD was slightly higher among females (males 2.5%, females 3.3%), but the difference was not statistically significant. The relative risk for divorced, separated, or widowed subjects was approximately 4.2 times higher for OCD than others (2.7% v 10.5%). The 1-year prevalence of OCD inversely related to age group in male subjects, but increased with age in female subjects. The prevalence rate of OCD was not different by the level of education, except it was statistically higher among subjects who were literate but had no schooling, of which the causal relationship was high prevalence rate of OCD among female literate-but no schooling subjects. Subjects with few (one or two) and more siblings (seven or more) had a significantly higher prevalence rate of OCD than subjects with moderate numbers of siblings (three to six). No significant difference was found according to employment, fertility, birth order, and income of the subjects. About 30% of subjects with OCD had only obsessions, whereas 68.5% had both obsessions and compulsions. Only one subject (1.1%) with OCD met compulsion criteria without obsessions. The prevalence rate of OCD we found in Konya, Turkey was similar to the prevalence rates of most epidemiological studies.

The predictors of health care seeking behavior in obsessive-compulsive disorder.

A majority of individuals with obsessive-compulsive disorder (OCD) do not seek health care. To better understand why not, health care-seekers (HCS) with OCD (n = 25) were compared with non-health care-seekers (NHCS) with OCD (n = 23) regarding their sociodemographic variables, symptom severity, types of obsessions and compulsions, insight degree, comorbid diagnosis, and quality-of-life (QOL) level. There was no significant difference for sociodemographic characteristics between the groups. NHCS scored significantly lower on a measure of illness severity than HCS. The NHCS group had significantly poorer insight degree than the HCS group. Aggressive and religious obsessions were significantly less identified in the NHCS group compared to the HCS group. NHCS were significantly less likely to have comorbid diagnosis than HCS. The NHCS group reported significantly higher levels of QOL in psychological health and level of independence domains [corrected]. To identify the predictors of health care seeking behavior, probable variables were entered in a logistic regression model. Insight degree and level of independence emerged as the predictors of health care seeking. Our results suggest that health care seeking behavior in OCD is associated with the individuals' ability to recognize their symptoms as a disorder and subjective interpretation regarding the impact of OCD on their level of independence. Results of the present study extend findings of two recent studies that have investigated factors related to health care seeking in OCD.