"Just Because I Don't Conform to Societal Norms": A Qualitative Study of Transgender People's Experiences of Domestic Violence and Coping Methods.

Background Transgender people experience violence in various forms, primarily domestic violence. The aim of this study was to examine transgender people's experiences of domestic violence and their coping methods. Materials and methods This study was conducted using the phenomenological method, one of the five basic qualitative research methods, with 20 transgender participants who applied to Ondokuz Mayis University, Samsun, Turkey, to start the gender-affirming treatment process. The participants comprised 19 transgender men and 1 transgender woman. A semi-structured interview form was used for data collection. The average interview duration was 75.7 minutes. Audio recordings were used in the interviews, which were then transcribed. The obtained data set was subjected to content analysis. Results As a result of the content analysis, three themes emerged: being a transgender individual and the family, experiences of domestic violence, and methods of coping. According to the study results, the participants had experienced domestic violence of different dimensions, primarily psychological violence. Defined gender roles and societal expectations were determined to trigger violent behaviors. The most frequently used coping methods were giving a direct reaction, seeking instrumental-social support, and ignoring the incidents. Conclusion Our findings demonstrated that transgender people experience domestic violence at a high rate and that transphobic behaviors are triggered by societal norms. Our results are particularly noteworthy for clinicians regarding the importance of family support and accurate information for transgender people and the coping methods they use most.

Evaluation of the relationship between death anxiety and clinical features of the disease and functionality in patients with schizophrenia.

Aim: This study aimed to examine the relationship between death anxiety in schizophrenia patients and the clinical characteristics of the disease and its functionality. Method: The study included 52 patients diagnosed with schizophrenia according to the DSM-5 diagnostic criteria and 52 healthy volunteers. Death anxiety scores were compared between the two groups using the Abdel-Khalek Death Anxiety Scale (ADAS). The functionality of the schizophrenia patients was evaluated with the Functional Remission of General Schizophrenia (FROGS) scale. Results: The mean ADAS total scores were statistically significantly higher in the schizophrenia patient group than in the control group. A low-level negative correlation was determined between the ADAS total points and the FROGS total points, the FROGS subscales of daily life skills and health. Conclusion: The results of this study showed higher death anxiety in schizophrenia patients than in the healthy control group. Patients with a higher level of functionality were determined to have a lower level of death anxiety. These results support our idea that interventions and therapeutic approaches to increase functionality in patients with schizophrenia can reduce their death anxiety. In order to reach more evident conclusions on this subject, prospective studies that deal with the causal relationship between death anxiety and functionality are needed.

Early maladaptive schemas in patients with bipolar and unipolar disorder.

OBJECTIVE: The aim of our study is to determine the difference between the bipolar disorder, unipolar disorder and control groups in terms of maladaptive schemes and childhood trauma. METHODS: Two groups of patients under monitoring with a diagnosis of bipolar or unipolar disorder and one group of healthy controls were enrolled in this study. Each group consisted of 60 subjects. The Young Mania Rating Scale and Beck Depression Inventory were used to confirm that patients were in remission. The Childhood Trauma Questionnaire and Young Schema Questionnaire-Short Form 3 were used to identify childhood traumas and early maladaptive schemas. RESULTS: In bipolar disorder, a positive, low power correlation was observed between the vulnerability to threats schema and emotional, physical and sexual abuse. In the unipolar disorder group, there was a positive, low power correlation between the emotional inhibition, failure, approval seeking, dependence, abandonment and defectiveness schemas and social isolation, and a positive, moderate correlation between social isolation and emotional abuse. CONCLUSIONS: Individuals with bipolar disorder suffered greater childhood trauma compared to subjects with unipolar disorder and healthy individuals. Greater maladaptive schema activation were present in individuals with bipolar disorder compared to those with unipolar disorder and healthy individuals.

Social Cognition in Schizophrenia Patients and Their First-Degree Relatives.

INTRODUCTION: Social cognition is a person's ability to configure the designs of relationships between themselves and others and to use these designs to guide social behaviors in a flexible manner. The models that are the most studied and describe social cognition are the theory of mind (ToM) and emotion recognition. This study was aimed to detect ToM and emotion recognition disorders in schizophrenia patients and their first-degree relatives. METHODS: Thirty schizophrenia patients in remission, the first-degree relatives of schizophrenia patients (n=30), and 30 healthy volunteers who were paired with the patients in terms of age and duration of education were included in the study. The Positive and Negative Symptom Scale (PANSS), Dokuz-Eylül Theory of Mind Scale (DEToMS), Reading the Mind in the Eyes test, Facial Emotion Identification Test (FEIT), and Facial Emotion Discrimination Test (FEDT) were performed by the patients participating in this study. RESULTS: ToM and emotion recognition were found to be defective in the schizophrenia patients and their relatives. The performances of ToM and emotion recognition were ranked as the schizophrenia group, family group, and control group, from the worst to the best. The schizophrenia group showed poor performance in all sub-components except irony. In the family group, the empathy subcomponent showed similar performance with the control group, whereas the subcomponents of the second-order false belief, metaphor, and faux pas tests showed similar performance with the patient group. There were differences among the three groups in the first-order false belief subscale as well as the total DEToMS. The patient and family groups showed the poorest performances, whereas the control group showed the best performance. CONCLUSION: The detection of ToM and emotion recognition disorders in the remission period, regardless of the attack period and asymptomatic first-degree relatives, may support the view that the period of schizophrenia is an independent continuous variable.

Coping with Stress and Body Image in Patients with Ankylosing Spondylitis.

INTRODUCTION: The aim of this study was to determine coping with stress and body image in patients with ankylosing spondylitis (AS) and to investigate the correlation between these two characteristics together and also between them and disease activity/functional capacity. METHOD: Fourty healthy controls and 40 patients with AS who were diagnosed on the basis of Modified New York Criteria were included in the study. The exclusion criteria were another medical disease or comorbid psychiatric disorder. All participants were administered the Coping Orientations to Problems Experienced (COPE) questionnaire in order to evaluate attitudes to coping with stress and the Multidimensional Body-Self Relations Questionnaire (MBSRQ) to evaluate body image. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI) were used to evaluate AS patients' disease activities and functional capacities. RESULTS: There was no difference between the two groups in terms of COPE scores. The MBSRQ 'health evaluation' subscale scores were lower and the 'fitness orientation' scores higher in the AS group. The COPE active coping subscale had a weak, positive correlation with MBSRQ total score and a weak, negative correlation with BASFI score. MBRSQ total score had a moderate, negative correlation with BASFI score, and a weak, negative correlation with BASDAI score. CONCLUSION: The attitudes to coping with stress in AS patients with no accompanying medical disease or psychiatric disorder may not differ from that in healthy controls. Negative health evaluation and fitness orientation must be characteristics considered in psychotherapeutic interventions applied to these patients. In addition, psychotherapeutic interventions directed toward coping with stress and body image may be especially useful in active stages of the disease and in patients with limited functional capacity.

The relationship between the presence of ADHD and certain candidate gene polymorphisms in a Turkish sample.

Due to the high heritability of attention-deficit hyperactivity disorder (ADHD), parents of children with ADHD appear to represent a good sample group for investigating the genetics of the disorder. The aim of this study was to investigate the association between ADHD and six polymorphisms in five candidate genes [5-HT2A (rs6311), NET1 (rs2242447), COMT (rs4818), NTF3 (rs6332), SNAP-25 (rs3746544) and (rs1051312)]. We included 228 parents of children diagnosed with ADHD and 109 healthy parents as the control group. The polymorphisms were genotyped using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) assays and analyzed using the chi-square test and the multinomial logit model. SNAP-25 (rs3746544) polymorphism was associated with loading for ADHD, while 5-HT2A (rs6311) and NET1 (rs2242447) polymorphisms were associated with ADHD. On the other hand, there was no significant association between the SNAP-25 (rs1051312), NTF3 (rs6332), or COMT (rs4818) gene polymorphisms and ADHD. In addition, we found that even if variation in the SNAP-25 gene alone does not affect the phenotype, it may nevertheless lead to the emergence of a clinical ADHD picture in the presence of other genetic factors. Our findings suggest that a combination of NET1 (rs2242447) and SNAP-25 (rs3746544) is a risk factor for ADHD. Problems associated with the noradrenergic and serotonergic systems and SNAP-25 may play a role, both alone and in interaction with one another, in the pathophysiological mechanisms of ADHD.

Internalized stigma and intimate relations in bipolar and schizophrenic patients: a comparative study.

OBJECTIVE: The aim of this study was to determine characteristics of internalized stigma and intimate relations in bipolar and schizophrenia patients and to compare characteristics of intimate relations in bipolar and schizophrenia patients with or without internalized stigma. METHOD: A total of 228 volunteers were included, 119 patients with bipolar disorder and 109 with schizophrenia. Schizophrenic and bipolar disorder patients were compared in terms of internalized stigma and intimate relations characteristics. Bipolar and schizophrenia patients with and without internalized stigma were compared in terms of characteristics of intimate relations. RESULTS: Internalized stigma was determined in one in three schizophrenia and one in five bipolar patients. Stigma resistance and relational esteem in intimate relations scores were higher in bipolar patients. Relational anxiety/fear of relationship, relational monitoring and external relational control scores were higher in schizophrenia patients with internalized stigma compared to those without, while their relational satisfaction, relational esteem and relational assertiveness scores were lower. Relational anxiety/fear of relationship and relational monitoring scores were higher in bipolar patients with internalized stigma compared to those without, while their relational satisfaction scores were lower. CONCLUSION: Internalized stigma in schizophrenia patients is a well-known subject that has been investigated previously. The results of our study are significant in terms of showing that internalized stigma is also frequent in bipolar disorder patients, and not solely in schizophrenia patients. Stigma resistance is higher in bipolar disorder patients. Internalized stigma is correlated with intimate relations in both bipolar and schizophrenia patients.

Temperament and character traits in patients with bipolar disorder and associations with attempted suicide.

OBJECTIVE: This study was intended to investigate temperament and character traits in bipolar disorder patients with or without a history of attempted suicide. METHODS: One hundred nineteen patients diagnosed with euthymic bipolar disorder based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and with no accompanying Axis I and II comorbidity, and 103 healthy controls were included. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I and II disorders were used to exclude Axis I and II comorbidity. Temperament and character traits of bipolar patients with a history attempted suicide (25.2%, n = 30) or without (74.8%, n = 89) and of the healthy volunteers were determined using the Temperament and Character Inventory. The association between current suicide ideation and temperament and character traits was also examined. RESULTS: Bipolar patients with or without a history of attempted suicide had higher harm avoidance (HA) scores compared with the healthy controls. Persistence scores of bipolar patients with no history of attempted suicide were lower than those of the healthy controls. Self-directedness (SD) scores of the bipolar patients with a history of attempted suicide were lower than those of patients with no such history. Self-transcendence scores of bipolar patients with no history of attempted suicide were lower than those of both the healthy controls and of those patients with a history of attempted suicide. A positive correlation was determined between current suicidal ideation scale scores and HA, and a negative correlation between SD and cooperativeness was determined. CONCLUSIONS: High harm avoidance may be a temperament trait specific to bipolar disorder patients. However, it may not be correlated with attempted suicide in such patients. These may have low persistence, high SD and low self-transcendence temperament and character traits that protect against attempted suicide. Harm avoidance, SD, and cooperativeness may be correlated with current suicidal ideation.

Neuropsychological weaknesses in adult ADHD; cognitive functions as core deficit and roles of them in persistence to adulthood.

Prior investigations have shown that individuals with attention deficit hyperactivity disorder (ADHD) have impaired neuropsychological functions. This study had two aims, first to investigate weakened cognitive functions in adult ADHD (aADHD), and second, to investigate difference between persisters (those having persistently ongoing ADHD diagnosis in adulthood), and remitters (those having ADHD diagnosis only in childhood and not in adulthood), in terms of cognitive deficits. We evaluated performance on a comprehensive neuropsychological battery in three groups including 34 persisters, 35 remitters, and 35 healthy control group (absence of childhood and adulthood ADHD diagnosis). Our findings showed that adults with ADHD have inefficient attention, interference control and set-shifting functions, which may be revealed on neuropsychological tests that require greater cognitive demand. Given the finding that interference control deficit exists across the lifespan in people with ADHD, we suggest that interference control-associated functional weakness may be a core deficit for ADHD. (JINS, 2012, 18, 1-8).

Perception of patient aggression among nurses working in a university hospital in Turkey.

The way patient aggression is perceived influences nurses' attitudes and behaviour towards patients. The aim of this cross-sectional, descriptive study was to investigate how nurses working in a university hospital perceive aggression and whether certain variables (sociodemographic and professional characteristics, exposure to aggressive behaviour) affect that perception. Two hundred and eighteen nurses (response rate 68.1%) from different departments were administered the Perception of Aggression Scale, a self-reported scale measuring perception of patient aggression towards nurses. The nurses in this study generally perceived patient aggression as dysfunctional. Nurses exposed to patient aggression in their professional lives regarded patient aggression more as dysfunctional. In addition, the oldest nurses, the most professionally experienced and those with the longest tenure in their departments had less perception of aggression as functional than others. Professional fatigue and burn-out might play a role in this.

[Possible subtypes of panic disorder]. / Panik Bozuklugunda Olasi Alt Tipler.

OBJECTIVE: The present study, is aimed to investigate the distributiondispersion of panic attack symptoms, the possible subtypes of panic disorder, and the clinical features related to these subtypes in patients with panic disorder. MATERIAL AND METHODS: The study included 105 patients that presented to the Ondokuz Mayis University Faculty of Medicine Psychiatric Outpatient Clinic and met the DSM-IV-TR diagnostic criteria for panic disorder. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I), Panic Attack Symptom Checklist (PASC), Structured Clinical Interview for DSM-III-R (SCID-II), Beck Anxiety Inventory (BAI), Anxiety Sensitivity Index (ASI), Panic Disorder Severity Scale (PDSS), and Panic and Agoraphobia Scale (PAS) were administered to all the patients. This study examined the correlation between clinical scales and the factors based on factor analysis using PASC. RESULTS: The 3 most frequently observed symptoms during panic attacks were palpitation, sensations of shortness of breath, and sensation of choking, and the 3 most severe were palpitation, chest pain, and sensation of shortness of breath. The 3 most frequently observed non-DSM-IV-TR symptoms were feeling of discomfort, dry mouth, and blurred vision. As a result of our analysis, 3 factors were defined: respiratory-circulatory, cognitive, and autonomic. Panic attack severity, panic attack frequency, and grade of agoraphobia were strong predictors of the respiratory-circulatory subtype; anticipatory anxiety was a strong predictor of the cognitive subtype. Grade of being anxious for health was stronger predictor for respiratory-circulatory subtype, predictor for the "autonomic" subtype, and a reverse predictor for the cognitive subtype. CONCLUSION: It should be considered that the panic attack symptoms in DSM-IV-TR are insufficient to determine the panic disorder subtypes that are based on symptom profiles. The determination of subtypes could contribute in prognosis of disorder and studies about treatment methods.

Prevalence of metabolic syndrome among inpatients with schizophrenia.

OBJECTIVE: Cardiovascular disease is one of the most prevalent factors responsible for excess mortality in schizophrenia. Metabolic syndrome (MetS) is associated with the development of coronary heart disease and diabetes mellitus. The aim in this cross-sectional study was to assess the prevalence of MetS in schizophrenic Turkish inpatients. METHOD: The study was conducted from January 2006 to June 2006, and included 231 patients with schizophrenia. All participants were enrolled from inpatients attending the Samsun Mental Health Hospital psychiatry clinic. All subjects were aged between 18 and 65 and met the DSM IV criteria for schizophrenia. MetS was taken as central obesity (defined as waist circumference: men > or = 94 cm, women > or = 80 cm) and meeting > or = 2 of the following abnormalities described by the International Diabetes Federation (IDF): a serum triglyceride level > 150 mg/dL, high-density lipoprotein (HDL) cholesterol < 40 mg/dL in men and < 50 mg/dL in women, blood pressure > or = 130/85 mm Hg, and a fasting serum glucose level > or = 100 mg/d/L. RESULTS: The study group consisted of 174 male and 57 female patients. Mean age was 38.5 +/- 10.5 and mean duration of illness was 15.76 +/- 9.95 years. The overall prevalence of MetS diagnosed according to the IDF criteria was 32.0% (n = 74) and was higher in females (61.4%) than in males (22.4%; p = 0.0001). In logistic regression analysis the last step of the regression model was gender (B = 1.70, p = 0.0001, OR = 5.50, 95% CI = 2.90-10.45). CONCLUSION: This study shows that the prevalence of MetS in Turkish patients with schizophrenia is similar to that of the general population, but lower than in other reports regarding the schizophrenia population.

The attitude of medical students to psychiatric patients and their disorders and the influence of psychiatric study placements in bringing about changes in attitude.

The aim of this study was to determine the general attitude of final year medical students towards psychiatric patients and psychiatric disorders and to reveal the influence of psychiatric study experience in changing the behavior and perception of students. The study comprised 172 final year medical students undergoing a period of placement at the Ondokuz Mayis University Medical School Department of Psychiatry who agreed to participate. They were asked to fill in the Opinions about Mental Illness Ideology Scale (OMI) the day before they commenced, on the last day of their placement and three months after completing it. The students reported the highest and lowest scores from the benevolence and social restrictiveness sub-dimensions of the OMI, respectively. The mean authoritarianism score was significantly higher in males than in females. The means of the OMI scores obtained over the three different periods were not statistically different. Medical school psychiatry departments need to develop new curricula to convey scientific information to students and play a pivotal role in developing, implementing and evaluating suitable programs leading to appropriate attitude development.

Association of serotonin 2A receptor and lack of association of CYP1A2 gene polymorphism with tardive dyskinesia in a Turkish population.

The aim of this study was to investigate the possible association of serotonin 2A receptor gene (HTR2A) -1438 G/A polymorphism and CYP1A2 gene 163C/A polymorphism with tardive dyskinesia (TD) in a Turkish population. A total of 47 patients with persistent TD, 80 patients who were consistently without TD, and 100 healthy controls were included in this study. The polymorphic regions of -1438 G/A polymorphism of HTR2A receptor gene (rs6311) and 163C/A of CYP1A2 (rs762551) gene were amplified using polymerase chain reaction (PCR), followed by digestion with restriction enzymes MspI and Bsp1201. Genotype and allele frequencies were calculated by the chi(2)-test. Crude and adjusted odds ratios (ORs) were estimated, and 95% confidence intervals (CIs) were computed by multivariate logistic regression analysis. The genotype and allele frequencies of HTR2A and CYP1A2 gene were similar in schizophrenia with TD, schizophrenia without TD, and healthy controls. The logistic regression analysis showed that cumulative exposure to antipsychotic drugs for every year (p = 0.003; OR = 1.15; CI = 1.07-1.23), and AA genotype of HTR2A gene (p = 0.0258; OR = 4.34; CI = 1.19-15.81) are risk factors for TD. The same logistic regression model showed no association between CYP1A2 polymorphism and TD. The results of the present study seem to indicate that HTR2A gene polymorphism influences the tendency to express TD following prolonged antipsychotic drug exposure in Turkish schizophrenia patients.

Schizophrenia in Turkish newspapers : retrospective scanning study.

The attitude of mass media is a strong determinant for stigmatisation since the majority of the society gets exposed to psychiatric disorders via either written or visual media. In this study we explored to demonstrate the meaning attributed to the word schizophrenia in Turkish written printed media. We screened the online sites of 12 national newspapers which allow word scanning between the dates January 1, 2001 and May 1, 2006. The searched terms appeared in a total of 878 texts. In all twelve newspapers, the terms "Schizophrenia", "Schizophrene", or "Schizophrenic" appeared once every 2.2 days. While a positive referral appeared once in every 12.2 days, a negative referral or metaphoric use was seen once every 3.1 days. Among the 878 texts scanned, in 491(55.9%) the searched terms appeared with reference to the disease and in 387 (44.1%) the searched terms were used metaphorically. Considering the assumption the negative reporting may have a stronger impact than positive reporting, it is possible to suggest that Turkish newspapers are raising stigmatisation. It is meaningful that the name of a disease is used almost with equal frequency as a metaphoric term. In our study, higher rates of metaphoric use observed can be explained with the fact that in Turkey the word Schizophrenia is attributed with strong negative perception.

[The effect of giving information forms about side effects of intravenous iodinated contrast material on the anxiety level of patients]. / Kontrast madde bilgi formlarinin hasta anksiyetesi üzerine etkisi.

PURPOSE: We aimed to determine the effect of informing patients about side effects of the contrast material on the level of patients' anxiety. MATERIALS AND METHODS: Two hundred-ninety seven patients undergoing computed tomography examination were enrolled in the study. Patients were grouped in three categories: (1) patients informed about adverse effects of contrast material and waiting for i.v. contrast material injection, (2) uninformed patients waiting for i.v. contrast material injection, (3) uninformed patients undergoing unenhanced CT examination. All patients were requested to complete a questionnaire including a standard anxiety test. The results were compared statistically. RESULTS: The mean anxiety scores calculated by variant analysis were 39.2 +/- 11.7, 42 +/- 10.4, and 38.6 +/- 9.5 in groups 1, 2, and 3, respectively. No statistically significant difference was found between the anxiety scores of the 3 groups. CONCLUSION: Informing patients about the adverse effects of the contrast material does not affect their anxiety level.