[Undergraduate psychiatric training in Turkey]. / Türkiye'de Mezuniyet Oncesi Psikiyatri Egitiminin Bugünü

OBJECTIVE: The current trend in medical education is to abandon the experience-based traditional model and embrace the competency-based education model (CBE). The basic principle behind CBE is standardization. The first step in standardization is to determine what students must know, what they must accomplish, and what attitude they should display, and the establishment of educational goals. One of the goals of the Psychiatric Association of Turkey, Psychiatric Training Section is to standardize psychiatric training in Turkish medical schools. This study aimed to determine the current state of undergraduate psychiatric training in Turkish medical schools. METHOD: Questionnaires were sent to the psychiatry department chairs of 41 medical schools. Data were analyzed using descriptive statistical methods. RESULTS: Of the 41 department chairs that were sent the questionnaire, 29 (70%) completed and returned them, of which 16 (66.7%) reported that they had already defined goals and educational objectives for their undergraduate psychiatric training programs. The Core Education Program, prepared by the Turkish Medicine and Health Education Council, was predominately used at 9 (37.5%) medical schools. Pre-clinical and clinical training schedules varied between medical schools. In all, 3 of the medical schools did not offer internships in psychiatry. The majority of chairs emphasized the importance of mood disorders (49.9%) and anxiety disorders (40%), suggesting that these disorders should be treated by general practitioners. Computer technology was commonly used for lecturing; however, utilization of interactive and skill-based teaching methods was limited. The most commonly used evaluation methods were written examination (87.5%) during preclinical training and oral examination (91.6%) during clinical training. CONCLUSION: The most important finding of this study was the lack of a standardized curriculum for psychiatric training in Turkey. Standardization of psychiatric training in Turkish medical schools must be developed.

[Two stiff person cases misdiagnosed as conversion disorder]. / Kati insan sendromunda konversiyon bozuklugu yanlis tanisi: iki olgu.

Modern psychiatric diagnostic systems classify neurological symptoms that cannot be explained by a physical disease or another psychiatric disorder as conversion disorder (CD) or dissociative motor disorder. It is a well-known fact that the overall rate of misdiagnosis of conversion symptoms is high. The most common presenting symptoms of misdiagnosed patients are gait and movement disturbances. Stiff-person syndrome (SPS) is a rare progressive autoimmune neurological disorder. The identification of antibodies against glutamic acid decarboxylase (GAD) in association with SPS provided an important contribution to the understanding of the pathophysiology of this syndrome. Patients may present with severe muscle rigidity and sudden contractions. Simultaneous contraction of agonist and antagonist muscles produces gait disturbance. SPS can be exacerbated by emotional stressors, and sudden auditory, visual, and tactile stimuli. Herein we present 2 patients that were referred for psychiatric assessment, because their neurological symptoms initially could not be explained by a neurological disease, and subsequently diagnosed as SPS. The aim of this case report is to draw attention to the psychiatric presentations of SPS and to emphasize the importance of complete psychiatric and neurological examination, including brain imaging and electrophysiological studies, in the differential diagnosis of CD.

[Psychopathology and personality patterns in the first-degree relatives of bipolar patients]. / Bipolar bozuklugu olan hastalarin birinci derece akrabalarinda psikopatoloji ve kisilik orüntüleri.

OBJECTIVE: This is a cross-sectional study designed to assess psychopathology and personality patterns in a group of high-risk subjects for bipolar disorder compared to a control group. As high-risk subjects first-degree relatives of bipolar patients were selected. METHOD: Ninety-five first-degree relatives of 54 bipolar patients and 93 first-degree relatives of 54 subjects without any psychiatric disorder were recruited in the study. Control subjects were matched to bipolar patients according to age, gender and educational status. SADS-L (Schedule for Affective Disorders and Schizophrenia-Lifetime Version) was used both to ascertain the psychiatric status of the patient and control subjects, and to evaluate the psychopathology in probands' and controls' relatives. MMPI-2 (Minnesota Multiphasic Personality Inventory-2) profiles of relatives of patient and control groups were compared as well. RESULTS: In the relatives of bipolar patients the SADS-L diagnoses of hypomania, minor depression and schizotypal personality were statistically more prevalent than in the relatives of the control group. MMPI-2 profiles of both relatives of bipolar patients and controls were within "normal" range, whereas relatives of patients were more defensive in disclosing psychopathology. Any specific profile characteristic for relatives of bipolar patients could not be described. CONCLUSION: Minor mental disorders were more prevalent in the relatives of bipolar patients group. A personality pattern specific to high risk group for bipolar disorder couldn't be detected.

[The utility of an endophenotype approach in overcoming the difficulties in bipolar and schizophrenia genetics]. / Bipolar Bozukluk ve Sizofreni Genetigindeki Sorunlarin Giderilmesinde Endofenotip Yaklasiminin Yeri.

Despite the progress in molecular genetics, the genes responsible for the development of bipolar disorder (BPD) and schizophrenia have not yet been identified. This failure can be attributed to an ambiguous phenotypic description and several variations in the genetic transmission of these diseases. There is a growing consensus that an endophenotype approach may be utilized to overcome the difficulties regarding the phenotypic description and facilitate the identification of the susceptibility or protective genes. The endophenotypes which can be defined as subclinical vulnerability markers may assist in the identification of the genetic underpinnings of psychiatric disorders regardless of the disease status. This approach may provide well-defined phenotypes having a stronger relationship with the pathophysiology and genetic etiology than with the diagnostic categories themselves. An endophenotype may be an inherited neurophysiological, neuropsychological, cognitive, neuroanatomical, biochemical or endocrinological trait. Nevertheless, it must be 1) associated with illness, 2) present in nonaffected family members at a higher rate than in the general population, 3) present within the normal population to a lesser extent and 4) state-independent. Besides increasing the power of genetic analysis in BPD and schizophrenia, an endophenotype approach may help in reshaping the classical nosological systems and diagnostic categories. Lastly, it may have additional use in psychiatry, including the development of suitable animal models for these disorders. In this article, the rationale for the use of endophenotypes in genetic studies of BPD and schizophrenia is discussed and the proposed candidate endophenotypes for both disorders are reviewed.

Is vitamin D hypothesis for schizophrenia valid? Independent segregation of psychosis in a family with vitamin-D-dependent rickets type IIA.

The vitamin D hypothesis of schizophrenia is a recent concept bringing together old observations on environmental risk factors and new findings on the neurodevelopmental effects of vitamin D. Candidate genes related to the vitamin D endocrine system have not yet been fully explored for this purpose. The coexistence of vitamin-D-dependent-rickets type II with alopecia (VDDR IIA) and different forms of psychosis in the same inbred family has provided us with an opportunity to investigate the presumed relationship between vitamin D deficiency and psychosis. Psychiatric examination and molecular genetic studies were performed in this family overloaded with psychotic disorders and VDDR IIA. Forty members were evaluated in order to describe their phenotypic features. The family was tested for a linkage to the chromosome 12q12-q14 region where the vitamin D receptor (VDR) gene is located. Psychosis was the common phenotype in the 18 psychiatrically affected members. Pedigree analysis did not show a cosegregation of psychosis and rickets. Lod scores were not significant to prove a linkage between psychosis and VDR locus. The authors concluded that (1) the neurodevelopmental consequences of vitamin D deficiency do not play a causative role in psychotic disorders, (2) these two syndromes are inherited independently, and (3) vitamin D deficiency does not act as a risk factor in subjects susceptible to psychosis.

[Hunting the susceptibility gene for psychosis: a study of a family overloaded with schizophrenia and bipolar disorder]. / Sizofreni ve bipolar bozuklugun yüklülük gösterdigi genis bir ailede psikoza yatkinlik geninin arastirilmasi.

OBJECTIVE: It is a long-standing debate whether schizophrenia and bipolar disorder are separate clinical entities or different poles on a spectrum. In this paper we present a family overloaded with schizophrenia, and schizoaffective, bipolar and unipolar disorders. Common loci for bipolar affective disorder and schizophrenia were tested by linkage analysis. METHOD: The pedigree of an index family which had been followed by our department for nearly 20 years was extended. The index family members were diagnosed by two psychiatrists with two distinct structured interview schedules (SCID-I and SADS-L). A field visit was undertaken for the evaluation of the extended family (n= 40) and SADS-L was used for psychiatric assessment. Blood samples were collected for molecular studies. A linkage study has been performed for overlapping susceptibility regions for schizophrenia and affective disorders (10p13-p12, 13q32, 18p and 22q11-q13) and a locus (20p11.2-q13) to which a linkage had been shown in a bipolar family who lived in the same region. Both autosomal recessive and dominant mode of inheritance were assumed in the analysis. RESULTS: The pedigree consisted of 108 individuals of whom 23 are affected. All affected subjects presented psychotic features except for 5 unipolar patients. The pedigree was reconstructed with respect to psychosis phenotype. Further linkage and haplotype analysis excluded all five loci on chromosomes 10, 13, 18, 20 and 22 under both autosomal dominant and recessive modes of inheritance assumption. CONCLUSION: A potential linkage between the psychosis gene and reported susceptibility loci overlapping in bipolar affective disorder and schizophrenia was not demonstrated Genome-wide analysis should be performed.