[Clinical and Sociodemographic Characteristics That Affect the Recommendation for Assignment of A Legal Representative in Patients With Bipolar Disorder]. / Bipolar Bozuklugu Olan Hastalara Yasal Temsilci Atanma Önerisini Etkileyen Sosyodemografik ve Klinik Özellikler.

OBJECTIVE: In this study, we aimed to evaluate the clinical and sociodemographic characteristics of patients with bipolar disorder who had been sent to the Forensic Psychiatry Unit by the court in order to determine factors that affected the decision to appoint a legal representative. METHODS: The reports of health council, follow-up outpatient, and hospitalization files of a total of 78 patients with bipolar disorder who had been sent to the Department of Forensic Psychiatry Outpatient Clinic of Bakirköy Mental Health and Neurological Diseases Education and Research Hospital between 1st June 2009-31st December 2011 were examined. Patients had been sent by the court in order to determine whether a legal representative was required. Seventy patients meeting enough to sociodemographic and clinical form were separated as appointment group of legal representative or not and decision variables were compared statistically. RESULTS: Forty-six patients (66%) were recommended assignment of a legal representative. In the patients with bipolar disorder for whom a legal representative was recommended, the presence of other first axis comorbidity, the presence of psychotic episodes, delusions of persecution and reference, hallucinations, the total number of manic and mixed episodes, incidence of alcohol and substance abuse, lifetime total number of attacks, and the total number and duration of hospitalizations were found to be significantly higher. The probability of assignment of a legal representative was increased 11-fold by the presence of first axis comorbidity, 1.3-fold by the number of manic episodes, and 2.2-fold by the number of mixed episodes were specified. CONCLUSION: In the practice of forensic psychiatry, clinicians should focus on the course of the disease, especially the number and frequency of manic or mixed episodes, total number of episodes and hospitalizations, duration of hospitalizations, alcohol and substance use, the presence of episodes accompanied by psychosis with paranoid delusions and hallucinations, and the presence of the other first axis comorbidity in the patient with bipolar disorder for assessment of the decision to appoint a legal representative.

Obsessive compulsive disorder and symptoms may have different effects on schizophrenia.

The aim of this study is to investigate the possible different effects of obsessive compulsive disorder (OCD) and obsessive compulsive symptoms (OCS) on schizophrenia illness in regard to clinical characteristics such as severity of symptomatology. We included 184 patients with schizophrenia on monotherapy with a stable dose of antipsychotics for at least three months. Severity of clinical symptoms was evaluated by Positive and Negative Syndrome Scale. OCS was examined by Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Checklist. We also assessed OCD by using Y-BOCS. Seventeen percent of the patients were diagnosed with current OCD, while 17.4% of the patients were found to have OCS without OCD. Age of onset for OCD group was earlier than non-OCS group (p=0.007). The rate of occupation was higher (p=0.001), prevalence of other comorbid psychiatric disorders was lower (p=0.05), number of hospitalization was lower (p=0.03), GAF score was higher (p=0.03) and duration of education was longer (p=0.02) in the OCS group than in the non-OCS group. The rate of occupation was higher (p=0.04) and that rate of comorbid psychiatric disorders was lower (p=0.01) in the OCS group than in the OCD group. We found more OCS in patients using atypical antipsychotics (p=0.03). Our findings suggest that OCD and OCS might have different effects on schizophrenia.

[The impact of socioeconomic and sociodemographic factors on the criminal behavior of patients with a psychotic disorder]. / Sosyoekonomik Etmenlerin ve Sosyodemografik Ozelliklerin Psikotik Olgularin Suç Islemesinde Etkisi.

INTRODUCTION: The impact of socioeconomic and demographic factors on the criminal behavior of patients with a psychotic disorder was evaluated. METHOD: The study included 70 psychotic men hospitalized in the forensic psychiatry unit of the Bakirköy State Hospital for Psychiatric and Neurological Diseases for compulsory treatment who were compared to 70 psychotic disorder cases with no criminal history hospitalized in the acute wards in the same hospital. Socioeconomic and sociodemographic data were collected and statistical evaluations were made. RESULTS: The vast majority of all the patients (90.7%) in both groups were diagnosed with schizophrenia. The forensic group was significantly less educated than the control group (7.99+/-3.81 years vs. 9.37+/-3.62 years, P<0.05). More than 50% of the cases in both groups were never married ; when considering divorced and widowed patients together with these unmarried patients, the percentage rose to 83%. Fewer forensic cases lived in urban areas than did control cases (50% vs. 84.3%). Logistic regression analysis highlighted a relationship between unemployment and the lack of social insurance to the criminal behaviour of the forensic group. Of those in the forensic group, 48.6% had no social insurance, whereas only 15.7% of the control group had none. CONCLUSION: The data suggested that unemployment and the lack of social insurance are 2 independent variables that may contribute to the probability that patients with a psychotic disorder will engage in criminal behavior.