Dandy-Walker Malformation Presenting with Affective Symptoms.

Dandy-Walker malformation is defined by enlarged posterior fossa, cystic dilatation of the fourth ventricle, and cerebellar hypoplasia. Although developmental delay and mental retardation are common in Dandy-Walker malformation cases, other comorbid psychiatric conditions have been rarely reported. There are limited numbers of case reports about comorbidity of bipolar disorder with Dandy-Walker malformation in the literature. Herein, a Dandy-Walker malformation case presenting affective symptoms is reported, and psychiatric symptoms which might be seen in this rare malformation are discussed along with diagnosis, treatment, and follow-up processes. A 27-year-old male patient, hospitalized for compulsory treatment, had been diagnosed with Dandy-Walker malformation in childhood. First complaints were attention deficiency, behavioral problems, learning difficulties; and manic and depressive episodes have occurred during follow-ups. He recently complained of decreased need for sleep, irritability, and increased speed of thought, and psychiatric examination was consistent with manic episode. Cranial computed tomography (CT) revealed bilateral ventriculomegaly, enlarged third and fourth ventricles with posterior fossa cyst, and cerebellar hypoplasia. His treatment included 30 mg/day aripiprazole, 1000 mg/day valproic acid, 200 mg/day quetiapine, 4 mg/day biperiden, and 100 mg/month paliperidone palmitate. Beside its traditional role in the regulation of coordination and motor functions, cerebellum is increasingly emphasized for its involvement in the mood regulation. Thus, as seen in Dandy-Walker malformation, cerebellar anomalies are suggested to play a role in the pathophysiology of mood disorders. Further studies are needed to better understand the relationship between mood disorders and cerebellum. Moreover, treatment options should be considered carefully in terms of resistance to treatment and potential side effects, for psychiatric disorders occurring in these cases; and detailed examinations, including cranial imaging, would be beneficial in bipolar cases with early onset, unresponsiveness to treatment, presenting atypical symptoms, mental retardation, and developmental delay as well as neurological symptoms and signs.

[Examination of anger reactions and psychiatric diagnoses in terms of gender in a group of university students having difficulty with anger control]. / Öfke Kontrolünde Zorluk Yasayan Bir Grup Üniversite Ögrencisinde Öfke Tepkileri ve Psikiyatrik Tanilarin Cinsiyet Açisindan Incelenmesi.

OBJECTIVE: We aimed to determine axis-I and axis-II diagnoses and identify gender difference in anger reactions among young adults who have difficulty controlling their anger. METHOD: Students from various faculties who had difficulty controlling their anger were invited to the psychiatry department. The SCID-I, SCID-II, Multidimensional Anger Scale, Childhood Trauma Questionnaire, Social Comparison Scale, Boratav Depression Screening Scale, and Beck Hopelessness Scale were administered to consecutive admissions of 50 males and 50 females. RESULTS: Axis-I diagnoses were present in 60% of males and 74% of females. Axis-II diagnoses were present in 28% of males and 36% of females. Somatoform disorders and impulse control disorder were higher in males, whereas anxiety disorders and mood disorders were higher in females. Depression was diagnosed in 10% of males and 36% of females. "Not being taken seriously" was the most prominent reason for anger among females. The "Revenge reactions" score was strongly correlated with the education level of the mother in both genders (in females r=0.472, p=0.001; in males r=-0.396, p=0.006). The best predictor of an axis-I diagnosis in women was the "anger symptoms" total score, whereas it was the "thoughts related to anger" subscale score in males. On the other hand, the best predictors of an axis-II diagnosis were "anxious behavior" in females and "smoking" in males. CONCLUSION: Anger is an important component of psychiatric disorders. Reaction styles and underlying psychiatric disorders vary according to gender.

[Valproate induced hypoactive delirium in a bipolar disorder patient with psychotic features]. / Psikotik Ozellikli Bipolar Bozuklugu Olan Bir Hastada Valproatin Neden Oldugu Hipoaktif Deliryum Tablolari.

Delirium may present with hyperactive, hypoactive or mixed clinical pictures. The signs of hypoactive delirium are lethargy, confusion, apathy, hypersomnia, muttering, difficulty in maintaining attention, and difficulty in understanding and performing commands. Valproate is commonly used for the treatment of epilepsy and bipolar disorders. It is also used for the management of alcohol withdrawal delirium and agitative-aggressive deliriums. However, few reports are available about the valproate-induced delirium. In this report, we present a 46 years-old woman with bipolar disorder for 14 years. During her last two hospital admissions, she had been diagnosed with manic episode with psychotic features and she had received valproate. She experienced three hypoactive delirium episodes lasting 2-3 days throughout the treatment period of first week. The patient predominantly had the following signs; vomiting, hypersalivation, confusion, drowsiness, dysphasia, and hypoactivity. At the first day of delirium episode, serum valproate level was found to be within the therapeutic range (98.4, 117.1, and 65.6 mug/ml; respectively). In addition, she had normal results of cranial MRI, complete blood count, urine analysis, electrocardiogram, ALT, AST, albumin, bilirubin, BUN, creatinine and electrolytes. The serum ammonia level of the patient could not been measured due to limitations of laboratory facilities. The patient's consciousness improved dramatically 2-3 days after cessation of valproate. In conclusion, valproate can induce delirium at therapeutic blood levels in some patients via various mechanisms and this side effect has to be considered during valproate use.

One-year follow-up study of posttraumatic stress disorder among earthquake survivors in Turkey.

Earthquakes and their consequences present a major global public health problem. In 1998, a major earthquake struck Southern Turkey. The aims of this study were to describe longitudinally the severity and the course of posttraumatic stress disorder (PTSD) and depression among earthquake survivors in Turkey and to explore risk factors associated with psychiatric disorders. The sample of this study consists of 105 consecutive subjects who used our psychiatric service, via either outpatient clinic or home visit. PTSD was assessed by the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The severity of depression was assessed using Beck Depression Inventory. The rates of earthquake-related Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PTSD were 42% within 1 month and 23% within 13 months. The diagnosis of PTSD was significantly related to the presence of injury and to less social support in the initial assessment. In the follow-up assessment, although the mean total Clinician-Administered PTSD Scale severity score improved significantly, the mean Beck Depression Inventory score did not change significantly. The decrease in posttraumatic stress symptoms 13 months after the earthquake may be related to relatively good living conditions and adequate social and health services. Early mental health intervention may serve to prevent the chronicity of posttraumatic stress reactions among earthquake victims.

Long-term urologic, orthopedic, and psychological outcome of posterior urethral rupture in children.

OBJECTIVES: To evaluate the long-term urologic, orthopedic, and psychological outcome of children after posterior urethral rupture (PUR) due to pelvic trauma. METHODS: We retrospectively reviewed the records of 49 children with PUR from 1986 to 2000. The long-term urologic results were determined by voiding function, continence, and erectile function. The orthopedic results were determined by pelvic radiography and a questionnaire. Psychiatric diagnoses were made using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), criteria and the Structured Clinical Interview for DSM-IV Axis I Disorders. RESULTS: The mean follow-up was 12 years (range 4 to 17). The average age was 8 years at the time of the trauma and 20 years at the last follow-up. Urethral continuity was achieved in 97.9% of the children. Of the 49 patients, 19 had at least one urologic complication, 18 had orthopedic pathologic findings, and 21 had psychiatric diagnoses. The number of urologic procedures required (more than three), presence of long-term complications, and total number of hospitalizations (more than three) secondary to the injury significantly affected the development of a psychological disorder. CONCLUSIONS: The results of our study have shown that posttraumatic PUR in children is associated with a significant rate of long-term complications. Nonoperative treatment of pediatric pelvic fractures associated with PUR has been quite successful. Repeated operations, the presence of long-term urologic complications, and frequent and long hospital stays result in serious attendant psychological problems. Therefore, careful and prolonged follow-up of posttraumatic urethral injury with a multidisciplinary approach is necessary to provide better outcomes and a better quality of physical and social life for these children.

Juvenile delinquency in a developing country: a province example in Turkey.

The aim of this study was to determine offence behavior, socio-demographic characteristics and some features of the juvenile offenders' families in a selected region, and compare with developed countries. A total of 165 juvenile offenders were included. Information was obtained by individually interviewing all children. Of a total of 165 juveniles, 162 (98%) were boys. The most frequently committed crimes were theft (52%) and wounding (20%). Of these juveniles, 33% were 14 years old when they committed offence, 21% had a history of an offence behavior, 14.5% had an offender sibling, 36% had smoking habits, 21% had a history of running away from home, and 28% had a history of internal migration. Mild psychiatric disorders were detected in 9 (5.4%) and 51% of them were not student at the time of offence behavior. Most of the families were crowded and had rather low economical and educational levels. Some features such as low income and low family educational levels, insufficient parental control, crowded family, migration, repetition of offences, and cigarette smoking were found to be risk factors for offensive behavior. These risk factors can be taken into consideration for the prevention of future crimes.

Frequency of PTSD in a group of search and rescue workers two months after 2003 Bingol (Turkey) earthquake.

This study aimed to determine the frequency of posttraumatic stress disorder (PTSD) in a group of search and rescue workers 2 months after the May 2003 Bingol earthquake. Forty-four of 55 workers were interviewed. The Personal Information Form, the Clinician Administered Posttraumatic Stress Disorder Scale, the State Anxiety Inventory, the Trait Anxiety Inventory, the Beck Depression Inventory, the Quality of Life Enjoyment and Satisfaction Questionnaire, and the Endicott Work Productivity Scale were used. PTSD was diagnosed in 25% of the subjects. In subjects with PTSD, all scale scores were significantly higher. A positive correlation was determined between Clinician Administered Posttraumatic Stress Disorder Scale score and State Anxiety Inventory, Trait Anxiety Inventory, Beck Depression Inventory, Endicott Work Productivity Scale scores (r = 0.712, p = .000; r = 0.429, p = .004; r = 0.381, p = .011; r = 0.720, p = .000, respectively). The high scores of all scales showed that PTSD may also have comorbidity with other psychiatric disorders. Rescue workers who give first-level service in disasters should receive psychiatric support in specific time frames.

Female suicides in Diyarbakir, Turkey.

The aim of this study was to investigate the methods used and demographic data of women suicides by examining postmortem investigation and autopsy reports from the Branch of the Council of Forensic Medicine in Diyarbakir Province, Turkey, between 1996 and 2001. Fifty-eight percent (174/302) of suicides were females and 42% (128/302) were males. The suicide rates were similarly higher for females than for males (2.6 and 1.8 per 10,000 population, respectively). Over half of female suicides (56.3%) occurred in those under 20 years of age. The most common suicide method for women was hanging (32.2%), and for men was firearms (51.7%), but for women younger than 20 years the most frequent method was firearms. Among the female suicides, five (2.8%) were known to have attempted suicide at least once in the past. Twenty-nine women (16.7%) were documented to have any psychiatric illness. None of the women had a history of drug or alcohol abuse. A suicide note was found in only six cases (3.4%). The predominant suicide motive was family problems (in 32% or 56/174). The higher rate of suicide in females than in males, and the absolute female predominance in suicides in Diyarbakir, Turkey, are in contrast to most of the medical literature and statistical information about suicide rates by country, in which suicide rates are usually higher among males.

Long-term outcomes of conservatively treated paediatric pelvic fractures.

The long-term orthopaedic, urologic, and psychiatric outcomes of patients treated non-operatively for unstable pelvic fractures were assessed. There were 55 males and 3 females with an average age of 7 (3-13). Eighty-one percent of the fractures were caused by motor vehicle accidents, and 68% by auto-pedestrian accidents. Thirty-four of the 58 fractures were type Tile type B and 24 were type C. Posterior urethral injury was determined in 41 patients, and head injury in 21. Three patients with type C injury died within the first 3 days. After an average follow-up period of 7.4 years of the patients with type B injuries, leg length discrepancy of 1cm was determined in two, and limited motion associated with open-knee wound in one, and low back pain in two. Of the patients with type C injuries, low back pain was found in four, gait abnormality in three, sacroiliac ankylosis in one, and symphyseal ossification in two. Urethral stricture was determined in 11 patients, urinary incontinence in 6 and erectile dysfunction in 6. A total of 31 patients were diagnosed with 41 psychiatric illnesses, including dysthymic disorder, social phobia, post-traumatic stress disorder, and major depression. No difference was found in the treatment outcomes of the two groups. From a holistic standpoint, long hospital stays and urologic complications are associated with serious psychological problems, and thus should be considered during selection of treatment modality.

Increased oxidative stress and altered activities of erythrocyte free radical scavenging enzymes in autism.

There is great evidence in recent years that oxygen free radicals play an important role in the pathophysiology of many neuropsychiatric disorders. The present study was performed to assess the changes in red blood cells thiobarbituric acid-reactive substances (TBARS) levels, and superoxide dismutase (SOD), catalase (CAT), adenosine deaminase (ADA) and xanthine oxidase (XO) activities in patients with autism (n = 27) compared to age- and sex-matched normal controls (n = 26). In the autistic group, increased TBARS levels (p < 0.001) and XO (p < 0.001) and SOD (p < 0.001) activity, decreased CAT (p < 0.001) activity and unchanged ADA activity were detected. It is proposed that antioxidant status may be changed in autism and this new situation may induce lipid peroxidation. These findings indicated a possible role of increased oxidative stress and altered enzymatic antioxidants, both of which may be relevant to the pathophysiology of autism.

Suicide in children and adolescents at a province in Turkey.

Despite the well-documented increases in the rate of completed suicide among children, accurate knowledge of the characteristics of these suicides is limited. We examined all suicides by children and adolescents in Diyarbakir during 1999 and 2001. All of the cases were analyzed regarding the age, sex, method and location of suicide, time of year, and predictive factors. There were 56 children aged 11 through 19 years. Adolescents between 15 and 19 years of age constituted the overwhelming number (87%) of all the childhood suicides. Female children and adolescents predominated among the suicide victims (71%). The most frequent means of suicide were firearms (43%), hanging (28%), and jumping (16%), respectively. The majority of suicides occurred at the decedent's home (88%). Reasons identified were mainly psychiatric disorders, followed by troubles within the family. A prior suicide attempt or a note that was left by the decedent and elucidated the reason for the suicide was rare. There was no seasonal difference in rates of suicides.

No evidence for an association between the T102C and 1438 G/A polymorphisms of the serotonin 2A receptor gene in attention deficit/hyperactivity disorder in a Turkish population.

Disturbances in the serotonergic neurotransmission system have been implicated in the etiology of attention deficit/hyperactivity disorder (ADHD). As the importance of genetic factors is well established, genes encoding for proteins of the serotonergic pathway are important candidates to unravel the underlying genetic contribution. We previously demonstrated that the polymorphisms of the serotonin transporter gene promoter and regions of variable number of tandem repeats were involved in the pathogenesis of ADHD. The purpose of this study was to examine the relationship between ADHD and two polymorphisms (T102C and 1438 G/A) in the 5-HT2A gene in a sample of Turkish children. Using the PCR technique, these polymorphisms were assessed in 70 patients with ADHD and in 100 healthy controls. There was no significant difference between the frequencies of the T, C, G and A alleles of both groups. No association was found between the studied polymorphisms of the 5-HT2A gene and ADHD in this sample consisting of Turkish children. Overall, our results suggest that the investigated 5-HT2A polymorphisms are not major susceptibility factors in the etiology of ADHD.