Functional Movement Disorder and Parkinson's Disease Comorbidity: A Case Report. / Fonksiyonel Hareket Bozuklugu ve Parkinson Hastaligi Es Tanisi: Bir Olgu Sunumu.

Functional movement disorders (FMD) are abnormal involuntary movements that are not attributable to known neurological and neuroanatomical causes. In the past decade, FMD diagnoses have been based on positive factors that are inconsistent with neurological disorders and not on the exclusion of neurological disorders. In this report, we presented the case of a female patient who had been followed up for 4 years in multiple health centers with the diagnosis of a neurological disorder which was suspected in the previous 1 year to be of psychogenic origin. A neurological disorder comorbid with depression and FMD was diagnosed after admission as an inpatient to our clinic. By presenting this case, it was intended to emphasise the importance of follow up after diagnosing FMD, given its common basis with Parkinson's disease and the high incidence of comorbidites seen with it. Imaging and elecrophysiological techniques should be relied upon.for differentiating FMD and neurological diseases. Although psychological causes are significant disease risk and/or maintenance factors, they are not sufficient for explaining the aetiology of FMD, which requires a multidisciplinary approach. Keywords: Functional movement disorders, Parkinson's disease, DaTscan.

Is there any relationship between quality of life and polysomnographically detected sleep parameters/disorders in stable myasthenia gravis?

It is known that quality of life in myasthenia gravis is positively correlated with subjective sleep quality, still no data is available regarding the relationship between QOL and polysomnographically detected sleep parameters and disorders. In this study, we tried to highlighten this relationship, by performing polysomnography. Sleep-related complaints were evaluated in face-to-face interviews with 19 clinically stable MG patients and 26 healthy controls. During the interviews questionnaires assessing sleep quality, excessive daytime sleepiness, fatigue, depression, anxiety, and Turkish version of the MG-QOL 15-item scale [(MG-QOL15(T)] were administered and then an overnight polysomnography was performed. Sleep disorders, especially obstructive sleep apnea and fatigue were higher, whereas subjective sleep duration was significantly lower, in patients than controls. Excessive daytime sleepiness and poor sleep quality were not different between patients and controls. Other than percentage of sleep stage III, which was negatively correlated with MG-QOL15(T) scores, neither other sleep parameters nor sleep disorders were correlated with MG-QOL15(T) scores. MG composite, subjective sleep duration, fatigue severity and Hamilton depression rating scale scores were found to be positively correlated with MG-QOL15(T) scores. It was shown that decreasing disease severity and enhancing psychological well-being will improve patients' quality of life. We recommend that our findings should be repeated in a large prospective cohort of MG patients.

[Executive Functions in Frontal Lob Syndrome: A Case Report]. / Frontal Lob Sendromunda Yönetici Islevler: Bir Olgu Sunumu.

Prefrontal cortex in frontal lobe (FL) is the center of executive functions (EF). FL damage can lead to executive dysfunction by influencing frontal-subcortical circuits (dorsolateral, orbitofrontal, ventromedial). Damage to the dorsolateral prefrontal cortex (DLPFC) can lead to deterioration in EF, whereas damage to the orbitofrontal cortex (OFC) can lead to personality changes with the characteristic of disinhibition and irritability. In addition, damage to the anterior cingulate cortex/medial prefrontal cortex (ACC/MPFC) can result in decreased spontaneity. Neuropsychological tests are important components in the assessment of EF including goal-directed behavior, decision-making, risk assessment, making plans for the future, setting of priorities and order of our actions. Clinical conditions affecting frontal-subcortical connections outside of the FL can also lead to executive dysfunctions and frontal lobe syndrome (FLS). This case report is about an adolescent patient diagnosed as FLS. The clinical symptoms, assessment and treatment processes of this case are discussed in this report. The case is a 15-year-old boy that was admitted to our clinic with behavioral problems, which began after a car accident three years ago. Magnetic resonance imaging (MRI) of the brain indicated hyperintense signal increase in periventricular deep white matter that is associated with traumatic brain damage. Neuropsychological tests results (Stroop, Wisconsin Card Sorting Test, Serial Digit Learning Test, Line Orientation Test, Verbal Memory Processes Scale) have demonstrated impairment in cognitive flexibility, verbal fluency, setting priority, inappropriate response inhibition, sustained attention, planning, problem solving, organization skills and subcortical memory functions. We thought that cognitive and behavioral symptoms of this case were associated with the dysfunctions of frontal-subcortical circuits, independent of an obvious frontal lesion. FLS for the patients with sudden-onset behavioral and cognitive problems after head traumas should be kept in mind in differential diagnosis, even in the absence of an obvious frontal lesion.

Reliability and validity of the Turkish version of myastheniagravis-quality of life questionnaire-15 item.

BACKGROUND/AIM: The myasthenia gravis-quality of life questionnaire 15 item (MG-QOL15) is a validated, short, and easy to use disease-specific quality of life (QOL) tool in myasthenia gravis. Other than Turkish, a lot of versions of the MG-QOL15 have been used in different languages in different cultures. Therefore, the aim of this study was to translate and construct a validated and adapted Turkish version of the MG-QOL15 [MG-QOL15(T)]. MATERIALS AND METHODS: After translation, back-translation, and comparison of the 2 English versions of the MG-QOL15, it was tested by 22 monolingual healthy individuals and then 23 patients with clinically stable MG. Afterwards, 11 voluntary patients out of these 23 patients were interviewed for a second time. During the second interview, the MG-QOL15(T) and the 36-item short-form health survey (Turkish version) were administered simultaneously. RESULTS: The MG-QOL15(T) was found to have high internal consistency (1st and 2nd evaluation Cronbach's alphas were 0.958 and 0.928, respectively), test-retest reliability, and concurrent validity. The MG-QOL15(T) was negatively correlated with physical functioning, general health, vitality, and social functioning domains and with the physical and mental composite scores of the SF-36. CONCLUSION: The MG-QOL15(T) is accepted to be a valid, reliable, valuable tool for measuring disease-specific QOL in Turkish patients with MG.

Childhood trauma and suicide risk in the population living in Zonguldak Province.

INTRODUCTION: No previous study has investigated the association between early trauma and suicidal behavior in Zonguldak. The aim of this study was to investigate the incidence of childhood abuse and neglect in the general population living in Zonguldak province and the relationship between childhood trauma and suicidal ideations and attempts. METHODS: The present study was carried out with 897 people in the general population, as assessed in a representative sample from Zonguldak province. The cluster sampling method was used. After obtaining written consent from the people who agreed to participate in the study, the Socio-demographic Information Form, Suicide Probability Scale, Childhood Trauma Questionnaire, Beck Depression Inventory, and Beck Anxiety Inventory were administered. RESULTS: The lifetime prevalence of suicidal ideations was 18.3% among those who experienced at least one type of early trauma, and it was 9.6% among those without a history of childhood trauma (P < 0.001). Only emotional abuse exhibited a significantly high odds ratio for lifetime suicidal ideations (odds ratio [OR] = 3.168, 95% confidence interval [CI] = 1.731-5.798) and attempts (OR = 3.467, 95% CI = 1.343-8.952). Emotional neglect showed a high odds ratio only for lifetime suicidal attempts (OR = 3.282, 95% CI = 1.287-8.371). There were significant correlations among the Beck Depression Inventory, Beck Anxiety Inventory, and Suicidal Probability Scale sub-scores and all six Childhood Trauma Questionnaire scores. DISCUSSION: Emotional abuse and neglect in childhood are significantly associated with lifetime suicidal ideations and attempts in the general population living in Zonguldak province. Therefore, clinicians should be aware of the importance of the childhood trauma in the patients with suicidal ideations and attempts.

The Relationship between Quality of Life and Cognitive Functions, Anxiety and Depression among Hospitalized Elderly Patients.

OBJECTIVE: Older people seek not only a longer life, but also a better quality of life (QOL). Our aim was to find out the relationship between QOL and socio-demographic factors, social activities, cognitive status, depression and anxiety symptoms among medically ill and hospitalized elderly people in Turkey. METHODS: Two hundred forty three patients age 65 years or older were examined. The Socio-demographic Data Survey, the Mini Mental State Examination (MMSE), the Geriatric Depression Scale-short form (GDS-15), the Beck Anxiety Inventory (BAI) and the World Health Organization Quality of Life Instrument-Older Adults Module (WHOQOL-OLD) were applied to participants. The independent samples t-test and analysis of variance (ANOVA) were used to analyze quantitative data. Pearson's correlation and linear regression analysis were performed. RESULTS: The total score for QOL was significantly higher for those who saw their family members and relatives frequently rather than rarely (p=0.002), who were always busy with social activities rather than rarely or never (p<0.001), who had more years of education (p=0.003), and who were frequently exercising (p=0.023). According to linear regression analysis, the WHOQOL-OLD total score increased by 0.295 and -0.936 units, while MMSE and GDS-15 scale scores increased one unit respectively (ß=0.295, t=1.979, p=0.04; ß=-0.936, t=-4.881, p<0.001). CONCLUSION: Cognitive disabilities, depression, and other psychiatric problems along with medical disease negatively affect the QOL of elderly patients. While performing medical assessment regarding elders, detecting and treating cognitive disabilities and depression is very valuable in improving the QOL of elderly patients.

The Effect of Dressing Styles and Attitudes of Psychiatrists on Treatment Preferences: Comparison between Patients and Psychiatrists.

INTRODUCTION: Recently, different dressing styles and attitudes of psychiatrists have been proposed to enhance the interaction between patients and the physician. The aim of the present study was to investigate the preferences of dressing style and attitudes of a psychiatrist of the patients referred to an outpatient psychiatry clinic and the perception of psychiatrists regarding the preferences of the patients. METHODS: One hundred and fifty-three patients referred to the outpatient psychiatry clinic of the Bülent Ecevit University School of Medicine, and 94 psychiatrists have been included in the present study. RESULTS: When the images of psychiatrists were evaluated in terms of referral for treatment, trust in treatment, and willingness to share their confidential matters, both groups gave minimum scores to causal/sports dress style. While psychiatrists preferred to dress in a suit, casuals, and white coat, the preference order was white coat, casual dress, and suit in the patient group. There was a significant difference between the groups with respect to three dressing styles. CONCLUSION: It can be suggested that psychiatrists assume that patients are traditional in terms of their preference of the dressing style of a doctor and doctor-patient relationship, and a white coat is important to enhance the treatment adherence of patients.

The prevalence and clinical features of the night eating syndrome in psychiatric out-patient population.

OBJECTIVE: In this study we aimed to investigate the prevalance and clinical correlations of night eating syndrome (NES) in a sample of psychiatric outpatients. METHOD: Four hundred thirthy three consecutive psychiatric out-patients older than 18years were evaluated in the outpatient clinics using clinical interview according to the DSM-IV with regard to psychiatric diagnosis. Participants were also screened for presence of NES utilizing both clinical interview and self report based on Night Eating Questionnaire (NEQ) instruments. Sociodemographic and clinical features such as age, gender, education level, socioeconomic level and body mass index (BMI) were also recorded. The Body Shape Questionnaire (BSQ) and the Symptom Checklist-90 Revised (SCL-90R) were administered. RESULTS: Based on the proposed diagnostic criteria of the NES via utilizing clinical interview method, 97 (32 male, 65 female) of the sample met diagnostic criteria for NES. The point prevalence of NES was 22.4%. No statistically significant differences were found between the two groups in terms of age, gender, marital status, education and BMI. The patients with NES had higher NEQ, BSQ and SCL-90R subscale scores than patients without NES. Prevalance of depressive disorder, impulse control disorder, and nicotine dependency was higher among patients with NES. No differences were found with regard to the medication (antipsychotics, antidepressants and mood stabilizers). CONCLUSION: Night eating syndrome is prevalent among psychiatric outpatients and associated with depression, impulse control disorder, and nicotine dependency. Body dissatisfaction and higher symptom severity are also other risk factors for the development of NES.

The mediator role of ruminative thinking style in the relationship between dysfunctional attitudes and depression.

BACKGROUND: The main aim of the present study was to examine whether ruminative thinking styles (brooding and reflection) mediate the effects of dysfunctional attitudes on depressive symptoms. METHODS: 120 psychotropic drug-naive first episode depression patients recruited from Bulent Ecevit University School of Medicine psychiatry department and Zonguldak State Hospital psychiatry department outpatient clinics were involved in the study. Participants completed the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Beck Depression Inventory (BDI), Dysfunctional Attitude Scale (DAS) and Ruminative Responses Scale (RRS-short version). Regression analyses together with the Sobel tests were performed for testing the mediator hypothesis. RESULTS: According to the path model, the level of brooding fully mediated the relationship between dysfunctional attitudes and depressive symptomatology but reflection did not play a mediator role in the relationship between dysfunctional attitudes and depressive symptoms. CONCLUSIONS: Assessment of brooding with both mental status examination and specific measurements and focusing on brooding as an intervention strategy would be beneficial components for an effective treatment of depression.

Relationship of Internet addiction with cognitive style, personality, and depression in university students.

BACKGROUND: The aim of the study was to investigate the relationship of dysfunctional attitudes, self-esteem, personality, and depression with Internet addiction in university students. METHODS: A total of 720 university students participated in the study in Bülent Ecevit University English Preparatory School which offers intensive English courses. Students were evaluated with a sociodemographic data form, Beck Depression Inventory (BDI), Dysfunctional Attitudes Scale form A (DAS-A), Internet Addiction Scale (IAS), Rosenberg Self-Esteem Scale (RSES), and Eysenck Personality Questionnaire Revised/Abbreviated Form (EPQR-A). RESULTS: The results indicated that 52 (7.2%) of the students had Internet addiction. There were 37 (71.2%) men, 15 (28.8%) women in the addicted group. While the addicted groups' BDI, DAS-A perfectionistic attitude, need for approval, RSES, EPQR-A neuroticism, and psychoticism scores were significantly higher, EPQR-A lie scores were significantly lower than those of the non addicted group. According to the multiple binary logistic regression analysis, being male, duration of Internet usage, depression, and perfectionistic attitude have been found as predictors for Internet addiction. It has been found that perfectionistic attitude is a predictor for Internet addiction even when depression, sex, duration of Internet were controlled. CONCLUSIONS: To the knowledge of the researchers, this study is the first study to show the dysfunctional attitudes in Internet addiction. It can be important to evaluate dysfunctional attitudes, personality, self-esteem and depression in people with Internet addiction. These variables should be targeted for effective treatment of people with Internet addiction in cognitive behavioral therapy.

Relationship of Cognitive Functions with Daily Living Activities, Depression, Anxiety and Clinical Variables in Hospitalized Elderly Patients.

INTRODUCTION: Cognitive impairment in elderly patients, which may be a sign of dementia, depression, anxiety or medical diseases, has been determined as a risk factor for functional loss. In this study, we aimed to investigate the frequency of cognitive impairment and to investigate the relationship of cognitive status with sociodemographic variables, daily living activities, anxiety and depression in elderly inpatients. METHOD: The sample of this cross-sectional and descriptive study consists of 243 patients aged 65 years and older who were hospitalized in Bülent Ecevit University Hospital. A sociodemographic questionnaire,, the Mini-Mental State Examination (MMSE), Activities of Daily Living Scale, Lawton-Brody Instrumental Daily Activities Scale, Geriatric Depression Scale (GDS) and the Beck Anxiety Inventory were used for data collection. RESULTS: One hundred and six (43.6%) patients were female and 137 (56.4%) were male. The patients were divided into two groups according to the Mini-Mental State Examination (MMSE) 23/24 cut-off score. The cognitive decline was statistically significantly more frequent in patients who were older, female, less educated, low socioeconomic status, and living in rural areas. There were more problems in the basic and instrumental activities of daily living and nutrition in patients with cognitive decline. Anxiety and depression scores were higher in this group. In our study, although the frequency of cognitive decline and depression according to GDS were 56% and 48%, respectively; we found that only 10.5% of patients applied to the psychiatrist, and 9.3% of patients received psychiatric treatment. CONCLUSION: Cognitive decline may cause deterioration in the daily living activities, nutrition and capacity for independent functioning. Older age, female, low education, low socioeconomic status and living in rural area are important risk factors for cognitive impairment. Cognitive decline in older age may be associated with depression and anxiety. We assume that when cognitive decline, depression and other psychiatric problems are unidentified, it may contribute to deterioration of mental health in medically ill elderly.

The comorbidity of adult attention-deficit/hyperactivity disorder in bipolar disorder patients.

OBJECTIVE: High comorbidity ratio of bipolar mood disorder (BMD) with Axis I and Axis II diagnoses is reported in the literature. The possible relationship between BMD and attention-deficit/hyperactivity disorder (ADHD) in all age groups has been attracting more attention of researchers due to highly overlapping symptoms such as excessive talking, attention deficit, and increased motor activity. In this study, we aimed to investigate the prevalence of ADHD comorbidity in BMD patients and the clinical features of these patients. METHODS: Of 142 patients, who presented to the Bipolar Disorder Unit of Zonguldak Karaelmas University Research and Application Hospital between the dates of August 1, 2008 and June 31, 2009 and diagnosed with BMD according to DSM-IV criteria consecutively, 118 patients signed informed consent and 90 of them completed the study. They all were in euthymic phase during the study evaluations. A sociodemographical data form, Wender-Utah Rating Scale (WURS), ADD/ADHD Diagnostic and Evaluation Inventory for Adults, and Structural Clinical Interview for DSM-IV Axis I Disorders, Clinical Version (SCID-I) were applied to all participating patients. RESULTS: A total of 23.3% of all patients met the criteria for A-ADHD diagnosis along BMD. No difference was detected regarding sociodemographical features between the BMD+A-ADHD and the BMD without A-ADHD groups. The BMD+A-ADHD group had at least one extra educational year repetition than the other group and the difference was statistically significant. The BMD starting age in the BMD+A-ADHD group was significantly earlier (p=0.044) and the number of manic episodes was more frequent in the BMD+A-ADHD group (p=0.026) than the BMD without ADHD group. Panic disorder in the BMD+A-ADHD group (p=0.019) and obsessive-compulsive disorder in the BMD+C-ADHD group (p=0.001) were most frequent comorbidities. CONCLUSIONS: A-ADHD is a frequent comorbidity in BMD. It is associated with early starting age of BMD, higher number of manic episodes during the course of BMD, and more comorbid Axis I diagnoses.

Antipsychotic prescriptions in a university hospital outpatient population in Turkey: a retrospective database analysis, 2005-2006.

OBJECTIVE: The aim of this study is to document the sociodemographic and the clinical profile of patients who are on antipsychotic (AP) medication prescribed in outpatient mental health clinic of a university hospital. METHODS: A retrospective chart review was conducted for all outpatient files between 2005 and 2006 at the Zonguldak Karaelmas University, Medical Faculty Hospital, Department of Psychiatry in Turkey. All patients prescribed AP with regular follow up were recruited for the study. The type of AP and the route of administration were recorded. The diagnosis, age and gender of the patients were also evaluated. RESULTS: We reviewed 1606 patients' files. APs were prescribed in 27.6% of the patients. Atypical antipsychotics (AAPs) represented 75.1% and typical antipsychotics (TAPs) represented 24.9% of all antipsychotic prescriptions in our study. The main psychiatric diagnoses associated with a TAP prescription were: psychotic disorders (6.5%), major affective disorders (49.5%), anxiety disorders (36.4%), and other psychiatric diseases (7.4%). The main psychiatric diagnoses associated with an AAP prescription were: psychotic disorders (35.1%), major affective disorders (31.1%), anxiety disorders (27.8%), somatoform disorders (2.4%) and other psychiatric diseases (6.4%). Twenty-eight of these patients (6.3%) were prescribed more than one AP, 45 patients were prescribed mood stabilizer (10.2%) and 272 patients were prescribed antidepressant agents (61.2%) in addition to AP. CONCLUSIONS: The results reflect the particular use of AAPs in present study population. In line with the published data, the results of this study show that AAPs and TAPs are widely used in those with major affective disorders and psychotic disorders. These findings also underline the widespread off-label use of APs in the treatment of other psychiatric disorders.