Impact of childhood trauma and affective temperament on resilience in bipolar disorder.

BACKGROUND: The aim of this study was to investigate whether childhood trauma (CT) and affective temperament have an impact on resilience in bipolar patients. METHODS: One hundred cases with bipolar disorder (BD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) were evaluated consecutively in their euthymic period during outpatient follow-up interviews. Diagnostic interviews were done with SCID-I, affective temperament was evaluated with the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, and resilience was evaluated with the Resilience Scale for Adults (RSA). The presence of CT was determined and measured with the Childhood Trauma Questionnaire (CTQ). RESULTS: Among the bipolar patients, it was found that 35 cases (35%) were CT+. Depressive, cyclothymic, and anxious temperament scores were higher in CT+ cases. However, resilience scores were higher in CT- cases. In bipolar patients with and without childhood trauma, the relationship between temperament and resilience appears to be different. A negative relation between sexual abuse, emotional abuse, emotional neglect, and anxious temperament scores and resilience scores was shown in regression analysis. CONCLUSIONS: CT and affective temperament both have an impact on resilience in bipolar patients.

Prevalence of unintentional injuries and related risk factors among university students in Canakkale city, western Turkey.

OBJECTIVE: We examined the prevalence of unintentional injuries and associated risk factors among university students in Canakkale city, Turkey. METHODS: A cross-sectional study was conducted in 2007-2008. Atotal of 4,762 students completed the questionnaire. Risk factors associated with the rate of accidents were assessed by chi-square analysis and effects of these factors on unintentional injuries were described by logistic regression analysis. RESULTS: The rate of unintentional injuries among university students was 14.9% during the previous 12 months. The most reported injuries occurred on the road (43.8%), at home (33.2%) and outside the home (26.9%) such as workplaces, schools or sports venues. The prevalence of unintentional injuries was significantly higher in males than females (18.1% vs. 12.0% p <0.05). Results of the logistic regression analysis indicated that male gender (OR 1.51), studying in college and vocational school (OR 1.34), perception of very bad (OR 0.49) or good economic status (OR 0.49), drinking alcohol (OR 1.52), using illicit substances (OR 1.70), having a diagnosed illness (OR 1.36), or having risk of developing depres- sion (OR 1.54) had significant effects on the risk of unintentional injuries (p <0.05). CONCLUSIONS: This study indicated that male gender, studying in college and vocational schools, illicit substance use, poor economic conditions, having a diagnosed illness and risk of developing depression can be risk factors for unintentional injuries among university students. Public health training programmes giving priorityto high-risk groups such as university and high school students may be a valuable tool in reducing unintentional injuries among young people.

Is the relationship between affective temperament and resilience different in depression cases with and without childhood trauma?

OBJECTIVE: The aim of this study was to investigate if the relationship between affective temperament and resilience in major depression is different in cases with and without childhood trauma. METHODS: For this purpose 100 cases with major depressive disorder (MDD) diagnosis according to DSM-IV were evaluated consecutively in their regular outpatient clinic follow-up interviews. Diagnostic interviews were done with SCID-I, affective temperament was evaluated with TEMPS-A (Evaluation of Temperament Memphis, Pisa, Paris and SanDiego-Autoquestionnaire) Temperament Questionnaire, resilience was evaluated with The Resilience Scale for Adults (RSA)-Turkish version. The presence of childhood trauma (CT) was determined by Early Trauma Inventory. RESULTS: In MDD cases without CT a correlation was present between psychological resilience and hyperthymic temperament, while there was a correlation between psychological resilience and depressive temperament in cases with CT. The relationship between depressive temperament and psychological resilience in cases with CT was observed in the perception of self, family cohesion, and social resources dimensions of psychological resilience. CONCLUSION: In depression cases with and without childhood trauma, the relationship between temperament and resilience appears to be different. According to our results psychological resilience was associated with hyperthymic temperament in depressive cases without childhood trauma, while it was associated with depressive temperament in depressive cases with childhood trauma.

Prevalence and related risk factors of tobacco, alcohol and illicit substance use among university students

Background and Objectives: The objective of this study was to determine the frequency of cigarette, alcohol and substance use and the possible associations between different types of substance use and various risk factors among university students. Methods: A self-assessment questionnaire was administered to 4762 students from Canakkale Onsekiz Mart University. The risk factors associated with cigarette, alcohol and substance use were investigated with logistic regression analysis. Results: The frequencies of regular or occasional tobacco and alcohol use were 38.6%and 46.3% respectively. The frequency of using substance at least once in life time was6.3% among students. In the present study, male gender was found to be a statistically significant risk factor associated with all of the three dependent variables. The statistically significant risk factors for using alcohol were studying in college and vocational schools, having a parent with high school and above educational level, having a family income of1226 USD’s and above, having tried tobacco once or a couple of times and using tobacco occasionally or regularly, and having used another substance at least once. Substance use risk was found to be higher in those with higher depression scores, in those who tried tobacco once or a couple of times and who were not using regularly, and who were using tobacco or alcohol occasionally or regularly. Conclusions: The practices and activities of the health center incorporated in the university should be enhanced for the establishment of effective control programs related to tobacco, regular alcohol and substance use (AU)

The relation between affective temperament and resilience in depression: a controlled study.

BACKGROUND: The aim of this study was to investigate the presence of a relationship between affective temperament and resilience in patients with major depressive disorder (MDD) diagnosis, and to examine whether this relationship, if present, differs from healthy individuals. METHODS: In line with this purpose, 100 cases with major depressive disorder diagnosis who were in their remission period were evaluated consecutively in their regular outpatient control interviews. The control group consisted of 100 healthy individuals without any history of psychiatric admission and treatment, matched with the depressive group in terms of age and sex. Diagnostic interviews were conducted with SCID-I, affective temperament and resilience were evaluated with TEMPS-A (Evaluation of Temperament Memphis, Pisa, Paris and San Diego-Auto questionnaire) and The Resilience Scale for Adults (RSA)-Turkish version, respectively. RESULTS: We observed a strong relationship between resilience and hyperthymic temperament both in depressive and healthy individuals. There was an inverse relation between psychological resilience and irritable and anxious temperament in both groups. A negative correlation was observed between irritable temperament and family cohesion in depressive disorder group, while in healthy individuals a strong correlation was observed between family cohesion and depressive and anxious temperament, and a weak correlation between family cohesion and hyperthymic temperament. LIMITATIONS: The measurements of temperament and resilience were estimated depending on the patient's statement. CONCLUSION: There is a strong relationship between hyperthymic temperament and psychological resilience in MDD. The relationship between the type of affective temperament and the family cohesion sub-dimension of psychological resilience differs from that of healthy individuals.

Late-life Onset Mania After Varenicline Use: A Case Report.

Late-life onset manic attacks generally occur secondary to general medical conditions or drug use. Varenicline is an α4ß2 nicotinic acetylcholine receptor partial agonist, used for the cessation of smoking. In this case report, we present a 67-year-old male patient with a new-onset manic episode following varenicline treatment. The patient's manic symptoms started on the seventh day of varenicline treatment. His symptoms started on the 7th day of treatment. He was admitted to the psychiatric outpatient clinic since his symptoms did not improve despite discontinuing varenicline treatment. In the initial mental status examination, he scored 35/60 on the Young Mania Rating Scale (YMRS). On the twenty-fifth day of the hospitalization, the patient was discharged since his YMRS score improved (5/60). Varenicline may cause manic episodes in patients with bipolar disorder and in healthy individuals. An increasing number of serious psychiatric disorders are being reported due to varenicline treatment. Mental state examination before and during varenicline treatment seems necessary.

The prevalence of death ideation and attempted suicide and the associated risk factors in Isparta, Turkey.

OBJECTIVE: Suicide is a complex process from the initiation of ideation to planning, and finally to an attempt. This study aimed to investigate the prevalence of death ideation, attempted suicide, and the associated risk factors in Isparta, Turkey. MATERIALS AND METHODS: The study included 600 participants aged 18-65 years representative of the population of central Isparta that were selected via the stratified simple randomized sampling method. The participants were administered a questionnaire for collecting demographic data, and the participant's experiences of death ideations and suicide attempts, and the clinical version of SCID were used. RESULTS: The lifetime prevalence of attempted suicide and death ideations was 4.3% and 27.5%, respectively. Death ideas and attempted suicide were both more prevalent among women and younger adults. All those that attempted suicide were exposed to a stress factor prior to the attempt. The rates of death ideation and attempted suicide were lower among the participants that had children. A family history of attempted suicide was associated with an increase in the frequency of death ideations and attempted suicide. Attempted suicide and death ideas were more common among those with major depressive disorder. Generalized anxiety disorder was observed significantly more frequently among those that had attempted suicide. Panic disorder and a specific phobia were also significantly associated with death ideation. CONCLUSION: The present study's findings indicate that there were common risk factors for attempted suicide and death ideations in the study group. Determination of the prevalence of attempted suicide and death ideation in a population, identification of the associated risk factors and assessment of their relationship to mental disorders can facilitate a better understanding of suicidal behaviour.

Compulsive buying in bipolar disorder: is it a comorbidity or a complication?

BACKGROUND: The objective of this study was to investigate the frequency of compulsive buying in bipolar disorder (BD), to compare it with healthy controls, and to search if there is a difference between bipolar cases with and without compulsive buying in terms of sociodemographic qualities, temperament, clinical characteristics and comorbid diagnoses. METHODS: One-hundred outpatient cases diagnosed as BD according to DSM-IV were evaluated consecutively. Following the diagnosis interview (SCID-I and II) the subjects completed the mood disorders registry form, Compulsive Buying Scale and TEMPS-A. RESULTS: Compulsive buying scores were higher in bipolar patients than healthy controls (p<0.001). Cases with compulsive buying revealed higher cyclothymic and irritable temperament scores than other bipolar patients (p=0.029 vs 0.045). Premenstrual syndrome and postpartum onset were more frequent, while psychotic symptoms were less in compulsive buyer bipolar patients (p=0.002, 0.009 vs 0.034). Severity of episode was lower (p=0.01), number of episodes was higher (p=0.009). Acute onset and remission before and after maintenance treatment were more frequent in patients with compulsive buying (p=0.011 and p=0.011). Full remission between episodes was 100%. Cases with axis-1 and axis-2 comorbidities demonstrated higher compulsive buying scores (p=0.025 and 0.005). LIMITATIONS: Treatment regimen differences between patients are a limitation of the study. CONCLUSIONS: This is the first study to relate compulsive buying with the clinical characteristics of BD. Our results reveal that compulsive buying in BD occurs together with mood episodes which are not very severe, but frequent and with abrupt onset.

The levels of stress, depression and anxiety of parents of disabled children in Turkey.

BACKGROUND: Parents of disabled children experience some special problems in their lives. It is reported that the parents of disabled children experience a very high level of stress. OBJECTIVES: This study aims to determine the situations in which the parents experience higher levels of stress; to investigate the relation between the levels of stress, depression and anxiety. MATERIAL AND METHODS: This cross-sectional study was conducted with parents whose children attend a Special Education and Rehabilitation Centre. The total number of parents was 156 and 127 (81.4%) of them voluntarily participated in this study. A questionnaire form, consisting of questions regarding the socio-demographic characteristics of disabled children and of their parents, was given to the participants. Additionally, the participants were asked to score 10 possible stressful situations (financial problems, relations with other people, having limited free time, not to be able to participate in social activities, etc.) on a scale of 0-10 points. Moreover, psychometric scales such as Beck Depression Inventory (BDI) and Spielberger State Trait Anxiety Inventory (STAI) were applied to the participants. RESULTS: The mean BDI (SD) score was found to be 14.9 (10.9). The mean STAI-state and STAI-trait scores were 55.1 ± 12.2 and 48.6 ± 8.8, respectively. Among the stressful experiences, the parents gave the highest points to 'attitudes of society towards disabled people', 'having limited free time' and 'financial problems' (Top three situations). In multiple analyses, it was found that by employing the BDI there was a relation between financial problems (ß: 0.32, p < 0.01), a decrease in relations with other people (ß: 0.21, p < 0.05), having limited free time (ß: -0.19, p < 0.05) and insufficiency of physical structures (ß: 0.21, p < 0.05). The relations between financial problems (ß: 0.31, p < 0.01) and being an individual who has close relations with disabled person other than his/her parents (ß: 0.27, p < 0.01) were defined employing the STAI-state as effective variables. 'Negative attitudes of society towards disabled people' (ß: 0.29; p < 0.01) were defined employing the STAI-trait as the only effective variable. CONCLUSION: Financial problems are the most important factors that affect the psychology of the parents of disabled people. Social programmes that support the parents in respect of both financial matters and home-care facilities should be set up.

Predictors of burnout in the family caregivers of Alzheimer's disease: evidence from Turkey.

OBJECTIVE: The aim of this study was to investigate the factors related to burnout in the family caregivers of Alzheimer's disease. METHODS: Subjects included in the study were 44 Alzheimer's disease patients and their primary caregivers. Patients were evaluated with Mini Mental State Examination, Brief Psychiatric Rating Scale, Physical Self-Maintenance Scale and Geriatric Depression Scale, and carers were administered Maslach Burnout Inventory, Ways of Coping Scale, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale. RESULTS: The emotional exhaustion of caregivers revealed a significant relationship with the caregivers' anxiety, submissive approach for coping and the patient's self-maintenance. Depersonalisation was found to be related to the depression score of the patient. DISCUSSION: This study may serve to increase clinicians' awareness of burnout in relatives of dementia patients. It points to the fact that research for determining the causes and consequences of burnout in the family caregivers is warranted.

Dental Hygiene Fear Survey: reliability and validity of the Turkish version.

The aims of the present study were to 1) investigate patient anxiety as it relates to dental hygiene procedures and 2) conduct validity and reliability testing of the Turkish version of the Dental Hygiene Fear Survey (DHFS) to test its psychometric properties in the Turkish culture. The study consisted of 200 periodontal patients. The patients completed the DHFS, the Modified Dental Anxiety Scale (MDAS), and a questionnaire designed to elicit sociodemographic and clinical characteristics. Reliability was estimated by Cronbach's alpha. Validity was examined by correlating the DHFS with measures found in the literature that correlate with dental fear and anxiety. Construct validity was determined using exploratory factor analysis with a direct oblimin (oblique) rotation, which revealed a model with three factors accounting for 62.8 of the variance when item 11, which has the lowest item total correlation, was omitted. The Cronbach alpha coefficients of the subscales in the fifteen-item scale (generalized anxiety, dental hygiene specific anxiety, and catastrophe) were 0.83, 0.86, and 0.79, respectively. The overall reliability of the DHFS was 0.91. Significant negative correlations were found between total DHFS scores and age (p<0.05). Females reported dental hygiene fear more frequently than did males. The DHFS demonstrated good psychometric properties in spite of being translated into another language and used in a culture different from the one where it was originally developed. The Turkish version of the DHFS is a valid and reliable instrument and may be included in assessments designed to measure fear related to dental hygiene treatment procedures.

Public awareness of, attitudes toward, and understanding of epilepsy in Isparta, Turkey.

The social stigma attached to epilepsy very often constitutes a considerable problem and much private grief for patients and their relatives. This study was aimed at investigating "perceivers"' awareness of, attitudes toward, and understanding of epilepsy in Isparta, Turkey. Using a questionnaire survey, we interviewed, face-to-face, a random sample of 582 persons older than 18, excluding persons with epilepsy or those with relatives who had epilepsy. Eighty-one percent of respondents had heard of epilepsy, 47% knew a person with epilepsy, and 54% had seen an epileptic seizure. Somewhat less knowledgable were the elderly and less educated individuals. Attitudes toward social acceptance and employment of persons with epilepsy were generally negative, especially to children's associations and marriage. Twelve percent considered epilepsy as a form of insanity. Although understanding of epilepsy was favorable, the results indicate that there exists significant discrimination against persons with epilepsy, and there is a need to implement public education campaigns.

[Confabulation: a symptom which is intriguing but not adequately known]. / Konfabulasyon (Masallama): Ilgi Ceken Ancak Yeterince Bilinmeyen Bir Belirti.

Confabulation has been defined as the falsification of memory occurring in clear consciousness in association with an organically-derived amnesia. It was first described by Korsakoff in 1889 in alcoholic amnesic patients. Later studies showed that confabulation is also seen in a variety of other pathologies, such as anterior communicating artery rupture, traumatic brain injury, Alzheimer's disease, and brain tumors. Two forms of confabulation have been described: Momentary (provoked) confabulation which is produced in response to questions, for compensating the gaps in memory; and fantastic (spontaneous) confabulation consisting of grandiose and wish-fulfilling characteristics. There is no specific localization for provoked confabulations. However spontaneous confabulations appear as a result of basal forebrain and posterior orbitofrontal cortex lesions. There are numerous hypotheses for explaining the specific nature of confabulations with reference to impairment of general executive dysfunction, temporality, and memory-control processes. Commonly, these interpretations explain memory distortion in terms of frontal network dysfunction. There is a general consensus that confabulation is primarily the result of a deficit of memory retrieval, rather than one of encoding, consolidation, or storage. The normal process of memory recall consists of the evaluation of the cues for retrieval, matching the cues with episodic memory, and reality monitoring. One possible explanation for confabulation is that these patients have lost the checking procedure in memory retrieval, i.e. reality monitoring. This article aimed to describe confabulation and to review its clinical, neuroanatomical, and neuropsychological correlates in an effort to raise clinicians' awareness of the phenomenon and the problematic areas that need to be clarified.

How should we inform patients about antidepressants? A study comparing verbal and written information.

Objective. To compare the efficacy of verbal, written and, combined verbal and written information about selective serotonin reuptake inhibitors in patients with depression. Method. Patients with a diagnosis of major depression who were prescribed selective serotonin reuptake inhibitors (n=104) were randomly allocated to verbal (n=34, 18F 16M), written (n=38, 19F 19 M) and verbal and written information (n=32, 18F 14M) groups, the content of the verbal and written information being exactly the same. Beck depression inventory was used to evaluate the depressive symptoms. Patients were called back after 10-14 days and their retention of the knowledge was measured. Results. The total retention scores of the verbal group, written group and the combined written and verbal group were 12.85±2.19, 7.39±2.85, and 13.19±2.12, respectively. The total scores of the verbal and the combined verbal and written information groups were significantly higher than those of the written group. The information scores had a significant positive correlation with education level. Conclusion. The retention of verbal information given to patients with low levels of depression concerning the effects and side effects of serotonin reuptake inhibitors is higher than written information. Further studies with more severely depressed patients, comparing the basal information level and the information level after the intervention and the effect of information on compliance are needed.

Multiple sclerosis presenting with fantastic confabulation.

Multiple sclerosis (MS) is the most common inflammatory, demyelinating disease of the central nervous system. Besides neurological signs and symptoms, the disease may be associated with various psychiatric manifestations, and uncommonly, psychiatric manifestations may be the presenting symptom. On the other hand, confabulation is defined as falsification of memory occurring in clear consciousness in association with an organically derived amnesia or as spontaneous narrative reports of events that never happened. We report an unusual association of confabulation with MS. A 23-year-old man was admitted to a hospital, telling unusual stories. After evaluation and a detailed workup, the patient was given the diagnosis of MS with fantastic confabulations. Neuropsychological evaluation revealed mild frontal lobe dysfunction. Confabulation has been reported after frontal lobe lesions and is also hypothesized to be associated with a deficit primarily in the retrieval of more than one of the following: encoding, consolidation or storage. Clinicians' awareness of this kind of rare association may further enlighten the neural basis of confabulation.

Autoerythrocyte sensitization syndrome associated with grief complications.

The clinical presentation of a patient with autoerythrocyte sensitization syndrome associated with a complicated grief reaction is reported. A 50-year-old female patient presented with recurrent episodes of painful ecchymotic bruising on the lower extremities which started in 1995 after the sudden death of her son and exacerbated almost every year at approximately the same time her son died as an anniversary reaction. No pathological findings were detected in the laboratory examinations. The diagnosis was confirmed by induction of similar lesions by i.d. injection of the patient's own washed erythrocytes and whole blood. Psychiatric assessment revealed that the patient was depressed, socially introverted, overly defensive and avoidant in interpersonal relationships. Antidepressant treatment and psychotherapy for major depression and grief complications were started with the patient. Having an awareness of this rare condition will assist in the prevention of unnecessary investigations in such cases and will allow early referral for appropriate psychological counseling.