Executive Functions, Intellectual Capacity, and Psychiatric Disorders in Adults with Type 1 Chiari Malformation.

OBJECTIVE: Contrary to popular belief, the cerebellum is involved not only in motor planning, balance, and coordination but also in cognitive processes. The present study aimed to investigate executive functions (EFs), intellectual capacity, and psychiatric disorders in adults with type 1 Chiari malformation, which is defined as a hindbrain anomaly that involves the cerebellum. METHODS: The study included 62 adults, with 29 in the CM group and 33 in the control group. EFs were evaluated using the Stroop test, number sequence learning test, and standardized mini-mental state examination (SMMSE). The intelligence quotient (IQ) was measured using the Kent EGY and Porteus maze tests, and psychiatric disorders were evaluated using the Structured Clinical Interview for DSM-5, Clinician Version (DSM-5-CV). RESULTS: The CM group took longer than the control to complete the Stroop test for each section (P < 0.005). Although the mean IQ scores of both groups were within the normal range, the CM group had a lower mean IQ score than the control group (P < 0.005). Although the mean SMMSE scores of both groups were within the normal range, the CM group had a lower mean SMMSE score than the control group (P < 0.005). The CM group had a higher rate of psychiatric comorbidities than the control group (P < 0.005). CONCLUSIONS: The study found that subjects with type 1 Chiari malformation performed worse in EFs than healthy controls and had a higher prevalence of psychiatric disorders.

Childhood trauma and general cognitive ability: Roles of minimization/denial and gender.

The aim of this study was to investigate the effects of minimization and gender on the interaction between childhood trauma and general cognitive ability. The study included 345 students. The data were obtained via an information form, the Childhood Trauma Questionnaire (CTQ), and Raven's standard progressive matrices (RSPM). The mean CTQ total score and the mean sexual abuse, physical, and emotional neglect subscale scores of the male students were significantly higher than those of the female students (p<0.05). The mean minimization score of the female students was greater than that of the male students (p<0.05). However, among the female students with minimization scores of 3, there was a moderate and significant negative correlation between the CTQ and RSPM scores (r=-0.533, p<0.05). This study found that general cognitive ability was influenced by childhood trauma among female students with higher minimization/neglect scores. The results of the current study suggest that ignoring the effects of minimization may be a misleading factor for determining the gender ratio of childhood trauma and evaluating its effect on long-term cognitive functions.

[The Relationship Between Anger Expression, Body Image and Eating Attitudes in Social Anxiety Disorder]. / Sosyal Anksiyete Bozuklugunda Öfke Ifadesinin Beden Imgesi ve Yeme Tutumu ile Iliskisi.

OBJECTIVE: The aim of the present study was to investigate both the prevalence of social anxiety disorder (SAD) and itsassociation of trait anger and anger expression, eating attitudes and body perceptions in university students having the said disorder. METHOD: One thousand students from Cumhuriyet University were included in the study. During the initial stage, Liebowitz Social Anxiety Scale (LSAS) and socio-demographic data form were administered to the students. Those obtaining 30 points or more in LSAS were called for a psychiatric interview. The students diagnosed with social anxiety disorder (n=87) and the control group (n=87) were administered Eating Attitude Test (EAT), Multidimensional Body-Self Relations Questionnaire (MBSRQ) and The State Trait Anger Scale (STAXI). RESULTS: The point prevalence of social anxiety disorder was found to be 9.4% in those attending the study. Trait anger, anger-in and anger-out scores were statistically significantly higher; anger control and multidimensional body-self relations scale points were statistically lower at the SAB group when compared to the control group. The MBSRQ scores correlated negatively, while the EAT scores correlated positively, with anger-in scores in students with SAD. CONCLUSION: SAD is a common disorder in university students. Our study, showed that repressed anger could adversely affect body image and eating behaviors in SAD. In students having social anxiety disorder, approaches aiming at appropriate anger expression and positive body perception may yield positive results to treatment in students with SAD.

[The prevalence of eating disorders and comorbid psychiatric disorders in the Sivas Province]. / Sivas Il Merkezinde Yeme Bozukluklarinin Yayginligi ve Eslik Eden Psikiyatrik Tanilar.

OBJECTIVE: The purpose of this study was to determine the prevalence of eating disorders (EDs) in the Sivas province, and to identify the sociodemographic characteristics and co-morbid axis-I and axis-II diagnoses in EDs. METHOD: 1122 people between 18-44 years of age were enrolled in the study after completing the eating attitude test (EAT), and people who had points around the cut-off score had clinical interviews. The control group included subjects that were age- and sex-matched with the ED group, were not diagnosed with an ED, and had an EAT score <30. In order to determine the following as axis I or axis II, SCID-I (Structured Clinical Interview for DSM-IV Axis-I Disorders) and SCID-II (Structured Clinical Interview for DSM-III-R Personality Disorders) were performed on both the eating disorder and control groups. RESULTS: As a result of the scanning done with EAT, we observed that 5.25% of this population might have an eating behavior disorder. The prevalence of the eating disorders was found to be 1.52% by the structured clinical interview in the second step of the study. While the prevalence of bulimia nervosa was determined to be 0.63%, that of binge eating disorder was 0.81%. The diagnosis of ED is common and statistically significant among women (88.2%). According to the study, persons diagnosed with ED were more likely to have a moderate income as compared with those who were not diagnosed with an ED. Also, people with ED had been exposed to more traumas, and it was more likely that someone in their family had a psychiatric diagnosis. Among the patient group, the axis I and axis II co-morbidity rates were significantly higher than those of the control group. 47% (8/17) of the patients were determined to have a co-morbid axis I diagnosis. The most frequently diagnosed co-morbidity was major depressive disorder. 41% of the patients were determined to have an axis II diagnosis. The most common rate of diagnosis was 11.8% for both obsessive-compulsive personality disorder and avoidant personality disorder. CONCLUSION: The results of this study show that the point prevalence rate for EDs among all the participants was 1.52%, with binge eating disorder being the most prevalent ED. Psychiatric co-morbidity is common in patients with eating disorders. An ED is a disease that can be seen in different age groups and socioeconomic levels. Studies with larger samples, including different regions of the country and different age groups, and with diagnoses that have been confirmed by clinical interviews, are required.

Post-Traumatic Stress Disorder in Migraine Patients: Migraine, Trauma and Alexithymia.

INTRODUCTION: In recent studies, it has been suggested that there is a relationship between migraine headaches and post-traumatic stress disorder (PTSD). The PTSD has not been diagnosed by a clinician in these studies; the evaluation has been carried out by the screening scales. Besides, it has also been asserted that there was relationship of alexithymia with migraine and other chronic painful disorders. In this study, our aim was to investigate the prevalence of clinically-diagnosed PTSD and alexithymic features among migraine patients. METHODS: Sixty consecutive migraine patients sent from neurology clinic and 60 healthy controls having similar features constituted the sample of this study. SCID-I/CV PTSD module and the Clinician-Administered PTSD Scale (CAPS) was administered to the sample. The subjects also filled in the socio-demographic data form and the Toronto Alexithymia Scale (TAS). The level of pain perceived by the migraine patients was evaluated using a Visual Analog Scale (VAS). RESULT: 17 subjects (28%) in the migraine group and 5 individuals (8.3%) in the control group were diagnosed with PTSD. Hence, PTSD was found to be statistically significantly higher in the migraine group. 25 persons in the migraine group (41.6%) and 12 in the control group (20%) scored above the TAS cutoff score in terms of alexithymic features. Alexithymia was found to be statistically significantly higher in the migraine group). In the migraine group, VAS scores of the ones with PTSD were statistically significantly higher compared to that in ones without PTSD. 94% of the persons diagnosed with PTSD in the migraine group reported that their migraine headaches started after a traumatic experience. In the migraine group, no statistically significant correlation was detected between CAPS and VAS scores in subjects with PTSD. CONCLUSION: In migraine patients, PTSD and alexithymic features have been found higher than in the healthy controls. Further studies are needed to search whether the practices aimed at treating the PTSD and alexithymic features can contribute to the treatment of migraine headaches or not.

Prevalence of attention-deficit/hyperactivity disorder and co-morbid disorders among students of Cumhuriyet University

Background and Objectives: Most of the previous studies investigated prevalence of attention-deficit/hyperactivity disorder (ADHD) among university students with self report measures. Present study investigated actual prevalence of ADHD and comorbid disorders among university students in Cumhuriyet University of Sivas in Turkey. Methods: In the first stage, 980 university students filled in the Adult ADHD Self-Report Scale and socio-demographic form, 79 of whom were above the cut-off score of Adult ADHD Self-Report Scale, considered as possible ADHD. They were evaluated in the second stage via structured interview SCID I, SCID II, Adult ADHD Module of MINI Plus. In addition, subjects filled in the self report Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale. Results: The self report ADHD prevalence rate was 10.1% and the actual prevalence rate of ADHD among the university students was calculated 6.1%. The prevalence of ADHD was greater among male than female (7.0% vs. 5.5%). Among the male students inattentive subtype was 1.6%, hyperactive-impulsive 0.24%, combined 5.1%. Female students were found to be inattentive by 1.45%, hyperactive-impulsive by 0.56% and combined type by 3.48%. Most of the students with ADHD had Axis I (especially depressive disorders) and Axis II disorders (especially cluster B personality disorders). ADHD diagnosis was associated with more cigarette and alcohol use, academic failure, legal problems, somatic complaints and suicide attempts. Students with ADHD were spending more time on the Internet than students without ADHD. Only one student diagnosed with ADHD reported to have had previous ADHD diagnosis. Conclusions: ADHD is common among university students. Having a diagnosis of ADHD in early adulthood seems to be associated with psychological, social, and academic problems (AU)

Prevalence of anxiety disorders among elderly people.

OBJECTIVES: The objectives of this study are to determine current and lifetime prevalence of anxiety disorders and also to explore the relationship, if any, between possible risk factors and anxiety disorders, amongst elderly people living in the Sivas province of Turkey. METHODS: The research sample consisted of 462 persons. A Socio-demographic Data Form was given to the participants and the Anxiety Module of SCID-I was applied. Chi-square and Fischer's exact tests were used to evaluate the data obtained. RESULTS: The current prevalence for all types of anxiety disorder was found to be 17.1% overall and the lifetime prevalence was found to be 18.6%. The current prevalence rates for particular disorders were found to be 0.4% for panic disorder, 3.2% for obsessive-compulsive disorder, 1.9% for post-traumatic stress disorder, 2.8% for social phobia, 11.5% for specific phobia, 6.9% for generalized anxiety disorder (GAD). Lifetime prevalence rates for these disorders (except GAD) were 1.1%, 3.2%, 3.0%, 2.85%, 11.5% respectively. CONCLUSIONS: Anxiety disorders are more common among elderly people than was previously thought. The lifetime prevalence of specific phobia amongst the elderly is higher than that of general population; the lifetime prevalence ratios of obsessive-compulsive disorder and social phobia are similar to that of the general population in Sivas. In order to improve the delivery of health services, it is recommended that further studies should be conducted among elderly people, both by applying standardized diagnostic tools, but also taking into account socio-economic factors and using convenient therapy methods developed specifically for this group.

Trauma and dissociation among prisoners.

The current study examined childhood abuse, dissociation and post-traumatic stress disorder (PTSD) among male prisoners. A sample of 101 randomly selected male prisoners was interviewed. The Dissociative Experiences Scale (DES), Childhood Abuse and Neglect Questionnaire (CANQ) and Structured Clinical Interview for DSM-IV (SCID-I)-PTSD module were applied. Probands reported high frequency of criterion A trauma (85.2%) and lifetime PTSD (66.4%). Also, dissociative experiences more frequent than that of general population and most frequent dissociative symptoms were amnesia and absorption. PTSD and childhood traumas occur at high rates in prisoners and this finding has implications for management and treatment.

Axis I dissociative disorder comorbidity in borderline personality disorder and reports of childhood trauma.

OBJECTIVE: The purpose of this study was to examine the dissociative disorder comorbidity of borderline personality disorder and its relation to childhood trauma reports in a nonclinical population. METHOD: In April 2003, 1301 college students were screened for borderline personality disorder using the Structured Clinical Interview for DSM-IV Personality Disorders. The Childhood Trauma Questionnaire and Steinberg's dissociation questionnaires were also administered. During May and June 2003, 80 students with a diagnosis of borderline personality disorder and 111 nonborderline students were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders by an interviewer blind to the diagnosis and scores obtained during the first phase. RESULTS: The prevalence of borderline personality disorder was 8.5%. A significant majority (72.5%; 58/80) of the borderline personality disorder group had a dissociative disorder, whereas this rate was only 18.0% (20/111) for the comparison group (p < .001). Childhood emotional and sexual abuse, physical neglect, and total childhood trauma scores had significant effect for borderline personality disorder (p < .001, p = .038, p = .044, and p = .003, respectively), whereas emotional neglect and diminished minimization of childhood trauma had significant effect for dissociative disorder (p = .020 and p = .007, respectively). CONCLUSION: A significant proportion of subjects with borderline personality disorder have a comorbid dissociative disorder. Lack of interaction between dissociative disorder and borderline personality disorder diagnoses for any type of childhood trauma contradicts the opinion that both disorders together might be a single disorder. Recognizing highly prevalent but usually neglected Axis I dissociative disorder comorbidity in patients with borderline personality disorder may contribute to conceptual clarification of this spectrum of psychopathology.

The prevalence of eating disorders among university students and the relationship with some individual characteristics.

OBJECTIVE: The purpose of this study was to determine the prevalence of eating disorders (EDs) among university students in a rural area of Turkey and to compare groups based on the sociodemographic data, history of child abuse and neglect, family roles and self-esteem with a normal control group regarding EDs. METHOD: Subjects who were chosen by simple random sampling method were consisted of 980 Cumhuriyet University students who agreed to participate out of the 1003 total students and were given a sociodemographic information form and an Eating Attitudes Test (EAT). Students who scored above a cutoff level on the EAT were interviewed using the Structured Clinical Interview for DSM-IV axis I Disorders (SCID-I), Clinical Version. The Rosenberg Self-Esteem Scale, Family Assessment Device (FAD) and Childhood Abuse and Neglect Questionnaire Form were given to subjects in the control and study groups. RESULTS: Seventy-one of the 951 students (492 female, 459 male) who correctly filled out the EAT had a score above the cutoff level of 30 or higher. Of these 71 students, 21 (2.20%) were found to have an eating disorder based on the SCID-I. No subjects were found to have anorexia nervosa. Eighteen of the 21 subjects were female. Of these 18 female students, 15 (1.57%) were found to have bulimia nervosa and three (0.31%) were found to have binge eating disorder (BED). All of the three male subjects were diagnosed with BED (0.31%). The self-esteem of those in the study group was lower than those in the control group (p < 0.001). Subjects in the study group had more frequent histories of sexual and emotional abuse in childhood (p < 0.05). Also, in the study group scores showing communication in FAD families, unity and emotional attachment were statistically significantly lower than the control group (p < 0.001). CONCLUSIONS: It has been observed from the results of this research that the frequency of bulimia nervosa and BED in this sample is so similar to Western samples. Besides that, self-esteem, child abuse and neglect, and family functions must be examined in detail because they are risk factors for EDs and affect the course of treatment.

Reported childhood trauma, attempted suicide and self-mutilative behavior among women in the general population.

This study attempted to determine the prevalence of childhood trauma among women in the general population as assessed in a representative sample from a city in central Turkey. The Dissociative Experiences Scale (DES) was administered to 628 women in 500 homes. They were also asked for childhood abuse and/or neglect. DES was administered to 251 probands. Mean age of the probands was 34.8+/- 11.5 years (range 18-65). Sixteen women (2.5%) reported sexual abuse, 56 women (8.9%) physical abuse, and 56 women (8.9%) emotional abuse in childhood. The most frequently reported childhood trauma was neglect (n= 213, 33.9%). The prevalence of suicide attempts was 4.5% (n= 28). Fourteen probands (2.2%) reported self-mutilative behavior.

Dissociation and childhood abuse history in epileptic and pseudoseizure patients.

The aim of this study was to examine dissociative experiences, childhood abuse and anxiety in epileptic and pseudoseizure female patients. Thirty-three patients with pseudoseizures and thirty patients with epilepsy were recruited from Cumhuriyet University Hospital Psychiatry and Neurology Units. We assessed each participant using the Dissociative Experiences Scale, the Clinician-Administered Dissociative States Scale and the Childhood Abuse and Neglect Questionnaire. The female patients with pseudoseizures showed significantly higher levels of dissociative experiences and childhood trauma. Epileptic female patients showed higher levels of anxiety. The significantly higher incidence of dissociative experiences and childhood trauma in the patients with pseudoseizures makes a case for dissociation in the pathogenesis of these seizures.

Social phobia among university students and its relation to self-esteem and body image.

OBJECTIVE: To demonstrate the prevalence of social phobia and its relation to body image and self-esteem. METHOD: Study participants were 1003 students recruited from Cumhuriyet University as a randomized sample. Subjects were administered the Diagnostic Interview Schedule-III-Revised (DIS-III-R) Social Phobia Scale, the Rosenberg Self-Esteem Scale, and the Multidimensional Body-Self Relations Questionnaire (MBSRQ). We analyzed the data, using Fisher's exact chi-square test. RESULTS: Lifetime prevalence of social phobia among university students was 9.6% and past-year prevalence was 7.9%. Self-esteem was lower (P < 0.05) among those with social phobia than among those without social phobia. Students with social phobia had lower scores on the MBSRQ than did those without social phobia (P < 0.0001). CONCLUSIONS: The results show that persons with social phobia have lower self-esteem and more distorted body image than do those without social phobia.

Intraerythrocyte antioxidant enzyme activities in migraine and tension-type headaches.

BACKGROUND: The pathophysiology of migraine and other headaches is still unknown, and research is mostly done on neurotransmitter, biochemical and vascular mechanisms. The aim of this study was to examine the role of antioxidant enzymes in the pathophysiology of headache in the interictal period of the pain process. METHODS: In this study, glutathione peroxidase, catalase and superoxide dismutase enzyme activities were investigated in 88 cases, which included 11 migraine cases with aura, 17 migraine without aura, 32 chronic type tension headache and 28 control cases. RESULTS: In migraine cases, superoxide dismutase and glutathione peroxidase enzyme activities were statistically lower than in the tension headache and control groups. The differences between tension-type headache and control groups were found statistically insignificant. CONCLUSIONS: Low intraerythrocytes, superoxide dismutase and glutathione peroxidase levels may play an important role in the etiology of migraine.

Sneddon's syndrome: clinical and laboratory analysis of 10 cases.

Sneddon's syndrome is characterized by livedo reticularis and cerebrovascular lesions. We report the cases of women (mean age, 36.2 +/- 8.1 years) diagnosed with Sneddon's syndrome based on the presence of livedo reticularis and characteristic cerebrovascular findings. Seven of these patients had cerebral infarcts on cranial computed tomography scan. Antiphospholipid antibodies were positive in 6 of these cases. Three cases had abnormal levels of antithrombin III. Analyses of chromosome 6 revealed no abnormalities. In 3 of the cases, investigation of the pedigrees revealed autosomal dominant traits. Two cases had epilepsy, and 3 had migraine. One case with migraine also had myasthenia gravis. In addition, we detected inferior altudinal hemianopia in 2 cases, cognitive functional disorder in 3 and depression in 2. Based on these findings, the entire vascular, haematologic, neurologic, and dermatologic systems should be evaluated in patients diagnosed with Sneddon's syndrome.

[Burning mouth syndrome and depression: a case report]. / Yanan agiz sendromu ve depresyon: bir olgu sunumu.

We present a 63-year-old male patient with major depression, characterised by prominent somatic symptoms localised especially around the mouth, whose complaints started just after a prostate operation. The symptoms consisting of burning in the mouth, pain, dry mouth (xerostomia), an unpleasant and strange feeling of taste and itching, are all consistent with burning mouth syndrome. Burning mouth syndrome is a common disorder, usually affecting elderly females, characterised by intractable pain and burning in the oral cavity, evident especially in the tongue, together with a normal mouth mucosa. In the scientific literature a variety of terms are used to describe similar symptoms, such as glossodynia, glossopyrosis, stomatodynia and oral dysestesia. Most patients suffer from the syndrome for a long time, ranging from months up to years. The onset was reported to be gradual for most of the subjects, although many patients relate the onset of symptoms to previous dental procedures or to a previous medical illness. Burning mouth syndrome has a multifactorial etiology. Anxiety disorder, hypochondriasis, conversion disorder and especially depression may be considered amongst the psychological factors responsible for this situation. The psychological findings in burning mouth syndrome patients may be either the consequence of the chronic pain condition or its cause. It is well known that those patients had a relatively high percentage of psychiatric or psychological treatment in the past and/or present. After excluding organic factors, depression should be considered in old patients with predominant mouth complaints.