An Evaluation of Psychogenic Predictors of Non-Organic Erectile Dysfunction.

Background and Objectives: Erectile dysfunction is a significant problem, which diminishes the quality of life. The aim of this study was to investigate the relationship of childhood trauma and attachment styles in the aetiology of psychogenic erectile dysfunction. Materials and Methods: The study included 80 participants (40 patients who presented with the complaint of erectile dysfunction, were not determined with an organic pathology, and were diagnosed with erectile dysfunction according to the DSM-5 criteria; and a control group of 40 healthy subjects.) The structured clinical interview form for DSM-5 (SCID-5) was applied to all the participants, together with the International Erectile Function Index (IIEF), the Childhood Trauma Questionnaire (CTQ), the Relationship Scale Questionnaire (RSQ), and the Beck Depression Inventory (BDI). Results: The emotional abuse (p = 0.002), physical abuse (p = 0.049), emotional neglect (p = 0.004), physical neglect (p = 0.002), and total scale points of the CTQ were determined to be significantly higher in the patient group than in the control group. Secure (p = 0.022) and dismissive (p = 0.009) attachment styles were found to be higher in the control group. As the time together with the current sexual partner increased, so the severity of erectile dysfunction increased, and sexual function, orgasmic function, sexual satisfaction, and general satisfaction decreased. As emotional abuse, sexual abuse, and physical neglect increased, the severity of erectile dysfunction increased. Childhood trauma (ß = -0.275, t (73) = -2.704, p = 0.009) and the duration together with the partner (ß = -0.249, t (73) = -2.512, p = 0.014) were found to be predictive of erectile dysfunction. Conclusions: The results of this study demonstrated that childhood trauma and the time elapsed without treatment are predictors of psychogenic erectile dysfunction severity, and secure attachment style and self-esteem play an important role in the aetiology of psychogenic erectile dysfunction.

Cognitive outcomes of transcranial magnetic stimulation in treatment-resistant depression: a randomized controlled study.

BACKGROUND: Major depressive disorder (MDD) is a significant cause of workforce loss, and is associated with cognitive impairments which can continue even after the elimination of mood and behavioural symptoms. The aim of this study was to investigate the benefit of transcranial magnetic stimulation (TMS) on cognitive functions in treatment resistant depression. METHODS: This randomised controlled clinical trial was conducted at a university hospital, department of psychiatry (tertiary centre) between October 2019 and July 2020. The study included 30 patients with depressive disorder, aged 18-50 years, who did not respond to at least two antidepressant medications for at least 8 weeks (one drug used was serotonin norepinephrine reuptake inhibitor [SNRI]; and 15 healthy control subjects. The patients were separated into two equal groups in a double-blind, random manner, and 20 sessions of repeated TMS was applied to one group, and 20 sessions of sham TMS to the other. The Montgomery Asberg Depression Scale (MADRS), Hamilton Depression Rating Scale (HAM-D), Stroop test, Wisconsin Card Sorting Test (WCST), Digit Span Test (DST), Trail Making Test A-B, and Verbal Memory Processes Test (VMPT) were applied to the patients before and after the TMS procedure. RESULTS: The decrease in the HAM-D score was greater in the active magnetic stimulation (25 trains, 10 Hz, 110% motor threshold intensity) group, and with the exception of verbal memory processes, better performance was obtained by the active magnetic stimulation group than the sham group in the cognitive function tests. DISCUSSION: TMS was seen toimprove the cognitive defects present in the active phase of treatment-resistant depression, and therefore TMS could provide early improvement in cognitive functions in clinical use. Key words: Depression, transcranial magnetic stimulation, neurocognitive functi.

Effects of Selective Serotonin Reuptake Inhibitor Treatment on Ovarian Reserves in Patients with Depression.

Background and Objectives: The goal of this study was to investigate the effect of selective serotonin reuptake inhibitor treatment on the ovarian reserves of women of reproductive age with major depressive disorder. Materials and Methods: The current study is a prospective controlled trial including 48 women with major depressive disorder and 48 age-matched healthy controls. Ovarian reserve tests are performed prior to treatment and after six cycles of selective serotonin reuptake inhibitor treatment in the major depressive disorder group. Serum follicle-stimulating hormone, luteinizing hormone, estradiol, and anti-Müllerian hormone levels were evaluated from blood samples, and endometrial thickness, total antral follicle count, and volume of both ovaries were assessed using transvaginal ultrasonography. Results: When the first measurements were compared, menstrual duration and menstrual bleeding increased (p = 0.007 and 0.005, respectively) and luteinizing hormone decreased (p = 0.045) in the major depressive disorder group, while follicle-stimulating hormone, estradiol, anti-Müllerian hormone, endometrial thickness, total antral follicle count, and mean ovarian volume did not differ significantly between groups (p > 0.05). When the major depressive disorder group's first and final measurements were compared, follicle-stimulating hormone, estradiol, and endometrial thickness increased (p = 0.05, 0.0001, and 0.005, respectively), luteinizing hormone remained constant (p = 0.541), and anti-Müllerian hormone and total antral follicle count decreased (p = 0.024 and 0.042, respectively). Conclusions: In this study, we observed that the ovarian reserve test results of patients diagnosed with major depression for the first time after 6 months of SSRI treatment were significantly different from the results of the pretreatment and control groups.

The Efficacy and Safety of Transcranial Magnetic Stimulation in Treatment-Resistant Bipolar Depression.

BACKGROUND: The aim of the current study is to investigate the efficacy and safety of Transcranial magnetic stimulation (TMS) treatment, a non-invasive brain stimulation technique, on depressive symptoms in treatment-resistant bipolar depression (TRBD). SUBJECTS AND METHODS: The study included 29 patients between the ages of 18-65, with bipolar disorder depressive episode according to DSM-5 and with the decision of non-response to treatment according to the Canadian Mood and Anxiety Treatment Network (CANMAT). Patients were divided into two groups double-blind-randomly, 20 sessions of TMS and 20 sessions of sham TMS were applied crossover. Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory (BDI), Young Mania Rating Scale (YMRS) and TMS Side Effect Questionnaire were applied to the patients before the treatment, at the 2nd week which is the crossover phase, and at the end of the treatment at 4th week. RESULTS: In both groups, the severity of depression was decreased significantly according to HAM-D and BDI scores after the procedure. As well as active stimulation, some positive placebo effects were observed with sham stimulation. But the decreases seen in HAM-D and BDI scores and response to the treatment were higher during the weeks when the groups received active stimulation (respectively p=0.000, p=0.001, p=0.005). At the end of the study, according to HAM-D, 55.7% of the patients showed response to the treatment, 24.13% partial response. According to BDI, 41.37% of the patients showed response to the treatment, and 31.03% partial response. No associations were found between TMS response and sociodemographic - clinical features, or type of the disease (p>0.05). During the study, no serious adverse effects such as seizures or manic / hypomanic switches were observed. CONCLUSIONS: The results of our study showed that TMS treatment is an effective and safe treatment for patients with treatment-resistant bipolar depression.

Relationship of Apathy with Depressive Symptom Severity and Cognitive Functions in Geriatric Depression.

INTRODUCTION: Apathy which is known as loss of primary motivation is observed more frequently in elderly depression in comparison with younger adults. It is put forth that apathy is related with depressive symptom severity and cognitive functions, that the existence of apathy may be a predictor of neurocognitive impairment. The objective of this study was to examine the apathy levels in elderly patients with major depression as well as the relationship between depressive symptom severity and cognitive functions. METHODS: The study was carried out with 40 major depressive disorder patients (MDD) aged 60 and above, 40 healthy controls aged 60 and above. Sociodemographic data form, structured psychiatric interview (SCID-I), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Montgomery-Asberg Depression Rating Scale (MADRS), Standardized Mini Mental State Examination (SMMSE), Montreal Cognitive Assessment Scale (MoCA), Apathy Evaluation Scale (AES) and Sheehan Disability Scale (SDS) were applied to the participants. RESULTS: In our study, HAM-D, HAM-A and MADRS scale scores of MDD group was determined to be higher in comparison with those of the healthy control group. A positive correlation was determined in the MDD groups between the AES scores and depressive symptom severity, whereas a negative correlation was determined between the AES scores and cognitive functions. The SMMSE and MoCA scores of the geriatric MDD group were determined to be lower in comparison with healthy control group. Low performance was observed in the geriatric MDD group especially in the fields of orientation, visual/spatial functions, memory and language. Functionality was found to be lower in MDB group than in the control group, and functionality decreased as the level of apathy increased. CONCLUSION: Our results indicate that the apathy levels in geriatric depression are higher in comparison with the control group. Cognitive functions are affected adversely in geriatric patients in major depressive disorder, depressive symptom severity, impairment in cognitive functions and functionality are observed to be related with apathy level.

[Is Clinical Insight Associated with Working Memory Components in Schizophrenia and Schizoaffective Disorder?] / Sizofreni ve Sizoaffektif Bozuklukta Klinik Içgörü Isleyen Bellek Bilesenleri ile Iliskili midir?

OBJECTIVE: Previous studies suggest that the level of clinical insight in schizophrenia patients is related to working memory functions. However, these studies were not specifically concerned with the components of working memory and had not focused in detail on working memory functions. For this reason, the current study investigated the relationship between clinical insight and working memory components in patients with schizophrenia and schizoaffective disorder.  METHOD: The patient group was evaluated by using the Scale for Assessment of Negative Symptoms, the Scale for Assessment of Positive Symptoms, and the Scale to Assess Unawareness of Mental Disorder to measure clinical insight. Moreover, all participants underwent a "Situation Awareness" test in order to measure working memory functions. Based on published data, the first stage of this test was accepted to measure the "visual spatial sketchpad" component of working memory, and the second stage was accepted to measure the "episodic buffer" (bound information storage) component. The functions of these components were measured separately as top-down and bottom-up cognitive processes.  RESULTS: The episodic buffer function (managed by the bottom-up cognitive process) was related with clinical insight. This relationship also continued after correcting for the effect of positive symptoms on insight. The patients performed worse than the controls in terms of visual spatial sketchpad function, which was managed by both topdown and bottom-up cognitive processes. The patients performed worse than the controls in terms of both top-down and bottom-up cognitive processes and visual spatial sketchpad function. Furthermore, the patients were also worse than the controls in terms of episodic buffer function (managed by top-down cognitive processes).  CONCLUSION: Clinical insight may be associated with binding function (associated with episodic buffer function) managed by bottom-up cognitive processes in patients with schizophrenia and schizoaffective disorder. Further studies are necessary to confirm this novel finding.

[Adaptation and Reliability of the Structured Clinical Interview for DSM-5-Disorders - Clinician Version (SCID-5/CV) to the Turkish Language]. / DSM-5 Bozukluklari için Yapilandirilmis Klinik Görüsmenin Klinisyen Versiyonunun Türkçeye Uyarlanmasi ve Güvenilirlik Çalismasi.

OBJECTIVE: In this study, we aimed to adapt the Structured Clinical Interview for DSM-5-ClinicianVersion into Turkish and to demonstrate its reliability.  METHOD: A total of 185 patients, both inpatient and outpatient, from two different university hospitals were included. Training sessions on the features and use of SCID-5/CV were held before the data collection. During the study, in order to test the diagnostic agreement and accuracy, two psychiatrists remained present at the evaluation of each participant; alternatively being interviewer and the observer. Cohen's kappa coefficient for inter-rater reliability was calculated for every diagnostic category.  RESULTS: The patient group had a mean age of 37.2 (±13.5) years and 55.7% were female. The education status was as follows: 2.7% were illiterate, 1.7% literate with no primary education, 33% had primary education, 23.8% had secondary education and 38.9% had higher education. The calculated kappa value showed excellent agreement for schizophrenia (κ=0.93), bipolar disorder (κ=0.96), major depressive disorder (κ=0.89), dysthymic disorder (κ=0.82), alcohol use disorder (κ=0.96), panic disorder (κ=0.84), agoraphobia (κ=0.85), social anxiety disorder (κ=0.95), generalized anxiety disorder (κ=0.89), obsessive compulsive disorder (κ=0.87), posttraumatic stress disorder (κ=0.89), adult attention deficit and hyperactivity disorder (κ=1.00), specific phobias (κ=0.82) and very good agreement with adjustment disorder (κ=0.78) and somatic symptom disorder (κ=0.65).  CONCLUSION: Similar to the past SCID versions, kappa values were found to be quite high and all were statistically significant. The Turkish version of SCID-5/ CV can be reliably used in both clinical practice and clinical studies.

An evaluation of the differences in DNA damage in lymphocytes and repair efficiencies in patients with schizophrenia and schizoaffective disorder.

Schizophrenia and schizoaffective disorder are chronic and debilitating psychiatric disorders. The present study was designed to determine DNA damage in patients with schizophrenia and schizoaffective disorder to assess the roles of oxidative metabolism and DNA repair mechanisms in this process, to assess the contribution of drugs, and thus to demonstrate the differences between schizophrenia and schizoaffective disorder. Thirty schizophrenia and 30 schizoaffective disorder patients, each having at least five years of disease history, aged between 18 and 60 years with no physical or neurological diseases, and 30 healthy volunteers participated in the study. Psychometric scales were applied, and 5 ml of blood was taken from all participants. The DNA damage was measured in lymphocytes by the comet assay method; the total oxidative parameters by ELISA; OGG1 and NEIL1 gene expressions by real-time PCR; and the role of drugs by in vitro assays. The most important finding in this study was that patients with schizophrenia had significantly greater DNA damage than schizoaffective disorder patients and the controls. This study also provides evidence of high oxidative stress statuses and inadequate DNA repair capacities in patients with schizophrenia. Moreover, psychotropic drugs did not induce any DNA damage to the lymphocytes according to in vitro analyses. The use of clozapine and adequate repair processes of the patients were the decisive factors in the prevention of DNA damage. The results of this study provide a reexamination of schizoaffective disorder within the schizophrenia spectrum and indicate that schizoaffective disorder may be considered a different diagnostic category.