Childhood Traumatic Experiences and Trauma Related Psychiatric Comorbidities in Dissociative Disorders

Objective: Different prevalence rates are reported for dissociative disorders (DD) in different clinical populations (inpatient, outpatient, emergency). It is around 10% among admissions to psychiatry outpatient clinics. Since DD harbors disruption/discontinuation of memory, identity, emotion, and perception many other psychiatric symptoms may be triggered by it. On the other hand, high amount of childhood traumatic experiences in DD patients may be associated with comorbid trauma related psychiatric disorders among them. We aimed to determine the diagnostic distribution of DD in psychiatric outpatients; to show the types of childhood traumatic experiences, their frequencies and sub-types, and co-morbid psychiatric disorders related to these traumas; and to compare the patients with and without DD diagnoses. Methods: We conducted a cross-sectional study involving 1314 participants who were screened with the Dissociative Experience Scale (DES) and the Somatoform Dissociation Questionnaire (SDQ). Of the participants, 272 who scored above the cut-off point of either of these scales (DES score > 30 or SDQ score >40 points) were invited to complete a structured interview using the Dissociative Disorders Interview Schedule (DDIS). Of this subsample, only 190 participants agreed to participate in this second phase of the study. A semi-structured interview form was applied to them to collect demographical and clinical variables. In these patients psychiatric comorbidity and trauma history were assessed according to DDIS sub-items, conversion disorder was diagnosed according to DSM IV-TR criteria, and post-traumatic stress disorder was diagnosed according to the post-traumatic stress disorder module of Structured Clinical Interview (SCID-I). Patients with DD diagnosis and without it were compared in terms of study variables. Results: In the first phase of the study, a total of 272 patients (20.7%) have scored above cut-off level of either of DES or SDQ. Of the 190 participants who were enrolled to the second phase, 167 patients were diagnosed with a dissociative disorder (87.8%). We found that dissociative disorder not otherwise specified was the most prevalent type of DD in these patients. All the measured traumatic experiences were significantly higher in the patients with DD than patients without DD, except for sexual abuse. When compared to patients with and without DD, borderline personality disorder, conversion disorder and lifetime major depressive episodes were significantly higher in the patients with DD (p=0.011, p=0.035, p=0.013, respectively). In the logistic regression analysis the neglect, physical trauma, verbal abuse/threat histories in childhood were identified as predictive factors of DD diagnosis (Table 5). Conclusion: Clinicians should keep in mind that around one fifth of psychiatry outpatients have clinically significant amount of dissociative symptoms. Childhood traumas and related psychiatric comorbidities are quite common among them with a higher frequency observed in those patients with DD diagnosis. Further studies are needed to determine dissociative symptoms, childhood trauma and trauma related psychiatric comorbidity of psychiatry outpatients and to understand better how they interact with each other especially in those diagnosed with DD

Paliperidone ER-induced Tardive Dyskinesia

The evidence suggests a lower tardive dyskinesia risk associated with atypical antipsychotics. We present two adult female cases with tardive dyskinesia. Tardive perioral dyskinesia developed in patients at the ninth and twelfth months of paliperidone ER treatment (12 mg/day and 9 mg/day, respectively). These symptoms were improved after switching to quetiapine 800 mg/day in the first patient while lowering the dose of paliperidone ER to 6 mg/day resulted in significant improvement in the second patient. Although atypical antipsychotics have a low risk for movement disorder related events, paliperidone ER does not seem to be lacking in such adverse effects

Circumcision and its potential effects on children's mental health state

Objectives: Circumcision is one of the oldest elective surgical interventions in the history of mankind. Though many studies have been conducted on the surgical complications of circumcision, the potential effects on the mental state of the children has not been satisfactorily reviewed. In this prospective study, we analyzed potential effects of circumcision on their mental state, anxiety levels and moods using updated scales. Material and methods: One hundred and two male children aged between 6 and 8 and their families were included in the study. Children with their families completed sociodemographic data form Anxiety Sensitivity Index For Children, the Strengths and Difficulties Questionnaire (SDQ), Depression Scale for Children during the preoperative period. All children received oral 0.5 mg/kg midazolam as a premedication before circumcision procedure. Circumcisions were performed under general anesthesia in the operating room. During the 6th week of the postoperative period, the children and their families were returned to the facility and parents were asked to complete the questionnaire again. Results: Mean score of the preoperative depression scale was statistically and significantly higher than the mean postoperative depression scale score (P=0.001; P<0.01). Pre-, and post-operative depression scale scores of the children with divorced parents showed a higher statistical significance higher than those of the children whose family togetherness was not broken (P=0.001; P<0.01). Conclusion: Before circumcision, in all children to be circumcised a tendency to depression and an increase in anxiety were observed regardless of the presence of subgroups. At the end of the study, it was found that low socioeconomic level, disrupted family dynamic, and/or the presence of mental disease in a parent could increase the predisposition to pre and postoperative depression. At this stage the main factor determining the level of anxiety is the procedure of circumcision itself. (C) 2016 Asociacion Espanola de Andrologia, Medicina Sexual y Reproductiva. Published by Elsevier Espana, S.L.U. All rights reserved

A cross-sectional analysis of patient characteristics and practice patterns in the management of bipolar disorder across Turkey

Objective: Bipolar disorder (BD) is one of the leading causes of disability among medical and psychiatric disorders associated with prevalent, chronic, severe and highly disabling characteristics. This study was designed to identify clinical characteristics and practice patterns in the management of outpatients with BD across Turkey. Method: This multi-center cross-sectional study involving 1001 patients diagnosed with using DSM-IV criteria was conducted prospectively at 31 outpatient psychiatry clinics for 12 months. Patient demographics, clinical features, family history, comorbid psychiatric disorders, and the treatment modalities were assessed by means of semistructured questionnaire. Results: Age at the onset of symptoms was 26.7 +/- 9.8 years, age at diagnosis was 28.9 +/- 10.4 years, and the time interval between them was 2.2 +/- 4.7 years. Misdiagnosis prior to current diagnosis was evident in 40.3% of bipolar patients. The most common type of first episode was mania (57.1%) and depression (34.5%). Comorbid psychiatric illness was identified in 12.0% of patients. Only 10% of patients were receiving monotherapy. The most commonly prescribed drugs for depressive, manic and mixed episodes were lithium, sodium valproate and quetiapine, respectively. Conclusion: The time interval between onset of symptoms and the initial diagnosis in Turkish sample was quite shorter than reported in the literature. The misdiagnosis rate in the present study and recent studies were similar. A low comorbidity rate appears to indicate a lower prevalence of comorbid disorders in BD in Turkish sample. Lithium, sodium valproate and atypical antipsychotics were more commonly used drugs in the treatment of BD in Turkey

Neuroprotective effect of ebselen against intracerebroventricular streptozotocin-induced neuronal apoptosis and oxidative stress in rats

The goal of this study was to examine the neuroprotective effect of ebselen against intracerebroventricular streptozotocin (ICV-STZ)-induced oxidative stress and neuronal apoptosis in rat brain. A total of 30 adult male Sprague-Dawley rats were randomly divided into 3 groups of 10 animals each: control, ICV-STZ, and ICV-STZ treated with ebselen. The ICV-STZ group rats were injected bilaterally with ICV-STZ (3 mg/kg) on days 1 and 3, and ebselen (10 mg/kg/day) was administered for 14 days starting from 1st day of ICV-STZ injection to day 14. Rats were killed at the end of the study and brain tissues were removed for biochemical and histopathological investigation. Our results demonstrated, for the first time, the neuroprotective effect of ebselen on Alzheimer's disease (AD) model in rats. Our present study, in ICV-STZ group, showed significant increase in tissue malondialdehyde levels and significant decrease in enzymatic antioxidants superoxide dismutase and glutathione peroxidase in the frontal cortex tissue. The histopathological studies in the brain of rats also supported that ebselen markedly reduced the ICV-STZ-induced histopathological changes and well preserved the normal histological architecture of the frontal cortex tissue. The number of apoptotic neurons was increased in frontal cortex tissue after ICV-STZ administration. Treatment of ebselen markedly reduced the number of degenerating apoptotic neurons. The study demonstrates the effectiveness of ebselen, as a powerful antioxidant, in preventing the oxidative damage and morphological changes caused by ICV-STZ in rats. Thus, ebselen may have a therapeutic value for the treatment of AD

Olfactory Reference Syndrome Developed After Stressful Life Events and Response to Pharmacological Treatment: Report of Four Cases

Olfactory reference syndrome (ORS) is a disorder of thought content characterized by strong beliefs in transmitting an unpleasant body odor and disturbing other people. ORS had not been recognized in the DSM-IV as a separate diagnosis; rather, it used to be categorized under delusional disorder, somatic type (DDST). Considering recent changes in the DSM-5, the syndrome is currently listed under the section of other specified obsessive-compulsive and related disorder with the name Jikoshu-kyofu, thus still not described as a major distinct entity. We claim that a universally accepted set of diagnostic criteria is lacking, and there is a set of overlapping symptoms with various other disorders. In this paper, we discuss four patients presenting with ORS after a triggering stressful life event from the nosological and treatment perspective, focusing primarily on antipsychotic augmentation

Depression and quality of life in hemodialysis andpredialysis patients in a sample from Turkey

In this study, we aimed to examine the quality of life, depression, and anxiety in chronic renal failure at the predialysis and hemodialysis stage and groups, to show that depression anxiety start prior to dialysis, and to explore the impact of depression and anxiety on the quality of life of these patients. We included 49 hemodialysis and 50 predialysis (stage IV chronic kidney failure) patients who were followed up at the Bakırkoy Dr. Sadi Konuk Training and Research Hospital‘s Dialysis Unit and Nephrology Outpatient Clinic. Sociodemographic data were obtained from all patients in addition to the Hospital Anxiety and Depression Scale and the MOS 36-Item Short-Form Health Survey (SF-36). Results: No significant differences were found in terms of sociodemographic characteristics of two study groups. No significant differences were found in terms of HADS scores of two study groups SF-36 scores were not significantly different except for pain and physical function subscale scores. Quality of life component scores were found significantly lower in depression risk group based on HADS scores, regardless of renal failure stages. Our findings revealed that the quality of life levels were similar in both predialysis and dialysis patients. Depression and anxiety were determinant of quality of life, regardless of the stage of the kidney disease. Since the quality of life in patients with chronic renal failure was considered to be an important factor that determines mortality and morbidity, the treatment of depression at all stages of the illness is gaining importance. Psychiatric examination, psychoeducation and treatment of depression and anxiety symptoms would facilitate psychosocial adjustment and improve patient‘s coping skills prior to developing end-stage renal failure and lower the mortality and morbidity rates in these patients

Increased Neutrophil/Lymphocyte Ratio in Patients with Depression is Correlated with the Severity of Depression and Cardiovascular Risk Factors

Objective Chronic inflammation is associated with cardiovascular (CV) risk factors and psychiatric disorders. The neutrophil to lymphocyte ratio (NLR) has been investigated as a new biomarker for systemic inflammatory response. The aim of the study is to investigate the relation of NLR with severity of depression and CV risk factors. Methods The study population consisted of 256 patients with depressive disorder. Patients were evaluated with the Hamilton Rating Scale for Depression (HAM-D). Patients were classified into four groups according to their HAM-D score such as mild, moderate, severe, and very severe depression. Patients were also evaluated in terms of CV risk factors. Results Patients with higher HAM-D score had significantly higher NLR levels compared to patients with lower HAM-D score. Correlation analysis revealed that severity of depression was associated with NLR in depressive patients (r=0.333, p<0.001). Patients with one or more CV risk factors have significantly higher NLR levels. Correlation analysis revealed that CV risk factors were associated with NLR in depressive patients (r=0.132, p=0.034). In logistic regression analyses, NLR levels were an independent predictor of severe or very severe depression (odds ratio: 3.02, 95% confidence interval: 1.867-4.884, p<0.001). A NLR of 1.57 or higher predicted severe or very severe depression with a sensitivity of 61.4% and specificity of 61.2%. Conclusion Higher HAM-D scores are associated with higher NLR levels in depressive patients. NLR more than 1.57 was an independent predictor of severe or very severe depression. A simple, cheap white blood cell count may give an idea about the severity of depression

Severity of Depression and Anxiety Symptoms is Associated with Increased Arterial Stiffness in Depressive Disorder Patients Undergoing Psychiatric Treatment

Objective: Depression and anxiety are associated with both subdinical and clinical cardiovascular disease. Endothelial dysfunction, atherosclerosis, and inflammation are some of the underlying mechanisms. Pulse wave velocity (PWV) and augmentation index (Alx) are noninvasive markers for evaluation of arterial stiffness. The aim of this study was to examine the association between arterial stiffness parameters and depression/anxiety scores in depressive patients undergoing psychiatric treatment. Methods: The study population consisted of 30 patients with depression undergoing psychiatric treatment at least 4 weeks, and 25 age and gender matched healthy controls. Depression and anxiety were assessed by self-reported scales, including the Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Measurements of arterial stiffness parameters were performed by using a Mobil-O-Graph arteriograph system, which detects signals from the brachial artery. Results: Baseline characteristics and clinical data were similar between the two groups. BDI and BAI scores were statistically significantly higher in patients with depression (p<0.001, p<0.01). PWV and Alx were statistically significantly higher in patients with depression compared to controls (6.40 +/- 1.31 m/s vs 5.51 +/- 0.41 m/s and 26.9 +/- 12.1 % vs 17.4 +/- 11.3 %, p=0.001, p=0.004, respectively). PWV and Alx positively, mildly and statistically significantly correlated with BDI and BAI scores. Conclusion: Arterial stiffness parameters were statistically significantly higher in depressive patients receiving antidepressant treatment. Moreover, arterial stiffness parameters statistically significantly correlated with BDI and BAI. Assessment of arterial stiffness parameters may be useful for early detection of cardiovascular deterioration in depressive patients undergoing antidepressant treatment