Symptomatic Remission Determines Functional Improvement and Quality of Life in Schizophrenia

Introduction: Schizophrenia is a chronic illness that negatively affects the quality of life and psychosocial functions. Defined criteria to assess remission in schizophrenia are considered to be useful in the longterm follow-up of patients and in discriminating diagnostic factors. This study investigated the quality of life and functionality in schizophrenia patients in symptomatic remission (R-Sch) and not in remission (Non-R-Sch). Methods: Sociodemographic data were collected for 40 R-Sch and 40 Non-R-Sch patients, and the following scales were administered: the Clinical Global Impression-Severity (CGI-S) Scale; Positive and Negative Syndrome Scale (PANSS), World Health Organization Quality of Life Questionnaire-Short Form, Turkish Version (WHOQOL-BREF-TR), Quality of Life Scale for Schizophrenia Patients (QLS), and Global Assessment of Functioning Scale (GAF). Results: The total and all subscale scores of PANSS and the CGI-S score were significantly lower in the R-Sch group than in the Non-R-Sch group, whereas the GAF scores and all subscales of QLS and WHOQOL-BREF-TR were significantly higher. Conclusion: This study demonstrates that improvement in symptoms in schizophrenia patients improves quality and functionality in all areas of life, suggesting that an improvement in symptoms is the most important determinant of functional recovery in the treatment of schizophrenia

Frontal lobe syndrome and its forensic psychiatric aspects

Frontal lob sendromu, genellikle travmatik ya da neoplastik bir frontal lob hasarı sonucu görülen kişilik değişikliği tablosudur. Lezyonun lokalizasyonu orbitomedial bölgede ise amnezi ve konfabulasyon (masallama), disinhibe kişilik değişiklikleri çocuksuluk, şakacı eğilim, seksüel dishinhibisyon, saldırganlık yelpazesinde bir kliniğe neden olur. Dorsolateral lezyonlar ise kararsızlık, apati ve yürütücü işlevlerin zayıfladığı bir tabloya yol açabilmektedir. Frontal lob sendromuna en sık yol açan neden, travmalar ve tümörler olup, serebrovasküler olaylar, nörodejeneratif hastalıklar, santral sinir sistemi enfeksiyonları ve bazı başka hastalıklarda da bu tablo görülebilmektedir. Hastanın kişiliğindeki dramatik değişiklikler, frontal lob sendromunudikkat çekici kılmakta, bu olgular, travma kökenliler çoğunlukta olmak üzere çeşitli davalarda adli tıbbi değerlendirmeye konu olabilmektedirler. Bu vakaların değerlendirildiği raporlarda söz konusu tablonun anatomik ve psikiyatrik komponentleri detayları ile irdelenmeli, dava dosyası da beraberinde incelenmek suretiyle görüş sunulmalıdır.Frontal lobe syndrome is a clinical entity leading to personality change that is often seen as a result of a traumatic or neoplastic frontal lobe injury. If the lesion is orbitomedially located, the clinic presents in the spectrum of amnesia confabulation, disinhib-ited personality changes, joking tendency, puerility, sexual disinhibition, aggression and violence. In dorsolateral lesions clinic of apathy, instability and poor executive abilities can be seen.Frontal lobe syndrome is mostly caused by traumas and neoplasia; other causes are cerebrovascular events, neurodegenerative diseases, central nervous system infections and and many other diseases. Frontal lobe syndrome is remarkable by the dramatical changes in the personality of the patient and these cases may be subject to forensic medical evaluation in various cases, mostly traumatic origin. In the reports evaluating these cases, anatomical and psychiatric components of the clinic should be examined in detail and expert opinion should be presented by reviewing whole case file

First manic episode induced by over the counter slimming drug that contains sibutramine

Sibutramin obesite tedavisinde kullanılan serotonin, noradrenalin ve daha zayıf bir şekilde de dopamin geri alımını engelleyen ve birçok psikiyatrik yan etkileri olan bir beta feniletilamindir. Kardiyolojik yan etkileri nedeniyle yasaklanmış olmasına rağmen halen internet üzerinden “Zayıflama hapı” adı altında satışı devam etmektedir. Antidepresanların manik veya hipomanik kaymaya neden olabilecekleri bilinmektedir. Sibutramin, antidepresan özelliğinden dolayı manik veya hipomanik kaymaya neden olabilir. Biz, internetten satın aldığı sibutramin içeren bir zayıflama ilacını kullandıktan hemen sonra ilk kez manik bir hecme geçiren altı ay sonrasında ise servisimize yine manik hecme nedeniyle yatırılan bir adölesanı sunuyoruz.Sibutramine, a serotonin, noradrenalin and to a lesser extent dopamine reuptake inhibitor, is a beta phenyletylamine used in obesity treatment and has many psychiatric side effects. Although, prohibited due to cardiologic side effects, it is still being sold as “Slimming pills” via internet. It is known that antidepressants can cause manic or hypomanic shifts. Since sibutramine has an antidepressant activity it may cause manic or hypomanic shifts. We present an adolescent who had his first manic episode after using sliming pills, which contain sibutramine, and was admitted to our service for his second manic episode 6 months after his first episode

Otoskopik fenomenin eşlik ettiği kannabis kullanımına bağlı psikotik bozukluk olgusu

Kannabis (esrar), en fazla kullanılan bağımlılık yapan yasa dışı maddelerden birisidir. Kannabis kullanımı ile birlikte görülen psikiyatrik belirtiler huzursuzluk, uykusuzluk, depresif ya da yükselmiş duygudurum, anksiyete, halüsinasyonlar ve konsantrasyon güçlüğüdür. Kannabis kullanımının psikoz ve bipolar bozukluk ortaya çıkma riskini arttırdığı ve var olan psikoz ve bipolar bozukluğun klinik görünümünü kötüleştirdiği bilinmektedir. Otoskopik psikozun karakteristik semptomu, kişinin kendi vücudunun bir parçasının ya da tümünün görsel varsanısıdır. Kişinin davranışları taklit ediliyor ve sanki aynada görünüyormuş gibi algılanır. Herhangi bir mental bozukluğun özel bir semptomu değildir. Sebebi tam olarak bilinmemektedir. Bu olgu sunumunda, kannabis kullanımına bağlı otoskopik psikoz tanısıyla takip edilen hastanın klinik belirtileri literatür eşliğinde tartışılmıştı

Türkiye'nin doğusunda üniversite öğrencilerinde depresif belirti sıklığı ve risk faktörleri

Amaç: Bu çalışmanın amacı Kars, Artvin, Ardahan ve Iğdır illerindeki üniversite öğrencilerinde depresif belirti sıklığını ve ilişkili faktörleri belirlemektir.Gereç ve Yöntem: Kesitsel olan çalışma 2118 öğrenci üzerinde uygulandı. Veriler anket yöntemiyle toplandı, depresyon düzeyini saptamak için Beck Depresyon Ölçeği kullanıldı. Bulgular: 646 (%30.5) öğrencinin Beck Depresyon Ölçeğinin kesme noktası olan 17 ve üzerinde puan aldığı görüldü. Üniversite bölümü, lokalizasyonu ve süresi depresyon açısından istatistiksel olarak anlamlı fark yaratmaktadır. Doğduğu mevsim, öğretim türü ve cinsiyet anlamlı farklılık yaratmamaktadır. Tartışma: Öğrencilerde depresif belirtiler yaygındır. Depresif belirti sıklığı ile okulun türü, yeri ve süresi arasında ilişki vardır.Aim: The study aimed at investigating the prevalence of depressive symptoms and factors related to depression in Kars, Artvin, Iğdır ve Ardahan university students. Material and Method: An cross-sectional study was conducted 2118 undergraduate students. The datas were obtained by a selfreported student questionnaire and the Beck Depression Envantory is used to determine the depression level. Results: 646 students (30.5%) scored on and above the cut-off point on the Beck Depression Inventory (BDI). There were statistical significant differentiations of the depression prevalence regarding division, localization and duration of the university . Although there weren't significant differentiation regarding type of teaching, gender and season birth. Discussion: Depressive symptoms are common among students. There is a significant relationship between depression and place, duration and kind of school

The frequency of Demodex spp in depression patients

Objective: Demodex spp., usually located on the human skin, including the face and eyelashes, is a mandatory ectoparasite. The aim of this study was to evaluate the prevalence and factors affecting Demodex spp. in patients with depression. Materials and Methods: In this study, 63 depressed patients and 63 healthy controls were evaluated. To collect samples for analysis, a drop of glue containing cyanoacrylate was put on a lamella and the lamella was pressed on the certain areas of the face (forehead, cheeks, nose, and chin) for about a minute. Then it was carefully removed and the density of Demodex spp. in a cm 2 was counted under a microscope. For the diagnosis, the presence of fve or more Demodex spp. in a cm 2 was considered to be positive. Results: In 23.8% of depressed patients (n=15) and in 9.5% of the control group (n=6), Demodex spp. was detected in the facial area. The presence of Demodex spp. in the facial area of depressed patients was signifcantly higher compared to the control group. When CGI severity scores of patients and the relationship between the severity of depression and the presence of Demodex spp. were compared, no signifcant difference was detected. Conclusion: Depression may be a risk factor for the infection of Demodex parasites because of impaired immune system as well as reduction of self-care and hygiene of the person. For the itchy lesions on the face of depressed patients, Demodex spp. infestation should also be taken into consideration

Orak hücre hastalarında premenstrual sendrom semptomlarının şiddeti- Vaka kontrol çalışması

Objective: Sickle Cell Disease (SCD) patients experience recurrent pain attacks and up to 30% of these become chronic pain. There is known to be a relationship between chronic pain and depression and other psychological problems. Therefore, Sickle Cell Disease patients often experience a series of social and psychiatric problems. The aim of this study to determine the frequency and severity of premenstrual syndrome in women aged ≥18 years with sickle cell disease and to compare these values with healthy women. Methods: This case control study was conducted from January 2018 to March 2018. The data were collected using a questionnaire of 21 items and the Premenstrual Syndrome Scale (PMSS). Statistical analysis was performed using SPSS 21 software. Results: The study included 50 patients aged with 18 years who were diagnosed sickle cell anemia at the University Hospital and control group of 50 subjects have no chronic disease. Premenstrual Syndrome (PMS) according to DSM-5 was determined in 34 (68%) of the case group and 39 (78%) of the control group (p=0,26). Mean depressive effect subscale score was 15.64±6.56 in the sickle cell anemia group while, it was 19.48±6.67 in control group (p=0,05). Conclusions: Although PMS frequency and symptom severity in women with SCD were similar with normal population, the depressive effect subscale scores were lower in SCD group. This results’ cause could be attributed to PMS symptoms being perceived as less severe compared to the pain experienced in sickle cell crises. Keywords: Sickle Cell Disease, Premenstrual Syndrome, Chronic Pain, Depression, Hemoglobinopathies.Amaç: Orak Hücre Hastalığı (OHH)’nda, hastalar tekrarlayan ağrı atakları geçirir ve bunların %30'u kadarında kronik ağrı gelişir. Kronik ağrı ile depresyon ve diğer psikolojik problemler arasında bir ilişki olduğu bilinmektedir. Bu nedenle Orak Hücre Hastalığı hastaları sıklıkla bir dizi sosyal ve psikiyatrik problem yaşayabilirler. Bu çalışmasının amacı; Orak Hücre Hastalığı olan 18 yaş ve üstü kadınlarda premenstrüel sendromun (PMS) sıklığını ve ciddiyetini belirleyerek sağlıklı kadınlarla karşılaştırmaktır. Gereç ve Yöntem: Bir vaka kontrol çalışması olarak Ocak 2018-Mart 2018 arasında yapılmıştır. Veriler 21 maddeden oluşan bir anket formu ve Premenstrüel Sendrom Ölçeği (PMSS) kullanılarak elde edildi. İstatistiksel analiz SPSS 21 yazılımı kullanılarak yapıldı. Bulgular: Çalışmaya üniversite hastanesinde orak hücreli anemi tanısı konan ve 18 yaşından büyük 50 hasta ve kronik hastalığı olmayan 50 kişiden oluşan kontrol grubu dahil edildi. DSM-5'e göre PMS; vaka grubunun 34'ünde (%68) ve kontrol grubunun 39'unda (%78) tespit edildi (p = 0,26). Orak hücreli anemi grubunda ortalama depresif etki alt ölçek skoru 15.64 ± 6.56 iken, kontrol grubunda 19.48 ± 6.67 idi (p = 0,05). Sonuç: OHH'li kadınlarda PMS sıklığı ve semptom şiddeti normal popülasyonla benzer olmasına rağmen, depresif etki alt ölçek puanları SCD grubunda anlamlı olarak daha düşük olmasının nedeni; orak hücre krizlerinde yaşanan ağrıya kıyasla, PMS semptomlarının daha az şiddetli algılanması olabilir

“Post-traumatic stress disorder” in case of a child exposed to multiple sexual abuse

Bu çalışmada farklı zamanlarda ve farklı kişiler tarafından cinsel istismara maruz kalmış bir çocuk olgusu sunularak TSSB'nin hangi eylem sonucunda meydana geldiğinin tartışılması amaçlanmıştır. Olgumuz on dört yaşında bir kız çocuğu, son iki yıl içinde farklı zamanlarda beş farklı kişi tarafından cinsel istismara maruz kalmıştır. Sanıkların yaşları 18 yaş ve üzeri olduğu belirlenmiştir. Öyküsünden anne ve babasının kendisi çok küçük yaştayken ayrıldıkları, annesinin tekrar evlendiği ve ikinci kez boşandığı öğrenilmiştir. Olaylardan sonra olgumuz okulu bırakmıştır ve yaşadıkları ili değiştirmek zorunda kalmıştır. Üç defa intihar teşebbüsünde bulunmuştur. Yapılan psikiyatrik muayenesinde kendisine “posttravmatik stres bozukluğu” tanısı konulmuştur. Çoklu cinsel istismar olgularında hangi olayın ruhsal bozukluğa neden olduğu hususunda kesin bir kanaate varılamayacak olunması TSSB'nin ceza arttırıcı unsur olarak değerlendirilmesini tartışmalı hale getirmektedir. Yargıtay kararı gereğince daha önceki bir olay nedeniyle TSSB tanısı alan bir kişinin ikinci bir eylem sonucunda TSSB'nin söz konusu ağırlaştırıcı unsur olamayacağı hatırlanmalıdır. TSSB ceza arttırıcı bir unsur olarak değil, cinsel istismar eyleminin tıbbi bir delili olarak kabul edilmesi gerekmektedir.In this study, we present a child, who has been exposed to multiple sexual abuse by different people at different times and we aimed to discuss which action is the main reason of post-traumatic stres disorder (PTSD). In our case, a fourteen year old girl has been subjected to sexual abuse by five different people at different times in the last two years. The age of the defendants was determined to be 18 years and over. From her story it was learned that when she was young her mother and father divorced, her mother remarried and divorced again. After the events, our patient left school and had to change her province. She has attempted to commit suicide three times. In the psychiatric examination she was diagnosed with post-traumatic stress disorder. In multiple sexual abuse victims which event caused mental disorders cannot be reached with regard to a definite conviction makes assessment of PTSD as controversial penalty enhancer elements. It must be remembered that in accordance with the Supreme Court decision, second incident of PTSD for a person who has been diagnosed as PTSD due to an earlier incident cannot be said an aggravating factor. PTSD shouldn’t accept as a factor increasing the penalty, should accept as a medical evidence of sexual abuse

Depression and neglect of a girl child due to baby boy pressure of the society

Bu çalışmada; üç tane kız çocuğu olduğu için, toplum ve akrabaları tarafından duygusal baskı gören ve major depresyon gelişen; bu nedenle bilerek kız çocuklarını ihmal eden bir annenin sunulması planlanmıştır. Olgumuz 28 yaşında, ortaokul mezunu ev hanımıdır. Hayattan zevk alamama, halsizlik, isteksizlik, ağlama ve özkıyım düşünceleri nedeniyle polikliniğe başvuran hasta özellikle özkıyım planları ve motor retardasyonun belirgin olması nedeniyle major depresyon tanısı konularak psikiyatri servisine yatırılmıştır. Öyküsünde son depresyon atağının 2 yıl önce gebeyken kontrol için gittiği kadın doğum uzmanın, çocuğunun cinsiyetinin kız olduğunu söylemesi ile başladığı anlaşılmıştır. Eşinin ailesi erkek çocuk istediklerini, bunu başaramadığı için de kendini suçladığını ve o zamandan sonra çocukları ile ilgilenmemeye başladığını söylemiştir. Hamile olduğu dönem ve daha sonraları çocuklarına karşı ilgisinin azaldığını, hasta olsunlar diye soğuk havalarda daha ince giydirdiğini, gece çocuklarının üstünü kasıtlı olarak örtmediğini, hasta olduklarında ilaçlarını bazen hiç vermediğini ve "Keşke kızlarım ölse de ben de erkek çocuk doğursam" şeklinde ifadeler kullanmıştır. Cinsiyet ayrımcılığı, kız çocuklarına gösterilmesi gereken ilgiyi azaltmaktadır. Olgumuz da bu ayrımcılık nedeniyle çocuklarının zarar görmesini istemiş ve erkek bir çocuk doğurma ümidi nedeniyle çocuklarını ihmal etmiştir.In the present study, a condition of a major depressed mother who had three daughters and evidently neglect her daughters because of the pressure by the society and her relatives is presented. Our case is a 28-years old housewife with secondary school degree. She was admitted to our clinic with the symptoms of anhedonia, fatigue, unwillingness, crying and suicidal thoughts. She was hospitalized to psychiatric service with diagnosis of major depression because of the obvious symptoms of suicidal plans and motor retardation. It was understood that the last depression episode was experienced by her two years ago when she learned her child's sex form the gynecologist during her pregnancy. She stated that her husband's family wanted baby boy and blamed herself because she had failed to do so. Then, she started to neglect her girls after that time. She also stated that her care was reduced during her pregnancy and even she started to dress her children finer at cold weather and did not cover them at cold nights and did not give their medications to make them more and more ill. Also, said "I wish my daughters die and I have a baby boy". Sex discrimination reduces the care that should be shown to girls. Our case wanted to harm her children because of the sex discrimination and ignored her daughters with the hope of having a baby boy

The role of active video-accompanied exercises in improvement of the obese state in children : a prospective study from Turkey

Objective: The aim of this study was to determine the effects of active video games and music-accompanied aerobic and callisthenic exercises on body mass index (BMI), body fat ratio, physical performance tests, psychosocial status, and self-respect in overweight and obese adolescents. Methods: Fifty (21 males and 29 females) slightly overweight and obese participants with no chronic disorder and of an average age of 12.16±0.99 years were included in the study. The percentile values for BMI, triceps skinfold thickness, waist circumference measurements, and physical performance tests were evaluated. The effects of obesity on psychological wellness were evaluated using the depression scale for children (DSC) and the Piers-Harris Children's Self-Concept Scale for selfesteem. Following these evaluations, the participants were subjected to an exercise program in five groups of 10 people, 3 days a week for a duration of 8 weeks. Each exercise session lasted 45 minutes. Participants were re-evaluated at the end of the exercise program. The data collected both before and after the exercise program were analyzed using the SPSS 18.0 program. Results: According to BMI reference values, 28% of the 50 participants (n=14; 6 males and 8 females) were assessed to be overweight and 72% to be obese (n=36; 15 males and 21 females). Following the exercise program, 14% of the participants (n=7; 3 males and 4 females) were assessed as normal, 46% (n=23; 14 males and 9 female) as slightly overweight, and 40% (n=20; 4 male and 16 female) as obese. It was determined that the decrease in BMI values (p<0.05) was higher in male participants than in female participants and that the frequency of obesity was higher in the females. A statistically significant decrease in BMI values was found after the exercise program (p<0.01). Following the exercise program, statistically significant differences have also been observed in the self-esteem (p<0.01), psychological wellness (p=0.025), triceps skinfold thickness, as well as in waist circumference and BMI values of the participants compared to the pre-exercise phase (p<0.01). Conclusion: An exercise program applied with active video games was found to have positive effects on the obese state as well as on the psychosocial status and self-esteem of obese individuals, indicating that exercise and physical activity have an important role in improvement of the obese state in childhood as well as having positive contributions to self-esteem and psychological wellness state.Objective: The aim of this study was to determine the effects of active video games and music-accompanied aerobic and callisthenic exercises on body mass index (BMI), body fat ratio, physical performance tests, psychosocial status, and self-respect in overweight and obese adolescents. Methods: Fifty (21 males and 29 females) slightly overweight and obese participants with no chronic disorder and of an average age of 12.16±0.99 years were included in the study. The percentile values for BMI, triceps skinfold thickness, waist circumference measurements, and physical performance tests were evaluated. The effects of obesity on psychological wellness were evaluated using the depression scale for children (DSC) and the Piers-Harris Children's Self-Concept Scale for selfesteem. Following these evaluations, the participants were subjected to an exercise program in five groups of 10 people, 3 days a week for a duration of 8 weeks. Each exercise session lasted 45 minutes. Participants were re-evaluated at the end of the exercise program. The data collected both before and after the exercise program were analyzed using the SPSS 18.0 program. Results: According to BMI reference values, 28% of the 50 participants (n=14; 6 males and 8 females) were assessed to be overweight and 72% to be obese (n=36; 15 males and 21 females). Following the exercise program, 14% of the participants (n=7; 3 males and 4 females) were assessed as normal, 46% (n=23; 14 males and 9 female) as slightly overweight, and 40% (n=20; 4 male and 16 female) as obese. It was determined that the decrease in BMI values (p<0.05) was higher in male participants than in female participants and that the frequency of obesity was higher in the females. A statistically significant decrease in BMI values was found after the exercise program (p<0.01). Following the exercise program, statistically significant differences have also been observed in the self-esteem (p<0.01), psychological wellness (p=0.025), triceps skinfold thickness, as well as in waist circumference and BMI values of the participants compared to the pre-exercise phase (p<0.01). Conclusion: An exercise program applied with active video games was found to have positive effects on the obese state as well as on the psychosocial status and self-esteem of obese individuals, indicating that exercise and physical activity have an important role in improvement of the obese state in childhood as well as having positive contributions to self-esteem and psychological wellness state