2 Türk Psikiyatri Dergisi 2 - Turkish Journal of Psychiatry

Transcription

2 Türk
Psikiyatri Dergisi 2
Turkish Journal of Psychiatry
CİLT | Volume 26
YAZ | Summer 2015
EK | Supplement 1:
ISSN 1300 – 2163
19. YILLIK TOPLANTISI ve KLİNİK EĞİTİM SEMPOZYUMU
ABSTRACTS
TÜRKİYE
SİNİR VE
RUH SAĞLIĞI
DERNEĞİ
2 Türk
Mart, Haziran, Eylül ve Aralık aylarında olmak üzere yılda 4 sayı çıkar
Four issues annually: March, June, September, December
CİLT | Volume 26
YAZ | Summer 2015
EK | Supplement 1
ISSN 1300 – 2163
Türkiye Sinir ve Ruh Sağlığı Derneği
tarafından yayınlanmaktadır.
www.turkpsikiyatri.com
Türk Psikiyatri Dergisi
Türkiye Sinir ve Ruh Sağlığı Derneği adına
Sahibi ve Sorumlu Müdürü
Published by Turkish Association of Nervous and Mental Health
Prof. Dr. M. Orhan Öztürk
Yayın Yönetmeni/ Editor in Chief
Prof. Dr. Aygün Ertuğrul
Yazışma Adresi / Corresponding Address
PK 401, Yenişehir 06442 Ankara
Yönetim Yeri / Editorial Office Kenedi Cad. 98/4, Kavaklıdere, Ankara
Telefon: (0-312) 427 78 22
Faks: (0-312) 427 78 02
Yayın Türü / Publication Category
Yaygın, Süreli, Bilimsel Yayın
Reklam / Advertisements
Reklam koşulları ve diğer ayrıntılar için yayın yönetmeniyle
ilişkiye geçilmesi gerekmektedir.
(Dergide yer alan yazılarda belirtilen görüşlerden yazarlar sorumludur.
Yazılardan kaynak göstererek alıntı yapılabilir.)
(Authors are responsible for the opinions reported in the articles. All rights reserved.)
∞
Bu yayında ISO 9706: 1994 Uluslararası standartlarına uygun olarak asitsiz kağıt
kullanılmıştır.
This publication is printed on acid-free paper that meets the international standart ISO
9706: 1994 (Requirements for permanence)
Bu Sayının Yayın Yönetmeni /Editor in Chief of this Issue
Doç. Dr. Semra Ulusoy Kaymak
Sempozyum Eşbaşkanları
Prof. Dr. Simavi Vahip - Prof. Dr. M. Murat Demet
Düzenleme Kurulu
Prof. Dr. Tamer Aker (MYK)
Doç. Dr. Ömer Böke (BTDK)
Prof. Dr. M. Murat Demet (BTDK)
Doç. Dr. Cüneyt Evren (BTDK)
Prof. Dr. Meram Can Saka (MYK)
Doç. Dr. Semra Ulusoy Kaymak (BTDK)
Doç. Dr. Selim Tümkaya (BTDK)
Prof. Dr. Simavi Vahip (MYK)
Bu Sayının Yayın Yönetmen Yardımcıları /
Assoc. Editors in Chief of this Issue
Dr. Selim Tümkaya
Yayın Hizmetleri / Publishing Services
BAYT Bilimsel Araştırmalar
Basın Yayın ve Tanıtım Ltd. Şti.
Tel (0-312) 431 30 62, Faks: (0-312) 431 36 02
E-posta: [email protected]
Grafik Tasarım / Graphic Design
Mehmet Uluşahin
Baskı / Printing
Miki Matbaacılık San. ve Tic. Ltd.Şti.
Matbaacılar Sitesi 560. Sk., No:27, İvedik, Ankara
Tel. (0-312) 395 21 28
Baskı Tarihi: 10 Ağustos 2015
Ağtasarımı ve Çevrimiçi Yayıncılık Hizmetleri Ada Yazılım Ltd. Şti. tarafından sağlanmaktadır.
Türk Psikiyatri Dergisi’ne gelen bütün yazılar yazarların adları saklı tutularak bağımsız danışmanlarca değerlendirilir.
All manuscripts submitted to the Turkish Journal of Psychiatry are assessed by independent referees anonymously.
TÜRK PSİKİYATRİ DERGİSİ INDEX MEDICUS, TÜBİTAK TIP, PSYCHINFO, TÜRKİYE ATIF DİZİNİ ve SSCI DİZİNLERİNDEDİR.
Turkish Journal of Psychiatry is indexed in INDEX MEDICUS, TUBITAK Medical Index, PSYCH-INFO, TURKIYE CITATION INDEX, and SSCI
ABSTRACTS
A1
TÜRKİYE PSİKİYATRİ DERNEĞİ KURULLARI
2014-2016 YÖNETİM KURULU
Merkez Yönetim Kurulu
Simavi Vahip (Genel Başkan)
Ahmet Tamer Aker (Genel Başkan Yardımcısı)
Mehmet Yumru (Genel Sekreter)
Meram Can Saka (Sayman)
Şahut Duran (Örgütlenme Sekreteri)
Murat Aktepe (Asistan Hekimlik Sekreteri)
Ayşe Gül Yılmaz Özpolat (Eğitim Sekreteri)
Merkez Denetleme Kurulu
Sezai Berber
Gamze Özçürümez
Kazım Yazıcı
Merkez Onur Kurulu
Doğan Yeşilbursa
Nevzat Yüksel
Rukiye Peykan Gençoğlu Gökalp
Hüseyin Soysal
Haldun Soygür
Yeterlik Yürütme Kurulu
Eğitim Programları Geliştirme Altkurulu
Akreditasyon Altkurulu
Mustafa Sercan (Başkan)
Serhat Çıtak (Başkan Yardımcısı)
Leyla Gülseren (Genel Sekreter)
Numan Konuk
Ömer Böke
Feryal Çam Çelikel
Aylin Ertekin Yazıcı
Levet Atik
Ayşe Gül Yılmaz Özpolat
Ömer Böke (Başkan)
Ayşe Devrim Başterzi
Feryal Çam Çelikel
M. Hamid Boztaş
Ozan Pazvantoğlu
Selime Çelik
Gamze Erzin
Mustafa Sercan (Başkan)
Numan Konuk
Serhat Çıtak
Can Cimilli
Berna D. Uluğ
Sibel Örsel
Hüseyin Güleç
Yeterlik Sınav Altkurulu
Yaygın ve Örgün Eğitim Kurulu
Yayıncılık Kurulu
Aylin Ertekin Yazıcı (Başkan)
Leyla Gülseren
Levent Atik
E. Timuçin Oral
Altan Eşsizoğlu
Medine Yazıcı Güleç
Özlem Kuman
Ayşe Devrim Başterzi (Başkan)
Halis Ulaş
Evrim Tellioğlu
Cem Cerit
Koray Başar
Tuğba Özel
Zerrin Oğlağu
Deniz Ceylan
Umut Mert Aksoy
Necip Çapraz (AHK)
Hamid Boztaş (EPGAK)
İ. Tolga Binbay (Başkan)
Ömer Aydemir
Ömer Saatçioğlu
Taner Yılmaz
Adem Bayrakçı
A2
2 Türk
TÜRKİYE
SİNİR VE
RUH SAĞLIĞI
DERNEĞİ
İçindekiler | Contents
CİLT | Volume 26
YAZ | Summer 2015
EK | Supplement 1
19. YILLIK TOPLANTISI ve KLİNİK EĞİTİM SEMPOZYUMU
ABSTRACTS
A5 WELCOME
M. Murat Demet
President of BTDK
Simavi Vahip
President of TPS
A6 SYMPOSIUM ORGANISING COMMITTEES
1 ORAL PRESENTATIONS
9 POSTER PRESENTATIONS
51AUTHOR INDEX
A3
A4
TÜRKİYE
SİNİR VE
RUH SAĞLIĞI
DERNEĞİ
2 Türk
Hoş Geldiniz | Welcome
CİLT | Volume 26
YAZ | Summer 2015
EK | Supplement 1
TPD 19. Yıllık Toplantısı ve Klinik Eğitim Sempozyumu
Değerli meslektaşlarımız,
Türkiye Psikiyatri Derneği 19. Yıllık Toplantısı ve Klinik Eğitim Sempozyumu her yıl olduğu gibi bu yıl da gerek uzmanlar
gerek asistanlar için dopdolu bir eğitim şöleni olarak hazırlanıyor.
Meslektaşlarımızın geribildirimleri ve talepleri dikkate alınarak klinisyene yönelik olarak hazırlanacak onlarca eğitici etkinlik
bizleri bekliyor.
Ağırlıklı olarak Çalışma Birimlerimizden gelecek önerilerle oluşacak bilimsel programda çok çeşitli formatta eğitim etkinlikleri
yer alacak. Kurslar, 10 Soruda Bir Konu, Siz Olsaydınız Ne Yapardınız, Uzmanla Buluşma oturumları, Münazara, Geçen Yılın
En Önemli Araştırmalarından Bilgiler bu etkinliklerin bazıları…
Bu oturumlara ek olarak Sempozyumun niteliğini daha da yükseltecek eğitim etkinlikleri de gerçekleştirilecektir. Bu yıl beşinci
yılına giren sürekli eğitim-sürekli mesleki gelişim dergimiz Psikiyatride Güncel’in yeni sayılarının etkileşimli sunumlarından
oluşan Olgular ve Sorularla Psikiyatride Güncel oturumları, yoğun gereksinim duyulan ve önemli üç konuyu Sempozyum’a
getirecek:
• Cinsel sorunlar ve cinsel işlev bozuklukları
• Anksiyete bozukluklarının tedavisine çok yönlü bakış
• Psikiyatride acil
Zor olgularda tedavi yaklaşımları konunun uzmanları tarafından, olgu örnekleriyle ve etkileşimli oturumlarla Sempozyum’da
olacak. Hem de klinisyenin sık karşılaştığı 4 konuda:
• Bipolar bozukluk tanılı zor olgularda tedavi
• Şizofreni tanılı zor olgularda tedavi
• Depresyon tanılı zor olgularda tedavi
• Alkol ve madde kullanım bozukluğu olan zor olgularda tedavi
Her yıl olduğu gibi bu yıl da TPD Mesleğe İlk Adım Bursu alarak Sempozyuma katılacak genç uzmanlık öğrencilerine Mesleğe
İlk Adım Programı ile gereksinim duyacakları birçok konuda eğitim verilecektir.
TPD Yıllık Toplantısının önemli bir işlevi de Çalışma Birimlerinin üyeleriyle yüz yüze toplantılar yapması ve çeşitli konularda eğitim, araştırma ve diğer birçok konuda planlamaları ortaya çıkarmasıdır. Tüm üyelerimizi ilgi duydukları alanlarda
Çalışma Birimlerine üye olmaya ve Sempozyum sırasında gerçekleştirilecek Çalışma Birimi toplantılarına aktif katılmaya davet
ediyoruz.
Sempozyumda her yıl olduğu gibi “Kongre Destekleme Bursu”, “Araştırma Bildiri Ödülü” ve “Araştırma Projesi Teşvik Ödülü”
gibi olanakların varlığını hatırlatmak isteriz.
Tüm meslektaşlarımızı bir eğitim şöleni olacak TPD 19. Yıllık Toplantısı ve Klinik Eğitim Sempozyumu’nu hep birlikte oluşturmak üzere özellikle Çalışma Birimleri üzerinden önerilerde bulunmaya ve yaratıcılıklarıyla Sempozyum’u zenginleştirmeye
davet ediyoruz.
Muhteşem Efes’in yanı başında Kuşadası’nda 6-9 Mayıs 2015’te buluşmak dileğiyle…
Prof. Dr. Simavi Vahip
Genel Başkan
Türkiye Psikiyatri Derneği
Prof. Dr. M. Murat Demet
Başkan
Bilimsel Toplantılar Düzenleme Kurulu
A5
TPD 19. Yıllık Toplantısı ve Klinik Eğitim Sempozyumu
6-9 Mayıs, 2015
Kuşadası, Pine Bay Hotel, Türkiye
SEMPOZYUM DÜZENLEME KURULLARI
SEMPOZYUM EŞBAŞKANLARI / SYMPOSIUM CO-PRESIDENTS
TPD ÇALIŞMA BİRİMİ KOORDİNATÖRLERİ
Simavi Vahip - M. Murat Demet
Asena Akdemir
Erhan Akıncı
Umut Mert Aksoy
Tunç Alkın
Kürşat Altınbaş
Vesile Altınyazar
Nuray Atasoy
Agah Aydın
Hamdullah Aydın
Işın Baral Kulaksızoğlu
Koray Başar
Ayşe Devrim Başterzi
Sezai Berber
Tolga Binbay
Ali Bozkurt
Feyza Çelik
Ercan Dalbudak
Ayşe Esen Danacı
M. Murat Demet
Ferhan Dereboy
Kerem Doksat
Şahut Duran
Cüneyt Evren
Mehmet Güdük
Bahri İnce
Hira Sema Kalkan
Cem Kaptanoğlu
DÜZENLEME KURULU / SYMPOSIUM COMMITTEE
Ahmet Tamer Aker
Ömer Böke
M. Murat Demet
E. Cüneyt Evren
Meram Can Saka
Selim Tümkaya
Semra Ulusoy Kaymak
Simavi Vahip
BİLİMSEL TOPLANTILAR DÜZENLEME KURULU
M. Murat Demet (Başkan)
Ömer Böke
Cüneyt Evren
Selim Tümkaya
Semra Ulusoy
TPD ŞUBE TEMSİLCİLERİ
Cengiz Akkaya
Ünsal Aydınoğlu
Rabia Bilici
Hamid Boztaş
Murat Fettahlıoğlu
Gülcan Güleç
Taha Karaman
Evrim Özkorumak
Aslıhan Polat
Eser Sağaltıcı
Gökhan Sarısoy
Haldun Soygür
Bülent Sönmez
Mine Şahingöz
Musa Şahpolat
Cem Şengül
Zeliha Tunca
Aziz Yaşan
Neşe Yorguner
Fatma Yurtsever
A6
Hakan Karaş
Burhanettin Kaya
İsmet Kırpınar
Ramazan Konkan
Berna Özata
Osman Özdel
Müjgan Özen
İlker Özyıldırım
Yavuz Selvi
Bengi Semerci
Murat Semiz
Mustafa Sercan
Özen Önen Sertöz
Haldun Soygür
M. Zihni Sungur
Ayşegül Sütçü
Doğan Şahin
Vedat Şar
Lut Tamam
Şükrü Uğuz
Berkant Yelken
Ejder Akgün Yıldırım
Mustafa Yıldız
Taner Yılmaz
Ali Tarık Yılmaz
Mehmet Yumru
Gökşen Yüksel
ORAL PRESENTATIONS
OP01
OP02
EVALUATION OF THE THERAPEUTIC
EFFECTIVENESS OF BRIGHT LIGHT THERAPY IN
BIPOLAR DEPRESSION : RADOMISED, PLACEBO
CONTROLLED STUDY
PSYCHOMETRIC CHARACTERISTICS OF THE
TURKISH VERSION OF THE BERGER HIV STIGMA
SCALE, AND THE RELATIONSHIP BETWEEN
DEPRESSION AND STIGMATISATION OF THE HIVPOSITIVE INDIVIDUALS
Neşe Yorguner, Kaan Kora
O R A L P R E S E N TAT I O N S
ORAL PRESENTATIONS
Marmara University, Faculty of Medicine, Department of Psychiatry,
İstanbul
Mevhibe İrem Yıldız1, Koray Başar2, Özge Karadağ Çaman3,
Ahmet Çağkan İnkaya4
Aim:Bright light therapy, effectiveness of which has been confirmed in
seasonal depression ranks as the first method of treatment while evidence
has been accumulating for its beneficial use in nonseasonal depression.
Different and new approaches are being seeked for the treatment of bipolar
depression with many characteristics similar to that of seasonal depression.
There has not been any investigation in Turkey on the use of the highly
promising bright light therapy on bipolar depression. This study has aimed
at comparing the effects on depression of bright light versus placebo light
added to the existing treatment of bipolar depression.
1
Method: This study has enrolled 32 patients diagnosed with bipolar
depression after consulting the Marmara University, Faculty of Medicine
Psychiatry Policlinics, Pendik TRH. The patients have been randomly
separated into two groups, one group being exposed to bright light (10.000
lux) illumination and the other group to ‘placebo light’ (<500 lux)for 30
minutes in the morning hours for a 2-week duration. Weekly SCID-I and
SIGH-SAD have been employed to assess the diagnosis and the seasonality,
and also weekly MADRS and HAM-D have been used to determine any
changes associated with the treatment.
Results: Although the MADRS depression scores at the outset were not
significantly different between the two groups (Bright Light Group: 31.81,
Placebo Group: 27.5), at the end of the treatment the response ratio of
the Bright Light Group was 81.3%, compared to 18.8% in the Placebo
Light Group (p<.000), indicating a statistically significant change. The most
frequently observed adverse side effect of light treatment was mild headache
attested with comparable incidence in both groups.
Conclusion: It has been concluded that bright light therapy as an added
treatment in the morning hours for bipolar depression is effective and
reliably safe with respect of side effects in comparison to illumination with
placebo light. Further studies of wider scale are needed to support these
data.
References
Musetti L, Del Grande C, Marazziti D et al (2013) Treatment of bipolar
depression. CNS spectr 18(04), 177-187.
Oldham MA, Ciraulo DA (2014) Bright light therapy for depression: A
review of its effects on chronobiology and the autonomic nervous
system. Chronobiol Int 31(3): 305-19.
Key Words: Bipolar depression, bright light therapy
MD, Ankara
Hacettepe University, Faculty of Medicine, Department of Psychiatry,
Ankara
3
Hacettepe University, Institute of Public Health, Ankara
4
Hacettepe University, Faculty of Medicine, Department of Infective
Disease, Ankara
2
Aim: Awareness by the HIV-positive individuals of being ‘’socially
labeled’’ results in failure to use health services effectively and
incompliance with the treatment prescribed, as well as adversely affecting
self respect and increasing the incidence of psychological disorders
headed by depression. There is need for psychometric devices of high
validity and reliability to score the depression for the assessment of the
relation between stigma and depression in order to form protective
strategies. It has been aimed in this study to establish the validity and
reliability of the Turkish version of the Berger HIV Stigma Scale (BHSS)
and investigate the relationship between the level of ‘’labeling’’ and the
symptoms of depression in HIV-positive individuals.
Method: BHSS is a Likert type scale comprising 40 items. In this study
it has been translated to Turkish and then translated back to English and
the final form has been formed by its application to a small group of
health workers experienced in the clinics of HIV to evaluate the power of
each item in measuring the stigma associated with HIV. Patients (n=91)
being observed at the Hacettepe Adult Hospital for HIV infection were
assessed using the BHSS, the Beck Depression Inventory (BDI) and the
Montgomery Asberg Depression Rating Scale (MADRS).
Results: The Cronbach alpha function for the BHSS internal
consistency was 9.29. Construct validity was based on principal
component analysis and principal axis factoring with varimax rotation
yielded 4 factors determining 51,87% of the variance. These factors
were internalized stigma, anxiety on society approach, low self esteem
and anxiety in opening up. A low but statistically significant correlation
was found between the low self esteem factor score and the scores of
BDI and MADRS; and between the total score and the internalized
stigma factor scores of BHSS and the MADRS score (p<0,05). Patients
with depression on the basis of MADRS scoring had a significantly
higher BHSS total and factor scores as compared to those with those
who do not have depression on the MADRS (p< 0,05).
Conclusion : Turkish version of the BHSS was a valid and reliable tool
for measuring the stigmatization level in the HIV-positive patients tested
in this study. There was a low but statistically significant correlation
between level of stigma and the depression scale scores.
References
Berger BE, Ferrans CE, Lashley FR (2001) Measuring stigma in people
with HIV: Psychometric assessment of the HIV stigma scale. Res
Nursing Health, 24: 518–529.
Key Words: Stigma (‘’labelling’’) , depression, validity, reliability , HIV
3
OP03
OP04
VALIDITY AND RELIABILITY STUDY ON THE
REVISED LEIDEN INDEX OF DEPRESSION
SENSITIVITY : PRELIMINARY RESULTS
POST TARUMATIC STRESS SYNDROME IN
CHILDREN SUBJECTED TO SEXUAL ABUSE AND
RESULTS OF PRELIMINARY STUDIES ON THE
HYPOTHLAMIC-PITUITARY-ADRENAL AXIS
Sedat Batmaz1, Sibel Koçbıyık2, Özgür Ahmet Yüncü3
Gaziosmanpaşa University, Faculty of Medicine, Department of
Psychiatry, Tokat
2
Atatürk Training and Research Hospital Psychiatry Clinic, Ankara
3
Ankara Training and Research Hospital Psychiatry Clinic, Ankara
1
Aim: Psychometric scales on depression sensitivity are limited. The
revised Leiden Index of Depression Sensitivity (LIDS) has been
developed for improvements in this respect. This study has aimed to
investigate the validity and the reliability of the Turkish version of LIDS.
Method: In order to establish the Turkish version of LIDS, cross
translations of the text have been checked for equivalence in Turkish and
English by a bilingually competent group, as a first step. Subsequently,
its validity and reliability were tested on 113 volunteers consisting of
healthy individuals and of patients consulting the psychiatry polyclinics
on an outpatient basis.
Results: For assessment of the reliability of the total index, the
Cronbach alpha function was determined to be 0.868, and the material
total correlation functions were found out to vary in the 0.046-0.555
range. In the first half reliability, the alpha was 0.779; and for the
second half of reliability the alpha was 0.825. Principal factor analysis
for construct validity yielded 10 factors, each with an eigenvalue of >1,
which expressed 78,29% of the variance. However, parallel analysis with
the Monte Carlo simulation yielded 6 factors able to explain 63.57%
of the variance. On the combined validity method, the correlation
functions between LIDS total score and (a) the depression subscale
of the Hospital Anxiety Depression Scale (HADS) was r=0.514, (b)
the anxiety subscale of HADS was r=0.709, (c) the total score of the
Revised Dysfunctional Attitudes Scale (DAS-R) was r=0.388), (d) the
‘(need for) approval by others’/’dependency’ subscale of DAS-R was
r=0.427, (e) the ‘perfectionism’ / ‘achievement’ subscale of DAS-R
was r=0.304,and (f ) the Anxiety Sensitivity Index (ASI) was r=0.582.
Independent variables t tests carried out to determine whether or not
LIDS could discriminate between depressive and healthy groups gave
statistically significant results. The multiple linear regression analyses on
the HADS depression subscale score have demonstrated LIDS subscales
of aggression, control, risk avoidance and rumination to be significant
predictors.
Conclusion: It has been demonstrated that the Turkish version of LIDS
has the validity and the reliability to be used for relevant psychometric
investigations.
References
van der Does W (2002) Cognitive reactivity to sad mood: structure and
validity of a new measure. Behav ResTher, 40: 105–120.
Key Words: Depression, sensitivity, validity, reliability, Leiden Index of
Depression Sensitivity
Miraç Barış Usta1, Seher Akbaş1, Özgür Tunçel2
Ondokuz Mayıs University, Faculty of Medicine, Department of Pediatric
and Adolescant Psychiatry, Samsun
2
Ondokuz Mayıs University, Faculty of Medicine, Department of
Biochemistry, Samsun
1
Aim: Studies made in the recent years on child victims of sexual abuse
have yielded evidence that the basal cortisol level may be associated with
the severity of the trauma and that response to treatment can be expected.
Psychotherapy and selective serotonin reuptake inhibitors (SSRIs) have
been emphasized to change the stress response. We have investigated
the differences in the blood cortisol and dehydroepiandrosteronesulphate (DHEA-S) of sexually abused children in post traumatic stress
syndrome (PTSS) and age matched controls. As a primary hypothesis
we have considered on the basis of past studies that the stress may be
associated with the higher DHEA-S levels in the traumatized children;
and, as a secondary hypothesis we have considered that in the PTSS
group the severity of symptoms may be associated with the cortisol and
the DHEA-S/cortisol levels.
Method: Children who have suffered sexual abuse examined and
diagnosed on the DSM-IV criteria with PTSS at the Psychiatry
Polyclinics of the 19 Mayıs University Faculty of Medicine have
been enrolled in this study as volunteers together with their families.
Subsequent to psychometric and psychological evaluation, the DHEA-S
and cortisol levels have been estimated.
Results: All patients were females. The patient and the control group
were matched for age and gender. The mean age of both groups was 15,4
years.; and did not differ in the years of education. The patient group
had significantly higher scores for the Children’s Depression Inventory
(CDI). Their PTSS span was determined as 10,0±4,2 months and the
PTSS scores were summed as 43,3±13,3. A significant difference was
not observed between the basal cortisol levels of the two groups. The
control DHEA-S levels significantly deviated higher and significant
differences from the patient group was observed in DHEA-S levels as
well as the in the cortisol/DHEA-S ratios. Negative correlations were
determined between the PTSS symptoms and the biological indicators,
and between the depressive symptoms and the DHEA-S levels.
Conclusion: We had aimed to find out differences in the
neuroendocrinological criteria between the children in PTSS after
sexual abuse and the age and gender matched controls. Studies on the
HPA axis of children will assist us in the understanding of the effects of
childhood traumas on the neurobiology of normal development.
References
Mouthaan J, Sijbrandij M, Luitse JS et al (2014) The role of acute
cortisol and DHEAS in predicting acute and chronic PTSD
symptoms. Psychoneuroendocrinology, 45: 180-182.
Key Words: PTSS, DHEA, cortisol, childhood trauma
4
OP07
RELATIONSHIP OF THE RGS4 POLYMORPHISM
WITH THE CLINICAL AND NEUROCOGNITIVE
CHARACTERISTICS OF SCHIZOPHRENIA
VALIDITY AND RELIABILITY OF THE ALTERNATIVE
DSM-5 MODEL FOR PERSONALITY DISORDERS
Güneş Şayan Can , Emre Gülsu , Banu Değirmencioğlu ,
Ahmet Topuzoğlu1, Çiğdem Yazıcıoğlu3, Berna Akdede1,
Köksal Alptekin1
1
3
2
Dokuz Eylül University, Faculty of Medicine, Department of Psychiatry,
İzmir
2
Dokuz Eylül University, Instute of Neuroscience, İzmir
3
Dokuz Eylül University, Faculty of Medicine, Department of Medical
Genetics, İzmir
1
Aim: The Regulator of G protein signaling 4 (RGS4) gene polymorphism
is known to contribute to the development of schizophrenia. A
relationship between the SNP1, SNP7 and SNP18 polymorphisms
of the RGS4 gene and the memory functions have been determined.
Another study has demonstrated the relationship of negative symptoms
to SNP4 and SNP18 polymorphisms. The aim of this study was to
investigate the relationship of the clinical and cognitive characteristics
of schizophrenia with RGS4 polymorphisms.
Method: This study enrolled 104 patients diagnosed with schizophrenia
on the DSM-IV criteria. All patients were tested with the Positive and
Negative Symptoms Scale (PANSS) and neurocognitive tests battery.
The patients were divided into 4 groups on the basis of SNP1, 4, 7 ve
18 genotyping assessed by DNA sequence analysis and the four variants
were controlled for the Hardy-Weinberg-equilibrium. Each genotypic
variant with normal distribution was analyzed using the ANOVA test,
while those not displaying normal variation were analyzed with the
Kruskal Wallis test.
Results: Relationship between the SNP1 and SNP7 heterozygote G/A
and the Part A and B scores of the trail making test was observed.
Significant relationships were demonstrated between the SNP1
homozygote AA, SNP4 homozygote GG, SNP7 homozygote AA
and the SNP18 homozygote AA and the PANSS g7 subscale (motor
retardation) scores (p: 0,011; p: 0,013; p: 0,048; and p: 0,003,
respectively). Also, a relationship was found to be present between the
SNP18 homozygote AA and the PANSS n1 subscale(blunt affect) scores
(p: 0,007).
Conclusion: Significant relationships between all SNP genotypic
variants and the PANSS g7 scores, and between SNP18 PANSS n1
subscale were established. A relationship between the SNP1, 7 and the
parts A and B scores of the trail making. However, relationship between
the four RGS4 polymorphisms and the other neurocognitive test scores
was not demonstrable. RGS4 polymorphism may be associated with
motor function and the affective symptoms.
References
So HC, Chen RY, Chen EY et al (2008) An association study of RGS4
polymorphisms with clinical phenotypes of schizophrenia in a
Chinese population. American Journal of Medical Genetics Part B:
Neuropsychiatric Genetics, 147(1), 77-85.
Key Words: Blunt affect, motor function, neurocognitive functions, RGS4
polymorphisms, schizophrenia
Ferhan Dereboy1, Çiğdem Dereboy1, Mehmet Eskin1,
Çiğdem Kırcı Dallıoğlu2
Adnan Menderes University, Faculty of Medicine, Department of
Psychiatry, Aydın
2
Doç.Dr. Mustafa Kalemli Government Hospital, Psychiatry Clinic,
Tavşanlı, Kütahya
1
Aim: Here the aim is to investigate the validity and the reliability in
Turkey of the general diagnostic (American Psychiatric Association,
2013) criteria of the alternative DSM-5 model for personality disorders
(PD).
Method: The study waws carried out with a group of 20 psychiatry
patients who were evaluated on the bases of the diagnostic criteria of the
alternative DSM-5 model and of the DSM-IV-R. The alternative model
and the DSM-IV/5 PD diagnostic status of each participant was debated
in case sessions on the combined opinions of a panel of three experts on
the list of clinical data in hand. The diagnoses made by the panel were
considered as the ‘gold standard’ in the investigations for ‘validity’. For
the purposes of the ‘reliability’, the 20 participants were individually
evaluated by a panel of 4 clinicians on the alternative model criteria.
Agreement levels between the longitudinal rankings were assessed by
using intraclass correlation coefficients (ICC) or the Pearson r, and the
agreement level between the categorical diagnoses was determined with
the intraclass kappa statistics.
Results: The diagnoses made on the A diagnostic criterion of the
alternative model used for determining the severity of personality
pathology agreed very well (k=0.68) with the diagnoses of the panel.
Reliability of the dimensional ranking on the Personality Function Level
Scale (ICC=0.67) and reliability of the categorical decisions related to
the A criterion based on these rankings (k=0.52) were found to be
satisfactory. The reliability of the scores for combined characteristics
associated with combinations of pathological personality characteristics
placed within the B criterion, used to determine the type of personality
disorder in the alternative model, were found to be satisfactory
(ICC=0.60 , close to or above). However, only the PD combined
score among the 6 combined characteristics scores showed correlations
agreeable with the expectations on the DSM-III-R PD olcut scores.
Conclusion: Our results suggest that clinicians using the Turkish
version of the Personal Personality Function Level Scale integrated with
the A diagnostic criterion of the alternative DSM-5 model will be able to
evaluate the severity of personality disorder with validity and reliability.
Our psychometric data on combinations of pathological personality
characteristics described in the B diagnostic criterion of the model
while strongly supporting the validity of the extreme PD combined
characteristics score, support only mildly the validity of the antisocial,
schizotypal and inhibited PD combined scores, but do not support the
validity of the combined scores of obsessive-compulsive and narcissistic
personality disorders. For the time being, the alternative model appears
to be useful for the evaluation of the severity rather than the type of PD.
References
American Psychiatric Association (2013) Diagnostic and Statistical
Manual for Mental Disorders, Fifth Edition. Washington, DC:
American Psychiatric Publishing.
Key Words: Personality disorder, diagnosis, psychometric study
5
OP06
OP08
OP09
EFFECTS OF COGNITIVE TECHNIQUES ON THE
PROCESSING OF VISUAL EMOTIONAL STIMULI
AND THE O.1 HZ HEART RATE VARIABILITY
ANTIPSYCHOTIC POLYCPHARMACY USE IN
SCHIZOPHRENIA OUTPATIENTS
Necati Serkut Bulut, Axel Würz, Mehmet Zihni Sungur
İstanbul
Introduction: Functional imaging methods developed in the recent
years have contributed to the diagnosis of complicated reactions
between the main structures and the neural network activated with
emotional stimuli. This research has also covered the effects of some
of the cognitive techniques, next to those of various psychographs and
psychoactive substances, on emotion regulating processes.
Aim: The aim of this study was to evaluate the effectiveness of the
Heart Rate Variability (HRV) parameter, as a new, cheap and easy to
use method, in the detection of psychophysiological responses related to
emotion regulation; and, to demonstrate the possible action of cognitive
techniques on the emotion regulation processes by using the 0.1 Hz
HRV.
Method: The study was carried out with 30 healthy volunteers
distributed equally to the personality control and cognitive technique
groups. The volunteers were subjected in a laboratory to an experiment
with visual emotional stimuli that consisted of 15 neutral and 15
negative pictures selected from an International affective picture
system (IAPS). The experiment was organized in blocks of 5-minute
demonstrations with the stimuli in a particular block changing every
10 seconds. Increasing spectral power of HRV in 0.1Hz in accordance
with the described experimental pattern was aimed to determine with
sensitivity the reaction given by the autonomous system to the emotional
quality of the picture observed. The control group of volunteers
were asked to look at the pictures without making any mental effort;
while the volunteers in the cognitive distancing group were asked to
observe the pictures from an objective and neutral perspective. The
psychopshysiological data were gathered using galvanic skin response
sensors on the fingers of the volunteers.
Results: 1) In all the volunteers, the 0,1 Hz HRV data were at a higher
level for the negative emotional stimuli compared to the neutral stimuli
(p< 0,01). 2) In the group using the cognitive technique, this relative
increase in response to the negative pictures were significantly higher as
compared to the control group (p<0,05).
Conclusion: 0,1 Hz HRV is a parameter sensitive to emotional
reactions. Cognitive techniques contribute to the effective regulation
of evoked emotions.
References
Koenigsberg HW, Fan J, Oschner KN (2010) Neural correlates of using
distancing to regulate emotional responses to social situations.
Neuropsychologia 48(6), 1813-1822.
Vaschillo EG, Bates M, Vaschillo B ve ark (2008) Heart rate variability
response to alcohol, placebo, and emotional picture cue challenges:
Effects of 0.1-Hz stimulation. Psychophysiology 45(5),847-858.
Key Words : Cognitive, emotion, regulation
Pınar Kızılay, Ahmet Tiryaki, Filiz Civil Arslan
Karadeniz Teknik University, Faculty of Medicine, Department of
Psychiatry, Trabzon
Introduction: Although not recommended by guidelines based on
experience, use of polypharmacy in the treatment of schizophrenia
patients has been increasing. Our study has aimed to assess the incidence
of polypharmacy use among the schizophrenia outpatients together
with the associated factors, in comparison to the use of monotherapy on
the basis of the characteristics of the disease and treatment compliance.
Method: The data of the study were retrieved from the files of the
outpatients followed between January 2009 and December 2014 in
Karadeniz Technical University Psychiatry Department and the Ataköy
RSHH, the two hospitals providing psychiatric health care to the largest
percentage of the patient population in the Trabzon province and the
Eastern Blacksea Region. The patients population studied consisted of
those who met the criteria of the study, had a complete file and had
used the last drug or drugs prescribed for minimally 8 weeks. Patient
files were evaluated on the basis of a file inspection form prepared by
the researchers and based on the American Psychiatry Association (APA)
Practice Guidelines for the Treatment of Patients with Schizophrenia
and the National Association of State Mental Health Program Directors
(NASMHPD) classification of polypharmacy.
Results: The incidence of polypharmacy use among the 183 patients
whose files were studied (118 males and 65 females) was determined
to be 41% (n=75). No significant differences were found between the
polypharmacy and monotherapy groups of patients with respect to the
years of education, age at disease presentation, disease duration, and the
total duration of antipsychotic agent use. Use of atypical antipsychotics
was more frequent in both groups. Use of depot antipsychotics, clozapine
and biperidine was significantly increased in polypharmacy use, which
was applied in a large scale with the same class of antipsychotic agents.
In the polypharmacy group the incidence of flare ups, number of
hospitalizations and the duration of the last hospitalization were
significantly higher in the polypharmacy group. Polypharmacy use was
related to treatment noncompliance.
Conclusion: Antipsychotic polypharmacy is giving rise to increased
adverse side effects, pharmacokinetic interactions, high cost of treatment
and disorganization of patient compliance with the prescribed therapy.
The understanding of the reasons causing the clinicians to resort to
polypharmacy may help prevent the applications not in line with the
rational of empirical approaches in pharmacotherapy which is only
one dimension of the treatments for a multidimensional illness such as
schizophrenia.
References
Barnes TE, Paton C (2011) Antipsychotic Polypharmacy in
Schizophrenia. CNS Drugs, 25: 383-99
Stahl SM, Grady MM (2004) A Critical Review of Atypical Antipsychotic
Utilization: Comparing Monotherapy with Polypharmacy and
Augmentation. Curr Med Chem, 11: 313-27
Key Words: Antipsychotic polypharmacy, outpatients, schizophrenia,
treatment compliance
6
OP11
INVESTIGATION OF THE RELATIONSHIP BETWEEN
THE ATTACHMENT OF PATIENTS CONSULTING
PSYCHIATRY POLYCLINICS TO THEIR SPOUSES
AND COUPLE COMPATIBILITY
WORK ON VALIDITY AND RELIABILITY OF
THE TURKISH VERSION OF THE COGNITION
CHECKLIST: PRELIMINARY RESULTS
Meltem Gündoğan , Gülcan Güleç , Fezan Mutlu ,
Cem Kaptanoğlu1
1
1
2
ESOG University, Faculty of Medicine, Department of Psychiatry,
Eskişehir
2
ESOG University, Faculty of Medicine, Department of Biostatistics and
Medical Informatics, Eskişehir
1
Aim: This study included the 100 patients and their spouses
consecutively consulting the Eskişehir Osmangazi University, Faculty of
Medical, Psychiatry Polyclinics in order to investigate the relationship
between the attachment of the patients to their spouses and their clinical
characteristics as well as their compatibility as couples.
Method: Attachment between the couples was investigated by
means of The Experiences in Close Relationships-Revised (ECR-R)
Questionnaire; and Marriage Compatibility Scale was used for the
couple compatibility. The rest of the psychometric investigations were
carried out using the General Health Questionnaire and the Violence
Questionnaire.
Results: Analyses demonstrated that the social functionality, couple
compatibility and the violence experienced by the individuals varied
according to their attachment style.
Those with the secure attachment style (n:45,%22.5) had better social
functionality, couple compatibility, satisfaction, attachment, emotional
expression, and experienced less emotional and sexual violence. They
had better level of couple compatibility, and the individuals with couple
compatibility displayed less violence. Also, partner satisfaction score of
females among those couples with one or both of the members with secure
attachment style and , among those couples with one member with and
one member without a secure attachment style were higher. The female
scores for concurrence of opinion and emotional expression were higher
among the couples with both members having a secure attachment
style. Our study has shown that females were subjected to more physical
violence than the males; and, especially the females in couples with both
members without a secure attachment style experienced more violence
as compared to couples with only one member with secure attachment
style. Those couples with both members without a secure attachment
style had the longest duration of married life.
Conclusion: Female scores on couple compatibility in couples with
Secure-Secure and Secure-Not Secure attachment styles were higher
compared to that of female scores of couple compatibility in couples
with Not Secure-Not Secure styles of attachment.
References
Selcuk E, Gunaydın G, Sumer N et al (2005) A New Measurement for
the Adult Attachment Dimensions: The Psychometric Evaluation
of the Turkish Version of the Experiences in Close RelationshipsRevised (ECR-R) Questionnaire. Türk Psikoloji Yazıları 8, 1-11.
Key Words: Attachment styles, couple compatibility, violence
Sedat Batmaz1, Özgür Ahmet Yüncü2, Sibel Koçbıyık3
Psychiatry, Tokat
2
3
1
Aim: Availability of psychometric scales evaluating automatic
thoughts in detail are limited. The Cognition Checklist (CCL) had
been developed to determine the automatic thoughts associated with
depression (CCL-D) and anxiety (CCL-A). Our study has aimed to
investigate the validity and reliability of the Turkish version of CCL.
Method: In order to establish the Turkish version of CCL, cross
translations of the text have been checked for equivalence in Turkish and
English by a bilingually competent group, as a first step. Subsequently,
its validity and reliability were tested on 95 volunteers consisting of
healthy individuals and of patients consulting the psychiatry polyclinics
on an outpatient basis.
Results: For assessment of the reliability of the total index, the
Cronbach alpha function was determined to be 0.961, and the materialtotal correlation functions were found out to vary in the 0.542-0.825
range. In the first half reliability, the alpha was 0.928; and for the
second half of reliability the alpha was 0.952. Principal factor analysis
for construct validity yielded 5 factors , each with an eigenvalue of >1,
which expressed 79.71% of the variance. However, parallel analysis with
the Monte Carlo simulation yielded 2 factors, able to explain 63.84%
of the variance. One factor represented the anxiety related thoughts
(CCL-A), and the other the depression related thoughts (CCL-D), the
material loading on these factors varying , respectively, in the ranges of
0.580-0.899 and 0.448-0.863.
On the combined validity method, the correlation functions between
CCL total score and (a) the depression subscale of the Hospital Anxiety
Depression Scale (HADS) was r=0.755, (b) the anxiety subscale of
HADS was r=0.712. , (c) the total score of the Automatic Thoughts
Questionnaire (ATQ) was r=0.757). Similarly, the correlation functions
between the depression subscale (CCL- D) score and the depression
subscale of HADS was r=0.580 and with the HADS total score was
r=0.579. The correlation functions between the anxiety subscale (CCLA) score and the HADS anxiety subscale score was r=0.541. Results of
the independent groups t tests, carried out to demonstrate the capacity
of CCL to discriminate between the healthy and the clinical case groups,
were statistically significant.
Conclusion: It has been demonstrated that the Turkish version of CCL
has the validity and the reliability to be used for relevant psychometric
investigations. .
References
Steer RA, Beck AT, Clark DA et AL (1994) Psychometric Properties
of the Cognition Checklist With Psychiatric Outpatients and
University Students. Psychological Assessment, 6(1): 67-70.
Key words: Anxiety, automatic thoughts, Cognition Checklist on depression
and anxiety, depression, reliability, validity
7
OP10
OP12
DEFENSES IN SOMATISATION AND CONVERSION
DISORDERS AND PERCEON OF SOCIAL SUPPORT
Gökhan Sarısoy, Ömer Faruk Kaçar, Arif Öztürk,
Tuba Yılman, Sema Mor, Deniz Deniz Özturan,
Neslihan Yazıcı, Kübra Gümüş
Psychiatry, Samsun
Aim: The aim of this study was to investigate the defense modes of
patients with somatisation and conversion disorders and the perceived
social support.
Method: The study enrolled 50 patients diagnosed with conversion
disorder on the DSM-IV TR criteria, 40 patients similarly diagnosed
with somatisation disorder and 50 healthy volunteers as controls. The
social support perceived by the two groups of patients was evaluated
using the Multidimensional Scale of Perceived Social Support (MSPSS)
and the groups were compared on the basis of the scores on the MSPSS.
The Defense Style Questionnaire (DSQ) was used to assess the defense
modes of all volunteers and the two groups of patients were compared to
the controls on the basis of the scores on the DSQ. Statistical correlation
analyses were carried out between the scores of the two patients groups
on the subscales of DSQ and the subscales of MSPSS.
Results: The humor scores of mature defenses were lower in both the
conversion disorder and the somatisation disorder groups. The groups
did not differ in the scores on neurotic defenses. Of the immature
defenses, projection scores of the conversion group were higher
compared to the somatisation and control groups. Devaluation scores
of the conversion group were higher compared to the control while
displacement scores of the somatisation group were higher compared to
the conversion group. Somatisation scores were higher in both patients
groups than in the controls. The MSPSS ‘significant other’ scores of the
conversion group were higher than those of the somatisation group.
Correlations were found in the conversion and the somatisation groups
between some subscales of the DSQ and the MSPSS.
Conclusion: There are no reported studies in the literature on the
relationship between defense styles and the perceived social support
in somatisation and conversion disorders. Defensive styles have been
predominantly studies in depressive disorders. Given the results of our
study, defense styles in somatisation and conversion patients may exhibit
differences. And, further, these defensive styles may be associated with
the perceived social support.
References
Bronnec M, Corruble E, Falissard B et al. (2005) Reports on defense
styles in depression. Psychopathology 38: 9-15
Corruble E, Bronnec M, Falissard B et al. (2004) Defense styles in
depressed suicide attempters. Psychiatry Clin Neurosci 58: 285288.
Key Words: Conversion, somatisation, defense style, social support
8
ORAL PRESENTATIONS
POSTER PRESENTATIONS
PP1-01
PP1-02
RETROSPECTIVE EVALUATION OF THE CASES
INVESTIGATED FOR MEDICO-LEGAL REASONS
IN THE ERENKÖY TRAINING AND RESEARCH
HOSPITAL FOR PSCYHOLOGICAL AND
NEUROLOGICAL DISORDERS
DEVELOPMENT OF THE MARITAL RELATIONSHIP
EVALUATION SCALE: VALIDITY AND RELIABILITY
ASSESSMENTS
Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi
Aim: Data are scanty on psychiatric cases with hospital records to be
used for the purposes of developing psychological health policies in our
country. This study has aimed to find out the psychiatric complaints
and diagnoses, the clinical and demographic characteristics of the
patients investigated at our hospital for medico-legal reasons.
Method: The hospital records of 356 patients investigated in the
Erenköy Training and Research Hospital for Psychological and
Neurological Disorders between November 2014 and January 2015 for
medico-legal reasons were retrospectively evaluated.
Results: Of the investigated individuals, 47 (13.2%) were university
graduates while 34 (9.6%) were not literate; 144 (40.4%) were
married, 150 (42.1%) were single, 62 (17.4%) were either divorced
or widowed. The frequency of investigational reasons ranged from
37% for disabilities, 34.6 % for mental stability, 11.2% for mental
health to bear punishment, to 6.2% to assess affected psychological
health. The diagnoses included psychotic disorders (35.1%), mood
disorders (13.8%), dementia (12.9%), while active psychopathology
was not observed in 16%. Disability was confirmed in 78 (59.1%) of
the complaints; 75 (61%) of the complaints were confirmed mental
disorders; 20 (50%) of the referrals were of the age and capacity to
bear punitive measures; and 9 (40.9%) of the complaints had affected
psychological health.
Conclusion: The most frequent reasons given for psychiatric medicolegal investigations were assessment of any disability, of mental stability
and of having the mental capacity and the age required for bearing
responsibility.
References
Ozcanlı T, Ortakoylu L (2011) Medico-legal investigations for the
preparation of legal psychiatric reports. Turkiye Klinikleri Psikiyatri
Ozel Dergisi, 4: 60-6.
Soysal H (2012) Legal Psychiatry Printing Updated; Ozgur Yayınları,
İstanbul
Key Words: Legal Psychiatry, guardianship, punishment bearing
responsibility (capacity)
Forensic Medicine, İstanbul
Ankara University, Faculty of Medicine, Department of Psychiatry,
Ankara
1
2
Aim: The aim of this study was to develop a psychometric scale of
validity and reliability to evaluate marital relationship.
Method: The study has been completed with an experimental population
of 264 (52% female, 48% male) volunteers of 36 years of mean age,
married for at least 1 year, with mean education duration of 13 years,
and not diagnosed with mental retardation or cognitive inability. Four
professionals with expertise on the subject have worked on 600 items
in the order of elimination on the basis of content uncertainty, testmaterial correlation, elimination on the basis of similarity of content
and factor analyses, and thereby resulting in 99 items. Scale validity,
factorial construct validity, similar scales validity and different scales
validity have been assessed. Marital Compatibility Test (MCT) and
Family Evaluation Scale (FES) have been used to test the similar scales
validity; and, the Beck Depression Inventory (BDI) was used for the
different scales validity. The scale reliability was determined by internal
consistency and re-test methods.
Results: Following factor analyses, a 99-item final scale with a 3-factor
construct was obtained. The first construct represented compatibility
in marriage; the second construct represented security, loyalty and
violence, and the third construct consisted of materials with dysphoric
themes; and these 3 factors were given the respective titles of ‘’general
compatibility subscale’’(42 items ), ‘’trust, loyalty-violence subscale’’
(30 items ) and ‘’marital dysphoria subscale’’(27 items ). The scale
was named the Marital Relationship Evaluation Scale’’ (MRES). The
correlation coefficient between MRES and FES was (r=) 0.704; between
MRES and MCT was (r=) 0.775, and with BDI was (r=) 0.548. The
Cronbach Alpha coefficient was 0.974, and the re-test study resulted in
the Pearson Product Moment correlation coefficient of 0.951.
Conclusion: Although psychometric scales of validity and reliability
with accepted applicability to marriage have been developed in Turkey,
necessity for introduction of culturally more specific items have been
indicated. MRES aims to evaluate the quality and the emotional
atmosphere of the marital relationship. The parameters evaluated for
internal consistency have given satisfactory results. The number of items
in the scale can be reduced after future studies to estimate the emotional
atmosphere with greater sensitivity. This scale is important for indicating
the emotional dimension dominating the interactions between couples
and the possible interventions that can be made on them.
References:
Büyükşahin A Brief Definition of the scales that have Turkish reliability
and validity. Türk Psikoloji Dergisi 2004, 19: 129-143.
Erbek E, Beştepe E, Akar H, Eradamlar N, Alpkan RL, Marital
Harmony Düşünen Adam 2005, 18: 39–47.
Key Words: Marriage, marriage evaluation, scale, scale development
11
P O S T E R P R E S E N TAT I O N S
Neslişah Atgüden, Tuğba Göncü, Ayşe Terzi,
Nilüfer Sayılgan, Bülent Kadri Gültekin
İbrahim Söylemez1, Oğuz Erkan Berksun2
PP1-03
PP1-04
A RESPIRATORY SUB-TYPE PANIC DISORDER WITH
NOCTURNAL PANIC ATTACKS: CASE REPORT
LOW SERUM FOLIC ACID LEVELS IN CHILDREN
AND ADOLESCENTS WITH ANXIETY DISORDER: A
CROSS SECTIONAL STUDY
Gizem Aral, Evrim Özkorumak, Filiz Civil Arslan
Psychiatry, Trabzon
Aim: Panic syndromes have been classified in the literature into 5
subtypes, as the respiratory, nocturnal, fearless, cognitive and vestibular
panic disorders. There are studies showing that on the average 30-60%
of panic disorder cases meet the diagnostic criteria of the respiratory
subtype, and that nocturnal panic attacks mostly fall within this class.
Some 44-71% of the patients are reported to experience this type of
attack at least once, and that 30% have repeated nocturnal attacks.
It has been aimed here to draw attention to the core symptoms of
nocturnal panic attacks and thereby to assist future studies on diagnosis
and treatment.
Case: A 53-year old female, primary school graduate, married patient
with 4 children, who had been followed under treatment with
venlafaxine (300mg/day) in our polyclinics over three years for panic
disorder with depressive symptoms, had stopped her medication on
the grounds that her complaints had receded over the last 1.5 years.
She reconsulted our polyclinics for having experienced panic attacks at
daytime with shortness of breath, a feeling of drowning and vertigo, as
well as nocturnal attacks, probably caused by an argument that took
place 1 month previously between her husband and her son. At night,
approximately 1-2 hours after falling asleep she was awakened with
sudden shortness of breath and a feeling of drowning. Evaluation of
her condition by means of the Panic Disorder Severity Scale and Panic
and Agoraphobia Scale gave scorings of 20 and 22, respectively. She was
diagnosed with repeating nocturnal attacks of respiratory panic disorder
and started on 37.5mg/day venlafaxine, the dose being titrated up to
150mg/day. During follow up, significant reduction in the severity and
frequency of the nocturnal attacks were observed.
Discussion: Daytime onset attacks and the nocturnal panic attacks
evolve through different processes. Daytime panic attacks tend to
respond to cognitive behavioural therapy under the effect of cognitive
and psychological factors, whereas nocturnal attacks arise from
stimulatory role of biological factors such as autonomic nervous system
dysfunction and response to pharmacotherapy. The case presented here
has responded to psychopharmacotherapy of appropriate dose after an
adequate duration without needing psychotherapy.
References
Craske MG, Tsao JCI (2005) Assessment and treatment of nocturnal
panic attacks. Sleep Med Rev , 9: 173–184.
Key Words: Respiratory subtype panic disorder, nocturnal panic attacks,
treatment
Sabide Duygu Tunas1, Zeynep Göker1,
Özden Şükran Üneri1, Fatma Karaca Kara2
Ankara Pediatric Hematology and Oncology Training and Research
Hospital, Pediatric Psychiatry Clinic, Ankara
2
Ankara Pediatric Hematology and Oncology Training and Research
Hospital, Biochemistry Department, Ankara
1
Aim: Despite there being numerous studies on the aetiology of
anxiety disorder (AD) , the precise underlying factors are still not well
understood. Low B12 and folic acid levels have been implicated in
depression and explained in terms of increased homocyteine and single
carbon metabolism. Diagnosis of anxiety comorbidity with depression
is frequent but the relationship between serum vitamin B12 and folic
acid levels and anxiety symptoms is not clear. This study has compared
the vitamin B12 and folic acid levels of children with anxiety disorder
to those of healthy controls.
Method: This study has included 40 children (16 male and 24 female)
of normal intelligence diagnosed with AD on the basis of the DSMIV criteria , and did not have another psychopathology comorbid
with the anxiety disorder, together with 40 age and gender matched,
healthy controls (16 males and 24 females). Comparisons were made
on the basis of serum levels of vitamin B12 and folic acid. SPSS 17.0
program was used for statistical evaluations and p<0,005 was accepted
to represent statistical significance.
Results: The most prevalent types of AD disorders in the patient group
were Generalized AD (n=27, 67,5%) and Social AD (n=8, 20%). In
67,52% (n=27) of the patients any comorbidity was not observed, while
32.5% (n=13) had another type of AD. Serum vitamin B12 levels of the
AD and of the control groups were, respectively, 249,3 ± 83,3 pg/ml
vs 272,8 ± 95,9 pg/ml, the difference not being statistically significant
(p=0,245). On the other hand, folic acid levels of the AD and the
control groups were, respectively 8,5±2,2 ng/mL vs 10,4±2,8 ng/mL,
and the difference was statistically significant (p=0,001).
Conclusion: When compared to healthy age matched controls,
detection of lower serum folic acid levels was found to be significant
for this cross section of patients. The study did not evaluate the effect
of diet associated parameters on these results. It is believed that further
studies with a wider scale of investigation and also including estimations
of diet associated parameters will contribute to the understanding of the
aetiological role of vitamin B12 and folic acid in anxiety disorders of
children and adolescents.
References
Black MM (2008) Effects of vitamin B12 and folate deficiency on brain
development in children. Food Nutr Bull, 29 (Suppl. 2): 126-131.
Key Words: Anxiety disorder, child, adolescent, folic acid
12
PP1-05
PP1-08
RELATIONSHIP BETWEEN ANOREXIA NERVOSA
AND VE OBSESSIVE- COMPULSIVE DISORDER:
CASE REPORT
VALIDITY AND RELIABILITY OF THE TURKISH
VERSION OF THE DSM-5 LEVEL 2 ANXIETY SCALE
İstanbul
Aim: Eating disorders, and particularly anorexia nervosa (AN) are
believed to be related to obsessive-compulsive disorder (OCD).
Approximately 25% of AN cases are comorbid with OCD. Bulimia
nervosa, a type of AN with symptoms of over eating and throwing up
to avoid calorie gain, is frequently observed with OCD. This study has
aimed to emphasize the relationship of AN and OCD.
Case: The psychiatric history of the 30-year old married university
graduate consulting us revealed that she had been over concerned with
weight and body image, at the age of 20, endeavoring to reduce her
BMI to 17 in a very short time when she was diagnosed with AN for
the first time and was hospitalized for 2 months with fluoxetine (20
mg/day) therapy until remission. The treatment had been continued
for 1 year without an incidence of relapse. Six years previously her son
had contracted urinary tract infection with a bad prognosis, which
appeared to have triggered obsessions related to contamination fears and
controlling her environment, such as WC maintenance, with intrusive
thoughts of others infecting her son. These obsessions had increased
in severity over time much to the detriment of her functionality. She
was diagnosed with OCD and started with fluoxetine, which had been
beneficial in the past, the dose being titrated from 20mg to 60 mg/
day, while concurrent cognitive behavioural therapy was planned and
initiated.
Discussion: High incidence of AN comorbidity in OCD patients ,
and presence of premorbid compulsive personality traits in AN patients
have been known. Both disorders may present with intrusions and
compulsions. The similarities of the current and the past symptoms of
the presented case indicate that the these disorders can share common
structural and functional variations.
References
Błachno M, Bryńska A et al (2014) The influence of obsessivecompulsive symptoms on the course of anorexia nervosa. Psychiatr
Pol, 48: 429-39.
Błachno M, Bryńska A (2012) Comorbidity and characteristic of
obsessive-compulsive symptoms in anorexia nervosa. Psychiatr Pol,
46(6): 1019-28.
Key Words: Obsessive-compulsive disorder, eating disorders, anorexia
nervosa
Celal Bayar University, Faculty of Medicine, Department of Psychiatry,
Manisa
2
Boylam Psychiatry Hospital, Ankara
1
Aim: This study demonstrates the validity and the reliability of the
Turkish version of Level 2 Anxiety Scale (L2AS-TR) developed to assess
anxiety severity on the basis of DSM-5 criteria.
Method: This research was conducted with inpatients and outpatients
being treated in Celal Bayar University, Faculty of Medicine, Psychiatry
Department Services for different types of anxiety disorder (AD) on
the DSM-5criteria. The diagnoses of the participating AD patients (50)
consisted of panic disorder (14), generalized AD (10), agarophobia (4),
obsessive-compulsive disorder-OCD (4), not otherwise specified AD
(18) and post traumatic stress syndrome-PTSS (1). Also, 100 volunteers
without any psychiatric or physical illnesses were enrolled as the control
group. The Spielberger State-Trait Anxiety Inventory (STAI), the most
widely used self-report inventory, was used for validity assessments.
Reliability analyses included the internal consistency and material-total
score correlation analyses; and validity analyses included exploratory
factor analysis together with correlation analysis with STAI. In order
to estimate the specificity and sensitivity of the scale, ROC (receiver
operating characteristic) analysis was carried out.
Results: Mean age of the participants was 29.0±11.8, consisting of
66% university graduates, 15% high school graduates and 19% primary
school graduates; 60.1% (n=92) of the patient group were females; and
the AD duration was 17.1±9.7. The internal consistency of the L2ASTR was 0.94; and the material-total score correlation coefficient range
was 0.68-0.88, (p<0.0001). KMO (Kaiser-Mayer-Olkin) and Bartlett
tests, carried out to assess the sampling capacity of the L2AS-TR,
resulted in 0.92 and 1.57, respectively, (p<0.0001). A single factor
solution was obtained with an eigen value of 5.24, explaining 74.9%
of the variance. Correlation coefficient with STAI was 0.45 (p<0.0001),
and the area under the ROC curve was 0.76.
Conclusion: The results evince the validity and reliability of L2AS-TR.
References
American Psychiatry Association-APA- (2013) Diagnostic and Statistics
of Mental Disorders (DSM-5) Diagnostic Criteria Guidebook –
Translated by Koroğlu E, Hekimler Yayın Birliği, Ankara.
Phillips KA, Friedman MJ, Stein DJ, Craske M (2010) Special DSM-V
issues on anxiety, obsessive-compulsive spectrum, posttraumatic,
and dissociative disorders (Editorial). Depress Anxiety, 27: 91-92.
Key Words: DSM-5
13
Nilüfer Subaşı, Hikmet Ekin Sönmez
Ecenur Aydın Aşık1, Fikret Poyraz Çökmüş1,
Kadir Aşçıbaşı1, Ahmet Herdem1, Emine Özge Çöldür1,
Talat Sarıkavak1, Deniz Alçı1, Siğnem Öztekin1,
Orkun Aydın1, Kuzeymen Balıkçı1, Serra Yüzeren Başsivri1,
Fatma Akdeniz1, Didem Sücüllüoğlu Dikici1,
Ertuğrul Köroğlu2, Ömer Aydemir1
PP1-09
PP1-10
VERSION OF DSM-5 SPECIFIC PHOBIA SCALE
VERSION OF DSM-5 PANIC DISORDER SCALE
Siğnem Öztekin1, Orkun Aydın1, Kuzeymen Balıkçı1,
Ahmet Herdem1, Fikret Poyraz Çökmüş1,
Didem Sücüllüoğlu Dikici1, Kadir Aşçıbaşı1,
Talat Sarıkavak1, Fatma Akdeniz1, Deniz Alçı1,
E. Özge Çöldür1, Serra Yüzeren Başsivri1,
Ecenur Aydın Aşık1, Ertuğrul Köroğlu2, Ömer Aydemir1
Kuzeymen Balıkçı1, Ahmet Herdem1, Orkun Aydın1,
Siğnem Öztekin1, Fikret Poyraz Çökmüş1,
Didem Sücüllüoğlu Dikici1, Kadir Aşçıbaşı1,
Talat Sarıkavak1, Fatma Akdeniz1, Deniz Alçı1,
E. Özge Çöldür1, Serra Yüzeren Başsivri1,
Ecenur Aydın Aşık1, Ertuğrul Köroğlu2, Ömer Aydemir1
Turkish version of the Specific Phobia Scale (SPS-TR) developed to
assess severity of phobias on the basis of DSM-5 criteria.
Turkish version of Panic Disorder Scale (PDS-TR ) developed to assess
severity of panic disorder on the basis of DSM-5 criteria.
being treated in Celal Bayar University Medical School Psychiatry
Department Services for different types of anxiety disorder (AD)
meeting the DSM-5 criteria. The participating patients (50) with
different types of AD, consisted of panic disorder (14), generalized
anxiety (10), agarophobia (4), obsessive-compulsive disorder (4), not
otherwise specified anxiety disorders (18) and post traumatic stress
syndrome-PTSS (1). Also, 100 volunteers without any psychiatric or
physical illnesses were enrolled as the control group. The Spielberger
State-Trait Anxiety Inventory (STAI), the most widely used self-report
inventory, was used for validity assessments. Reliability analyses included
the internal consistency and material-total score correlation analyses;
and validity analyses included exploratory factor analysis together with
correlation analysis with STAI.
being treated in Celal Bayar University Medical School Psychiatry
Department Services for different types of anxiety disorder (AD) on the
DSM-5 criteria. The specific diagnoses of the participating AD patients
consisted of panic disorder (14), generalized anxiety (10), agoraphobia
(4), obsessive-compulsive disorder (4), not otherwise specified AD (18)
and post traumatic stress syndrome-PTSS (1). Also, 100 volunteers
without any psychiatric or physical illnesses were enrolled as the control
group. The Spielberger State-Trait Anxiety Inventory (STAI), the most
widely used self-report inventory, was used for validity assessments.
Reliability analyses included the internal consistency and material-total
score correlation analyses; and validity analyses included exploratory
factor analysis together with correlation analysis with STAI.
Manisa
2
1
Manisa
2
1
Results: Mean age of the participants was 29.0±11.8’dir, consisting of
school graduates; and 60.1% (n=92) of the patient group were females.
AD duration was 17.1±9.7. The internal consistency of the SPS-TR
was 0.79; and the material-total score correlation coefficients ranged
in 0.33-0.75 (p<0.0001). KMO (Kaiser-Mayer-Olkin) and Bartlett
test results (0.92 and 1.57, respectively; p<0.0001) were calculated to
assess the sampling capacity of the SPS-TR. A single factor solution
was obtained with an eigen value of 5.45, explaining 54.9% of the total
variance. Correlation coefficient with STAI was (r=) 0.36 (p<0.0001),
Results: Mean age of the participants was 29.0±11.8’dir, consisting of
school graduates; 60.1% (n=92) of the patient group were females; and
anxiety duration was 17.1±9.7. The internal consistency of the PDSTR was 0.96; and the material-total score correlation coefficients were
in the range 0.68-0.88 (p<0.0001). KMO (Kaiser-Mayer-Olkin) and
Bartlett test were carried out (0.92 and 1.57, respectively; p<0.0001)
to assess the sampling capacity of the PDS-TR. A single factor solution
was obtained with an eigen value of 7.38, explaining 73.8% of the total
variance. The scale item factorial loading were in the range of 0.73-0.91.
Correlation coefficient with STAI was (r=) 0.32 (p<0.0001).
Conclusion: The results demonstrate the validity and the reliability of
SPS-TR.
Conclusion: The presented results have demonstrated the validity and
the reliability of PDS-TR.
References
issues on anxiety, obsessive-compulsive spectrum, posttraumatic,
References
issues on anxiety, obsessive- compulsive spectrum, posttraumatic,
Key Words: DSM-5, specific phobia, anxiety, validity, reliability
Key Words: DSM-5
14
PP1-11
PP1-13
STUDY ON THE VALIDITY AND RELIABILITY OF
THE SHORT FORM OF SOCIAL PHOBIA SCALE
STUDY ON THE VALIDITY AND RELIABILITY OF
THE TURKISH VERSION OF THE CHECKLIST OF
COGNITIVE DISTORTIONS: PRELIMINARY RESULTS
Çankırı Government Hospital, Çankırı
2
Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital,
Psychiatry Clinic, Ankara
3
Başkent University, Faculty of Medicine, Department of Psychiatry,
Ankara
4
Bülent Ecevit University, Faculty of Medicine, Department of Psychiatry,
Zonguldak
1
Aim: Social phobia (SP) is recognized as a specific type of fear or anxiety
experienced when facing social situations with exposure to investigation
and/or judgment by other people. Although treatable, incidence of
appropriate diagnosis is not commensurate with the incidence of SP.
This insufficiency arises from many factors including the difficulty of
recognizing and discriminating the symptoms of SP. The aim of this
study was to test the validity and the reliability of the Turkish version
of the Short Form of Social Phobia Scale (SFSPS-TR) in a sample of
Turkish population.
Method: The SFSPS was translated to English, then translated back to
Turkish by three competent linguists and subsequently was tried on a
group of 55 patients diagnosed with SP. Statistical evaluations included
the internal consistency analysis, similar scale correlation analysis
(using the Libeowitz Social Anxiety Scale-LSAS), and construct validity
assessment with KMO and Bartlett tests, followed by exploratory factor
analyses.
Results: SFSPS-TR displayed adequate internal consistency with
a Cronbach alpha coefficient of 0,87. Factor analysis gave a 5-factor
solution, consisting of reaction with significant other (F1), social
unacceptability (F2), being observed by others (F3), physical appearance
(F4) and performance (F5), which together explain 71.4% of the
variance. Significant correlation was obtained between the scores on
SFSPS-TR and the LSAS.
Conclusion: Psychometric scales are necessary tools in the recognition
and severity ranking of illnesses. Availability of a reliable scale for
the diagnosis of a condition as difficult as SP is important. Although
scales are available to test SP, they are self-report tests with a rather
long application time. The SFSPS is a valuable tool completed by the
clinician. The study reported here has proven that it has the validity and
the reliability to be used in the Turkish population.
References
Davidson JRT, Potts NLS, Richichi EA et al (1991) The Brief Social
Phobia Scale. J Clin Psychiatry, 52: 48-51.
Zimmerman M, Chelminski I (2003) Clinician recognition of anxiety
disorders in depressed outpatients. J Psychiatry Res, 37(4): 325-333
Sedat Batmaz1, Sibel Koçbıyık2, Özgür Ahmet Yüncü3
Psychiatry, Tokat
2
3
1
Aim: There are a limited number of psychometric scales for the
systematic evaluation of cognitive distortions. The Checklist of
Cognitive Distortions List (CCDL) has been developed to identify
cognitive distortions. This study has aimed to assess the validity and the
reliability of the Turkish version of CCDL.
Method: In order to structure the CCDL-TR, the original CCDL was
first translated to Turkish and then back to its original language, and
the language equivalence was checked by a group of qualified linguists.
Subsequently, the validity and reliability of CCDL-TR was tested on a
group of 115 volunteers consisting of healthy controls and outpatients
being followed up at psychiatry polyclinics.
Results: Reliability testing yielded a Cronbach alpha coefficient of 0.923
and the material-total correlation coefficients were found to vary in the
0.470-0.769 range. The alpha value for the first half and the second half
of the reliability were 0.857 and 0.874, respectively. The correlation
between CCDL-TR total score and the Hospital Anxiety- Depression
Scale depression subscale (HADS-D) score was (r=)0.341; and between
CCDL-TR total score and the HADS anxiety subscale score (HADS-A)
score r= 0.550 . Similarly, the correlation coefficient between CCDL-TR
total score and the Cognitive Distortions Scale (CDS) total score was (r=)
0.460, and between CCDL-TR total score and the interpersonal subscale
score of CDS r= 0.442. Factor analysis to test the construct validity yielded
3-factors, explaining 66.29% of the variance, and each with an eigen
value >1; which, however, using the parallel analysis intermediated by the
Monte Carlo simulation reduced to a single factor explaining 49.24%
of the variance. The material loading on this factor varied in the range
0.528-0.809. Results of the independent groups t test, to determine if
CCDL-TR discriminated depressive groups from nondepressive groups,
was statistically significant. ROC analysis results indicated that the
depression cut off point for CCDL-TR was 22.50, with the area under
the ROC curve = 0.677, sensitivity = 63.1% and specificity =76.7%.
Conclusion: The results have indicated that CDDl-TR can be used
with validity and reliability.
References
de Oliveira IR (2015) Trial-based cognitive therapy: a manual for
clinicians. Routledge, p. 25-40.
Key Words: Anxiety, cognitive distortion, checklist of cognitive distortions,
depression, validity, reliability
Key Words: Clinical evaluation, scale, social phobia
PP1-14
COGNITIVE BEHAVIOURAL THERAPY FOR THE
PATIENT WITH SOCIAL PHOBIA AND VOMITING
PHOBIA : CASE PRESENTATION
Saliha Yalçın Gümüş
Gazi University, Faculty of Medicine, Department of Psychiatry, Ankara
Aim: This report aims to discuss the use of cognitive behavioural
therapy for a patient with social phobia and vomiting phobia
15
Gül Ferda Ş. Cengiz1, Yasir Şafak2, Kadir Özdel2,
Güler Alpaslan3, Erkan Kuru2, İlker Özdemir2, Sibel Örsel4
Case: A 16-year old female patient with complaints consisting of ‘’not
being able to talk after raising a hand in the class room and, to eat in
public, to ask for help in a shop, and not eating for fear of vomiting’’
was assigned with a 9-session cognitive behavioural therapy program,
consisting of 1 session per week. The rationale behind the exposure
was explained to the patient and behavioural tasks were planned from
a list of avoidance behaviours. Exposure to the planned situations in
the sessions resulted in reduction of the patient’s complaints with the
disappearance of her abstentions.
Discussion: Vomiting phobia is a poorly understood disorder seen in
6-7% of female patients. The case presented here had a comorbid social
phobia as well, both of which were effectively relieved by the use of
cognitive behavioural techniques.
References
Maack DJ, Deacon BJ, Zhao M (2013) Exposure therapy for
emetophobia: a case study with three-year follow-up. J Anxiety
Disord, 27: 527-34.
van Hout WJ1, Bouman TK (2012) Clinical features, prevalence and
psychiatric complaints in subjects with fear of vomiting. Clin
Psychol Psychother, 19: 531-9.
Keywords: Social phobia, vomiting phobia, cognitive behavioral therapy
PP1-15
COGNITIVE BEHAVIOURAL THERAPY FOR BODY
IMAGE DISORDER: CASE PRESENTATION
Mehmet Sinan Aydın, Murat Semiz, Murat Gülsün
Gülhane Military Medical Academia, Department of Psychiatry, Ankara
Aim: Body Image Disorder (BID) is the condition associated with
the imagination of a non-existing physical fault or the exaggerated
perception of a minor fault. Although it frequently involves visible
features such as the face, hair and the nose, it may rarely include the
genital organs. First choice of treatment has been the use of serotonin
uptake inhibitors (SSRIs), found to be effective in 60% of the cases.
This report is about the management of BID with cognitive behavioural
techniques (CBT) in lieu of pharmacotherapy.
Case: The 27-year old male patient has fostered from the years of
adolescence the worries that his penis was too short and he would
not be able to satisfy his female partners, as a result of which his
functionality had decreased. He had been using different medications
such as fluoxetine, sertraline and paroxetine. He was diagnosed on the
DSM criteria with BID , and as his history indicated that he had not
benefited from drug therapy, it was decided to use a 5-session CBT
in addition to his current medication. Before CBT, his test scores on
the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the Beck
Anxiety Inventory (BAI) were, respectively, 33 and 40. After CBT these
scores were reduced to , respectively, 21 and 22.
Discussion: According to the reports in the literature, some 40% of the
BID patients do not benefit from phamacotherapy and some cases do
not respond at all. The available alternatives include electro-convulsive
therapy (ECT) and the trans-cranial stimulation. There are some
reports that CBT has been effective in the treatment of BID, and the
case reported here confirms the reports that CBT is an effective choice
in the treatment of BID.
16
References
Aslan H (2000) Body Dysmorphia Disorder: A review. Duşunen Adam,
13: 33-41.
Ray PC (2012) Body Dysmorphia Disorder. Psikiyatride Guncel
Yaklaşımlar, 4: 547-565.
Key Words: Body image disorder, cognitive behavioural therapy, serotonin
reuptake inhibitors
PP1-16
PROLONGED EXPOSURE THERAPY FOR POST
TRAUMATIC STRESS SYNDROME AFTER SEXUAL
ASSAULT: CASE PRESENTATION
Nihan Coşkun, Aslıhan Dönmez
Aim: The aim of this report is to show on a case of post traumatic stress
syndrome (PTSS) the effectiveness of the clinical practice of prolonged
exposure therapy (PET) as a treatment for PTSS .
Case: The patient , a 26-year old female who had attempted suicide by
hanging, has been under observation for chronic PTSS and depressive
disorder in our psychiatry services, while undergoing a 3-month PET.
The patient, when 18 years of age, had been kidnapped and held captive
for one week when she suffered physical and sexual violence. Further,
she also had to marry her kidnapper. She has experienced from then
onwards unhappiness, pessimism, cheerlessness, nervousness, insomnia,
persistent recalling of the event, avoidance of certain situations and
objects, and symptoms of sudden startle. In the initial sessions of CBT
she was given psychoeducation with the explanations of the rationale
of the planned exposure and breathing exercises. Afterwards, she was
prepared with intrasession exposures and completion of the avoidance
hierarchy. Finally the intersession exposures were started. Following each
exposure, feelings and thoughts were discussed, together with the use of
techniques of normalizing, encouragement, evoking hope and security.
It was observed during this period that her avoidances decreased ,
her discomfort and problems with her traumatic experience and the
associated situations regressed and her scoring in PTSS tests decreased.
Discussion: PET is based on the cognitive behavioural theory and
its effectiveness on PTSS after sexual assault has been proven. The
aim of the planned PET is to expose the patient to the images of the
memory on the trauma (symbolic exposure), and to situations or objects
related to the trauma (in vivo exposure) so as to ease working on the
traumatized unprocessed memory and to reduce the problems and
avoidance associated with the trauma. In this case, systematic exposure
has significantly reduced the patient’s symptoms and the improved
condition has continued beyond the 3-month therapy.
References
Foa E, Hembree E, Rothbaum BO (2007) Prolonged exposure therapy
for PTSD: Emotional processing of traumatic experiences therapist
guide. Oxford University Press
Powers MB, Halpern JM, Ferenschak MP, Gillihan SJ, & Foa EB (2010)
A meta-analytic review of prolonged exposure for posttraumatic
stress disorder. Clinical psychology review, 30: 635-641.
Keywords: Cognitive behavioural therapy, posttraumatic stress disorder,
prolonged exposure
RELATIONSHIP BETWEEN THE PERCEIVED SOCIAL
SUPPORT BY TRANS MEN AND THE SELF- ESTEEM
AND DEPRESSION SYMPTOMS OF INDIVIDUALS
Arda Bağcaz, Koray Başar
Ankara
Aim: Individuals with gender dysphoria express that the social support
they receive is less than that given to other individuals of the same age
and gender. Low social support is associated with increased psychological
symptoms and self-harm behaviour in the trans men. This study has
aimed at investigating the relationship of the social support received by
trans men and the levels of individual self-esteem and depression.
Method: This study included 75 trans men, without diagnoses of any
psychological disorder, evaluated at the Hacettepe University Medical
School Psychiatry Clinic between January 2012 and December 2014.
These individuals were tested with the Multidimensional Scale of
Perceived Social Support (MSPSS); the Rosenberg Self-Esteem Scale
(RSES) and the Beck Depression Inventory (BDI).
Results: The mean total scores of the scales were 71 for MSPSS
(IQR:16), 0.75 for RSES (IQR:1) and 6 for BDI (IQR:10,5). A
significant negative correlation was determined between the total
scores of MSPSS and those of RSES (r: -0,279; p:0,016) and of BDI
(r: -0,332; p:0,006). When investigated, the scores on the family,
friend and special relationships subscale of MSPSS did not show any
significant correlation with the scores on RSES and BDI.
Conclusion: Being given a high level of social support is associated
with high self-esteem and low depression symptoms among trans men.
Investigation of the social support sources of trans men and intervention
to develop these as necessary, will be an important step in improving
their psychological health.
References
Claes L, Bouman WP, Witcomb G ve ark (2015) Non-suicidal self
injury in trans people: associations with psychological symptoms,
victimization, interpersonal functioning, and perceived social
support. J Sex Med, 12: 168-79
Davey A, Bouman WP, Arcelus J ve ark (2014) Social support and
psychological well-being in gender dysphoria: a comparison of
patients with matched controls. J Sex Med, 11: 2976-85.
Key Words: Depression, social support, transgender
of the perceived social support from friends and family on the life quality
and the effects of acceptance of the gender identity by friends and family
on the perceived social support and the quality of life. Prejudice and
discrimination developed against the trans individuals lead to mood and
anxiety disorders, alcohol-substance abuse and the risks of suicide.
Method: This investigation with cross sectional planning, reached
through snowball sampling, 45 trans individuals either members of
or liaised with the LGBTI (lesbian, gay, bisexual, trans, intersexual)
association. The participants were asked to complete a 62-item
questionnaire comprising demographic and socio-economical details;
presence of a shared emotional companionship; the scale of acceptance
of the gender identity by the family and the social environment; the
Multidimensional Scale of Perceived Social Support (MSPSS), and (to
assess the quality of life) the The World Health Organization Quality of
Life (WHOQOL-BREF.)
Results: A significant positive correlation has been found between the
family support scores of MSPSS and the level of social support received
from the mother (p<0.001), and from sisters/brothers (p<0.01) , as well
as with the total score of the questionnaire (p<0.05). Total MSPSS and
WHOQOL-BREF scores also gave a significant positive correlation.
Conclusion: This research has shown that acceptance of gender identity
and the perceived social support from family and environment affect
positively the quality of life of the trans individuals. This should be
taken into consideration by psychological health professionals. Also,
family members of the individuals with complaints on gender identity
and sexual orientation should be involved in supportive and educative
interviews. Playing the role of a rights defender next to that of a
physician is expected to increase the public social support for the trans
individuals and improve their life quality.
References
Lombardi E, Bettcher T Lesbian, Gay, Bisexual and Transgender/
Transsexual Individuals. Levy BS, Sidel VW. Social Injustice and
Public Health. Oxford University Press, New York 2006, 130-144
Wold Health Organization. WHOQOL Measuring Quality Of Life:
Program on Mental Health, 1997.01 Jan. 2015’de (http://www.
who.int/mental_health/media/68.pdf )
Key Words: Gender identity, social support, quality of life, trans
PP1-19
PAINFUL EJACULATION AFTER DULOXETINE: CASE
PRESENTATION
Zeynep Ezgi Bal, Hasan Belli
PP1-18
INVESTIGATION OF THE PERCEIVED SOCIAL
SUPPORT, ACCEPTANCE OF GENDER IDENTITY
AND QUALITY OF LIFE AMONG TRANS
INDIVIDUALS - (AS PSYCHOLOGICAL HEALTH
PROFESSIONAL AS DEFENDER OF RIGHTS)
Ardıl Bayram Şahin1, Nilgül Yalçınoğlu2, Nazan Aydın1
Bakırköy Prof. Dr. Mazhar Osman Psychiatry Training and Research
Hospital, Psychiatry Clinic,İstanbul
2
Ministry of Health, Provincial Health Directorate, Department of Public
Health, Denizli
1
Aim: We have aimed to investigate among trans individuals, who are
excluded, branded and discriminated against by the society, the effects
Bağcılar Training and Research Hospital, Psychiaty Clinic, İstanbul
Aim: Duloxetine, acting by inhibiting serotonin and noradrenaline
reuptake, is widely used as an antidepressant for the treatment of major
depressive disorder, generalized anxiety disorder and diabetic peripheral
neuropathic pain. Painful ejaculation is a rare side effect experienced
especially with the use of new antidepressant agents. There have been
complaints in the past with the tricyclic antidepressants (TCAs), selective
serotonin reuptake inhibitors (SSRIs), venlafaxine and monoamine
oxidase inhibitors (MAOs). This report has aimed to discuss a case on
painful ejaculation after duloxetine treatment for depression.
Case: Male, 49-year old patient who consulted our polyclinics with
complaints of inability to enjoy life, pessimism, being out of humor,
disinclination and insomnia. Since he had partly responded to
escitalopram (20 mg/day) in his previous depressive episode, he was
put on duloxetine (30 mg/day titrated to 60 mg/day). At follow up
17
PP1-17
he complained of painful ejaculation with sensation of stabbing and
intense burning at the root of the penis, which started before ejaculation
and lasted till ejaculation was over, when the penis was softened. This
experience caused him to refrain from sexual intercourse. He had
had normal sexual functions when he was not depressive. Duloxetine
treatment was discontinued and he was referred to urology services where
physical examination and laboratory investigations did not indicate any
pathology. His complaint disappeared after ceasing duloxetine therapy.
He was put on sertraline (50mg/day). He did not report any adverse
side effects on his sexual functions at follow up.
Discussion: Painful ejaculation is a very rare side effect of the new
antidepressants, although it had often been met in the past with the
use of TCAs, MAOs, SSRIs and venlafaxine. Two hypotheses have been
proposed to explain the physiology of painful ejaculation, which is still
not well understood. The first hypothesis argues that it is due to the
partial blockage of the peripheral adrenergic receptors, accounting for
the action mechanisms of the TCAs; whereas the second argues it to be
due to noradrenaline potentiation which accounts for the action of the
TCAs, reboxetine and the dual reuptake inhibitor venlafaxine. There
has not been any previously recorded complaint of painful ejaculation
due to duloxetine. During clinical examination, it is necessary to query
all possible adverse effects of the type of therapy given, which might be
embarrassing to the patient, in order to search for alternative treatments.
Refrences
Michael A (2000) Venlafaxine-induced painful ejaculation. Br J
Psychiatry, 177: 282.
Petrie WM (1980) Sexual effects of antidepressants and psychomotor
stimulant drugs. Mod Probl Pharmacopsychiatry, 15: 77-90.
Key Words: Pain, sexual function, duloxetine, ejaculation
PP1-21
DISSOCIATION AS A SYMPTOM OF ANXIETY: CASE
PRESENTATION
Irmak Polat Nazlı, Hayriye Elbi, Şebnem Pırıldar
Ege University, Faculty of Medicine, Department of Psychiatry, İzmir
Aim: Dissociative disorders are characterized by disruptions in the
integration of cognition, memory, identity, emotion, perception, body
image, motor control and behaviour, and decrease or loss in awareness
related to feelings and thoughts. This report has aimed to present a case
of sub-post traumatic stress syndrome (sub-PTSS) with dissociative
symptoms in situations evoking anxiety.
Case: The 27-year old female patient consulted us with the complaint
of ‘’not being able to remember her past and recognize people’’. For
example, 2 days previously, she had failed to recognize her husband for
a while; and, she had passed out after a meeting at work place and failed
to recognize the people and the premises upon gaining consciousness.
She had been referred to us after elimination of any organic pathology.
She had a 2.5-year history of this amnesia episodes and had become lost
frequently over the previous 1 month. It was explained by others that
one evening she had shaken bodily to and fro, with the fear of thunder
sounds, and had raved about earthquakes. It was learned that during
the event of the major earthquake on 17 August 1999 in Western
Turkey, she had been in İzmit (an epicenter) and had remained under
rubble for a period, experiencing insomnia thereafter for 1.5 years. In
2011, when having fiscal problems, she was seen to wet her pants, and
behave childishly, drawing close to her mother. She exhibited decreased
psychomotor activity, childish manners, attention deficit, selective
memory loss in response to events and individuals, blunt affect and la
18
belle indifference. Her family history was also chaotic. Her mother had
a history of depression diagnoses, panic disorder and suicidal attempt;
and her father’s history included panic disorder, depression and alcohol
dependency. She was started on alprazolam (0.75mg) and followed up
closely. She had no psychological symptoms at the end of 1.5 months
of treatment.
Discussion: Dissociative symptoms can be seen in many psychiatry
patients. Although the past trauma of the patient had not affected her
life and functionality, apart from her sleep disorder, stressful situations
faced years later induced amnesia, regression and somatic symptoms.
Events specific to PTSS also constitute risks of depression and anxiety
disorders. In such patients the possible effects of traumas need to be
investigated.
Refrences
Bersani G, Moscariello MA, Bersani FS ve ark (2014) Dissociative
symptoms in female patients with mood and anxiety disorders: a
psychopathological and temperamental investigation. Eur Rev Med
Pharmacol Sci,18: 3217-22
Şar V, Akyuz G, Doğan O (2007) Prevalence of dissociative disorders
among women in the general population. Psychiatry Res,149: 169–
76
Key Words: Dissociation, anxiety, post traumatic stress syndrome
PP1-22
TREATMENT OF A VAGINISMUS CASE BY
EYE MOVEMENT DESENSITISATION AND
REPROCESSING (EMDR)
Onur Okan Demirci1, Abdullah Yıldırım2, Eser Sağaltıcı3,
Berna Ermiş3
Bitlis-Tatvan Government Hospital, Psychiatry Clinic, Tatvan/Bitlis
Van Yüzüncü Yıl University, Faculty of Medicine, Department of
Psychiatry, Van
3
Bitlis Government Hospital, Psychiatry Clinic, Bitlis
1
2
Aim: Vaginismus can be summarized as inability to permit penetration
of the vagina despite desiring it, anticipation or experience of pain,
involuntary pelvic contractions, and phobic abstention from intercourse.
We have aimed to discuss the election EMDR as a treatment mode for a
case of vaginismus accompanied with traumatic experiences.
Case: The patient G.Y. was a 19-year old, primary school graduate
housewife, married for 8 months, who consulted our polyclinics with
the complaint of not being able to enter sexual intercourse. She had
been referred to us after examination by a consultant gynaecologist.
Detailed psychological examination revealed that as a 15-year old she
had been misinformed and scared by her mother and her aunt about
sexual functionality, which was recalled by her whenever she thought
of sexual intercourse and experienced deep anxiety. As the traumatic
experience had been in-built, the patient was subjected to an 8-session
structured standard EMDR protocol. The patient responded quickly
and at the end of the second session the SUD level was 0 and the VOC
level was 7, when she was successfully desensitized and reprocessed.
Since the patient stated that she was ready to enter sexual intercourse at
the end of the second session, this was allowed and the EMDR process
was ended. At the subsequent follow up and also at the 6th- month
control, it was learned that there had not been any problems.
Discussion: Effectiveness of EMDR in treating specific phobias, many
anxiety disorders and dissociative disorders accompanying PTSS have
Conclusion: It should be remembered that traumatic experiences may
occur even during getting informed on sexual functionality, which can
be effectively treated by EMDR.
Key Words: Sexual function disorders, EMDR, vaginismus
PP1-24
POST TRAUMATIC STRESS SYNDROME TREATED
WITH EYE MOVEMENT DESENSITISATION
AND REPROCESSING (EMDR) AND
PHARMACOTHERAPY: CASE PRESENTATION
Mehmet Celal Kefeli, Abdullah Yıldırım, Hülya Çeçen,
Osman Özdemir
PP1-23
Psychiatry, Van
TREATMENT WITH EYE MOVEMENT
DESENSITISATION AND REPROCESSING (EMDR)
OF MALE HYPOACTIVE SEXUAL DESIRE DISORDER
DUE TO SEXUAL TRAUMA
Aim: Post traumatic stress syndrome (PTSS) is a disorder with high
incidence of morbidity and can gain chronicity. The relationship between
the trauma and the psychosis elements have not been fully explained.
The report here discusses the introduction of EMDR to the treatment
of a hospitalized PTSS patient treated for the psychosis element which
did not satisfactorily respond to high dose pharmacotherapy.
Berna Ermiş1, Onur Okan Demirci2, Eser Sağaltıcı1,
Abdullah Yıldırım3
Bitlis Government Hospital, Psychiatry Clinic,Bitlis
Bitlis Tatvan Government Hospital, Psychiatry Clinic,Tatvan
3
Psychiatry, Van
1
2
Aim: Hypoactive sexual desire disorder (HSDD) is described as reduced
sexual desire, paucity or lack of sexual thoughts and fantasies, inadequacy
of any motivation to start, join or respond to any sexual activity. It is
believed that HSD arises from a multidimensional, multidisciplinary
and interactive mesh of cultural, behavioural and clinical factors. The
report here has aimed to present a case of male MSDD treated with Eye
Movement Desensitisation and Reprocessing (EMDR) method.
Case: The patient A., a 26-year old unmarried male employee, consulted
our urology polyclinics with complaint of reduced sexual desire. After
the elimination of any organic pathology, he had been referred to the
psychiatry polyclinics. Detailed history taking revealed that the patient
had been sexually assaulted by his second degree relations at the ages of
5 and 9. The traumatic experiences were thought to be the underlying
cause of his complaint and treatment with EMDR was elected. His
positive and negative cognitions were determined; and, the degrees to
which the positive cognitions convinced him were scored (VoC-Validity
of Cognition). The uncovered emotions and the disturbance (SUD)
given by these were evaluated. At the end of 2 sessions of EMDR, the
SUD level was reduced to 0, and the VoC level was increased to 7; and,
at the same time the lack of sexual desire regressed. The patient was
married 4 months after starting the follow ups and there was no relapse
at the first year controls.
Case: S.M., was a 28-year old male, single patient of Afghan origins.
In 2003, a bomb hitting his house killed his parents and his 6 siblings,
causing him to attempt suicide in the following 2 months. He had been
admitted to a psychiatry clinic in Iran and had settled in the city of Van,
in Turkey, after his discharge. He consulted a health center in Van with
complaints of frequent recall of the trauma, hallucinations, fright at the
slightest sound, not watching TV to avoid events similar to those in his
past, absent mindedness, amnesia, and complete internalization during
the previous 6 months. He was diagnosed with nonorganic psychosis and
treated with high dose antipyschotics without benefit when he was referred
to our polyclinics. He was evaluated as a PTSS case; his pharmacotherapy
was organized with sertraline (200mg/day) and olanzapine (5mg/day)
and was simultaneously started with EMDR. After the termination of
EMDR, the SUD level with all memories was 0 – 1 and the VOC level
was 7. His functionality became pronounced and the patient’s significant
improvement continued at the third month follow up controls.
Discussion: It has been reported that PTSS can directly and indirectly
facilitate the surfacing of psychotic symptoms leading to a misdiagnosis of
psychosis. As can be seen in the case of our patient, the underlying PTSS
not treated for a long period can be masked by the surfacing psychotic
symptoms resulting with complications in the treatment process.
Conclusion: EMDR can be used effectively in the treatment of PTSS
presenting with or without psychotic symptoms.
References
Auxemer Y, Fidelle G (2011) Psychosis and trauma. Theoretical links
between post-traumatic and psychotic symptoms. Encephale,
37(6): 433-8
Ricardo Centre corresponding, Paddy Power (2011) A diagnostic
dilemma between psychosis and post-traumatic stress disorder: a
case report and review of the literature. J Med Case Reports, 5: 97.
Discussion: There is clinical evidence that EMDR is effective in the
treatment of sexual function disorders caused by childhood sexual
traumas.
Key Words: EMDR, PTSS, Psychosis
Conclusion: As indicated by our case, patients consulting for HSDD
should be queried for experiences of sexual traumas, and EMDR should
be considered as an effective treatment approach.
PP1-25
References
Edmond T, Rubin A (2004) Assessing the long-term effects of EMDR:
results from an 18-month follow-up study with adult female
survivors of CSA. J Child Sex Abus, 13(1): 69-86.
İncesu C (2004) Sexual Functions and Sexual Function Disorders.
Klinik Psikiyatri Dergisi, 7(Ek 3): 3–13.
Key Words: EMDR, trauma, hypoactive sexual desire disorder
TRETMENT OF AN ADOLESCENT CHRONIC
POST TRAUMATIC STRESS SYNDROME CASE
WITH EYE MOVEMENT DESENSITISATION AND
REPROCESSING (EMDR): CASE PRESENTATION
Akın Coşkun, Burhanettin Kaya
Aim: Our aim is to present the successful treatment in a single session of
EMDR of the chronic PTSS of a 15-year old patient.
19
been reported. However, there are limited number of case reports on the
use of EMDR for treating vaginismus.
Case: The patient had been assaulted with stabbing and sexual abuse
two years previously. His PTSS gained chronicity by repeated recalls of
the traumatic event, avoidance of situations and objects related to the
traumatic event, hallucinations, nervous tension, indifference, feeling of
alienation, sudden frights, and attention deficit. With a single session of
EMDR a significant recession was observed in the wide scale psychotic
symptoms of the underlying PTSS.
Discussion: EMDR had been proposed for the treatment of PTSS
for the first time in the 1980s. It was believed that the individual’s
neurological coping mechanisms are overwhelmed by the traumatic
experience, and the memory and associated stimuli are inadequately
processed and stored in an isolated memory network and underlie the
psychotic symptoms. The treatment consists of bilateral stimulation
traumatized memory and to process the isolated memories in order
to restructure them. Children and adolescents very rarely present with
chronic PTSS. However, despite being a therapeutic method oriented
to the adult patient, limited studies in the literature with EMDR
application on the child and adolescent patient have produced positive
results.
Conclusion: The above discussed case of the adolescent patient with
symptoms of chronic PTSS has indicated significant benefits from a
single session of EMDR.
References
Greyber LR, Dulmus CN, Cristalli ME (2012) Eye Movement
Desensitization Reprocessing, Posttraumatic Stress Disorder, and
Trauma: A Review of Randomized Controlled Trials with Children
and Adolescents. Child Adolesc Social Work J 29(5): 409-425.
Smith P, Perrin S, Dalgleish T et al (2013) Treatment of posttraumatic
stress disorder in children and adolescents. Curr opin psychiatry,
26(1): 66-72.
Key Words: EMDR, trauma, PTSS
PP1-26
SPECIFIC PHOBIA TREATED WITH EYE MOVEMENT
DESENSITISATION AND REPROCESSING (EMDR) :
CASE PRESENTATION
Onur Okan Demirci1, Abdullah Yıldırım2, Eser Sağaltıcı3,
Berna Ermiş3
Bitlis-Tatvan Government Hospital, Psychiatry Clinic, Tatvan/Bitlis
Psychiatry, Van
3
Bitlis Government Hospital, Psychiatry Clinic, Bitlis
1
2
Aim: Specific phobias can be summarized as being significant level of
anxiety or fear experienced over specific objects or situations. The most
frequently used psychotherapeutic treatments for specific phobias have
involved the cognitive behavioural techniques. Although EMDR had
only been proven to be effective in the treatment of post traumatic
stress syndrome (PTSS), there are also reports on its effectiveness in the
treatment of specific phobias. We have aimed here to discuss the use
of EMDR, which is not the first choice treatment, in a case of specific
phobia.
Case: S.D., a 26-year old female patient consulted our polyclinics with
complaints of experiencing anxiety, nausea, widespread numbness
about her body before traveling on a bus and avoiding taking bus trips.
She had been given duloxetine 60mg/day by a neurology consultant
4 month previously, which, despite regularity of use produced slight
improvement of the nausea symptoms only. She was diagnosed with
20
specific phobia on the DSM-5 criteria, and EMDR was elected for her
treatment. The cognitive techniques used during EMDR revealed a bustrip experience of the patient at the age of 20 , when eau-de-cologne had
been offered to the passengers by the conductor. It was further revealed
that the patient, when 12-13 years of age, had fainted when sprayed
directly on her face with air freshener and was brought round by eaude-cologne. Hence, the phobia associated with buses could have been
triggered by the aroma of the eau-de-cologne. When the initial trauma
was processed in the EMDR, the SUD level was reduced to 0-1 and the
VOC level had reached 7. She improved completely at the end of the
4th session and maintained this at her 6th-month control.
Discussion and Conclusion: Effectiveness of EMDR in the treatment
of PTSS, many anxiety disorders and dissociative disorder have been
demonstrated. There are also reports on the successful us of EMDR for
specific phobias. As observed in the case reported here, EMDR on its
own can be the treatment choice for specific phobias linked to traumatic
experiences.
Key Words: EMDR, specific phobia, therapy
PP1-27
TREATMENT OF ANXIETY DISORDER DUE TO
CHILDHOOD TRACHEAL BLOCKAGE WITH
EYE MOVEMENT DESENSITISATION AND
REPROCESSING (EMDR)
Alişan Burak Yaşar1, Tufan Güneş1, Serap Erdoğan Taycan1,
Burhanettin Kaya2
Haydarpaşa Numune Training and Research Hospital, Psychiatry Clinic,
İstanbul
2
1
Aim: Trauma can frequently result in anxiety symptoms and disorders.
Eye movement desensitization and reprocessing (EMDR) is a technique
widely used in the treatment of psychological traumas. Its effectiveness
has been shown by randomized controlled studies on post traumatic
stress syndrome (PTSS), and with victims of sexual assault as well as
other similar disorders. This report discusses EMDR treatment given
to a patient who had experienced food blockage of her trachea at
childhood resulting in anxiety and unwillingness to eat with sensation
of food attachment in the throat.
Case: BO, a 19-year old female patient consulted us complaining of
sensations of a lump in her throat when eating, and fears of choking,
which interfered with her eating routine causing weight loss. Five years
previously she had nearly choked with tracheal blockage by bread
aspiration , and not being able to eat adequately, her low weight was
upsetting her life quality. She was clinically followed for anxiety disorder
which persisted after olanzapine and fluoxetine treatment for 4 months,
despite gaining 10 Kg. weight. After 2 sessions of EMDR, however, her
Beck Anxiety Inventory (BDI) score fell from 35 to 12. Her SUD level
fell from 9 to 2 after the first EMDR session and her positive cognition
‘’I can free myself ’’ increased from 2 to 6. After the second session, the
respective scores were lowered to 1 and 7. She admitted that she did
not fear eating, and that although she remembered the event it did not
haunt her during eating meals.
Discussion: EMDR is a useful technique in treating psychological
symptoms associated with trauma, as well as for treating PTSS, by
providing fast and lasting effects. However, further experience is
needed for its usage in the treatment of trauma related psychological
symptoms.
References
Chen YR, Hung KW, Tsai JC et al (2014) Efficacy of eye-movement
desensitization and reprocessing for patients with posttraumatic
stress disorder: a meta-analysis of randomized controlled trials.
PLoS One, 9(8): e103676.
Key Words: EMDR, trauma, anxiety
PP1-30
ALCOHOL USE AMONG GEROPSYCHIATRIC
PATIENTS
Gizem Donmezler1, Nurhan Fıstıkcı1, Ender Cesur1,
Elif Çarpar1, Evrim Erten1, Ali Keyvan1, Ömer Saatçioğlu2
Hospital, Psychiatry Clinic, İstanbul
2
Işık University, Faculty Arts and Sciences, Department of Psychology
İstanbul
PP1-29
COMPARISON OF CLINICAL AND DEMOGRAPHIC
PROFILES OF UNIPOLAR AND BIPOLAR GERIATRIC
INPATIENTS
Ender Cesur1, Nurhan Fıstıkçı1, Fadime Gizem Dönmezler1,
Elif Çarpar1, Evrim Erten1, İbrahim Ömer Saatçioğlu2,
Ali Keyvan1
2
Işık University, Faculty Arts and Sciences, Department of Psychology
İstanbul
1
Aim: Prevalence of the chronic illness bipolar disorder (BD) is 1% in the
general public, and it can can be as low as 0.1% in the elderly population.
However, in care homes and hospitals this rises to about 10% among
the elderly. The prevalence of major depression increases two fold at the
ages of 70-85 years. The aim of this study was to investigate the clinical
and sociodemographic details of geriatric inpatients diagnosed with BD
or unipolar disorder (UD).
Method: Clinical and sociodemographic records of UD and BP
inpatients above the age of 65 and hospitalized at Bakırkoy Hospital
for Psychological and Neurological Diseases between the dates of June
2011 and March 2013 were scanned retrospectively. Patients with other
health problems and with problems of substance/drug use, dementia,
delirium, mood disorders with organic causes were excluded from the
study which was approved by the hospital ethics committee.
Results: Mean age of all (n=93) patients was 69,3 years. BD patients
consisted of 29 (56,9%) females and 22(43,1%)males; and the UD
patients included 21(50%)females and 21(50%) males , without any
significant difference in the gender distribution of the groups (p=0,51).
Of the 93 patients, 51(54,8%)were diagnosed with BD and 42 (45,2%)
with UD. A history of psychiatric disorder existed in the families of 23
(45,1%) BD patients and of 10 (23,8%) UD patients (p=0,03). The
mean onset age of the disease was 41,33 years in the BD group, and
59,21 years in the UD group (p=0,000). Prevalence of suicidal ideation
was 17,6% (n=9)in the BD group and 78,6% (n=33) in the UD group
(p=0,000). Those who had once attempted suicide were 12(23.5%) in
the BD group and 20 (47.6%) in the UD group (p=0,03). Treatment
incompliance was 51,0% (n=26)in the BD group and 26,2%; (n=11)
in the UD group (p=0,000). Antipsychotics had been used in 51
patients (100%) in the BD group and in n=32 (76,2% )in the UD
group(p=0,000). Antidepressant usage was 7,8% (n=4) in the BD group
and 85,7% (n=36) in the UD group (p=0,000).
Aim: Prevalence of alcohol use in the elderly population ranges between
1% and 16%. Among the elderly prevalence of comorbidity of mental
disorders with alcohol/substance abuse is in the range 21%-66% and
in those with psychiatric disorders this comorbidity is in the range 7%
-38%. The aim of this study has been to investigate the effect of the
presence or absence of a history of alcohol use on the clinical data of
psychiatry inpatients above the age of 65 years.
Method: This study included inpatients above the age of 65, admitted
to Bakırkoy Hospital for Psychological and Neurological Diseases
between the dates of June 2011 and March 2013. Clinical data of the
patients with and without a history of alcohol use, were gathered from
the hospital files of the patients, recorded on the sociodemographic and
clinical forms prepared by the researchers, and compared.
Results: Of the total of 247 patients 31(12.6%) had a history of alcohol
use while 216 (87.4%) did not. In the alcohol using group, the mean
age of onset of the disorder necessitating hospitalization was 52.24
years and the mean duration of the disorder was 18.18 years , while
the corresponding data on the group not using alcohol were 43,93 and
26.55 years, respectively. Prevalence of the diagnoses among patients
with a history of alcohol use versus those without a history of alcohol
use included mood disorders (29% versus 42,6%), schizophrenia and
other psychotic disorders (22,6% versus 40,7%) and dementia (6.5%
versus 14,4%).
Conclusion: Patients with schizophrenia and alcohol use history were
males and showed a higher prevalence of cigarette smoking. Geriatric
patients with a history of alcohol use were hospitalized at an earlier
age and the duration of the disorders necessitating hospitalization were
longer.
References
Bartels SJ, Blow FC, Van Citters AD et al (2006) Dual diagnosis among
older adults: Co-occurring substance abuse and psychiatric illness. J
Dual Diagn, 2(3): 9-30
Blow FC, Barry KL (2012) Alcohol and substance misuse in older
adults. Current psychiatry reports, 14(4): 310-319
Key Words: Age above 65, alcohol use, geropsychiatry
Conclusion: There are significant differences in the clinical profiles of
geriatric BD and UD inpatients.
References
Teresi J, Abrams R, Holmes D et al (2001) Prevalence of depression and
depression recognition in nursing homes. Soc Psychiatry Psychiatr
Epidemiol, 36: 613–29
Vasudev A, Thomas A (2010) ‘Bipolar disorder’ in the elderly: What’s in
a name? Maturitas, 66: 231–35
Key Words: Bipolar disorder, unipolar disorder, geriatric patient
21
1
PP1-31
PP1-32
PSYCHIATRIC EVALUATION OF BARIATRIC
SURGERY CANDIDATES IN A UNIVERSITY
HOSPITAL
REVIEW OF THE PSYCHIATRIC COMORBIDITIES IN
EPILEPSY
Ebru Onrat Özsoydan, Behice Elif Onur Aysevener,
Neslihan Eminagaoglu
Dokuz Eylül Üniversitesi, Psikiyatri Anabilim Dalı, İzmir
Aim: Obesity is a widely seen epidemic disorder that involves multiple
health concerns. Increasing prevalence of obesity has necessitated the
development of alternative treatment methods. Over the last 10 years,
bariatric surgery has increasingly become the preferred treatment of
obesity. There are many studies reporting the incidence of psychiatric
disorders in candidates for bariatric surgery, the most frequently
encountered disorders being anxiety disorders, mood disorders, bulimia
eating disorder, and personality disorders. This study presents the results
of the Minnesota Multiphasic Personality Inventory (MMPI) and the
psychiatric diagnoses made in our psychiatry clinic on the bariatric
surgery candidates.
Method: Psychiatric evaluation with the MMPI testing and diagnoses
on the DSM-IV-TR criteria were included in the assessment of 214
patients due for bariatric surgery at the Dokuz Eylul University General
Surgery Polyclinics.
Results: The evaluated 24-patient group consisted of 6 (25%) males,
18 (75%) females. On the DSM-IV-TR criteria, 3 had major depressive
disorder, 2 had binge-eating disorder (BED) (ranking with anorexia
nervosa-AN and bulimia nervosa-BN eating disorders), 1 had BED and
anxiety disorder and 1 patient had social anxiety. Among the patients, 9
females responded to the MMPI at a highly defensive level, evaluating
all subtests subclinically ; while 6 males and 9 females did not take a
defensive stance.
Conclusion: The observation in this study of a highly defensive
approach to the MMPI by the females may be associated with a higher
anxiety over cancellation of the surgery. Similarly striking defensive
approaches have been observed in other studies using the MMPI
with bariatric surgery candidates. Although the standardization of
the characteristics of bariatric patients is not complete, the necessity
of psychiatric evaluation of these patients has been demonstrated and
relevant research is currently ongoing.
References
Sevincer GM, Coşkun H, Konuk N, Bozkurt S (2014) Psychiatric and
psychosocial aspects of bariatric surgery, Current Approaches in
Psychiatry, 6(1): 32-44.
Walfish S (2007) Reducing Minnesota Multiphasic Personality
Inventory defensiveness: effect of specialized instructions on retest
validity in a sample of preoperative bariatric patients. Surg Obes
Relat , 3: 184–188.
Key Words: Obesity, bariatric surgery, DSM-IV-TR, MMPI
Oğuzhan Kılınçel1, Cengiz Akkaya1, Gülfer Atasayar2,
Aylin Bican Demir2, İbrahim Bora2
Uludağ Üniversitesi Tıp Fakültesi Ruh Sağlığı ve Hastalıkları Anabilim
Dalı,Bursa
2
Uludağ Üniversitesi Tıp Fakültesi Nöroloji Anabilim Dalı,Bursa
1
Aim: Focal points in the management of epilepsy have consisted of the
medical therapy, the seizure or the type of epileptic syndrome, treatment
compliance and adverse effects of pharmacotherapy. The degree of the
balance and accord between the physical, psychological and social
limitations determine the quality of life of the epileptics. Quality of life
is significantly lowered by psychiatric and cognitive disorders, among
others. The biopsychosocial problems of epilepsy depend on patient
age, the underlying aetiology, duration of epilepsy, frequency, severity
and the type of the seizures, the EEG activity, the antiepileptic agents
used and the psychiatric comorbidities.
Method: The 117 epileptics included in this study did not have a
previously recorded history of psychiatric disorders. Clinical condition
of the patients were established on the DSM- IV criteria , by detailed
discussion with each of them and testing on the Hospital Anxiety Scale
(HAS) and the Hospital Depression Scale (HDS).
Results: Of the participating 117 patients 63 were females and 54
were males; the mean group age was 47; the seizures included the
primary generalized (41), complex partial (39), simple partial (20) and
secondary generalized (17) types. Psychiatric examinations revealed
that , on the basis of DSM-IV, 63 (56%) had psychiatric disorders, the
diagnoses ranging as adjustment disorder with depressive temperament
(23), major depressive disorder (18), conversion disorder (8), dysthymic
disorder (8), mild level of mental retardation (3), psychotic disorder
not otherwise specified (NOS), and obsessive-compulsive disorder (1).
Psychiatric disorders were not diagnosed in 54 of the patients.
Conclusion: Determination of the social and psychiatric problems of
epileptic patients and, if indicated, psychiatric approach and treatment
is as important as seizure control in improving the quality of life.
References
Fenwick P Psychiatric Disorder and Epilepsy (1995) 2nd edn. Edited
by Anthony Hopkins, Simon Shorvon and Gregory Cascino,
Published by Chapman& Hall
Fowler K Sperling M, Liporace J et al (2007) The effect of seizure
severity on quality of life in epilepsy. Epilepsy Behav, 11:208-11
Key Words: Epilepsy, psychiatry, depression, anxiety, comorbidity
PP1-33
BURNING MOUTH SYNDROME: CASE
PRESENTATION
Tuğba Göncü, Özgür Akdur, Neslişah Atgüden, Merih
Altıntaş, Sümeyye Kurtuluş Çallı
Erenköy Psychiatry Training and Research Hospital, Psychiatry Clinic,
İstanbul
Aim: We have aimed to draw attention to the Burning Mouth Syndrome
(BMS), also known as psychogenic dermatitis, in this case presentation.
We believe that clinicians should not ignore the psychogenic factors
22
Discussion: BMS is a chronic disorder characterized by taste change and
a burning sensation in the otherwise clinically normal oral mucosa and
is frequently met in female patients over 60 years of age. It is recognised
as a psychosomatic process resulting in oral dysesthesia. Although the
criteria for its diagnosis and treatment have not been defined clearly,
there are reports in the literature on Mg++ deficiency and elevated
IL2/IL-6 in the sputum. Vitamin B deficiency, local infections, badly
mounted oral prostheses and psychogenic factors are aetiologically
important. Psychometric depression and anxiety scores of the patients
are higher as compared to the normal healthy population.
References
Grushka M, Epstein JB, Gorsky M (2002) Burning mouth syndrome.
Am Fam Physician, 15; 65: 615-620.
Key Words: Burning mouth syndrome (BMS)
PP1-34
“FACTITIOUS SYMPTOMS IMPOSED ON THE
BODY’’ : CASE PRESENTATION
Hatice Ayça Kaloğlu, Burhanettin Kaya
Aim: Factitious disorder (FD) imposed on self is a chronic psychosomatic
disorder with high risk of mortality that is difficult to diagnose and
results in frequent hospitalization, disruption of functionality and
interpersonal relationships . This report discusses the case currently
being treated for factitious disorder.
Case: D.E, is a 37-year old, twice divorced mother of 3 children, She
is a primary school graduate and works as a building caretaker. She had
consulted the gastroenterology services for having lost 20 Kg of body
weight and episodes of haematemesis over six months. When organic
investigations did not reveal any pathology, she was referred to psychiatry
polyclinics for evaluation of stressor factors. The patient arrived with a
file of old medical documents including diagnosis of cancer pathology
and prescriptions for chemotherapy. It was discovered that she had
falsified a medical report by altering the diagnosis of gastritis to that of
cancer and had organized prescriptions for chemotherapy. She had also
devised a report from another hospital on diagnosis of breast cancer and
chemotherapy prescriptions. The patient, with a history of admissions
in different departments of alternative hospitals and long durations of
hospitalization, was diagnosed with FD and is currently undergoing
psychotherapy.
Discussion: FD involves the intention of the patient to imitate/act
sickness by creating physical and psychological symptoms. As there is no
intention of a secondary gain, this act is different from feigning illness.
There is an unconscious motivation to get emotional satisfaction by
getting accepted as ‘being ill’. Most of the cases have a history of being
abandoned, neglected or abused; and, most have been hospitalized for
treatment in childhood or adolescence. According to psychodynamic
points of view, the patient with unsatisfied dependency and approval
requirements, regards the physicians and other health officers as sources
meeting these needs. Our case had a history of neglect and an episode
of prolonged hospitalization at childhood and physical and sexual abuse
at adolescence
References
Eisendrath SJ (1989) Factitious physical disorders; treatment without
confrontation. Psychomatics, 30: 383-387,
Key Words: Factitious disorder, feigning, imposing symptoms on self
PP1-35
FACTITIOUS DISORDER OF REPEATED
HYPOGLYCAEMIC ATTACKS: CASE PRESENTATION
Cenan Hepdurgun
Aim: Factitious disorder (FD) is a psychological disorder with
intentional production of physical or psychological symptoms in order
to receive medical treatment. Since the patients consult different health
care centers and hospitals to receive treatment, FD is difficult to treat.
This report discusses the process of diagnosing FD after laboratory
investigations and clinical examinations on an inpatient presenting as
a case of insulinoma.
Case: A 24-year old married, junior high school graduate was referred
to the psychiatry polyclinics from the endocrinology services. She had
experienced over the previous week fatigue and tremor in her hands
after meals, and had been admitted to the hospital with the query of
insulinoma. Endocrinological examination reported hypoglycaemia
after taking exogenous insulin, which had been denied by the patient.
Her history indicated that she had lived in Italy for 10 years, and had
returned to Turkey 4 years previously. She had entered marriage out
of her will, and that her husband was a diabetic using insulin. Her
psychiatric examination showed that she was conscious with complete
orientation. Her accorded with her age and sociocultural status. Her
affect was compatible with her appearance and depressive mood. She was
experiencing difficulty going to sleep, lack of appetite and had thoughts
of guilt and low self esteem. She was over involved with thoughts on her
marriage. She did not have suicidal ideation or psychotic problems. She
was discharged from the endocrinology ward after being diagnosed with
FD and major depression, and was started on sertraline treatment. She
did not have any hypoglacaemic episodes during the first 1 month and
the depressive complaints regressed. She is currently being followed up.
Discussion: FD is a serious condition with risks of morbidity and
mortality on grounds of unnecessary medical treatment. There is no
treatment specific to FD. The patients can arouse anger in the health
personnel and, if faced with the diagnostic facts, can often abandon
the treatment protocols and consult alternative health care centers.
Therefore, aggressive confrontations of these patients with fact should
be avoided. Empathy with the patient’s seeking for therapy together
with the treatment of the comorbid psychiatric disorders can enable
management of the symptoms.
23
that may be underlying similar complaints on the mouth mucosa and
the tongue of consulting patients. Case: The 59-year old primary school
graduate house wife consulted our dental health clinics with complaints
of a burning sensation in her mouth which started 6 years previously. The
feeling was felt more acutely in the morning such that the predominant
taste of her food was hot. She had previously consulted the division of
general internal medicine, and had been prescribed mucosal protective
treatment after endoscopic examination. She did not have a history of
any known disease. Her psychiatric examination revealed anxious mood
disorder as the only diagnosable pathology. Her Hamilton Depression
Scale scoring was 8 and her biochemical data included normal vitamin
B levels. Ear-Nose-throat examinations did not result in any organic
pathology. She was started on paroxetine (20 mg/day) and clonazepam
(1 mg/day) and 2 months later her complaints had partially decreased.
She was included in the cognitive behavioural therapy program on the
possibility of its beneficialness in her case.
References
Wang DL, Powsner S, Eisendrath SJ (2009) Factitious Disorder.
Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. (9th
Edition) Sadock BJ, Sadock VA, Ruiz P (Ed), Lippincott Williams
& Wilkins. S.1949-1965
PP1-38
Key Words: Factitious disorder, Munchausen Syndrome, hypoglicemia
Barış Sancak1, Ürün Özer1, Veysi Çeri2
ATTITUDES TO PSYCHIATRIC DISORDERS
PRESENTED IN THE CINEMA FILMS AND SOCIAL
STIGMATISATION
2
Dumlupınar University, Faculty of Medicine, Department of Pediatric
and Adolescant Psychiatry, Kütahy
1
PP1-37
“THERE IS A NEEDLE IN MY BRAIN“ - IS IT A
DELUSION OR FACT? : CASE PRESENTATION
Eda Aslan Üçkardeş, Esin Levent, Pelin Dağ
Mersin University, Faculty of Medicine, Department of Psychiatry, Mersin
Aim: The aim of this report is to discuss the risks of making psychiatric
diagnoses without detailed clinical examinations in the case of the
patient presented here, whose complaint of ‘there being a needle in his
brain’ had been regarded as a delusion.
Case: Mr. O., a 40-year old primary school graduate male, married
with 7 children and working as a construction labourer consulted our
polyclinics with complaints of nervous tension, losing humour and
inability to go to sleep triggered by stressors over the previous 1 year. He
complained of having a needle in his head which had been confirmed by
one physician but not by others. His complaint had been evaluated as a
‘delusion’ at a psychiatric care center and different types of antipsychotics
had been prescribed. His psychological examination did not indicate
any psychopathology. He did not have any history of psychological
complaints up to the previous 1 year, and did not have a family history
of psychopathology. The antero-posterior (AP) projectional radiography
of his skull showed the presence of a needle and computerized cerebral
tomography indicated a metallic object of tubular configuration in
the left cerebral hemisphere. Neurosurgical consultation reported
that the object was located at an inoperable position without further
recommendation. Detailed history taking revealed that in the patient’s
family culture a needle is placed under the pillow of the neonate for
protection against ‘postpartum fever’. Hence, it was assumed that the
radiologically demonstrated needle could have entered the patient’s
cranium from the sphenoidal or mastoid fontanelles. The depressive
symptoms were diagnosed as adjustment disorder with depressive
temperament and treatment with selective serotonin reuptake inhibitors
(SSRIs) was started.
Discussion: Although cases with entry of needles into the cranium from
the front fontanelles have been encountered world wide, most cases
have been observed in Turkey and Iran. Placing needles and cutting
instruments under the pillows of the babies is an old Turkic custom.
Diagnosis of the symptoms as delusion without detailed investigation
leads to misdiagnosis and unnecessary treatment with antipsychotic
agents. ‘’Hearing the patient’’ who is consulting the psychiatry clinics
and careful examinations to eliminate organic pathologies prevent
misdiagnoses.
References
Sturiale CL, Massimi L, Mangiola A ve ark (2010) Sewing needles in the
brain: infanticide attempts or accidental insertion?. Neurosurgery,
67(4), 1170-1179.
Key Words: Delusion, needle, psychosis
24
Aim: Psychiatric disorders are frequently taken up in film scripts.
Current facilitation of access to cinemas and films has increased the
effects of the films scripts on populations. It has been reported that the
approach of populations with easier access to the cinema and television
regarded as instruments of information acquisition, have a relatively
negative approach to human psychological/psychiatric disorders. Our
study has particularly aimed at the stigmatizing public attitude to
psychological disorders induced by cinema films.
Method: The ‘’internet movie database (IMDb’’) was scanned for the
keywords ‘’mental illness’’ and ‘’mental patient’’; and 189 films with
watch list approval by minimally 10,000 people were selected and
completely investigated to be used for the study.
Results: The headings that most frequently appeared with the
keywords “mental patient” and “mental illness” were “murder”(n=89),
“blood”(n=84) and “death”(n=83). The psychiatric disorders most
frequently included in the film scripts were psychotic disorder (33.9%),
personality disorders (16.9%), depression (10.1%) and dissociative
disorders (9.5%). There were scenes from psychiatric clinics in 25.4%
of the films and disturbing scenes of violence in 65.6%, scenes
displaying violent behaviour on part of the character with a psychiatric
disorder (39.7%), or scenes showing exposure of the psychiatric
patient to violence (14.3%). Some 36.5% of the films included wrong
information or claims on the nature, symptoms or data on psychiatric
disorders. This misinformation had a 51.6% more incidence in films
handling psychiatric disorders when compared to films on other
disorders (28.8%)(p<000.1). In 28% of the films ‘’incurability’’ of
psychiatric disorders was expressed, especially in films with a psychotic
character (45.3% ) as compared to the films including characters with
other psychiatric diagnoses (19.2%) (p<0.0001). There were derogatory
and negative attitudes to psychiatric health workers and to psychiatric
therapies in 21.2% and 22.8% of the films, respectively. Female
characters with psychiatric disorders were often portrayed as being
‘’seductive and frivolous with doubtful morality’’ (20.3%), while male
psychotic characters were mostly ‘’homicidal and aggressive’’(22.9%) or
‘’victim or loser’’ stereotypes (22.9%).
Conclusion: The stigmatizing attitude of the scripts produced as
cinema films, which constitute an art form affecting large populations,
hardens the public prejudice, negative beliefs and attitudes towards
psychological ailments. The very same power of the cinema film can be
used to evoke and reinforce an understanding and positive attitude and
against stigmatization.
References
Granello DH, Pauley PS (2000) Television viewing habits and their
relationship to tolerance toward people with mental illness. JMHC,
22(2): 162-175
Key Words: Cinema, psychiatry, stigmatization, psychotic disorder,
stereotype
PP1-40
PP1-41
VALIDITY AND RELIABILTY OF THE TURKISH
VERSION OF THE DSM-5 REPETITIVE THOUGHTS
AND BEHAVOURS SEVERITY SCALE –ADULT
VERSION OF THE DSM-5 PRIMARY DIMENSIONAL
AND CROSS CUTTING SYMPTOM MEASURES SCALE
Kadir Aşçıbaşı1, Siğnem Öztekin1, Ecenur Aydın Aşık1,
Fikret Poyraz Çökmüş1, Ahmet Herdem1, Orkun Aydın1,
Kuzeymen Balıkçı1, Talat Sarıkavak1, Deniz Alçı1,
Emine Özge Çöldür1, Serra Yüzeren Başsivri1,
Fatma Akdeniz1, Didem Sücüllüoğlu Dikici1,
Fatma Akdeniz1, Kuzeymen Balıkçı1, Didem Sücüllüoğlu
Dikici1, Serra Yüzeren1, Deniz Alçı1, Siğnem Öztekin1,
Fikret Poyraz Çökmüş1, Emine Özge Çöldür1, Orkun
Aydın1, Talat Sarıkavak1, Kadir Aşçıbaşı1, Ahmet Herdem1,
Ecenur Aydın Aşık1, Ömer Aydemir1, Ertuğrul Köroğlu2
Aim: The aim of this study has been to demonstrate the validity and
the reliability of the Turkish version of the Repetitive Thoughts and
Behaviour Severity Scale-Adult (RTBSS-A) developed to assess the
severity of obsessive–compulsive disorder (OCD) on the criteria of the
DSM-5.
Method: This research has been conducted on the inpatients and
outpatients diagnosed on the DSM-5 criteria with OCD and being
treated at the Celal Bayar University Medical School Psychiatry Clinics.
OCD patients (30)and patients with physical or psychological disorders
other than OCD have been included in the study. Also, 100 volunteers
without any physical or psychological disorders have formed the
healthy control group. The Maudsley Obsessive-Compulsive Inventory
(MOCI), the most widely used self report scale, has been used together
with the RTBSS-A to assess the scale validity. Reliability analyses
included the internal consistency and material-total score correlation
analyses; and validity analyses included exploratory factor analysis
together with correlation analysis with MOCI. The specificity and
sensitivity of the scale have been determined with ROC analysis and the
area under the curve with a value above 0.90 was accepted as significant.
Results: The mean age of the total experimental group was 31.2±9.7
years; and 65.0% (n=39) were females. The groups consisted of
graduates from universities (56.7%), high schools (25.0%) or primary
schools (18.3%); Mean duration of OCD was 7.5±6.1. The internal
consistency of the RTBSS-A was 0.97, and the material-total score
correlation coefficient range was 0.86-0.95 (p<0.0001). The KMO and
the Bartlett test results on sampling capacity were , respectively, 0.87
and 436.89 (p<0.0001) and a single factor solution was obtained with
an eigen value of 4.5, explaining 90% of the variance. The scale item
factorial loading were in the range of 0.91-0.97. Correlation coefficent
with the MOCI was (r=) 0.71 (p<0.0001); and the area under the ROC
curve was 0.93.
Aim: This study has aimed to establish the validity and reliability of the
Turkish version of the DSM-5 primary dimensional and cross cutting
measures scale (1.DCCMS) developed to assess the severity of general
symptoms on the DSM-5 criteria.
Method: This research has been carried out at the Celal Bayar Research
and Training Hospital Medical School Psychiatry Clinics with patients
meeting the DSM 5 criteria of any psychiatric disorder and their
respective relations and a control group consisting of healthy individuals
without any physical or psychological disorders. The diagnoses of the
patient groups consisted of major depressive disorder (39 ), panic
disorder (3), obsessive-compulsive disorder-OCD (2), schizophrenia
(2), schizoaffective disorder (2), anxiety disorder not otherwise specified
(NOS), atypical psychosis (2), conversion disorder (2) and post
traumatic stress syndrome (1). Exploratory factor analysis was used for
the 1.DCCMS validity , and the Symptom Control List -90-Revised
Form (SCL-90-R) and its subscales were used for convergent and
discriminant validity.
Results: The internal consistency of the 1.DCCMS was 0.94, and
the material-total score correlation coefficient range was 0.37-0.79
(p<0.0001). The KMO and the Bartlett tests carried out to assess the
sampling capacity of 1.DCCMS resulted , respectively, in the values
0.92 and 3007.76 (p<0.0001) and a 3- factor solution was obtained with
eigenvalues of 10.82, 2.01 and 1.04 explaining 60.8% of the variance.
The correlation analysis between the subscales of 1.DCCMS and the
subscales of SCL-90-R yielded r=0.72 (p<0.0001) for depression,
r=0.80 (p<0.0001) for anxiety=0.72 (p<0.0001) for somatization,
r=0.70 (p<0.0001) for psychosis, r=0.68 (p<0.0001) for OCD, r=0.72
(p<0.0001) for personality disorder, r=0.53 (p<0.0001) for suicidal
attempt, r=0.76 (p<0.0001) for sleep disorders, r=0.64 (p<0.0001) for
anger , and r=0.87 (p<0.0001)for the total scores.
Conclusion: The results have demonstrated the validity and the
reliability of the Turkish version of the 1.DCCMS.
Key Words: Cross cutting, DSM-5, validity, reliability
Conclusion: The results presented have proven the validity and
reliability of the Turkish verison of RTBSS-A.
References
Regier DA (2009) Obsessive-compulsive behavior spectrum: refining
the research agenda for DSM-V. Psychiatry Res, 170: 1-2.
Leckman JF, Denys D, Simpson HB et al.(2010) Obsessive-compulsive
disorder: a review of the diagnostic criteria and possible subtypes
and dimensional specifiers for DSM-V. Depress Anxiety, 27:507527
Key Words: Obsessive-compulsive disorder, validity, reliability
25
Manisa
2
1
Manisa
2
1
PP1-42
REVERSAL OF TARDIVE DYSKINESIA BY
ARIPIPRAZOLE TREATMENT
Sevilay Kunt, Büşra Gürel, Mustafa Tunçtürk, Çağatay
Karşıdağ
Bakırkoy Prof. Dr. Mazhar Osman Psychiatry Training and Research
Aim: The adverse side effects of many currently used medications, lead
by the typical antipsychotics (TA) , on the extrapyramidal system (EPS)
have been known, tardive dyskinesia (TD) being one of the rarely met
outcomes. Although the EPS effects of TA are well known, use of the
atypic antipsychotics (AA) have also been reported to be associated with
tardive dyskinesia-tardive dystonia. This report presents the significant
normalization of TD after aripiprazole treatment.
Case: The 32-year old single, unemployed male patient consulted our
emergency services, complaining of insomnia, involuntary movements,
tremor, thoughts of getting harmed and talking to himself. His
symptoms had persisted for 2 months prior to consultation. His history
included haloperidol and biperiden treatment after being diagnosed
with schizophrenia 5 years previously. He had not attended the follow
up controls at the polyclinics for 1.5 years. Following history taking
and psychiatric examination he was diagnosed with TD and started on
AA agent aripiprazole after termination of the haloperidol therapy. He
was discharged after psychotic symptoms had subsided and at the 6thmonth follow up controls, his EPS symptoms had regressed significantly
despite the continuation of mild tremor.
Discussion: There is not a consensus among the clinicians on the
treatment protocol for TD. The general point of view defends the
planning of treatment according to the case specifics with the most
suitable antipsychotic agent at the lowest possible dosage, and with
frequent follow up controls. Most data on antipsychotic agents has been
acquired with the use of clozapine, there being not much information or
research on the place of the other antipsychotic agents in the treatment
of TD. Given the foresight that complications might take place with this
patient in treatment compliance and follow up on an outpatient basis,
treatment was on an inpatient basis and with aripiprazole. Reversal of
the symptoms has indicated that aripiprazole is an alternative choice of
treatment for TD.
References
Glazer WM, Morgenstern H, Doucette JT (1993) Predicting the
long-term risk of tardive dyskinesia in outpatients maintained on
neuroleptic medications. J Clin Psychiatry, 54(4): 133-139.
Ozdemir C, Eryılmaz M (1999), Gec Distoni, Gec Diskinezi ve Tedavi
Yaklaşımları (Late Onset Dystonia,Late Onset Dyskinesiaand
Therapeutic Approaches). Klinik Psikofarmakoloji Bulteni, 9: 152158.
Key Words: Aripiprazole, tardive dyskinesia, drug dependent movement
disorders
PP1-43
ENCEPHALOPATHY ASSOCIATED WITH VALPROIC
ACID TREATMENT: CASE PRESENTATION
Serdar Atik, Murat Semiz, Murat Erdem, Adem Balıkçı,
Özcan Uzun
Gülhane Military Medical Academia, Department of Psychiatry, Ankara
Aim: The frequently met side effects of valproic acid include sedation,
gastrointestinal disorders, tremor, weight gain, increase in serum hepatic
enzyme levels and hair loss. Irreversible hepatic failure, haemorrhagic
26
pancreatitis and encephalopathy are also rare and serious adverse side
effects.
Case: Mr. Y., the 21-year old patient, weighing 77 Kg, was brought
to our polyclinics with complaints of excessive talking, reduced sleep
requirement and agressive behaviour. He was admitted as an inpatient
with the diagnosis of manic episode and started on haloperidol (10mg/
day) and valproic acid (1000mg/day -titrated to 1500 mg/day after
one week). On the third day of his therapy the patient developed sleep
tendency, blurred consciousness and irregular myoclonal contractions.
Neurological examination indicated confusion. Pathological reflexes and
meningeal irritation were negative. Physical examination and evaluation
of the vital signs did not result in any pathological findings. His brain
CT, EEG test results ,blood biochemistry and hepatic function tests
were normal. Blood valproate level was 110 (the normal range being
80-120). Valproate related confusion was suspected and the treatment
was discontinued, while supporting the patient with fluids. Fast and
significant improvement was observed in 24 hours. He gained full
consciousness and had normal neurological examination results. His
treatment was continued with risperidone (4 mg/day) and lithium (
1200 mg/day). He was discharged on the 42nd day of his admission
with the reversal of his symptoms.
Discussion: Realization of valproate associated encephalopathy was
important for the reversal of the pathological symptoms. During
valproate treatment patients may develop changes in consciousness such
as drowsiness and lethargy, neurological symptoms, EEG anomalies,
epileptic seizure and emesis. Hyperammonemia may also develop,
but encephalopathy in the absence of hyperammonemia has also been
reported. Despite the 20mg/Kg body weight dosage, and normal serum
level of valproate, development of encephalopathy in the case presented
here should indicate to the clinicians that valproate treatment requires
attention on the development of adverse side effects.
References
Okay İT, Kısa C, Dilbaz N (2002) Valproate use in psychiatric disorders.
Klinik Psikiyatri, 5: 33-41.
Ozen Ş, Bulbul İ, Soyucok E (2010) Hypoactive Delirium Due To
Valproate In A Patient With Psychotic Bipolar Disorder. Turk
Psikiyatri Derg, 21: 79-84.
Key Words: Bipolar disorder, confusion, encephalopathy, valproic acid
PP1-44
MANIA DEVELOPMENT AFTER
DISCONTINUTATION OF CLOZAPINE TREATMENT
IN SCHIZOPHRENIA: CASE PRESENTATION
Onur Hurşitoğlu, Hatice Özdemir, Aslıhan Güneş, Orhan
Murat Koçak, Şadiye Visal Buturak
Kırıkkale University, Faculty of Medicine, Department of Psychiatry,
Kırıkkale
Aim: Clozapine is still accepted as the most effective antipsychotic
agent for the treatment of resistant schizophrenia. Discontinuation of
clozapine after long term treatment is known to result in different side
effects and psychiatric conditions. This report presents the case of a
patient who developed mania after discontinuation of clozapine therapy.
Case: The 42-year old male patient being followed up for the previous
17 years for schizophrenia had been treated up to date with different
antipsychotic agents including the atypic antipsychotics risperidone
(4 mg/day), paliperidone (3 mg/day), olanzapine (20 mg/day),
aripiprazole (30 mg/day). The patient had, from the onset the disorder,
Discussion: Psychotic flare ups, catatonia, autonomic instability
and rarely mania and delirium development have been reported after
discontinuation of clozapine. Here a case of mania development after
clozapine discontinuation has been discussed. Research on the “clozapine
discontinuation syndrome’’ may assist in the understanding of the
special mechanism of action of clozapine in treatment of schizophrenia.
References
Bastiampillai T, Juneja V, Nance MJ (2014) Clozapine rebound mania.
Aust N Z J Psychiatry, 48(1): 98-9.
Wadekar M, Syed S (2010) Clozapine-withdrawal catatonia.
Psychosomatics, 51(4): 355-355
Key Words: Clozapine, discontinuation syndrome, mania
inclusion of risperidone in her treatment resulted in hyponatraemia
due to the syndrome of inappropriate antidiuretic hormone secretion
(SIADH). Therefore, treatment with risperidone was discontinued,
while the quetiapine dose was titrated to 900 mg/day. Subsequent
biochemistry tests demonstrated normalization of the serum level and,
also, flare up of manic symptoms did not repeat.
Discussion: Hyponatraemia is the most frequently occurring fluidelectrolyte imbalance with about 1/3 of the cases being due to
SIADH. Although the current explanatory hypothesis proposes that
supersensitisation of D2 receptors by long term blockage of D2 receptors,
results in excessive release of ADH, development of hyponatraemia in
our patient after 2 days of risperidone use is noteworthy. Observation
of many of the symptoms related to hyponatraemia with mental
disorders, makes diagnosis of hyponatraemia difficult. Observation of
hyponatraemia in our case as a result of 2mg/day risperidone supports
the view that the hyponatraemia due to antipsychotic agent use is not a
dose dependent event.
References
Meulendijks D, Mannesse CK, Jansen PA et al. (2010) Antipsychotic
induced hyponatraemia: a systematic review of the published
evidence. Drug Safety, 33: 101–114
Key Words: Risperidone, hyponatraemia , SIADH
PP1-46
REVIEW OF THE CASES OF UNILATERAL
ELECTROCONVULSIVE THERAPY IN A UNIVERSITY
HOSPITAL
Şule Ezer, Arda Bağcaz, Koray Başar, Yavuz Ayhan,
Şeref Can Gürel
Ankara
PP1-45
HYPONATRAEMIA TRIGGERED WITH
RISPERIDONE: CASE PRESENTATION
Siğnem Öztekin, Emine Özge Çöldür, Erol Ozan
Manisa
Aim: Hyponatraemia is a fluid-electrolyte imbalance due to the fall of
the serum sodium concentration below 135 mEq/L. and is considered
to be serious when the serum sodium level falls below 125 mEq/L.
Hyponatraemia is a rare but serious side effect that occurs after the use of
psychotropic agents and case reports in the literature on hyponatraemia
due to antipsychotics are very limited.
Case: Miss S.Y.A., the 29-year old female patient, who had been
followed up for the previous 10 years with bipolar disorder diagnosis,
was admitted to our psychiatric ward for the appearance of manic
episode symptoms during the previous 5 days. Her haemogram,
biochemistry and ECG investigations were normal. She did not have
any known illnesses. On the 15th day of her admission, risperidone
(2 mg/day) was added to her ongoing therapy with quetiapine (300
mg/day) and carbamazepine (800 mg/day) when her biochemical test
results indicated serum sodium level of 125 mEq/L, uric acid level of
1.3 mg/dl and serum osmolarity of 257 mOsm/Kg. Her blood pressure
was 110/70 mm Hg and her physical examination did not reveal
any anomaly other than mild sedation. These finding suggested that
Aim: Although right unilateral electroconvulsive therapy (RU-ECT)
is argued to be as effective as bilateral electrode therapy but with less
cognitive side effects, there are also reports to the contrary. This study
has aimed to investigate retrospectively the clinical characteristics
of patients given RU-ECT, effectiveness of the therapy, necessity of
changing electrode placements during the therapy and the side effects.
Method: Patients given RU-ECT between the dates January 2013
and January 2015 at Hacettepe University Medical School Psychiatry
Services were selected from the ECT records. Patients’ epicrisis, hospital
files and all other available medical records were investigated. Psychiatric
diagnoses, ECT indications, effectiveness of the treatment, electrode
replacements and side effects were recorded as data for evaluation.
Results : Records showed that RU-ECT had been given to 20
patients with diagnoses comprising depression (n=7), psychotic
depression (n=7), bipolar affective disorder depressive phase (n=4) and
schizoaffective disorder depressive phase (2). Mean age of the patient
group was 71,5 (IQR: 21,75). Indications for RU-ECT consisted of
resistance to treatment (n=14), requirement of rapid intervention (n=4),
high suicidal risk (n=1). In 25% of the patients ECT was started by
bilateral (BL) placement of the electrodes and switched to RU-ECT
on account of the confusion effect. Among the patients started directly
with RU-ECT, 7 were nonresponsive, and effective seizure could not
be induced in 1 patient, necessitating switch to BL-ECT, the remission
incidence being 75% in this group of patients. Remission incidence was
86% in the group of patients completing the entire therapy with RU27
a history of negative symptoms including paucity in volume and
content of conversation, avolition, asociality and regression together
with three episodes of touchiness and delusion of suspiciousness which
necessitated the changing of his medication. After the flare up of his
psychotic symptoms while using aripiprazole (30 mg/day) he was
switched to clozapine with titration of the dose up to 350 mg/day. In
the 6 months of continuing clozapine treatment, positive symptom
development was not attested, but negative symptoms were seen to
increase. Decrease in volume of speech, unwillingness to get out of the
house, avoiding social relationships had come to the foreground. In this
phase of the illness, citalopram (20 mg/day) was added to the treatment
to counteract any possibility of depression, but no improvements were
observed in the side effects or the symptoms, and the antidepressant
treatment was discontinued after 6 weeks. Also, clozapine was
discontinued with gradual reduction of the dose due to significant
loss of appetite, dysphagia, weight loss, drowsiness and fatigue. The
patient was switched to olanzapine (20 mg/day). One week later the
patient was admitted to psychiatric ward with diagnosis of psychotic
mania associated with symptoms of euphoria, increased volume and
loudness of speech, reduction in sleep requirement, increased libido,
and delusions of touchiness and grandeur.
ECT. Hence, 40% of the patients starting the therapy with RU-ECT
attained remission.
Conclusion: Although RU-ECT was elected to reduce cognitive side
effects in the elderly, nearly one half of the patients did not respond
to RU-ECT necessitating the use of BL-ECT, which is regarded to be
superior to RU-ECT in effectiveness. However, wide scale studies with
recording of the electrical dosage are required to support this conclusion.
References
Kellner CH, Knapp R, Husain MM et al (2010) Bifrontal, bitemporal
and right unilateral electrode placement in ECT: randomized trial.
Br J Psychiatry, 196: 226–234.
Key Words: Electroconvulsive
electroconvulsive therapy
therapy,
confusion,
unilateral
PP1-48
RELATIONSHIP BETWEEN TEMPERAMENT AND
CHARACTER FACTORS AND DISSOCIATIVE
SYMPTOMS ON CONVERSION DISORDER
Gökhan Sarısoy, Ömer Faruk Kaçat, Arif Öztürk, Tuba
Yılman, Sema Mor, Deniz Deniz Özturan, Neslihan Yazıcı,
Kübra Gümüş
Psychiatry, Samsun
Aim: The aim of this study has been to investigate the relationship
between the dissociative symptoms and the temperament and character
profiles of patients diagnosed with conversion disorder (CD).
Method: The study included 60 patients diagnosed with CD on the
basis of DSM-IV TR criteria and 60 healthy volunteers as the controls.
All participants were tested with Cloninger’s Temperament and
Character Inventory (TCI). The CD patients were also tested with the
Dissociative Experience Scale (DES) and placed in two groups as those
with dissociation (DIS+) (n=30, %50) and those without (DIS-)(n=30,
%50). The two patient groups were compared to the controls on the
scores of TCI. Also, correlation analyses were carried out between the
TCI and the DES scores of all of the CD patients.
Results: The TCI-Novelty Seeking (TCI-NS) subscale scores were lower
in both patient groups as compared to the controls; Harm Avoidance
(TCI-HA) subscale scores of were higher in the DIS+ group than in the
control group; Reward Dependence (TCI-RD) subscale scores of the
DIS+ group were higher from those of both the control and the DISgroups; Self-Directedness (TCI-SD) subscale scores were lower in the
DIS+ group than in the control group and Self-Transcendence (TCIST) subscale scores of the DIS+ group were higher than the scores of the
DIS- group. In all CD patients taken as a single group, the DES scores
showed a negative correlation with the TCI-RD and TCI-SD subscale
scores and a positive correlation with the TCI-ST subscale scores.
Conclusion: There are limited number of reports in the literature on
the temperament and character details of CD patients. There are no
studies on the relationship between these details and the dissociation
in CD patients. The observed low TCI-NS temperament scorings
may be associated with CD; whereas the elevated TCI-HA and low
TCI-RD temperament scorings, and the elevated TCI-ST and the
low TCI-SD character scorings of the CD patients may be related to
dissociation.
References
Erten E, Yenilmez Y, Fistikci N et al (2013) The relationship between
temperament and character in conversion disorder and comorbid
depression. Compr Psychiatry, 54(4): 354-61.
Gulec MY, İnanc L, Yanartaş O et al (2014) Predictors of suicide in
patients with conversion disorder. Compr Psychiatry, 55(3): 45762.
Key Words: Conversion disorder, temperament, character, dissociation
PP1-49
RELATIONSHIP OF TEMPERAMENT AND
CHARACTER PROFILES IN SOMATOFORM
DISORDER WITH ALEXITHYMIA
Gökhan Sarısoy, Ömer Faruk Kaçar, Arif Öztürk, Tuba
Yılman, Sema Mor, Zehra Babadağı, Deniz Deniz Özturan,
Neslihan Yazıcı, Kübra Gümüş
Psychiatry, Samsun
Aim: The aim of this study has been to investigate the relationship
between temperament and character profiles of somatoform disorder
patients with alexithymia.
Method: The study enrolled 75 patients diagnosed with somatoform
disorder (SD) on the DSM-IV TR criteria and 70 healthy volunteers
as the control group. All participants were tested with Cloninger’s
Temperament and Character Inventory (TCI) and the Toronto
Alexithymia Scale (TAS-20). SD patients were placed in two groups
as those with (ALX+) and those without (ALX-) alexityhmia and their
temperament and character profiles were determined. Also, correlation
analyses were carried out between the TCI and TAS-20 scores of the SD
group and the control group.
Results: The TCI-Novelty Seeking (NS) subscale scores of both ALX+
and ALX- groups were lower as compared to the control group; Harm
Avoidance (TCI-HA) subscale scores of both ALX+ and ALX- groups
were higher than those of the control group; Reward Dependence (TCIRD) and the Persistence (TCI-PS) subscale scores of the ALX+ group
were, respectively, lower and higher than those of the control group;
Self-Directedness (TCI-SD) subscale scores of the ALX+ group were
lower than those of both the ALX- and the control groups. Correlation
existed between the TCI and TAS-20 subscale scores of the total SD
group of patients, but this was not observed with any of the TCI and
TAS-20 subscale scores of the control group.
Conclusion: There are limited number of reports in the literature on
the temperament and character profiles of SD patients. There are no
studies on the relationship between these profiles and alexityhmia in SD
patients. The observed low TCI-NS and TCI-HA temperament scores
may be associated with SD; whereas the elevated TCI-PS and low TCIRD temperament scores, and the low TCI-SD character scores of the
SD patients may be related to alexityhmia.
References
Hakala M, Vahlberg T, Niemi PM et al (2006) Brain glucose metabolism
and temperament in relation to severe somatization.
Psychiatry Clin Neurosci, 60(6): 669-75.
Karvonen JT, Veijola J, Joukamaa M (2007) temperament profiles in
women with somatization disorder. Psychiatry Clin Neurosci,
61(5): 578.
Key Words: somatoform disorder, temperament, character, alexithymia
28
PARASOMNIA DEVELOPMENT AFTER
RISPERIDONE USE : CASE PRESENTATION
Nükhet Yiğitbaşı, Fatma Özlem Orhan
Kahramanmaraş Sütçü İmam University, Faculty of Medicine,
Department of Psychiatry, Kahramanmaraş
Aim: Parasomnia is related to sleep disorders including sleep related
abnormal movements (such as sleep walking or somnambulism) ,
behaviour, emotions, perceptions, dreams or clinical disorders related to
the autonomic nervous system dysfunctions. This report discusses a case
of somnambulism due to pharmacotherapy with risperidone.
Case: The 45year old patient on follow up over 15 years for diabetes
and admitted to hospital for diabetic foot infection was referred to
the psychiatry clinic for severe nervous tension. The patient accepted
expressing explosive anger to injustice when he also destroyed objects
around him, which he did not come to regret . He had a history of legal
problems due to his experiences in the work place. It was learned that
being put on citalopram (20mg/day) for the previous 4 months had not
been beneficial despite regularity of use. Since the patient had antisocial
personality disorder and had not responded to the antidepressant
therapy prescribed, risperidone (0.5 mg/day) was added to his treatment
protocol. About 4-5 days after starting risperidone, the patient was
observed to wake around 2:00-2:30 AM, adjust his clothes and stand
up for 5 minutes, which he could not recall later. This behaviour,
not observed before, suggested parasomnia due to risperidone and
the treatment was discontinued whereby the parasomnia symptoms
disappeared completely and did not repeat. However, quetiapine (50
mg/day) had to be added to his treatment with citalopram (20mg/
day) against persistent nervous tension and insomnia, which were also
corrected after the quetipaine dose was titrated to 100mg/day.
Discussion: Restless legs syndrome, sleep walking and eating, sleep
disorders can be observed as the side effects of antipsychotic drugs.
Two cases of night terrorism after a single dose of risperidone have been
reported. The development of parasomnia in our patient after short
term risperidone treatment is in accordance with these previous reports.
References
Prueter C, Luecke FG, Hoff P (2005) Pavor nocturnus as a side effect
of a single daily risperidone dose. Gen Hosp psychiatry, 27(4):
298–303
Key Words: Parasomnia, risperidone, sleep, somnambulism
PP1-51
COFFE BEANS OR BARBACUE CHARCOAL: A CASE
PRESENTATION ON PICA
diagnosis of breast cancer at the age of 40. Her complaints included
nervous tension, agression, amnesia and pessimism. She was diagnosed
with depressive episode and benefited from venlafaxine (75 mg/
day) treatment. When she was in remission for a span of 2 years, her
follow up controls indicated that she had tachycardia due to daily
consumption of coffee beans. She did not attend the appointment
for routine biochemical tests including serum Fe level estimation and
ignored her control appointment for 8 months on account of living in
the country. At her next control it was recorded that she had continued
consuming coffee beans for the previous 5 months and that she had
also eaten barbacue charcoal in the previous 3 months, which at times
of shortage she acquired from her neighbours without permission.
Routine biochemistry tests revealed Fe deficiency; replacement therapy
was started and continued for 3 months. Her pica complaints regressed
in 15 days after starting Fe replacement therapy.
Discussion: Most of the pica cases are embarrassed in being aware
of their unusual behaviour and, therefore, when pica is suspected the
individuals tending to hide their compulsion should be queried without
implying judgement. Explanation of the disorder to the patients and
starting appropriate treatments give satisfactory results. In the case
presented here, the Fe deficiency anaemia was treated before serious
complications had arisen.
References
Johnson BE (1990) Pica. In: Walker HK, Hall WD, Hurst JW, editors.
Clinical METHODS: The History, Physical, and Laboratory
Examinations. 3rd edition. Boston,148: 709-710.
Key Words: Iron deficiency anaemia, DSM-5, Pica
PP2-01
PSYCHIATRIC DISORDER DUE TO PHENIRAMINE
MALEATE USE: CASE PRESENTATION
Soner Alıcı, Ayşe Fulya Maner, Merve Babalıoğlu
Aim: Pheniramine maleate is an anticholinergic antihistaminic agent
(first generation H1 antagonist) and is used in the treatment of allergic
conditions such as hay fever urticaria and angioedema. Given its sedative
effects, it is also used to incur sleep. Drugs other than the psychotropic
agents can be misused to cause psychiatric episodes. This report presents
a case of pheniramine maleate dependency and complaints associated
with it. Here the substance misused is different from the typical habit
forming agents, and since rarely met, the case merits discussion on its
diagnosis and treatment.
Aim: Pica is a disorder characterized with appetite for and repeated
consumption of non-nutritive substances. On the basis of DSM-5
criteria, persistence for more than a month of this type of behaviour
which is incompatible with the developmental level of the individual
and culturally unacceptable is diagnosed as pica disorder. This report
discusses the case of a patient presenting with pica on coffee beans and
barbacue charcoal.
Case: The 27-year old male patient was prescribed 3 years previously
pheniramine maleate tablets for complaints of raised and itchy skin
lesions. Since the problem had persisted he was started on ampules.
During the month before consulting our services he had been using
2x5 and sometimes 3x5 pheniramine maleate ampules 3-4 times per
week. He also consumed 70cc vodka with 1x4 tablets giving rise to
psychiatric symptoms. He was hospitalized and started on oral sertraline
(50 mg/day) + diazepam (40 mg/day) + biperiden (2 mg/day) and was
also given intravenous fluid therapy. Supportive psychotherapy was also
initiated with the cooperating patient. After 3 days of treatment his
hallucinations and cravings ceased, and at his control follow ups were
they noted not to have repeated.
Case: The 44-year old house wife living in the country (outside town)
had been referred to psychiatry polyclinics about 6 months after the
Discussion: Abuse of antihistaminic agents prescribed for dermatological
disorders and development of dependency in those patients with the
Sercan Belirgan
29
PP1-50
tendency should be prevented by following the patients in coordination
with the psychiatry services.
Key Words: Pheniramine maleate, dependency, antihistaminic
PP2-02
ALCOHOLIC HALLUCINOSIS: CASE PRESENTATION
Halenur Teke1, Fatih Sağlam2, Eda Aslan Üçkardeş2
Mersin University, Faculty of Medicine, Department of Pediatric and
Adolescant Psychiatry, Mersin
2
1
Aim: This report presents the case of a patient presenting with alcoholic
hallucinosis during her last attempt to wean off, after several attempts
during the 18-year duration of heavy alcohol use.
Case: The 45-year old female patient consulted our services with
complaints of perspiration, tremor, tachycardia, discomfort and distress.
She had an 18-year history of heavy alcohol use and had stopped using
alcohol the day before consulting the hospital emergency services. Her
detailed history revealed that she had attempted repeatedly to give up
using alcohol and had been admitted to psychiatric wards. In two of
the past attempts to give up alcohol she had experienced episodes of
delirium tremens at the ward. When she was admitted to our psychiatry
ward with diagnosis of alcohol withdrawal syndrome, she was fully
conscious, with complete orientation, and autonomic nervous system
hyperactivity. Diazepam and thiamine treatment with fluid support
resulted in visual and auditory hallucinations on the 10th day of the
therapy. The patient displayed irritability and psychomotor agitation.
She was started on risperidone (1mg/day) for alcoholic hallucinosis,
and, when sufficient response was not observed, the dose was titrated
to 4 mg/day, which significantly decreased her symptoms. The patient
was also started on acamprosate to counteract the cravings. Two months
after admission to the hospital her cravings and psychotic symptoms
significantly subsided and she was discharged to be followed as an
outpatient on acamprosate and risperidone therapy.
Discussion: The acute visual hallucinations after alcohol withdrawal
initially suggested delirium tremens, but, with the patient being fully
conscious with normal orientation and attention, the hallucinations were
believed to be egodystonic and the diagnosis of delirium was discarded.
Delusions, abnormal affect and psychomotor unease can be observed
in hallucinosis. Our case had irritability and psychomotor agitation.
Psychotic disorder associated with alcohol, despite good progress, can
become chronic in 10-20% of the cases. Alcoholic hallucinosis is a
rarely encountered clinical picture and needs to be carefully diagnosed
by clinicians.
References
Tsuang JW ve ark (1994) Characteristic of men with alcoholic
hallucinosis. Addiction, 89: 73-78.
Soyka M (1996) Alcohol induced hallucinosis. Clinical aspects,
pathophysiology and therapy. Nervenarzt, 67: 891-895.
Key Words: Alcohol, hallucination, psychosis
30
PP2-03
TREATMENT AND FOLLOW UP ON PSYCHOTIC
SYMPTOMS DEVELOPING AFTER SYNTHETIC
CANNABINOID USE: CASE PRESENTATION
Semra Aksoy, Demet Güleç Öyekçin, Atila Gürgen
Çanakkale Onsekiz Mart University, Faculty of Medicine, Department of
Psychiatry, Çanakkale
Aim: Synthetic cannabinoids (SC) were produced in the 1990s. They
are known to increase psychotic disorder risk in the sensitive individual.
The schizophrenia/chronic psychosis incidences show variability after
SC use. This report discusses the treatment and follow up on a patient
who presented with psychotic symptoms after synthetic cannabinoid
use.
Case: The patient was a 23-year old single male university student. He
consulted the psychiatry polyclinic complaining of ‘’sounds in his ears’.
He had been using SC for the previous 3 years, and weekly alcohol use
amounted to 25 standard drinks. During his psychological examination
he was conscious with complete orientation. He experienced audial
hallucinations with comments about his person. The patient was
diagnosed with alcohol-substance use disorder and treatment was
started. Weekly interviews were planned and the first one was on
informing the patient on alcohol and substance use. He was started
on diazepam (30mg/day) which was withdrawn gradually in 10 days.
Risperidone (3 mg/day) was started in the 4th week. At the end of
the 8th week the hallucinations had nearly completely disappeared.
Treatment was terminated at the end of 6 months. The patient has
been attending follow ups at the clinic for 1 year and has been free of
psychotic symptoms.
Discussion: SC use presents with cardiac side effects, electrolyte
imbalance, physiological non-epileptic seizures and psychiatric disorders.
SCs are full agonists on CB1 receptors with higher affinity than the
Δ9-tetrahydrocannabinoid. Effects on the GABA and the dopaminergic
system give rise to psychotic symptoms. Taking the example of the case
presented here, we would like to emphasize that treatment of psychotic
symptoms after SC use should be with low doses of antipsychotic agents
over a short period and supported with a structured psychosocial type
of therapy.
References
Evren C, Bozkurt M (2013) Synthetic cannabinoids: the crisis of recent
years. Duşunen Adam The Journal of Psychiatry and Neurological
Sciences, 26: 1-11.
Papanti D, Schifano F, Botteon G et al (2013) “Spiceophrenia”: a
systematic overview of “Spice”-related psychopathological issues
and a case report. Hum Psychopharmacol Clin Exp, 28: 379–389.
Keywords: Antipsychotic therapy, psychosocial support, risperidone,
synthetic cannabinoid, bonzai
SUBSTANCE ABUSE AND KORO SYNDROME: CASE
PRESENTATION
Sema Ulukaya, Ayşe Fulya Maner, Melike Yerebakan,
Gülşen Teksin, Özlem Baş, Cana Canbay
Aim: Koro syndrome involves sudden and severe anxiety over the
change of the of the genital organs, and resultant sex change. Review
of the literature indicates that it is also a personal anxiety reaction over
the fear of retraction of genitalia and death which may also develop as
mass hysteria. The differences in the context of koro at the individual
and collective levels suggest the possibility of different underlying
causes. Koro has been observed together with psychiatric disorders
such as agoraphobia, panic attacks, anxiety, schizophrenia, depression,
narcotics use as well as with organic illnesses as brain tumours, epilepsy
and neurosyphilis, in the absence of narcotics use. This report is on a
case of koro syndrome, with severe anxiety over the retraction of his
penis and substance dependency.
Case: The 19-year old male single patient with education up to the
second year of high school, was unemployed and living with his family.
He consulted psychiatry services complaining that he had developed
thoughts over the previous month which were aggravated in the last
week that his penis would retract into his body and that he would
become a female. He had a history of hospital admission one year
previously with the diagnosis of antisocial personality disorder and
substance abuse. Physical examination revealed only a facial scar from
childhood. Psychiatric examination showed medium level self care,
courtesy, accessibility, natural speech, limited affect, irritable mood,
purpose orientedness, organized recall, and the presence of auditory
hallucinations of genees talking into his ear, and delusions about
persecution of his family. Routine investigations did not reveal any
pathology.
Discussion: The thoughts of the patient on the retraction of his penis
and that he was being treid to be converted to a female was diagnosed as
koro syndrome (genital retraction) with organic causes due to narcotics
use.
References
Atalay H (2007) Two Cases of Koro Syndrome with Fear of Retracting
Genitalia Comorbid with Anxiety Disorder. Turk Psikiyatri Derg,
18(3): 282-285
Keywords: Koro syndrome, substance abuse
PP2-05
WERNICKE-KORSAKOFF SYNDROMU: CASE
PRESENTATION
Mine Ergelen, Dicle Bilge Öğüt, Özgür Süner
İstanbul
Introduction: Wernicke’s encephalopathy (WE)is a neuropsychiatric
disorder that develops with thiamine (vitamin B1) deficiency and
presents mainly with opthalmoplegia, confusion and ataxia. It is
frequently observed with chronic alcohol use. If not treated it can lead
to chronic and irreversible Korsakoff syndrome (KS) characterized with
amnesia, confabulation and time-place disorientation.
Case: In this report the case of a 46-year old male patient with a 20year history of increasing alcohol use that resulted in talking nonsense,
time-place disorientation and hallucinating upon stopping drinking is
presented. His psychiatric examination after admission as an inpatient
at our clinic indicated reduced self care and a cachectic appearance . He
was conscious with limited cooperation and had orientation disorder.
His affect was blunted, recall was slowed down, not purpose oriented
and he was confabulating. Also, he asked the same questions repeatedly,
all being compatible with anterograde amnesia. He also had auditory
and visual hallucinations. Neurological examination showed nystagmus
and ataxic gait. Diagnosis with Wernicke-Korsakoff Syndrome was
arrived at after evaluation of the investigative data and examination
results and the patient was started on high dose thiamine therapy.
Conclusion: A great majority (84%) of patients with WE are diagnosed
with KS at the progressive stages of the disease. As both conditions have
overlapping neurolopathological symptoms, WE and KS are considered
to be the acute and chronic phases, respectively, of the same syndrome,
thus referred to as the WE-KS arising from thiamine deficiency. In the
case presented here, chronic alcohol use, malnutrition with thiamine
deficiency and the resultant encephalopathy were attributed to WEKS since, if not properly treated, WE progresses to the chronic and
irreversible amnestic disorder KS.
References
Homewood J, Bond NW (1999) Thiamine deficiency and Korsakoff ’s
Syndrome: Failure to find memory impairments following
nonalcoholic Wernicke’s Encephalopathy. Alcohol, 19: 75-84
Sechi GP, Serra A (2007) Wernicke’s encephalopathy: new clinical
settings and recent advances in diagnosis and management. Lancet
Neurol, 6:442-455
Key Words: Alcohol, Korsakoff, Wernicke
PP2-06
GERIATRICS AND CANNABIS USE
Semra Ulusoy Kaymak1, Dicle Yenilmez1, Görkem Karakaş
Uğurlu2, Serdar Süleyman Can2, Ali Çayköylü2
Ankara Atatürk Training and Research Hospital, Psychiatry Clinic,
Ankara
2
Ankara Yıldırım Beyazıt University, Faculty of Medicine, Department of
Psychiatry, Ankara
1
Aim: Use of cannabis, one of the most frequently exploited illegal
substances, at advanced age , especially after one or two decades of
use, leads to multiple symptoms difficult to interpret clinically. Here
two cases of cannabis use with atypical symptoms, and potentially
misleading demographic profile with respect to age, socioeconomic
status and gender are presented.
Case 1: The 58-year old female patient consulted the psychiatry services
with symptoms of agression, laughing and talking by herself and ideation
of killing her husband. Obtaining detailed psychiatric history was not
possible, but it was learned that her history included brief hospital
admissions, and that she did not have stressors. She did not have known
illnesses, and did not use any substance apart from cigarette smoking.
She appeared disorganized in local costume. She had anxiety; expressing
that she could not name the cause of her disturbances and that she
needed help. These atypical symptoms and her age necessitated blood
tests including toxicology screening and was referred for CT. There were
no findings other than a 0.5 cm meningioma at the occipitoparietal lobe
and cannabis positivity. Her condition was ascribed to cannabis. It was
learned that she smoked unpacked cigarettes sold cheaply on the streets.
31
PP2-04
Case 2: The 55-year old female patient was brought to the emergency
services as she could not wake up at lunch time hours. She did not
have a history of psychiatric consultations and a stressor could not be
described. She did not have any medication apart from pregabalin. As
she did not respond to painful stimuli, blood tests including toxicology
screening, and CT were requested. The only abnormal finding was
cannabis positivity. After gaining consciousness, she explained that she
used 3 pregabalin tablets against her pains; that she did not smoke , and
consumed infusion teas sold by herbalists.
Discussion: Cannabis is usually used after paper wrapping similarly to
cigarettes. It causes changes in perception of time, loss of inhibitions,
and inducing symptoms of suspiciousness and fear. The possibilities
of using medication or combinations of substances giving rise to
false positive results on cannabis positivity were queried. Recognition
of symptoms due to cannabis in the elderly individual is difficult.
Investigation of substance use in the elderly should be remembered
in the presence of changes in consciousness and cognitive functions,
agitation and psychotic symptoms,
References
Gfroerer J, Penne M, Pemberton M (2003) Substance abuse treatment
need among older adults in 2020: the impact of the aging babyboom
cohort. Drug Alcohol Depend, 69(2): 127-135.
Gossop M, Moos R (2008) Substance misuse among older adults: a
neglected but treatable problem. Addiction, 103(3): 347-348.
Key Words: Cannabis, geriatrics, sociodemographic profile
PP2-07
LIFE THREATENING EFFECTS OF SYNTHETIC
CANNABINOIDS: THREE CASE PRESENTATIONS
Ürün Özer, Utku Uzun, Barış Sancak, Bahadır Turan,
Elif Çarpar
Aim: New psychoactive substances known as the designer drugs,
headed by synthetic cannabinoids, have gained popularity in the recent
years. Synthetic cannabinoid use has increased among the youth and
constitutes a serious threat to public health. It is known that synthetic
cannabinoids have more powerful action compared to the natural
cannabinoids, but data on their effects is limited on grounds of the
difficulty of detection by known laboratory tests, given the changing and
unpredictable chemical structure of these substances. This report aims
to emphasise the life threatening effects of synthetic cannabinoid use
through the example of three patients consulting psychiatric emergency
services with psychiatric symptoms and developing toxic hepatitis, loss
of consciousness and cardiopulmonary arrest.
Cases: All three cases consulted the psychiatric emergency services
with psychiatric symptoms. While under observation for synthetic
cannabinoid use, they developed serious symptoms of toxic hepatitis with
life threatening characteristics. The second patient lost consciousness,
while the third patient developed cardiopulmonary arrest and could not
be saved. Only in one of the cases, but not in the two others, was it
possible to detect benzodiazepines in the urinary drug tests. This result
was not directly associated with synthetic cannabinoid use and indicated
the simultaneous use of benzodiazepines by the patient. The emergency
laboratory tests indicated raised creatine kinase, and abnormal levels of
hepatic function parameters.
32
Discussion: Psychiatric symptoms including anxiety, hallucinations
and psychomotor agitation are observed after synthetic cannabinoid
use. Nausea, perspiration, tachycardia, chest pain and syncope have
also been reported. Although most individuals exposed to synthetic
cannabinoids present with mild symptoms, some develop convulsions
or myocardial infarction. Developing life threatening complications
after synthetic cannbinoid use is effectively demonstrated by the three
cases presented here. Therefore, awareness of the clinicians of the effects
of these substances, increasingly preferred by the consumer in being
undetectable with the standard drug tests, more powerful than cannabis
and obtainable more economically with easier reach, is esssential for the
diagnosis, treatment and follow up as well as prevention of missing the
risky cases.
Key Words: Synthetic cannabinoid, toxic hepatitis, cardiopulmonary arrest
PP2-08
MODAFINIL USE DISORDER : CASE PRESENTATION
İhsan Aksoy, Osman Vırıt, Volkan Güçyetmez,
Bahadır Demir, Abdurrahman Altındağ
Gaziantep University, Faculty of Medicine, Department of Psychiatry,
Gaziantep
Aim: Modafinil, a drug that promotes awakeness is used for treating
narcolepsy, attention deficit hyperactivity disorder (ADHD), depression
and obstructive sleep apnea syndrome. Stimulant drugs produce
awakeness at low doses, euphoria at medium doses and dependency
when used at high doses as indicated by the so called inverted U-shaped
dose-effect curve. There are no published clinical trials on the euphoric
and dependency effects of modafinil, there being only three references
on the topic in the literature. We are reporting here the case of a patient
using 7 times more than the recommended dose of modafinil.
Case: The 52-year old male patient being followed up through 13 years
for bipolar disorder had been using about 30 tablets of modafinil and
about 8 tablets per day for the 2 previous years. He had a past history
of alcohol use but had stopped it over the previous 10 years. He was
admitted to hospital for treatment of mild tachycardia and raised blood
pressure. His ECG was normal. He felt like ‘’dead’’ with anhedonia and
loss of morale when he did not take modafinil tablets. Treatment was
started with diazepam (20 mg/day) and quetiapine (100 mg/day). On
the 10th day of his admission he entered a manic phase when quetiapine
dose was titrated to 200 mg/day and valproic acid (1000 mg/day) was
added to his treatment. He was discharged on the 27th day when he had
become eutyhmic and it was noted in his control follow ups that he had
stopped using modafinil.
Discussion: Although the recommended daily dose of modafinil is
400 mg, our patient had been using 3.0 gm/day; and, felt ‘’alive’’ when
using modafinil and very deprived without it. He was diagnosed on
the basis of DSM-5 criteria with substance use disorder and his use of
modafinil was regarded as self treatment. He was trying to overcome
the side effects of insomnia and tachycardia with the use of alprazolam.
Since modafinil use disorder has not been characterised in the literature,
accumulation of case reports should be followed with the point of view
of detecting and prevention of dependency development.
References
Cengiz Mete M, Şenormancı O, Saraclı O et al (2015) Compulsive
modafinil use in a patient with a history of alcohol use disorder.
Gen Hosp Psychiatry, doi: 10.1016/j.genhosppsych. 2015.01.001.
Wood S, Sage JR, Shuman T et al (2013) Psychostimulants and
cognition: a continuum of behavioral and cognitive activation.
Pharmacol Rev, 66(1): 193-221.
Key Words: Stimulants, modafinil, substance use disorder
PP2-10
PSYCHOTIC DISORDER DEVELOPED AFTER
NARCOTICS USE : CASE PRESENTATION WITH TWO
BROTHERS
Ekrem Yılmaz, Abdullah Yıldırım, Pınar Güzel Özdemir,
Ercan Atilla
SEXUAL FUNCTIONS OF MALE PATIENTS WITH
CANNABIS USE DISORDER—CONTROLLED STUDY
Ebru Aldemir , Betül Akyel , Duygu Keskin Gökçelli ,
Ayşe Ender Altıntoprak2, Hakan Coşkunol2
1
1
2
Ege University, Instute of Drug Dependence, Toxicology and Medicine,
İzmir
2
1
Aim: The aim of the study reported here has been to investigate and
compare the sexual functions of patients with cannabis use disorder and
healthy controls. The patients included in the study have consulted the
Ege University Alcohol and Substance Dependency Polyclinics between
the dates August 2013 and December 2014.
Method: Male patients (n=56), diagnosed with cannabis use disorder on
the DSM-5 criteria, and healthy male volunteers (n=25) were directly
interviewed on their proliferative functionality on a one-to-one basis;
and, data on their sexual functions were assessed from International
Index of Erectile Function Questionnaire (IIEF-Q,) which is a self
report form. Results: The mean age of the patient and control groups
were , respectively, 27±8 and 32.3±6.5; with the corresponding values
for the mean pubertal age being , respectively, 14.5±1.3 and 13.6±1.7
(p<0.01). The patients had been problem smokers over the previous
96.4±92.9 months, having consumed the mean amount of 4±4.8 gm/
day; and the mean time interval since the most recent cannabis use
being 34.1±34.3 days. A correlation between these data and the sexual
function scores of the patients could not be determined. Prevalence of
erectile dysfunction was higher among the patients with active sexual
lives, as compared to the controls (x2=4.065, p<0.05). In the patient
group the mean scores for erectile function, orgasmic function and
sexual desire on the IIEF-Q were, respectively, 25.2±4.3, 7.4±2.7 and
6.9±2.1, found to be significantly lower than the corresponding scores
of the controls, found to be, respectively, 28.5±2.5,.6±0.7, 7.8±1.3.
(p<0.05). A significant difference between the scores of the two groups
on intercourse satisfaction was not observed.
Conclusion: Cannabis is the most widely used illegal drug in the
world. While animal model experiments and in vitro work showed an
inhibitory effect of the endocannabinoid system on erectile functions ,
the results on human studies are discrepant. Work carried out with the
control group in this study has aimed to clarify the problem.
References
Rosen RC, Riley A, Wagner G et al (1997) The international index
of erectile function (IIEF): a multidimensional scale for assessment
of erectile dysfunction. Urology, 49(6): 822-30. Smith AM, Ferris
JA, Simpson JM et al (2010) Cannabis use and sexual health. J Sex
Med, 7: 787–93.
Key Words: Sexual functions, cannabis, substance use disorder
Yüzüncü Yıl University, Dursun Odabaş Medical Centre, Psychiatry
Department, Van
Aim: The cases of two brothers using narcotics, involving development
of psychiatric disorder that progressed to chronicity, are presented here
with the aim to draw attention to the effect of narcotics in bringing out
into the open psychotic disorder and to the possible underlying familial
and genetic factors.
Case 1: EG was a 20-year old male patients who consulted us with
the complaints of auditory and visual hallucinations, taking the form
of the persons he saw, talking and laughing by himself, impacting his
head with the wall, passing a long time in front of the mirror, irritability,
aggressiveness, and reduced self care. His history revealed that he had used
cannabis almost every day for the previous 4 years and his complaints
had surfaced some 3 years previously; that he had been hospitalized
twice, but did not fully improve given his bad treatment compliance.
He was admitted to the ward and put under quetiapine (900 mg/day),
zuclopenthixol (30 mg/day) and diazepam (10 mg/day) until he partly
recovered when he was discharged to be treated as an outpatient.
Case 2: MG, the 21-year old male patient had a 3-year history of
complaints including auditory and visual hallucinations, talking
nonsense, talking and laughing alone on his own, unease, irritability,
aggressiveness, swearing, reduced self care, passing long periods of time
alone and taking the shape of the person in front him. He had smoked
cannabis almost every day during the 3 years before the appearance of his
complaints. He had been hospitalized 3 times for treatment but had not
recovered fully. He was treated as an inpatient with clozapine (400mg/
day) and amisulpride (400mg/day) until he improved partly when he
was discharged and treatment continued on an outpatient basis.
Conclusion: Long term use of cannabis has been associated with
increased risk of psychosis with a genetic basis. Also, it has been
determined that genetic liability to schizophrenia is related to the
development of acute psychosis and its recurrence with cannabis use.
Genetic liability to psychosis can be seen with greater certainty in first
degree relatives after cannabis as demonstrated in the cases discussed
here. Further research on the genetics of psychosis is expected to clarify
the basis of the observed familial liability.
Key Words: Genetic, cannabis, psychotic disorder
PP2-11
ANTIEPILEPTIC LEVETIRACETAM DEPENDENCY:
CASE PRESENTATION
Burcu Kök, Turan Çetin, Özge Yüksel, Ekrem Cüneyt Evren
Aim: Barbiturates and benzodiazepines used in the treatment of epilepsy
have habit forming potential. Levetiracetam, mainly used in treating
epilepsy is also effective in treating neuropathic pain, Touret’s syndrome,
autism, anxiety and bipolar disorder. Antitussive suspensions consisting
of antihistaminic pheniramine and the sympathomimetic ephedrine are
33
PP2-09
generally preferred for treating upper respiratory tract infections. We
present the first case of levetiracetam dependency.
Case: The 19-year old patient, primary school graduate father of one child,
was admitted to the Bakirkoy Dr. M.O. Psychological and Neurological
Diseases Hospital after consulting the psychiatry emergency services
with psychotic symptoms of irritability, aggressiveness, insomnia,
talking to himself since stopping substance use for the last 4-5 days.
The patient, with definite motivation to stop substance use was directed
on the second day of hospitalization to the AMATEM (Alcohol and
Substance Dependency treatment and Research Center) in the hospital
grounds while on treatment as an inpatient. His detailed history
included use of narcotics, synthetic cannabis, ecstasy , as well as glue
solvent-sniffing, and misuse of gabapentin, clonazepam, levetiracetam
and antitussive suspensions. Discussion: Misuse of prescribed drugs
is well known. What is important is to be able to find out who are
doing it. Patients with a history of substance abuse usually entertain
the tendency to misuse drugs effective on the central nervous system.
However, sale of the antitussive suspensions, currently sold the over
the counter, also needs to be brought under control. Before prescribing
these types of medicines, detailed queries on personal/family history of
substance use and diagnoses of any psychiatric disorders have become
a necessity. If any such facts are found out the clinicians have to think
of alternative treatments of follow the treatment compliance of the
patients very carefully.
References
Sezgin E, Evren C, Cınar OG et al (2010) Two Cases With the
Antiapileptic Maliasin® dependency. Duşunen Adam Psikiyatri ve
Norolojik Bilimler Dergisi, 23: 128-132
Uhlmann C, Froscher W (2009) Low risk of development of substance
dependence for barbiturates and clobazam prescribed as antiepileptic
drugs: results from a questionnaire study. CNS Neurosci Ther,15:
24-31.
yield any pathological findings. Pathergy test and PPD (purified protein
derivative-turberculin) tests for vasculits as well as the serological tests
for secondary central nervous system vasculitis were negative.
Case 2: The 61-year old male patients consulted psychiatry services
after suicidal attempt by self stabbing. His complaints history had
commenced after stressors 30 years previously with a depressive episode
dominated with psychomotor retardation, avolition and hypersomnia
and had continued with an attack each year. The attacks of the last 7
years were complicated with pscyhotic symptoms. Cranial MR showed
records of gliotic ischaemic foci in the cerebral white matter which could
not be associated with any pathology after referrals to the neurology and
cardiology services.
Discussion: Research on depression patients with and without suicidal
behaviour has indicated that white matter lesions in the brain of the
suicidal patient were relatively of wider occurrence. Their spread was
associated with the suicidal behaviour and the cognitive losses of
the patient. The subcortical lesions found out in the presented cases
are believed to affect the motor functions while promoting suicidal
behaviour. Although the patients discussed here are not in the elderly
population, the findings remind the clinician that the process of aging
has biological, psychological and social aspects.
References
Raust A, Slama F, Mathieu F et al (2007) Prefrontal cortex dysfunction
in patients with suicidal behavior. Psychol med, 37(03): 411-419.
Sachs-Ericsson N, Hames JL, Joiner TE et al (2014) Differences
between suicide attempters and nonattempters in depressed older
patients: depression severity, white-matter lesions, and cognitive
functioning. Am J Geriatr Psychiatry, 22(1): 75-85.
Key Words: Gliotic lesions, suicidal attempt, emotion
Key Words: Antitussive suspension, dependency, epilepsy, levatiracetam
PP2-13
PP2-12
RELATION OF FUNCTIONALITY IN BIPOLAR
DISORDER WITH CHILDHOOD TRAUMAS
CORTICAL AND SUBCORTICAL GLIOTIC LESIONS
AND SUICIDAL ATTEMPT
Semra Ulusoy Kaymak , Dicle Yenilmez , Sümeyye
İslamoğlu2, Serdar Süleyman Can2, Hatice Seda Norçin
Demirtaş2, Murat İlhan Atagün2
1
1
Ankara
2
Psychiatry, Ankara
1
Introduction: Apart from the various risk factors leading to suicidal
attempts, silent changes taking place in the brain, although not
accepted as pathological, can also be important determinants of
suicidal behaviour. The necessity of identification and control of these
developments with the aims of prevention and treatment is emphasized
in this report discussing the cases of two patients.
Case 1: The 43-year old female patient consulted psychiatry clinics with
complaints of cognitive type and suicidal ideation. She had a history of
suicidal attempts since the age of 16 which progressed with one attempt
of suicide by hanging, once by trying to strangle herself with a scarf, 4
times by impacting her head with firewood and 6 times with overdose of
drugs. Cranial MR revealed records of gliotic signals at the subcortical
white matter. Referrals to the neurology and cardiology services did not
34
Tuba Yılman, Gökhan Sarısoy, Ahmet Rıfat Şahin,
Ali Cezmi Arık, Hatice Güz, Ömer Böke, Ozan Pazvantoğlu
Psychiatry, Samsun
Aim: The aim of this study has been to investigate the relationship of
functionality in the elderly bipolar disorder (BD) patient with childhood
traumas (CT).
Method: Patients (n=100) diagnosed with BD on the basis of DSMIV-TR criteria and healthy volunteers (n=100) as the control group
were enrolled in this study. All participating patients and controls were
tested with the Turkish version of the Childhood Trauma Questionnaire
(CTQ-TR). According to Sar et al. (2012) a total score exceeding 35
should be taken as a positive information. Participants with and without
CT were taken as separate groups. Patients with CT (n=47) and without
CT (53) were compared with respect to functionality. Assessment of
functionality in the BD group was made through testing with the
Bipolar Functional Status Questionnaire (BFSQ).
Results: Evaluation of the total CTQ-TR scores indicated presence of
CT in 47%, of the patients and 28% of the controls (p=0.009). More
individuals with BD had CTQ subscale scores of Emotional neglect
(p=0.000), emotional abuse (p=0.008) and sexual abuse (p=0.008). The
control and the BD groups did not differ with respect to physical abuse
subscale scores. The BD group with CT had lower total functionality
Conclusion: High prevalence of CT among the BD patients has
been reported in the literature. Garno et al., (2005)have reported CT
incidences in at least half of PD patient population, as also reported
in this study. Relationship of functionality in BD and a history of
CT is, therefore, a topic that merited investigating. Our study has
demonstrated a lower functionality among the BD patients investigated,
especially on the friendly relationships and perception of stigma aspects
of functionality. Focusing on these aspects of functionality in the
psychotherapy given to BD patients with a history of CT would be
beneficial.
References
Garno JL, Goldberg JF, Ramirez PM et al (2005) Impact of childhood
abuse on the clinical course of bipolar disorder. Br J Psychiatry, 186:
121-125.
Şar V, Ozturk E, İkikardeş E (2012) The validity and reliability of the
Turkish version of the Childhood Trauma Questionnaire. Turkiye
Klinikleri, 32(4): 1054-63.
Key Words: Bipolar disorder, childhood trauma, functionality
alopecia. Cooperation between the dermatology and psychiatry services
in the treatment of alopecia patients will not only contribute to the
success of the treatment given, but also improve the life quality of the
patient. Type of anger behaviour as well as the presence of anger require
attention which will greatly benefit the patients with diffuse alopecia.
References
Alfani S, Antinone V, Mozzetta A et al (2012) Psychological Status of
Patients with Alopecia Areata. Acta Derm Venereol, 92: 304–306.
Garcia-Hernandez MJ, Ruiz-Doblado S, Rodriguez-Pichardo A et al
(1999) Alopecia areata, stress and psychiatric disorders: a review. J
Dermatol, 26: 625-632.
Key Words: Anxiety, depression, diffuse alopecia, anger
PP2-15
DEVELOPMENT OF MANIA SECONDARY TO THE
USE OF WEIGHT LOSS PRODUCTS OF PLANT
ORIGIN: 2 CASE PRESENTATIONS
Büşra Gürel, Sevilay Kunt, Ersin Uygun, Çağatay Karşıdağ
PP2-14
ANGER, ANXIETY AND DEPRESSION IN WOMEN
WITH DIFFUSE ALOPECIA
Seçil Aldemir1, Seval Erpolat2, Ercan Dalbudak1, Seda Tan3,
Merve Topcu1
Turgut Özal University, Faculty of Medicine, Department of Psychiatry,
Ankara
2
Turgut Özal University, Faculty of Medicine, Research and Aplication
Hospital, Dermatology Clinic, Ankara
3
Gazi University, PhD Student, Ankara
1
Aim: This study has aimed at determining the psychiatric symptom
prevalence among women with diffuse alopecia in comparison to
healthy controls and the relationship of the alopecia with the level of
irritability.
Method: This study enrolled 43 female patients with alopecia under
treatment at the dermatology services and 52 age and gender matched
healthy volunteers as the controls. The diagnostic types of the alopecia
patients varied as androgenetic alopecia 19 (20.0%), Alopecia areata
10 (10.5%) and telogen effluvium 14 (14.7%). All participants of
both the patient and the control group were tested on the Hospital
Anxiety-Depression Scale (HADS and HDS) and the State-Trait Anger
Expression Inventory (STAI). The standard ‘’Patient Follow Up Form
on Hair Loss’’ were filled in with patient details.
Results: The HADS Anxiety and HDS depression scores of the patient
group were significantly higher than those of the control group. Also,
the STAI scores were significantly predictive and discriminative for the
patient group. The duration of hair loss showed a significant positive
correlation with the HADS anxiety and HDS depression scores. When
the scores of the different types of alopecia were compared on the basis
of STAI scores, significant differences were observed in the trait- anger
and anger-out subscale scores.
Conclusions: Psychiatric disorders of anxiety and depression are more
prevalent among patients with alopecia as compared to the healthy
population as has also been demonstrated in our study. Furthermore,
psychiatric disorders are believed to have a role in the pathogenesis of
Aim: Products labeled as ‘’plant Products’’ are sold in Turkey through
licensing by the Ministry of Good, Agriculture and Livestock
without the approval of the Ministry of Health. These products with
different chemical additives present with adverse side effects including
dermatological rashes, diarrhea, renal failure and , cardiac insufficiency
and death. This report presents the case of two patients who developed
psychotic mania after the use of slimming aids purchased without a
prescription over the internet.
Case 1: The 28-year old high school graduate married patient with one
child was admitted to the psychiatric ward with symptoms of insomnia,
irritability, aggressiveness, excessive talking and delusions of grandeur
which had started 3 days previously to the consultation. She had used
for a period of one month a slimming product of plant origin bought
over the internet.
Case 2: The 26year old male university graduate had started to use a
slimming product 4 days previously to his psychiatric consultation. His
family complained of reduced sleep requirement, excessive talking, over
involvement with religious activities, delusions of grandeur, irritability,
hypermobility. He did not have a history of known diseases and the
routine investigations in the clinic, MR and EEG did not reveal organic
pathology. These two patients were discharged from the clinic after full
remission and being followed up for bipolar1 disorder at our polyclinics.
Discussion: Sibutramine, used in slimming products of plant origin had
been used 30 years ago as an antidepressant on grounds of its inhibitory
effect on a number of neurotransmitter reuptakes. However, when the
anorexic effects were observed to overshadow the antidepressant effects,
its use as an antidepressant was discontinued. It is noteworthy that
symptoms of irritability, anxiety and hypermobility are shared with
other cases of manic episodes induced by sibutramine.
References
Buckett WR, Thomas PC, Luscombe GP(1988) The pharmacology
of sibutramine hydrochloride (BTS 54 524), a new antidepressant
which induces rapid noradrenerjic down-regulation. Prog
Neuropsychopharmacol Biol Psychiatry, 12: 575-84.
Key Words: Mood disorder, slimming product, sibutramine
35
scores (p=0.037) and also gave a lower performance in scoring on the
stigma perception (p=0.002) and friendly relations (p=0.014) subscales.
PP2-16
PP2-17
THE FIRST EPISODE PSYCHOTIC MANIA IN A
PATIENT WITH MULTIPLE SCLEROSIS: CASE
PRESENTATION
POSTPARTUM MANIC EPISODE IN THE FATHER:
CASE PRESENTATION
Emre Mısır, Ayşegül Özerdem
Fatih Sağlam1, Halenur Teke2, Eda Aslan Üçkardeş1
2
Mersin University, Faculty of Medicine, Department of Pediatric and
Adolescant Psychiatry, Mersin
1
Aim: Prevalence of bipolar disorder (BD) in patients with multiple
sclerosis (MS) has been known. MS treatment can also induce a manic
episode. This report aims to discuss BD in MS patients over the case
presented here.
Case: Miss G, the 23-year old single, unemployed university graduate
living with her family was brought to psychiatric emergency services
with fears of self harm after the appearance manic symptoms 10
days previously. The patient reported to be was extremely energetic,
with insomnia and experiencing auditory hallucinations related
to being the wife of a prophet. She had been diagnosed with MS 2
years previously. Psychiatric examination indicated the conscious
patient had a disorganized appearance with increased psychomotor
activity, heightened affect, reduced sleep, attention deficits, auditory
hallucinations and delusions of grandeur and persecution, reduced
orientation, difficulty in cooperating and had no insight.
She had a history of episodes with subthreshold depressive symptoms.
Her family history did not include psychological illnesses. She was
not diagnosed with a major psychopathy. Her laboratory and EEG
investigations gave normal results. Her cranial MR showed signals
of demyelinisation associated with cerebral MS. There being no
therapeutic recommendations from neurological consultation, he
patient was admitted to the psychiatric ward with the diagnosis of
psychotic manic episode and started on olanzapine (10mg/day) and
sodium valproate (1000 mg/day). Her psychotic symptoms regressed,
such that she was eutyhymic in 15 days and was discharged on the 20th
day of her admission. Olanzapine was withdrawn during follow up but
she is currently euthymic under continued valproate (1000mg/day).
Discussion: BD can be comorbid with MS and drugs used in
the treatment of MS can trigger psychotic disorders. For example
corticosteroids and interferon used in the treatment of MS can
trigger manic episode. On the basis of cerebral MR imaging results,
commonness of the pathophysiological mechanisms behind BD and
MS have been speculated.
Conclusion: Although the relationship between MS and BD has not
been clarified, clinicians have to be alert for any psychiatric symptoms
presenting with MS. .
References
Chwastiak LA, Ehde DM (2007) Psychiatric issues in multiple sclerosis.
Psychiatr Clin North Am, 30: 803-17.
Idiman E, Gulay Z, Doganer I (1994) Multiple sclerosis and affective
disorder HLA class I and class II antigens and MRI. J Neurol,241:
140.
Key Words: Bipolar disorder, multiple sclerosis, psychotic manic episode
36
İzmir
Introduction: Increased risk of mood disorder incidences in the
postpartum phase, and increased incidence of recurrence in women
diagnosed with bipolar disorder have been known. Research on mental
disorders in the fathers through the pregnancy and at postpartum phase
have gained momentum in the last 20 years. The common result of
most of these studies, which have concentrated on depressive disorders,
is the observation of increased risk of depressive disorder and increased
recurrence of hypomanic/manic episodes in the father during pregnancy
and at birth. Many factors are believed to play a role in the psychological
destabilization resulting in paternal psychosis and manic episodes.
Case: The 38-year old male patient with a history of bipolar disorder
(BD) diagnosis in the antenatal period, presented upon the birth of
his second child with psychotic manic episode after facing stressors
such as insomnia, psychological distress and negative life events. His
hospitalization created extreme suffering on his family.
Discussion: Postpartum psychosis, observed less frequently than mood
disorders in the postpartum period, is regarded as the presentation of BD,
facilitated by liability factors and exposure to social rhythm changes, sleep
deprivation and hormonal changes due to psychostressors. Development
of mood disorders and psychosis in the father during the postpartum
period is also explained by very similar hypotheses. Psychosocial factors
and psychological stress appear to be important. Having a history of
BD before the pregnancy can be decompensated by stressors in the post
partum period and cause the development of psychosis. In the case of our
patient, the risk factors for postpartum mania were maternal depression
at the peripartum phase, having an intrafamily marriage, diagnosis of
BD, concentrated working life, sleep deprivation to care for the infant,
and having a neurotic personality. Having been previously diagnosed
with BD, the patient started living in a separate home from his wife and
children with the fear of recurrence of attacks due to sleeplesness. This
not only created a change in his social rhythm but also involved a sense of
guilt for getting separated from his newborn infant and his wife who had
lost her mother in the peripartum period. These factors are believed, in
accordance with the proposals in the literature, to have prepared the basis
for the development of the manic episode.
Key Words: Mood disorder, paternal, pospartum psychosis
PP2-18
PSYCHOTIC MANIA DEVELOPMENT AFTER
TRAUMATIC BRAIN DAMAGE: CASE PRESENTATION
Hatice Melek Başar, Semiha Selük, Nazan Aydın
Aim: Secondary mania/hypomania can develop with uremia, thyroid
disorders, B12 deficiency, hyperbaric diving, open heart surgery, brain
tumors, central nervous system infections, strokes and traumatic brain
damage (TBD). Bipolar disorder, although not as common as the mood
disorders and anxiety disorders observed after TBD, is nevertheless,
a potential psychiatric complication of TBD and can complicate the
diagnostic process in patients with a history of TBD. Here we present
the psychiatric developments following TBD in the case of a patient.
Olgu: The 47-year old female patient was referred to psychiatry, after
developing mood changes, from the neurology services where she had
been followed up for 10 years for multiple sclerosis. She had been
diagnosed with depression and placed under treatment with different
types of antidepressants without remission. Her history indicated
several hospital admissions due to suicidal ideation. Her mother, sister,
brother and his daughter all had a history of treatment for depression.
In 2013 a flower pot fell on her head when clincial examination and CT
at neurolosurgery services indicated only soft tissue damage and she was
discharged after suturing and recommendation of follow up. She had no
history of hypomania or mania , or alcohol or substance use until the
day of the accident. However, 2 days after the accident she presented
with increased psychomotor activity, excessive talking, reduced sleep
and eating requirements, uneasiness, auditory and visual hallucinations
and was diagnosed with psychotic mania. Anti depressant therapy was
withdrawn, treatment was started with olanzapine (20mg/day) and she
was placed under close observation. Her symptoms improved within 7
days. Treatment with olanzapine was switched to aripiprazole (15 mg)
as she was diabetic and overweight. She is currently under control at the
neurosurgery and psychiatry services.
started with quetiapine (500 mg/day) and lorazepam (5 mg/day) for his
manic symptoms which regressed significantly within 5 days, such that
lorazepam was discontinued and he was discharged on quetiapine (50mg/
day). At discharge, his YMRS score was 1. He has attended control over 6
months regularly and remains without any complaints.
Discussion: This reports aims to draw attention to the frequently
observed psychiatric disorders after TBD. Research on this field is not
only important for the maintenance of the patients but also should
provide clues on the understanding of primary psychiatric disorders.
The importance of detailed psychiatric evaluation of mood disorders
after TBD, case-specific treatment plans and close observation against
the risk of emergence of new disorders is being emphasized.
Emine Yağmur Atay, Yücel Yılmaz, Engin Emrem Beştepe
Key Words: Bipolar disorder, secondary mania, cranial trauma, traumatic
brain damage
PP2-20
MANIA ASSOCIATED WITH DONEPEZIL USE : CASE
PRESENTATION
Eda Yakut, Mine Şahingöz
Necmettin Erbakan University, Meram Faculty of Medicine, Department
of Psychiatry, Konya
Aim: Although mania has been evaluated as a component of bipolar
disorder, it can develop as the result of organic pathologies and
pharmacological therapies. This report discusses presentation of mania
after using the acetylcholine esterase inhibitor donezepil for treating
dementia.
Case : The 70-year old male patient with complaints of amnesia had been
started on donezepil (5 mg/day) by a neurologist he had consulted one
month previously. He had a 3-year history of regularly using escitalopram
(10mg/day) prescribed for mild symptoms of depression. He was also
under control with regular management treatment for hypertension
and diabetes mellitus. He did not have a family history of psychiatric
disorders. About 10 days after starting donepezil therapy, the patient
developed gradually increasing irritability, increased psychomotor
agitation, insomnia, excessive talking, frequently wishing to go out in the
street and rearranging the furniture about the house. He was brought to
the psychiatry polyclinics by relations lest he harmed himself. He was
not cooperative during his psychiatric examination; his thought process
had accelerated and he talked emphatically and incoherently. His thought
contents included persecution delusions; his affect was euphoric, his
sleep requirement was decreased and he did not have insight. His score
on the Young Mania Rating Scale (YMRS) was 33. He was admitted
to the psychiatry ward ; donezepil was withdrawn and treatment was
Discussion: If manic symptoms appear in patients with symptoms
of dementia, effects of drugs used for treating the dementia should be
investigated as well as any underlying organic pathology. The manic
symptoms observed in the patient presented here were believed to be due
to donezepil rather than the 3 years of escitalopram treatment. There case
reports in the literature on development of mania after donezepil.
PP2-21
DIFFERENTIAL DIAGNOSIS OF FRONTOTEMPORAL
DEMENTIA AND PSYCHOTIC DEPRESSION
İstanbul
Introduction: Dementia is a neuropsychiatric disorder that progresses
with various cognitive disorders headed by memory disorder,
personality changes and varying psychiatric and behavioural symptoms.
In the differential clinical diagnosis of frontotemporal dementia, which
progresses with personality change and significant behavioural disorders,
psychotic depression is one of the disorders that must be eliminated.
Case: The 55-year old primary school graduate female patient, living
with her husband and 3 children was brought to Erenkoy Psychological
and Neurological Diseases Training and Resesarch Hospital by her
relatives. She had attempted suicide by hanging 10 days previously. Her
symptoms included insomnia, anhedonia, lack of appetite, amnesia,
dullness, absent- mindedness, a sense of guilt and thought of sinfulness.
At arrival she was conscious, lacked time orientation, showed prolonged
reaction time, was unwilling to communicate with reduced amount of
speech and was not making eye contact. Her self care was reduced, mood
was depressive, affect was apathetic. She had reduced impulse control,
auditory hallucinations of screams, her judgement was impaired and
she lacked insight. Her thought content was dominated by a sense of
sinfulness and the delusion that she would be punished for all sins of
the world. Her depression score on the hospital anxiety and depression
scale (HADS-D) was 48; and mini mental test (MMT) score was 20.
Investigations with CT, MR and positron emission tomography (PET)
did not indicate any pathology. Her evaluation on the neurocognitive
panel of tests concluded as primary dementia. Electro convulsive therapy
(ECT) and fluoxetine (40mg/day) treatment resulted in the correction
of her hallucination and delusions. Her depressive symptoms regressed,
her apathy was reduced. Her MMT score was 29 and her HADS-S score
was 18. Her amnesia and absent-mindedness were still partially present.
Discussion: Clinical observation of dementia and depression together
has been frequently emphasized in the literature. In the case presented
here the diagnosis of psychotic depression was accompanied with
nonclinical findings (based on a panel of neurocognitive tests) that
indicated a development in the direction of frontotemporal dementia
and the follow up controls were planned with the appropriate care.
References
Erden-Aki O (2010) Yaşlı bireylerde demans ve depresyonun ayırıcı
tanısı. Turkish journal of geriatrics, Supp.3: 37-42
Key Words: Dementia, depression, psychosis
37
Key Words: Donepezil, secondary mania, bipolar disorder
PP2-22
BIPOLAR TEMPERAMENT DISORDER AND
IMPULSIVITY, TEMPERAMENT, ATTENTION
DEFICIT HYPERACTIVITY DISORDER :
PRELIMINARY STUDY
Gamze Çelikeloğlu, Şadiye Visal Buturak, Hatice Özdemir
Rezaki, Aslıhan Güneş, Orhan Murat Koçak, Şerif Bora Nazlı
Kırıkkale
Aim: Data exist on the comorbidity of attention deficit hyperactivity
disorder (ADHD) in patients afflicted with bipolar temperament disorder
(BTD) and that ADHD adversely affects the progress of BDT. There are
studies on impulsivity level and temperament profile in BDT and ADHD.
This study has aimed to investigate the levels of ADHD and of impulsivity,
and temperament profiles in individuals diagnosed with BTD.
Method: The SKIP-TURK form has been used to assess the
sociodemographic data and information related to their disorders. The
participating patients have been tested using the Wender Utah Rating
Scale (WURS), Barratt Impulsivity Scale-11 (BIS-11), the Temperament
Evaluation of Memphis, Pisa, Paris, and San Diego auto questionnaire
(TEMPS-A). The data were statistically analyzed by exploratory factor
analyses and Pearson correlation analysis.
Results: The study included 30 BDT patients with a mean age (±standard
deviation) of 41.60±12.20 years. The mean WURS total scores of the
30 patients was 20.53±14.40. The mean BIS-11 scores of 19 patients
was 62.00±10.70 and the mean scores on the TEMPS-A –depressive,
-cyclothymic, -hyperthymic, -irritable and -anxious temperament
subscales were, respectively, 8.90±3.91, 10.50±5.62, 9.90±4.80,5.60±4.42
and 10.30±5.50. In 10% of the patients the WURS scores were above the
cut off score of the scale. Statistically significant positive correlations were
determined between the WURS score and BID-11 total score (p=0.028,
r=0.504), and between WURS score and the BIS-11 cyclothymic
temperament subscale score (p= 0.047, r=0.449) and the correlation
between WURS score and the BID-11 irritable temperament subscale
was close to significance (p=0.055, r=0.436). Furthermore, there were
statistically significant positive correlations between the age of disease
onset and the BIS-11 total score (p=0.035, r=-0.485), the BIS-11
cyclothymic temperament subscale score (p=0.005, r=-0.600) and the
BIS-11 irritable temperament subscale score (p=0.28 r=-0.491).
Conclusion: Our results are in agreement with those reported in the
literature. The relationship between ADHD, which adversely effects the
course of BTD, with high levels of impulsivity, cyclotymic and irritable
temperaments associated with more severe course of BTD is a natural result.
References
Ateşci F, Tuysuzoğulları HD, Ozdel O et al (2010) Comorbidity of
attention deficit hyperactivity disorder in adult bipolar I disorder: a
preliminary study. BCP, 20: 66-7.
Oğuz N, Oral T, Oğuz M (2014) Temperament and Personality Traits of
Bipolar Disorder I Patients Comorbid with Adult ADHD. Anadolu
Psikiyatri Derg, 15: 221-9.
Key Words: Bipolar temperament disorder, impulsivity, temperament
PP2-23
DELUSION OF PREGNANCY AND DIFFERENTIAL
DIAGNOSIS: CASE PRESENTATION
Ahmet Gürcan, Arda Bağcaz, Yavuz Ayhan, Aygün Ertuğrul,
Şeref Can Gürel
Ankara
38
Aim: Delusional pregnancy is a special type of somatic delusion with
differing interpretations of its aetiology and appearance. It is observed
in schizophrenia, schizoaffective disorder, delusion disorder, mood
disorders, epilepsy, urinary tract infections, galactorrhea, dementia and
other organic brain syndromes. In this report pregnancy delusions will
be discussed on the case itself.
Case: F.D., the 45-year old single female patient consulted our clinics
with symptoms of delusion on being pregnant, psychomotor agitation
and severe anxiety. She had a history of previous episodes of depression
and hypomania and had been put on various antidepressants and
mood stabilizers, but she had not shown treatment compliance. She
had consulted many pregnancy clinics over the previous 2 years with
assertion that she had pregnancy causing her anxiety. This delusional
symptom had adversely affected her functionality. She had noteworthy
premorbid personality, extraversion, attention seeking behaviour and
resentfulness of any oppositional situation. She was diagnosed with
psychotic depression and treated with ECT on account of severe anxiety
symptoms and agitation; and subsequently, antidepressant antipsychotic
treatment and maintenance ECT sessions were started.
Discussion: Delusions of pregnancy have been associated with aetiology
based on different basic biological and psychological causes by different
authors in the literature. The patient did not have any of the proposed
possible biological causes such as thyroiditis, metabolic syndrome or
polydipsia. The possible causes proposed in the literature have included
coming out to the open of culturally inhibited desires and associated
fears such as delusional interpretations of bodily changes, disorders
of interpretation of reality with serious ego-pathologies and having
children outside marriage. In the case of our patient this delusion can
be associated with living apart from her mother at childhood, reduced
attention given to her after the birth of her niece, early menopause and
a possible sense of guilt associated with sexual relationships outside
marriage. Absence of psychotic symptoms during her previous affective
disorder episodes, and given the appearance of this delusion at the
age of 45 indicate the probable association of this delusion with post
menopausal physiological changes.
References
Chatterjee SS, Nath N, Dasgupta G et al (2014) Delusion of pregnancy
and other pregnancy-mimicking conditions: dissecting through
differential diagnosis. Med J DY Patil Univ, 7: 369-72.
Kornischka J, Schneider F (2003) Delusion of pregnancy. A case report
and review of the literature. Psychopathology, 36: 276–278.
Key Words: Pregnancy delusion, psychotic depression, pseudocyesis
PP2-24
FAMILIAL MEDITERRANEAN FEVER AND
SCHIZOAFFECTIVE DISORDER: COINCIDENCE OR
ACCOMPANIMENT WITH SIGNIFICANCE ?
Ender Cesur, Fadime Gizem Dönmezler, Nurhan Fıstıkçı
Aim: In order to find new diagnostic, therapeutic and preventive
measures for mood disorders (MD) , the relationships of MD with
inflammatory mechanisms has to be well understood. Despite all
attempts for treatment, very frequent incidences of flare ups and
hospital admissions of a patient with schizoaffective disorder after being
diagnosed with familial Mediterranean fever( FMF or thalassaemia) are
discussed in this report.
Discussion: Prevalence of FMF, which is a genetically inherited
inflammatory condition seen mostly in eastern Mediterranean
populations, and especially among Arabs, Jews and Turkish nationals,
ranges between 1/250 and 1/1000. There is increasing evidence that
immune dysfunction plays a role in the pathophysiology of psychotic
disorders and especially of mood disorders.
References
Leboyer M, Soreca I, Scott J et al (2012) Can bipolar disorder be viewed
as a multi- system inflammatory disease?. J Affect Disord, Volume
141(1): 1-10
Ozaltın F, Ozen S (2003) Familial Mediterranean Fever. Turkiye Tıp
Dergisi, 10(2): 93-97
Key Words: Bipolar disorder, familial Mediterranean fever, inflammatory
disorder
One of the most frequently observed side effects of olanzapine is
increased appetite such that persistence of lack of appetite despite
olanzapine treatment is noteworthy.
The case reported here emphasizes the possibility of observing lack
of appetite as a residual symptom of depression treated with the
combination of olanzapine and fluoxetine.
References
Karp JF et al.(2004) Relationship of variability in residual symptoms
with recurrence of major depressive disorder during maintenance
treatment. Am J Psychiatry, 161(10): 1877-1884.
McClintock SM al (2011) Residual symptoms in depressed outpatients
who respond by 50% but do not remit to antidepressant medication. J
Clin Psychopharmacol, 31(2): 180-186.
Key Words: Fluoxetin, lack of appetite, residual symptom, olanzapine
Case: The 40-year old female patient was admitted to hospital on
account of persistent auditory hallucinations. Her first admission to
hospital psychiatry ward was in 1996, at the age of 22, with diagnosis of
bipolar disorder. She was also diagnosed with FMF in 2004. After being
in continual remission with regular use of her medication, her psychotic
symptoms flared up in 2007 with increasing incidences of attacks and
auditory hallucinations resistant to treatment.
PP2-27
IS ANXIETY DISORDER AT EARLY AGES THE
PREDICTOR OF BIPOLAR DISORDER?
Gamze Kutlu, Filiz Civil Aslan
PP2-25
LACK OF APPETITE AS RESIDUAL SYMPTOM OF
DEPRESSION: CASE PRESENTATION
Zekiye Çelikbaş, Nurgül Yeşilyaprak, Emrah Songur,
Mesut Yıldız, Sedat Batmaz
Psychiatry, Tokat
Aim: Residual symptoms of depression are the sub threshold symptoms
which continue on after therapy when the patient feels better with
the improvement of most of the symptoms. This report discusses the
residual symptom of lack of appetite in a patient treated with fluoxetine
and olanzapine for depression.
Psychiatry, Trabzon
Aim: Since episodes of depression, as against of mania or hypomania,
present at the prodromal stages of Bipolar Disorder (BD)), detection
of BD II is often missed and the patients are diagnosed with unipolar
depression (UD). Prevalence of life long comorbid anxiety disorder
in patients diagnosed with BD has been reported to range from 24%
to 93%. It has been intended here to emphasize, through this case
presentation, that patients seeking psychiatry consultations especially
during the depressive episodes with comorbid anxiety disorder (AD)
should be investigated for BD symptoms since this comorbid AD can
have a predictive significance for BD.
Case: The 21-year old male patient consulted a psychiatrist with
complaints of lack of morale, lack of appetite and depression when he
was put on fluoxetine (20mg/day) and , and alprazolam ( 0,75 mg/
day). On the 10th day of his treatment he consulted the emergency
services of our university with complaints of loss of appetite and
depression when alprazolam was switched to olanzapine (5 mg/day).
After two weeks on olanzapine and fluoxetine the patient abandoned
his treatment as he had nearly recovered from his symptoms. However
he came back in 2 months time with the repetition of his symptoms.
His scores on psychometric rating scales were BDI: 30/63, BAI: 16/63,
HDRS 17/53. He was started on fluoxetine (20mg/day) and olanzapine
(5 mg/day) for anxiety with major depression. After one month only
partial improvement necessitated titrating fluoxetine dose to 40 mg/day.
One month subsequently his control psychometric scores were BDI:
14/63, BAI: 2/63, HDRS: 12/53 indicating improvement, but his lack
of appetite had persisted.
Case: The 36-year old senior high school graduate, married male patient
complained of depressive symptoms including pessimism, disinterest,
irritability, amnesia, fatigue and anhedonia that he had developed over
the previous year. He was on fluoxetine (40 mg/day) and olanzapine(
7,5 mg/day) and his score on the Montgomery-Asberg Depression
Rating Scale (MADRS) was 28 and. His detailed anamnesis revealed
that he had had two past hypomania episodes with excessive spending,
insomnia, starting a new business, increased libido and increased speed
and content of speech. He had been treated for social phobia in his last
year in school. He had symptoms of generalized anxiety disorder with
severity that would seriously affect his functionality. He had also been
treated many times for UD. His fluoxetine treatment (40 mg/day) was
continued, but olanzapine treatment was discontinued and switched
to lithium (900 mg/day) as his liver functions tests were not normal.
As the depression symptoms regressed fluoxetine was discontinued
with gradual dose reduction. However, his complaints of disinterest,
anhedonia and anergia persisted and bupropion (150 mg/ day) and
lamotrigine (12,5 mg/day, which was titrated weekly to the 125mg/day
doses) were added to his treatment. His depression partially improved
and the score on MADRS fell to 20. He is currently under follow up
control at the polyclinics.
Discussion: Appetite disorders are among the residual symptoms of
depression. It has been known that loss of appetite can appear as a
symptom of depression and can persist as a residual symptom despite
antidepressant therapy or develop after the therapy.
Discussion: Attention should be paid to signs of mood disorder and
especially those of BD development in patients with multiple psychiatric
disorders. It must be remembered that AD onset at early ages may be
a prodromal symptom of BD. Patients arriving with major depression
39
signs should be carefully questioned for BD symptoms for the purposes
of correct diagnosis.
References
Lut T (2007) Comorbidity of Bipolar Disorder and Anxiety Disorder-A
Review. Turk Psikiyatri Dergisi, 18(1): 59-71
Ozturk Z, Karakuş G, Tamam L (2008) Effectiveness of Citalopram in
the Treatment of Post-Stroke Pathological Crying and Laughing:
Case Presentation. Achieves of Neuropsychiatry, 45: 100-2.
Key Words: Emotional lability, emotional incontinence, post-stroke
pathological crying, PLC, pathological laughing and crying
Key Words: Bipolar disorder, anxiety disorder, comorbidity
PP2-29
PP2-28
POST-STROKE PATHOLOGICAL CRYING AND
SERTRALINE EFFECT : CASE PRESENTATION
Ecenur Aydın Aşık1, Kıvanç Aşık2, Fatma Coşar1,
Kadir Aşçıbaşı1, Erol Ozan1
Manisa
2
Manisa Government Hospital, Anesthesiology and Reanimation Clinic,
Manisa
1
Aim: Pathological laughing and crying (PLC) present in absence of
stimuli, with sudden and uncontrollable attacks of exaggerated laughing
or crying. It is preferentially treated with selective serotonin reuptake
inhibitors (SSRIs), antidepressants and psychotropic agents. This case
presentation has aimed to discuss the process of post-stroke pathological
crying.
Case: The cranial CT of the 54-year old male patient after his
cerebrovascular accident (CVA) revealed acute infarction at the
right frontoparietotemporal area; and the MR images through the
supratentorial brain confirmed the presence of an acute infarct in
the right frontoparietotemporal lobe. He underwent decompressive
craniectomy and developed post-op sudden sentimentality, and
meaningless crying episodes independent of emotions.
Neurological examination indicated a vague left nasolabial groove, left
hemiparesis with limited left lateral gaze. Psychologically judgement
and evaluation of reality was adequate; but, depressive mood and affect,
anhedonia, diminished desire for attention, pessimism, hopelessness,
thoughts of low esteem and inadequacy, untimely and meaningless
emotional incontinence in the form of crying not related to mood and
affect were observed. The clinical picture suggested post-stroke PLC
and he was started on sertraline (25-50 mg) treatment resulting in
improvement in his condition.
Discussion: PLC is one of the most common post-stroke affective
disorders with a first year prevalence of 15-20%. PLC has three main
characteristics as the sudden loss of emotional control over laughing
and/or crying; development after non-specific and neutral stimuli; and,
not being related to the prevailing mood or affect. It was first described
by Fere in 1903 as the “Fourire prodromique” and subsequent referrals
in the literature have ranged as “emotionalism, pseudobulbar affect,
emotional lability, emotional incontinence, and post-stroke labile
affect’’. The underlying mechanism is believed to be a serotonergic
system dysfunction caused by damage to the serotonergic neurons of
the dorsal raphe nucleus or to the hemisphere the raphe nucleus is
located in. There have been reports in the literature on beneficial effects
of sertraline on cases of PCL.
References
Mukand J, Kaplan M, Senno RG, Bishop DS (1996) Pathological
crying and laughing: treatment with sertraline. Arch Phys Med
Rehabil, 77(12): 1309-11.
40
PSYCHIATRIC DISORDERS RELATED TO
STEROID USE AND A REVIEW OF PROPYLACTIC
ANTIPSYCHOTIC THERAPY : CASE PRESENTATION
Gülizar Şenol, Koray Başar
Ankara
Aim: Treatment of psychiatric adverse side effects of steroid use can be
managed with dose reduction or the discontinuation of the therapy.
However, when this is not possible, prophylactic use of psychotropic
agents can be recommended. This report aims to review the choice of
psychotropic agents for prophylactic use and prophylactic olanzapine
treatment in a case of psychotic mania due to steroid therapy.
Case: The 22-year old female patient with a history of acute lymphocytic
leukaemia (ALL) consulted the Hacettepe university Medical School
Haematology Department in September 2014 with the complaint of
double vision. Cranial MR imaging indicated metastasis and steroids
with radiotherapy (RT) were planned. She was referred to psychiatry
before the starting the treatment lest the previous complications of
her treatment in 2013 repeated. . Her history revealed that she had
been diagnosed with ALL in March 2013 and cranial RT with steroid
treatment had been started. On the 5th day of the therapy the patient
(who did not have a previous history of psychiatric disorder and
treatment) developed sleep disorder and started failing to recognise her
relatives and her whereabouts when RT was terminated. She was started
on haloperidol for delirium which was changed due to side effects.
Although her orientation was corrected, she developed symptoms of
excessive and nonsense speech, reduced sleep duration, psychomotor
agitation, envy and delusions of persecution and reference that lasted
for nearly 2 months despite immediacy in stopping her medication.
Her psychiatric examination did not indicate any pathology and her
history was evaluated as psychotic mania due to steroid therapy. She
was put on olanzapine with dose titration to 10 mg/day and started
on RT and steroid therapy without development of any psychiatric
symptoms. In the second month after her discharge the patient stopped
using olanzapine. And did not develop psychiatric symptoms over the
4-month follow up control.
Discussion: Mood stabilizers, antipsychotic agents and
nonpharmacological therapies have been recommended for the
prevention of psychotic and affective disorders caused by steroid use.
Controlled studies on the subject are limited. Algorithms should be
prepared for case specific choice of treatment approaches.
References
Warrington TP, Bostwick JM (2006) Psychiatric adverse effects of
corticosteroids. Mayo Clin Proc, 81: 1361–1367.
West S, Kenedy C (2014) Strategies to prevent the neuropsychiatric side
effects of corticosteroids: case report and review of the literature.
Curr Opin Organ Transplant, 19: 201–208.
Key Words: Steroid, mania, olanzapine
ACUTE INTERSTITIAL PNEUMONIA
DEVELOPMENT DUE TO HEROIN INHALATION
Şevin Hun1, Elçin Özçelik Eroğlu1, Şeref Can Gürel1,
Kazım Rollas2, Özlem Erden Aki1
Ankara
2
Hacettepe University, Faculty of Medicine, Department of Internal
Medicine, Ankara
1
Aim: Wide scale use of heroin by inhalation in the recent years has
caused an increased incidence of lung disease due to bronchial
reactivity, the most frequently seen complications being noncardiogenic
pulmonary oedema, aspiration pneumonia, lung abscess and atelectasis.
Acute interstitial pneumonia is a rarely seen condition in relation to
heroin aspiration that can develop suddenly causing respiratory failure.
This report aims to discuss the treatment of a patient with heroin
dependency presenting with fever, shortness of breath and coughing.
Case: The 22-year old married female patient without a past history of
any internal diseases consulted the emergency services with complaints
of fever and coughing which did not improve despite antibiotic use. She
was placed in intensive care unit with hypoxia, tachypnea and the need
for mechanical ventilation. It was learned that she had aspirated heroin
for the previous month, the last incidence being two days previous to
her consultation. She had severe unease and agitation. Her score on
the Clinical Opiate Withdrawal Scale-(COWS) was 9. Her psychiatric
treatment was planned with quetiapine (50 mg/day), hydroxyzine (
3x25 mg/day), ibuprofen (3x400 mg/day) and loperamide (16 mg/day).
Her COWS score at follow up control was lowered to 3. Results of the
serological tests, blood culture, and bronchoalveolar lavage investigation
together with lung tomography and ecocardiography lead to diagnosis
of acute interstitial pneumonia. She was given supplemental oxygen
therapy and intravenous steroids. She recovered in a short time and was
discharged.
Discussion: Acute interstitial pneumonia rarely develops with heroin
use. The pulmonary complications previously observed with cocaine
users are now being diagnosed in heroin-dependent patients. It
should be remembered that these types of potentially fatal pulmonary
complications can present without necessarily the use of very high doses
of heroin.
Refrences
Megarbane B, Chevillard L (2013) The large spectrum of pulmonary
complications following illicit drug use: features and mechanisms.
Chem Biol Interact, 206(3): 444-51.
Wolff AJ, O’Donnell AE (2004) Pulmonary effects of illicit drug use.
Clin Chest Med, 25:203-16.
Key Words: Heroin, heroin dependency, interstitial pneumonia
PP2-31
COMORBIDITY OF COGNITIVE DISORDERS AND
MULTIPLE SCLEROSIS: CASE PRESENTATION
and may progress with attacks. Frequently observed symptoms include
weakness of extremities, sensory symptoms, ataxia, urinary bladder
problems, visual symptoms, dysarthria, and cognitive symptoms of
memory-concentration-attention problems. This case is presented with
the aim to emphasize the necessity of eliminating organic pathology
during the examination of elderly patients with memory failure and
developing psychotic symptoms.
Case: The 62-year old female patient without a history of psychiatric
consultation had been followed for MS at the neurology services over the
previous 5 years. She was referred to psychiatry with the development of
psychomotor agitation and psychotic symptoms. During her psychiatric
examination she was conscious, with complete place-person orientation
but improper time orientation, and poor short term memory. Her mood
was anxious and fearful. She had insomnia, distractibility, delusions of
persecution and jealousy. Her routine investigations were normal. Her
neurological treatment for cognitive loss due to MS included citalopram,
memantine and donepezil. Risperidone was added to her medication
given the new psychomotor agitation and psychotic symptoms. She was
referred back to neurology services for cranial imaging as part of the
follow up control.
Discussion: Neurocognitive disorders have been classified by the
DSM-V in two groups on the basis of clinical severity. MS is one of
the causes of severe neurocognitive disorder. In a review on 118 studies
scanned for the incidence and prevalence of psychiatric disorders in
MS, the assessments on prevalence were 21.95% for anxiety, 14.8%
for alcohol misuse, 5.83% for bipolar disorder, 23.7% for depression,
2.5% for substance use, 4.3% for psychosis (1). Another study reported
neurocognitive losses in MS to have a prevalence range of 40-65% (2).
The case discussed here emphasizes the importance of determining the
organic aetiology fully and correctly in psychiatric evaluations.
References
Marrie RA, Reingold S, Cohen J et al.(2015) The incidence and
prevalence of psychiatric disorders in multiple sclerosis: A
systematic review. Multiple Sclerosis Journal, 1-13, DOI:
10.1177/1352458514564487
Yıldız M, Tettenborn B, Radue EW et al (2014) Association of cognitive
impairment and lesion volumes in multiple sclerosis—a MRI study.
Clin Neurol Neurosurg, 127: 54-58
Key Words: Neurocognitive disorder, multiple sclerosis, psychosis
PP2-32
MUNCHAUSEN SYNDROME IN DIFFERENTIAL
DIAGNOSIS OF RECURRENT HAEMOPTYSIS
Ekin Sönmez, Dilay Tunca
İstanbul
Aim: Differential diagnoses of not otherwise definable disorders include
factitious disorders and feigning illness. The case presented here is
an example to the differential diagnosis of factitious disorder which
constitutes an important complication in the consultative assessment
of adolescent and young adult patients referred to psychiatry services .
Duygu Keskin Gökçelli
Case: The patient was a 22-year old senior high school graduate single
male, unemployed and living with his family. He had lost his father 13
years previously after stomach cancer.
Introduction: Multiple Sclerosis (MS) is an autoimmune central
nervous system disease characterized by inflammation, demyelinisation
and axonal damage. It takes a progressive course at onset or at a later stage
He was referred to psychiatry for evaluation the from the pulmonary
diseases and surgery departments where he had been followed up for
5 years for complaints of recurrent haemoptysis without a successful
41
PP2-30
conclusion on the aetiology. The clinician responsible for his case made
the referral after the patient’s pessimism and languidness on account of
not being able to work gainfully. There were no pathological indications
in his laboratory and radiological investigation results. It was learned
through history taking that haemoptysis had started in high school,
with repeated incidences over three days or without any occurrence for
a month, and that he had been through ‘’more than 20 bronchoscopies,
hundreds of tomographic investigations, and 4 bronchial artery
embolization procedures’’ without the discovery of the underlying cause.
It was noted that he used many medical terms, exaggerated numerical
accounts and referred to the responsible clinicians with familial terms of
address such as ‘’brother, sister’’. Attitude to his interviewer was found to
be manipulative and demanding. Testing on the Minnesota Multiphasic
Personality Inventory (MMPI) indicated over involvement in physical
preoccupations, expressing problems and emotional difficulties by
somatization, manipulative approaches in relationships and immaturity,
suggesting borderline personality organization. He was planned to be
followed through supportive psychotherapy.
Discussion: Unclarified aetiology of haemoptysis, despite advanced
investigations, suggested the differential diagnosis of factitious disorder.
Being young and male, having a history of losing his father at an early
age, and his personality traits can be taken in favour of Munchausen
syndrome. Factitious disorder being an elimination diagnosis may create
problems in decision making over cases of interdepartmental referrals
for consultation.
References
Cinel G, Yavuz ST, Ozcelik U et al. (2012) A rare cause of hemoptysis:
Munchausen syndrome. ERJ, 40 (Suppl 56) P3510
Kokturk N, Ekim N, Aslan S et al. (2006) A rare cause of hemoptysis:
factitious disorder. South Med J, 99(2):186-7.
overeating and insomnia lasting for a month. Physical examination
showed the presence of skin lesions with blue and purple mottling at
the extremities. During neurological investigation she was conscious,
cooperative and oriented; her speech was dysarthric but comprehension
was normal. Her left nasolabial sulcus was vague but the rest of the
cranial area was intact. Muscular strength grading was 4/5 (sequel)at
right upper and lower extremities, 1/5 at upper left and 3/5 at lower
left extremities. Psychiatric examination indicated medium self care;
communicativeness with prolonged attacks of laughing followed by
crying; labile mood and inconsistent affect; and thought contents
without psychotic ideas. ECG had normal sinus rhythm. Cranial CT
showed haematoma at the right putamen. Microcytic anaemia was
the only pathological result of her routine investigations including the
vasculitis and thrombophlebitis workup.
Discussion: Observation of repeated strokes and livedo reticularis with
negative vasculitis tests was evaluated as SS. Although the definitive
aetiology of SS in not known, pathogenic involvement of anticardiolipin
(antiphospholipid) autoantibodies has been proposed, although cases
with negative anticardiolipin antibodies have also been reported (Arslan
et al., 2013 ). We have emphasized here that this rare syndrome can be
accompanied with psychiatric symptoms and can also start with these
symptoms.
References
Arslan E, Dirican A, Ertem H et al (2013) Sneddon Syndrome with
Negative Autoantibodies; Case Presentation and Literature Review.
Archieves of Neurpsychiatry 50: 180-182
Zelger B, Sepp N, Stockhammer G et al (1993) Sneddon’s Syndome. A
Long-term Follow –up of 21 Patients. Arch Dermatol, 129: 437447.
Key Words : Sneddon syndrome, livedo reticularis, stroke
Key Words: Factitious disorder, haemoptysis, Munchausen syndrome
PP2-34
PP2-33
SNEDDON SYNDROME STARTING WITH
PSYCHIATRIC SYMPTOMS: CASE PRESENTATION
Gülşen Teksin1, Meryem Gül Teksin Bakır2, Sema Ulukaya1,
Yavuz Altunkaynak3, Serkan Özben3
2
Ankara
3
Hospital, Neurology Clinic, İstanbul
1
Aim: Sneddon Syndrome (SS) is a type of arteropathy involving the
neurological symptoms of stroke, hypertension, epilepsy, dementia,
depression, emotional lability, and also repetitive abortus and livedo
reticularis or racemosca at the extremities (Zelger B et al., 1993). This
report discusses the case of a patient diagnosed with SS, having a history
of abortus and presenting with stroke, livedo reticularis, and negative
autoantibodies.
Case: The 47-year old female patient arrived with weakness on the left
side and speech disorder. Her history included an abortus. She was
diagnosed at rheumatology services with thromboangitis obliterans and
livedo vasculitis 1.5 years previously, and given anticoagulant (warfarin)
treatment. In the 6th month of her therapy she recovered from an
ischaemic stroke with a sequel of right hemiparesis. It was learned that
over the previous 2 years she had had several episodes of irritability,
42
DANDY WALKER SYNDROME AND BIPOLAR
DISORDER: CASE PRESENTATION
Burçhan Sözer, Mustafa Tunçtürk, Büşra Gürel,
Tuna Güzide Yener Örüm
Aim: Dandy Walker Syndrome (DWS) is the congenital anomaly
involving cystic enlargement of the 4th ventricule, hypoplasia of the
cerebellar vermis and hydrocephalus. There are case reports on the
comorbidity of DWS with Psychosis and Bipolar Disorder (BD). This
report has aimed to draw attention to the development of BD in a
patient diagnosed with DWS.
Case: The 33-year old female patient consulted us with symptoms of
psychotic manic episode that developed 3 weeks previously. She had a
history of DWS since childhood and had been followed up for BD-I
for the previous 10 years. Neurological examination did not reveal any
pathology apart from minimal ataxia. She had headaches and cranial MR
gave signals of increased definition in the CSF spaces of the posterior
fossa, increased definition of the cerebellar folia and hypoplasia of the
cerebellar vermis, all compatible with DWS.
Discussion: Cerebellum plays an important role in motor processes.
Also, recent research has demonstrated its part in mood stabilization,
and the pathogenesis of cognitive and psychiatric disorders. Diagnoses
of BD and DWS in the case presented here can be taken as an example
of the role of cerebellar vermis in mood organization.
Key Words: Bipolar disorder, Dandy Walker Syndrome, Cerebellum
PP2-35
FRONTOTEMPORAL DEMENTIA FOLLOWED AS
BIPOLAR DISORDER: CASE PRESENTATION
Mustafa Tunçtürk, Ersin Uygun, Burçhan Sözer,
Nezih Eradamlar
Aim: Frontotemporal dementia constitutes 13% of all early onset
type of dementias and has increasingly gained importance as one of
the causes. Patients with frontotemporal dementia display deficits of
executive functions but, unlike the Alzheimer’s patients, they retain
the memory and visual spatial functions. Since the clinical picture is
not clear due to the presence of many symptoms, wrong diagnoses are
made frequently. This report discusses the example of a patient with
frontotemporal dementia presenting with manic episode symptoms and
a history of treatment for bipolar disorder (BD).
Case: The 48-year old unemployed married patient with 2 children was
admitted to the ward from emergency psychiatry with symptoms of
irritability, amnesia, personality change, delusions involving grandeur
and religiousity and auditory hallucinations. He had a 3-year history of
follow up controls for BD, without any improvement in his symptoms.
He did not use alcohol or psychoactive agents. His family history did
not include any psychiatric complaints or consultations. He had been
sentenced once by court for unlawful wounding. Laboratory tests did
not reveal any pathology. His symptoms, clinical course, laboratory
results together with the imaging results on MR and PET (positron
emission tomography) were compatible with the diagnostic criteria for
frontotemporal dementia.
Discussion: The case presented her indicates that in the process of
evaluating patients with psychiatric symptoms, when the clinical data
do not converge on a typical pathology or previous treatments have not
resulted in improvements, the case should be differentially investigated
for different diagnoses including that of frontotemporal dementia,
which should also be included in the differential diagnosis of manic
episodes in the elderly patients.
References
Kuğu N, Doğan O, Kavakcı O al (2010) Frontotemporal Demans: Bir
Olgu Sunumu. (Frontotemporal Dementia: A Case Presentation)
Duşunen Adam Psikiyatri ve Norolojik Bilimler Dergisi, 23: 293299
Onur E, Yalınay PD (2011) Frontotemporal Demans ve Psikiyatrik
Belirtiler. (Frontotemporal Dementia and Psychiatric Symptoms)
Duşunen Adam Psikiyatri ve Norolojik Bilimler Dergisi, 24: 228238
PP2-36
MULTIPLE SCLEROSIS PRESENTING WITH
PSYCHOTIC SYMPTOMS: CASE PRESENTATION
Cem Özdağ, Özden Arısoy
AİB University, İzzet Baysal Psychiatry Training and Research Hospital,
Psychiatry Clinic, Bolu
Aim: Studies on MS have demonstrated the presence of mood disorders,
predominantly of depression, with different severities in most patients.
Although psychotic symptoms generally present at the later phases
of MS, they can rarely be detected at the first consultation. This case
has been presented to emphasize the importance of evaluating organic
pathologies when the psychiatric findings overshadow the neurological
symptoms.
Case: A. N. is a 47-year old female patient. Her complaints to us
included : slow walking, difficulties of speech, tremor, frozen facial
muscles and balance loss. History taking revealed that she had had these
complaints for the previous 10 years and one year previously she started
hearing voices blaming her, which lead to misunderstandings with
her neighbours making her unhappy. She had consulted a psychiatrist
after developing suicidal ideation when she did not use her medication
regularly but recovered in 7-10days. However, these symptoms
reappeared 1.5 months previously when she was given sertraline (50
mg) and aripiprazole ( 5 mg) at a health care centre, and her suicidal
symptoms receded after titration of aripiprazole dose to 10 mg; but the
neurological symptoms of tremor, facial frozenness, gait and speech
disorders which she complained of at consultation with us had persisted.
Further questioning indicated that she had double and blurred vision,
numbness and weakness in her knees and hands. Psychiatric examination
indicated adequate self care, consciousness with good orientation, blunt
affect, dysarthric speech, normal abstraction and judgement, adequate
attention and memory. She did not have hallucinations. Her score
on the standardized mini mental test (SMMT) was 28; her EEG was
normal and the cranial MR indicated many MS plaques with 4-5 active
ones. Her symptoms significantly improved after she was started on
steroid therapy for MS.
Discussion: Since the psychotic symptoms presented before the
depressive symptoms, the patient was suspected to have psychotic
disorder. Late age of onset of the symptoms, absence of negative
symptoms, disorganized behaviour and talking, and the improvement
of the symptoms of the first attack without therapy and the resistance
of the second attack to antipsychotic and antidepressants excluded
schizophrenia. There being extrapyramidal system, motor and sensory
symptoms she was referred to neurology services for consultation on
movement disorder and MS.
References
Carrieri PB, Montella S, Petracca M (2011) “Psychiatric onset of multiple
sclerosis: description of two cases,” Journal of Neuropsychiatry and
Clinical Neurosciences, 23(2): E6.
Key Words: Multiple sclerosis , psychotic disorder, depression
Key Words: Bipolar disorder, frontotemporal dementia, manic episode
43
References
Baldacara L, Borgio JGFB, Lacerda ALT etal (2008) Cerebellum and
Psychiatric Disorders. Rev Bras Psiquiatr, 30(3): 281-9.
Tumturk AF, Oktem İS (2013) Dandy Walker Malformation. Turk
Noroşirurji Dergisi, 23; 2: 180-4.
PP2-37
PP2-38
SACCULAR ANEURYSM AND POSTOPERATIVE
FRONTAL LOBE SYNDROME: CASE PRESEBTATION
STROKE VERSUS CONVERSION DISORDER: CASE
PRESENTATION
Meryem Gül Teksin Bakır1, Seçil Aldemir1, Duran Berker
Cemil2, Emre Cemal Gökçe2, Emine Şimşek1, Ercan
Dalbudak1, Şule Aktaş1
Merve Şahin1, Hamza Şahin2, Fatma Özlem Orhan1
Ankara
2
Turgut Özal University, Faculty of Medicine, Department of
Neurosurgery, Ankara
1
Aim: This report discusses the case of a patient whose psychiatric
complaints started after surgical correction of a saccular aneurysm on
the cerebral anterior communicating artery.
Case: The 55-year old male patient with symptoms of post operative
agitation, insomnia, behaviour changes and associated problems in
the neurology ward was referred to psychiatry services for consultative
assessment. It was learned that he was restless, talked nonsense, related
past events as recent events and made approaches to the hospital
personnel with sexual intent. He did not have a history of psychotic
symptoms, manic attack or psychiatric consultation. During psychiatric
examination he was conscious; his person and place orientations were
impaired; attention and memory were impaired; affect was labile and
anxious; mood was irritable; insight was weak and judgement was poor;
thought process was impaired with poor recall and thought content
harboured paranoid type hallucinations. Presence of psychomotor
agitation and insomnia suggested frontal lobe syndrome (FLS). He
was already on phenytoin (3 x 1 mg/day). He was given haloperidol
(i.m. 1x 1 mg/day) against agitation. Repetition of haloperidol dose at
night did not create sleep problems. Recommendations for the patient
included haloperidol injection as regarded necessary, cranial MR and
EEC investigations, and psychiatric follow up after discharge.
Discussion: FLS develops with damage to the frontal lobe when
the patient displays significant personality change (Hariri et
al.2004). Personality changes arising from brain damage are due to
pathophysiological changes in the brain, and is regarded as deviation
from the norms of the previous personality profile. This condition
cannot be explained as delirium or another psychiatric disorder. In the
case reported here delirium has been excluded since the clinical picture
was chronic rather than fluctuating. Powerful antipsychotic agents such
as haloperidol is used against the increased psychomotor activities such
as explosive anger attacks and aggressive behaviour. If impulse control
disorder is present, lithium, carbamazepine or valproic acid can be
recommended. Haloperidol was preferred in the case of our patient
against the display improper behaviour, explosive anger and insomnia.
References
Hariri AG, Oncu F, Karadağ F (2004) Two Cases of Frontal Lobe
Syndrome. Anadolu Psikiyatri Dergisi, 5: 179–187
Kaplan HI, Sadock BJ (2005) Comprehensive Textbook of Psychiatry,
8. edition, Philadelphia, Williams and Wilkins, 1. volume: 39
Key Words: Frontal lobe syndrome, postoperative
Department of Psychiatry, Kahramanmaraş
2
Department of Neurology, Kahramanmaraş
1
Aim: Conversion disorder (CD) makes up 40% of the conditions
mimicking stroke. This report discusses the case of a patient who was
suspected with CD after the first consultation at the emergency services,
but was correctly diagnosed with acute cerebrovascular accident (CVA)
after diffusion weighted MR imaging.
Olgu: The 76-year old female patient with a previous medical history
of hypertension, coronary artery disease and arrhythmia consulted the
hospital emergency services upon sudden development of involuntary
movements in her left hand and arm. She was referred to the neurology
services for possibility of seizure and the psychiatry clinics for conversion
disorder. When faced with questions and simple instructions the clonic
movements of the patient were seen to stop completely. When asked
to lift her left arm, involuntary movements restarted, she hit her face
and abdomen several times, and made pelvic pushing movements.
Neurological examination was normal except hypoaesthesia at the
left upper extremity, and left Babinski positivity. Diffusion weighted
MR imaging indicated acute diffusion restriction extending from the
periventricular area in the post-central gyrus of the right parietal lobe to
the cortical space. The patient was admitted to the neurology ward with
the diagnosis of acute CVA.
Discussion: As seen in the case reported here, the possibility of CD
mimicking stroke must be remembered in the evaluation of elderly
patients with high stroke risk factors. Otherwise stroke diagnosis would
be missed and treatment would be delayed.
References
Vroomen PC, Buddingh MK, Luijckx GJ et al (2008) The incidence of
stroke mimics among stroke department admissions in relation to
age group. J Stroke Cerebrovasc Dis, 17: 418-22.
Key Words: Conversion, stroke, diffusion weighted MR imaging
PP2-39
BROWN-SÉQUARD SYNDROME AFTER SUICIDAL
ATTEMPT: CASE PRESENTATION
Ilgaz Kınalı1, Ürün Özer1, Serkan Özben2, Şakir Özen1
2
Bakırköy Prof. Dr. Psychiatry Training and Research Hospital, Neurology
Clinic, İstanbul
1
Aim: Brown-Séquard Syndrome (BSS) , first described by the French
physiologist Charles-Edouard Brown-Séquard, is the clinical condition
that develops upon hemisection of the spinal chord. The classical
observations are ipsilateral hemiparesis and loss of proprioception
and contralateral loss of the sense of pain and temperature. In many
cases the syndrome is only partial. The most frequent causes are spinal
traumas, radiation necrosis and metastatic disease. It was reported that
after investigating 38 cases of BSS that traumatic BSS occurred mostly
in traffic accidents, wounding by boring-cutting instruments and diving
44
Case: The 43-year old male patient arrived at the psychiatric emergency
unit with complaints of depression and suicidal ideation. He had a
23-year history of alcohol dependency, depression and personality
disorder and had been placed under control observations. It was found
out that his first suicidal attempt was at the age at 20, followed by
diverse attempts by drinking potassium permanganate, intravenous air
injection, drinking drugs, lying on rail tracts and cutting blood vessels
of his wrists. In 2003 he had stabbed himself with a bread knife at the
level of C1-C3 vertebrae of the spinal chord and developed BSS, but the
resultant hemiplegia regressed with physiotherapy. When he consulted
us, 4/5 level of hemiparesis was still present at the left extremities. He
was admitted to the ward, and started on quetiapine (300mg/day),
valproic acid (750mg/day), venlafaxine (150mg/day), mirtazapine (30
mg/day) and Lithuril (1200mg/day). On the 12th day of the treatment
his complaints had improved and he was discharged.
Discussion: BSS generally has good prognosis as compared to other
spinal chord damages and motor skills can be regained with physical
therapy, enabling independent living. Therefore clinicians should be
attentive in cases BSS with traumatic wounding.
Key Words: Suicide, Brown-Séquard Syndrome, spinal trauma
PP2-40
ATTENTION DEFICIT HYPERACTIVITY SYNDROME
AND PSYCHOGENIC POLYDIPSIA: CASE
PRESENTATION
Şenay Kılınçel1, Pınar Vural1, Oğuzhan Kılınçel2
Uludağ University, Faculty of Medicine, Department of Pediatric and
Adolescant Psychiatry, Bursa
2
Uludağ University, Faculty of Medicine, Department of Psychiatry, Bursa
1
Aim: Psychogenic polidipsia is rarely noticed condition despite
surfacing frequently with psychiatric disorders. Its clinical recognition
is very important considering that it can lead to hyponatraemia, coma
and death. Although more frequently present with chronic psychiatric
disorders and especially schizophrenia, it has been rarely reported in
cases of attention deficit and hyperactivity disorder (ADHD). We have
attempted to discuss the comorbidity of psychogenic polydipsia and
ADHD and the choice of drugs for treatment.
Case: The 9-year old girl patient, drinking 18-20 litres of water per
day, was referred from the endocrinology clinics after completion of all
organic investigations. She was diagnosed with ADHD on the basis of
the DSM-V criteria, after her interview and psychiatric examination.
As the data in hand did not indicate any reasons for excessive fluid
ingestion, there being no indications of another illness or drug use,
psychogenic polydipsia comorbidity with ADHD was concluded upon.
Correction of the polydipsia after atomoxetine (40 mg/day) treatment
confirms this opinion.
Discussion: The case discussed here demonstrates the importance of
history taking and evaluation by pointing to the possible inclusion of
psychogenic polydipsia in the range of impulse control disorders as
well as to the capacity of comorbid physical illnesses to overshadow
psychiatric symptoms.
References
De Leon J, Verghese C, Tracy JI ve ark (1994) Polydipsia and water
intoxication in psychiatric patients: a review of the epidemiological
literature. Biol Psychiatry, 35(6): 408–19.
Costanzo ES, Antes LM, Christensen AJ (2004) Behavioral and medical
treatment of chronic polydipsia in a patient with schizophrenia and
diabetes insipidus. Psychosomatic Medicine, 66: 283–86.
Key Words: Psychogenic polydipsia, attention deficit, hyperactivity,
impulsivity
PP2-41
ECCHYMOSIS AFTER VENLAFAXINE USE : CASE
PRESENTATION
Özge Yüksel, Özlem Devrim Balaban, Ali Keyvan,
Burcu Kök
Aim: Venlafaxine is a serotonin-noradrenaline reuptake inhibitor (SNRI)
and is used for the treatment of psychiatric disorders. Thrombocyte
function disorder is a very rarely observed adverse side effects of these
agents. This study reports a case of ecchymosis which we believe has
developed after venlafaxine use.
Case: The 53-year old female patient, was married with 2 children and
worked as an as employee. She consulted our polyclinics with depression
symptoms of unhappiness, languidness, insomnia and frequent episodes
of weeping. She was started on escitalopram which she had benefited
from previously. However, lack of improvement in her condition
necessitated switching to venlafaxine with dose titration to 150 mg/day.
On the 8th week of the therapy she developed widespread ecchymoses
on her legs. It was learned that she had developed ecchymoses on her
arms on the 3rd week of the therapy but had not made complaints
as these had disappeared spontaneously. She did not complain of any
traumas and the tests on the aetiology of haemorrhage were normal.
As the pathology developed concurrently with venlafaxine use, the
treatment was interrupted, resulting in clearance of the ecchymoses in
two weeks. Her treatment was resumed with duloxetine and ecchymoses
had not reappeared in the first month follow up.
Discussion: Venlafaxine is thought to cause bleeding disorders through
its effect on serotonin despite its inhibition of noradrenaline reuptake
as well. There are case reports in the literature on increased risk of
haemorrhage with SNRI use. Since SNRIs inhibit the transport of
serotonin into the thrombocytes which influences haemostasis by
being released back into the circulation during aggregation and weakly
stimulating thrombocyte aggregation. Insufficiency of this serotonin
release is believed to be the cause deficient thrombocyte aggregation.
Studies have not indicated a reduction in the thrombocyte count during
velafaxine treatment. It is therefore important to query the use of SSRIs
or SNRIs in patients arriving with bleeding disorders or ecchymoses.
References
Serma A, Horne III MK (2006). Venlafaxine-induced ecchymoses and
impaired platelet aggregation. Eur J Haematol, 77: 533-537.
Song HR, Jung YE, Wang HR et al (2012) Platelet count alterations
associated with escitalopram, venlafaxine and bupropion in
depressive patients. Psychiatry and Clinical Neurosciences, 66: 457459.
Key Words: Venlafaxine, eccymosis, bleeding
45
accidents. We have aimed here to draw attention of clinicians to the
symptoms and investigative results of a BSS case with spinal damage
incurred during suicidal attempt.
PP2-42
PP2-43
RESTLESS LEGS SYNDROME AND THE POOSIBLE
RELATION WITH QUETIAPINE THERAPY: CASE
PRESENTATION
SEROTONIN SYNDROME SYMPTOMS IN PATIENTS
USING SEROTONERGIC AGENTS
Birmay Çam
Manisa Psychiatry Training and Research Hospital, Psychiatry Clinic,
Manisa
Aim: Restless legs syndrome (RLS) is a sensory-motor disorder
characterized with a typical urge to move, with worsening symptoms
at rest, and predominantly affects the lower extremities. Antipsychotic
agents clozapine, olanzapine, risperidone and aripiprazole have been
reported to induce RLS. Quetiapine triggered RLS is limited with
case reports. This report is on a case of RLS triggered by quetiapine
treatment.
Case: The 68-year old female patient complained of unhappiness,
anxiety, disinterest, insomnia, anergia she had experienced for long
years. She had a 10-year history of diabetes mellitus and was under
control on metformin hydrochloride with stable blood glucose levels.
She did not have a history of psychiatric treatment and her family
history was uneventful. She was diagnosed with major depression
disorder and started on duloxetine (30mg/day) and quetiapine (25
mg/day). At her first one monthly control the patient complained of
difficulty in going to sleep and, for the first time, of restlessness in her
legs with an urge to move them. Her biochemistry data on iron, ferritin,
transferrin, vitamin B12 and folic acid levels and hepatic, renal and
thyroid function tests were normal. Neurology consultation did not
result in any organic pathology. Discontinuation of quetiapine as the
possible underlying cause led to the reversal of the RLS symptoms. Her
treatment was continued with mirtazapine (15mg/day) and duloxetine
(60mg/day). She has been in partial remission under continued therapy
for 4 months.
Discussion: When the literature is scanned, quetiapine induced RLS
is restricted to case reports only. There are also reports on the effective
management of RLS with quetiapine therapy. In the case reported here,
ascribing the symptoms to diabetes is not convincing since she has used
the same medication for 10 years with stabile blood glucose levels. As
the symptoms developed for the first time after starting quetiapine (25
mg/day) when her laboratory test results were normal, and disappeared
after discontinuation of the quetiapine treatment , clinicians must pay
attention to RLS symptoms when using antipsychotics.
Şerif Bora Nazlı, Hatice Özdemir, Şadiye Visal Buturak
Kırıkkale
Aim: Serotonin syndrome (SS) is a life threatening clinical condition
that can develop after starting a therapy with a new serotomimetic or
serotonergic agent or merely increasing the therapeutic dosage. Mental
changes, neuromuscular hyperactivity and autonomic instability are the
main symptoms of SS. The aim of this study has been to investigate the
symptoms of SS development in patients started on a new serotonergic
agent or continued to be treated after increasing the dosage of the
already prescribed drug.
Method: This study included patients between the ages of 18-60
years planned to be started with or continued on an increased dose of
serotonergic agent. The criteria of exclusion were mental retardation,
history of neurological disease-cranial trauma, substance use disorder,
cognitive disorder, presence of an active infection and known thyroid
disorder. Patients were tested with a questionnaire on symptoms of
SS, on the Structured Clinical Interview for DSM-IV Axis I Disorders
(SCID-I), the Beck Anxiety Inventory (BAI) and Beck Depression
Inventory (BDI). They were examined neurologically and for SS
symptoms on the third day of their respective treatments.
Results: The study included a total of 37 patients including 19 (51.4%)
females. The mean age was 32.5 years (SD ±11.73). The diagnoses on the
basis of DSM-IV ranged as: depression, 16 (43,2%); generalized anxiety
disorder, 16 (43,2%); panic disorder, 3 (8,1%); obsessive-compulsive
disorder, 1 (2,7%) and social phobia, 1 (2,7%). Investigations were
started on the day when a new serotonergic agent was started on 26
(70,3%) patients and when the dose of the serotonergic agent used was
raised in 11 (29,7%) patients. SS symptoms were seen to have increased
significantly on the third day (p<0,0001). Analysis of the relationship
between the SS symptoms seen on days 0 and 3 with BAI and BDI total
scores indicated a positive correlation of the symptoms on day 0 with
the BAI scores (r: 0,396, p:0,015).
Conclusion: SS is rarely observed while subthreshold symptoms are
frequently missed. In this study symptoms of serotonin toxicity after
treatment started with a new agent or continued with an increased dose
attained levels that cannot be overlooked.
References
İpekcioğlu D, Havle N, Yuksel G et al (2012) Restless Legs Syndrome
Development with Quetiapine Use; Two Case Presentations. Yeni
Symposium, 50(4): 248-250.
Pinninti NR, Mago R, Townsend J et al (2005) Periodic Restless Legs
Syndrome Associated with Quetiapine Use: A Case Report. J Clin
Psychopharmacol 6: 617-618.
References
Iqbal M, Basil JM, Kaplan J (2012) Overview of serotonin syndrome,
Ann clin psychiatry 24(4): 310-318
Radomski JW, Dursun SM, Reveley MA et al (2000) An exploratory
approach to the serotonin syndrome: an update of clinical
phenomenology and revised diagnostic criteria. Med Hypotheses,
55(3): 218-24.
Key Words : Restless Legs Syndrome, antipsychotic, quetiapine
Key Words: Serotonin syndrome, side effect, antidepressant
46
CAVUM VERGAE AND SCHIZOPHRENIA –BRAIN
IMAGING RESULTS AND CLINICAL OBSERVATIONS
IN A 25-YEAR UNTREATED CASE
Berkant Sağır, Tolga Binbay, Ayşegül Özerdem,
Köksal Alptekin, Nefize Yalın, Deniz Ceylan
İzmir
Aim: Psychotic symptoms and disorders are observed with structural
anomalies of the brain. Septum pellucidum is a double membrane
structure in the brain midline and is part of the limbic system. When
the two membranes of septum pellucidum do not adhere completely the
structure is termed cavum vergae and is considered to be the most severe
of the anomalies associated with the development of septum pellucidum.
Case: The 60-year old male patient explained at his first consultation
that he organised his daily life according to the instructions he received
from the voices he heard and that he believed that if he did not do as the
voices ordered he would lose a member of his family. He believed that
he had lost his father and uncle after avoiding complete adherence to
these orders and that therefore he stayed away from his family and had
not spoken to his relatives for years. He had consulted the hospital for
the first time ever to receive help because the voices had threatened to
kill his daughter which he dreaded. The patient did not have a history
of receiving any psychiatric help. His cranial MR revealed a septum
pellucidum or cavum vergae with 43x20x10mm dimensions.
Discussion: Although there are reports that cavum vergae is more
frequently detected in schizophrenia and other psychotic disorders, it
is believed that significant relationships exist in anomalies exceeding
6 mm. Cavum vergae has been proposed to be an indicator of wider
developmental anomaly associated with other midline structures and
their connections. The report here has discussed the cavum vergae
anomaly, its dimensions and the psychotic symptoms observed in an
elderly patient diagnosed with schizophrenia who had not received any
treatment for the 25-year duration of his psychosis.
References
Flashman LA, Roth RM, Pixley HY et al (2007) “Cavum septum
pellucidum in schizophrenia: clinical and neuropsychological
correlates.” Psychiatry Res 154(2): 147-155.
Trzesniak C, Oliveira IR, Kempton MJ et al (2010) Are cavum septum
pellucidum abnormalities more common in schizophrenia spectrum
disorders?. A systematic review and meta-analysis. Schizophr Res,
125(1): 1-12.
Key Words: Cavum vergae, septum pellicidum, psychosis without treatment
limit the use of the drug. Hepatotoxicity affects the quality of life with
risks of fulminant hepatitis and mortality.
Case: Miss X, the 45-year old single university graduate was brought to
the hospital by the police. It was learned that her complaints had started
in 1991 with suspicions on a conspiracy planned against her mother and
herself, and despite degrees of improvements her thoughts persisted and
adversely affected her functionality. She had used haloperidol irregularly
with partial benefit but had abandoned the medication. Psychiatric
examination revealed dispersed recall and systemized hallucinations.
Her routine tests were normal. She was believed to have schizophrenia
and was started on risperidone and amisulpride. When the treatment
was not effective, it was switched to clozapine. On the 36th day of
her treatment, when the clozapine dose was 750 mg, she presented
with myoclonic jerks. EEG indicated mild-medium level of cerebral
diffusion. Serum hepatic enzyme levels were raised. Toxic hepatitis
was suspected; treatment was discontinued and physiological serum
iv infusion was started. Abdominal-pelvic ultrasonography indicated
hepatosteatosis. Cytomegalovirus (CMV) IgM, Epstein Bar virus
(EBV) IgM , total IgG, IgA, IgM and IgE and rest of the serological
tests , and also her blood culture were all negative. Procalcitonin level
was 28 and C-reactive protein (CRP) was 101. For 10 days she was
given invanz 1 gm iv infusion. Hepatic enzyme levels were corrected,
CRP and procalcitonin level fell to 24.9 and 0.17, respectively. Hepatic
function tests, haemogram and bleeding parameters were followed and
haloperidol treatment was continued.
Discussion: In 30-50% of the patients treated with clozapine
asymptomatic hepatic enzyme elevation can be observed. Generally
when the enzyme levels reach three fold the normal levels,
discontinuation or dose reduction would be considered. In the case
reported here AST and ALT were elevated 5 and 13 fold, respectively,
necessitating discontinuation of clozapine with dose reduction and the
switch to haloperidol. Side effects of clozapine treatment should be
closely followed by the clinician.
References
Hummer M, Kurz M, Kurtzhaler I ve ark (1997) Hepatotoxicity of
Clozapine. J Clin Pharmacol, 17: 314-7.
Macfarlane B, Davies S, Mannan K ve ark (1997) Fatal acute fulminant
liver failure due to clozapine: a case report and review of clozapine
induced hepatotoxicity. Gastroenterology, 112(5): 1707–9.
Key Words: Toxic hepatitis, clozapine
PP2-46
FREGOLI SYNDROME: CASE PRESENTATION
Ersin Uygun, Burçhan Sözer, Sevilay Kunt, Nurhan Fıstıkçı
PP2-45
TOXIC HEPATITIS DEVELOPMENT DUE TO
CLOZAPINE TREATMENT FOR SCHIZOPHRENIA:
CASE PRESENTATION
Şule Aktaş1, Meryem Gül Teksin Bakır1, Burhanettin Kaya2
Ankara
2
1
Aim: Clozapine is the most effective choice of antipsychotic agent to be
used for treatment resistant schizophrenia. However, adverse side effects
Aim: Fregoli syndrome (FS) or Fregoli delusion is one of the delusional
misidentification syndromes (DMS) that can develop in the context
of psychological or neurological disorders, when the patient comes to
believe that the identity of an individual, object or place is replaced by
another. DMS are evaluated in 4 basic groups consisting of Capgras,
Fregoli intermetamorphosis and the doppelganger delusions. The case
presented here discusses the development of FS in a patient with a
history of schizophrenia diagnosis.
Case: The 64-year old retired male patient consulted psychiatry services
with complaints including hearing female voices, the presence of a
woman over the previous 3 years getting into the outward appearance
47
PP2-44
of everyone and interfering with him, hearing voices in his head
giving him instructions, loss of interest and motivations, anhedonia,
dissatisfaction and amnesia. He had a 15-year history of psychiatric
disorder, but his family history was uneventful. His medical condition
involved hypertension and cardiac failure and he was under controlled
pharmacotherapy. He did not use cigarettes or alcohol. He declared that
up to the date of his consultation he had not used any psychoactive
substance. His psychiatric examination indicated restricted affect,
depressive mood, persecution delusions and auditory hallucinations.
His thought content was dominated by the voice of a woman who
continually appeared in the identity of others ; he had insight and his
symptoms were ego dystonic. The neuropsychometric data on him were
evaluated in favour of a psychiatric disorder rather than the process
of dementia, and the results of the Bender Gestalt test which gives an
indication of neurological intactness were significant with respect to
organicity.
Discussion: Different hypotheses have been put forward to explain
the DMSs. The initial attempts of Capgras with psychodynamic
explanations later shifted to aetiological neuroanatomical and organic
reasons supported by the development of neuroimaging techniques, and
the neuropsychiatric and cognitive findings especially associated with
dysfuntion and damage in the right brain. MR imaging results on the
patient discussed here support the neuroanatomical hypotheses.
References
Christodoulou GN, Margariti M, Kontaxakis VP et al (2009) The
delusional misidentification syndromes: strange, fascinating, and
instructive. Curr Psychiatry Rep 11: 185-92.
Key Words: Fregoli syndrome, delusional misidentification syndrome,
Capgras syndrome
PP2-47
ANTI CIGARETTE CAMPAIGNER : A MEDIATIC
DELUSIONAL DISORDER CASE
Mehtap Sarıoğlu, Ilgaz Kınalı, Ürün Özer, Şakir Özen
Aim: Delusional Disorder is characterized by systematic delusions
of persistent type. It can be discriminated from others by involving
delusions that are nonbizarre, the absence of hallucinations and the
organized free associations. In DSM-V the requirement of nonbizarre
delusions has been cancelled and erotomanic, grandiose, jealousy,
persecutory, somatic, mixed and unidentified types have been included.
These are dominated by persecutory delusions. The case of the patient,
who had also found a place in the media as ‘the anticigarette campaigner’,
has been presented here with the aim to draw attention to the possibility
of missing the diagnosis of a delusion with a ‘realistic’ basis.
Case: The 51-year old male patient was referred to our clinic for
evaluation of his psychiatric condition in relation to his status as an
employee on grounds of his history of campaigning against cigarette
smoking at his work place, which included his written applications, the
court cases started by him and against him. The patient came to the
interviews with a file that contained his pictures cut off many local and
national news papers, the punitive decisions of his employer to stop
his promotion, requests for obligatory assignment and court cases on
defamation. He also brought to the interviews detailed explanations of
his intent and efforts to make state institutions non-smoking areas, and
what he had suffered in the process so far, all written at night time.
He had thoughts of delusional dimensions about blowing cigarette
48
smoke to the faces of pregnant women, the entry of cigarette smoke
into the work place from the cafes; that cigarette smokers had become
his enemies, and outright persecutory delusions associated with his
colleagues and his superior director. The patient was diagnosed with
delusional disorder and discharged on treatment with risperidone (2mg/
day).
Discussion: Patients diagnosed with delusional disorder are known to
make their delusions the focal point of their lives and continually look
for further evidence to support their claims. The illness is not easily
understood as functionality is not impaired outside self care and the
activities associated with the delusion, such that they can convince
others on the validity of their delusion. As these patients lack insight,
they do not seek treatment and/or do not accept treatment and can
create multiple concerns in their own lives as well as of others as
discussed in the case presented here. Therefore, clinicians have to
bear an important task during the diagnosis, treatment and control of
patients with delusional disorders.
Key Words: Media, delusional disorders, cigarette smoking
PP2-48
TETRALOGY OF FALLOT AND TOTAL SITUS
INVERSUS COMORBIDITY WITH SCHIZOPHRENIA:
CASE PRESENTATION
Esra Kabadayı1, Semra Ulusoy Kaymak2,
Görkem Karakaş Uğurlu1, Özkan Ünal3, Ali Çayköylü1
Psychiatry, Ankara
2
Ankara
3
Radiology, Van
1
Aim: Observation of the comorbidity of structural anomalies or genetic
conditions with schizophrenia have been regarded as opportunities to
search the aetiology of the psychiatric disorder. This reports describes a
case with comorbidity of the tetralogy of Fallot and total situs invertus
with schizophrenia.
Case: The 36-year old male patient complained to the emergency
services that he did not use the mediation prescribed to him because
of a conspiracy to poison him and having aggressive behaviour. He had
developed his suspicions a few weeks previously and therefore had started
eating prepacked foods only. He or his family did not have a history of
psychiatric consultation. However, he had been operated as a 5-year old
for tetralogy of Fallot and situs inversus totalis, and had incidences of
hypoxic seizures. He smoked 15 packages of cigarettes per annum. His
physical examination indicated no other pathology than receiving S1
and S2 cardiac sounds from the right side due to dextrocardia. During
his psychological examination he was conscious, with anxiety and in
a defensive attitude. HE was using ear plugs. His affect was anxious
and irritable, his evalution and judgement of reality was impaired, high
thought content included delusions of reference, persecution and of
being controlled. He displayed psychomotor agitation, and aggression,
lack of appetite, weight loss and insomnia. His routine biochemistry
tests were within normal limits. Chapman&Chapman Handedness
Scale indicated preference for the right hand. Cranial MR showed sulcal
widening, atrophy and a 2-cm long gliosis in the right frontal cortex.
Functional investigation showed that his speech centre was in the left
posterior sylvian area and that the length of the sylvian fissue, width of
He was diagnosed with psychotic disorder and started on risperidone (2
mg/day) treatment.
Discussion: In this case presentation our study method of the reflection
in the brain of the displacement of the internal organs was discussed.
References
Apitz C, Webb GD, Redington AN (2009) Tetralogy of Fallot. Lancet
374: 1462-71.
Key Words: Tetralogy of Fallot;, situs inversus totalis , şchizophrenia
PP2-49
REUSE OF CLOZAPINE AFTER DEVELOPMENT
OF MYOCARDITIS DUE TO CLOZAPINE: CASE
PRESENTATION
Buket Sevinç, Melike Küçükkarapınar, Mustafa Ender Taner
Gazi University, Faculty of Medicine, Department of Psychiatry, Ankar
Aim: Clozapine is the sole antipsychotic agent with confirmed
effectiveness on ‘treatment resistant schizophrenia’. Next to its frequently
observed side effects of hypotension, hypersalivation and confusion, it
has serious adverse effects such as agranulacytosis, hepatitis, myocarditis
and cardiomyopathy. There is not sufficient information on the
retreatment of schizophrenia patients with clozapine after developing
myocarditis due to previous clozapine therapy. However, it is known
that this has been tried in some clinics with good results. The report
below reviews and discusses myocarditis development with clozapine use
and reuse of clozapine after this development together with the case of
a patient retreated with clozapine after the development of myocarditis
ascribed to the previously ongoing clozapine therapy.
Case: The 30-year old single and unemployed male patient consulted
psychiatry services with complaints of suspiciosness, doubtfulness,
disorganised behaviour and excessive talking which had started after
he discontinued his management treatment with amisulpiride (1200
mg/day) and quetiapine (1200 mg/day). He had a 10-year history of
schizophrenia, 2 years of which had been under the control of our
clinics, and an incident of developing myocarditis 7 months previously
after being on clozapine therapy. His routine tests and cardiology
consultation were completed and, with the permission of his family,
he was started on clozapine (12.5 mg/day). He was followed for 8
weeks with weekly tests including full haemogram, cardiac enzymes,
electrocardiography (ECG) and echocardiography (ECHO). Follow up
tests were carried out less frequently thereafter. During the second week
of the newly started therapy, clozapine dose was increased by 12.5 mg /
day and thus titrated up to 400 mg/day. The patient’s symptoms were
improved. He is being followed by controls and was in partial remission
in the 15th week.
Discussion: Although rarely observed, myocarditis due to clozapine use
is a potentially fatal condition that presents with nonpathognomonic
symptoms of fever, tachycardia, chest pain, dyspnea, elevated white blood
cell count, non specific ECHO changes and elevated cardiac enzymes
in the serum. In cases suspected with myocarditis, the parameters of
cardiac damage are estimated together with the assessment of cardiac
functions, and if myocarditis is confirmed, clozapine treatment is
discontinued. Reuse of clozapine after myocarditis incidence is subject
to controversy. There are reports on the subject and recommendation
of close follow up during the first 4 weeks on the cardiac enzyme and
CRP levels. The observations made on the patient presented here are
in agreement with those recommended in the literature and indicate
that clozapine can be used successfully on a patient with a history of
myocarditis due to clozapine therapy. Here the dose titration was slower
than in the previous treatment protocol, which may have prevented the
redevelopment of myocarditis. Faster titration of the dose may trigger
the observed myopathy in the liable patient. Further investigations on
the risk factors are needed.
References
Bray A, Reid R (2011) Successful Clozapine Rechallenge after Acute
Myocarditis. Aust NZJ Psychiatry, 45; 90
Key Words: Clozapine, myocarditis, treatment resistant schizophrenia
PP2-50
the sylvian fissure and planum temporale, and the leftward posterior
asymmetry observable at the sylvian fissure were preserved.
VERSION OF DSM-5 SYMPTOM SEVERITY SCALE
FOR SCHIZOPHRENIA AND OTHER PSYCHOTIC
DISORDERS
Ahmet Herdem1, Didem Sücüllüoğlu Dikici1,
Kadir Aşçıbaşı1, Ecenur Aydın Aşık1, Talat Sarıkavak1,
Orkun Aydın1, Emine Özge Çöldür1, Deniz Alçı1,
Serra Yüzeren Başsivri1, Kuzeymen Balıkçı1, Fikret Poyraz
Çökmüş1, Siğnem Öztekin1, Fatma Akdeniz1,
Manisa
2
1
Aim: DSM-5 Symptom Severity Scale for Schizophrenia and Other
Psychotic disorders (SSSPD) has been designed to assess the severity of
adult psychotic disorder on the basis of the DSM-5 criteria. This work
has aimed to test the diagnostic validity and the clinical reliability of the
Turkish version of SSSPD-TR.
Method: This research has been conducted on the inpatients and
outpatients being treated at the Celal Bayar University Medical School
Psychiatry Clinics after being diagnosed on the DSM-5 criteria with
psychotic disorders. The patients (n=49) consisted of 40 cases of
schizophrenia, 6 cases of otherwise not specified psychotic disorders and
3cases of schizoaffective disorder. Controls consisted of 101 volunteers
without any psychological or physical disorders. . Reliability analyses
included the internal consistency and material-total score correlation
analyses; and validity analyses included exploratory factor analyses.
The specificity and sensitivity of the scale have been determined by
the comparison of the mean scores of the two groups and with ROC
analysis.
Bulgular: The mean (± SD) age of the experimental groups was
26.3±10.3; and 52.7% (n=79) were females. The group consisted of
graduates from institutes of higher education (69.3%), high schools
(25.0%) or primary schools (8.0%); consisting of graduates from
universities (56.7%), high schools (19.3%) or primary schools (8.0%).
Mean duration of psychotic disorders was 17.1±9.7. The internal
consistency of the PPPDS-TR was 0.91, and the material-total score
correlation coefficient range was 0.25-0.82 (p<0.0001). The KMO and
the Bartlett test results on sampling capacity were , respectively, 0.81
and 1.03 (p<0.0001); and a single factor solution was obtained with
an eigenvalue of 5.12, explaining 64.0% of the variance. The scale item
factorial loading were in the range of 0.33-0.88. The mean PPPDS-TR
score of the psychotic disorders group was 11.00±5.20 in comparison
49
to 0.21±1.21 in the control group with a significant difference between
the two groups (T=20.05, p<0.0001).
Conclusion: The results obtained have indicated that PPPSD-TR has
the required diagnostic validity and the clinical reliability to be used
with Turkish population.
References
American Psychiatry Association-APA-2013- DSM-5 Diagnostic
Criteria Guidebook– Translated by Koroğlu E, Hekimler Yayın
Birliği, Ankara, 2013.
Gaebel W, Zielasek J (2008) The DSM-V initiative “deconstructing
psychosis” in the context of Kraepelin’s concept on nosology.
EurArch Psychiatry Clin Neurosci 258 (Suppl 2): 41-47.
Keywords: Psikotik bozukluk, şizoaffektif bozukluk, şizofreni
PP2-51
A NEUROLEPTIC MALIGNANT SYNDROME CASE IN
ICU- CAN ECT SAVE LIFE?
Onur Yirün, Şafak Yalçın Şahiner, Merve Cingi,
Elif Tatlıdil Yaylacı
Ankara Numune Training and Research Hospital, Psychiatry Clinic,
Ankara
Aim: Neuroleptic malignant syndrome (NMS) and lethal/malignant
catatonia(MC) are classified under the heading of catatonic syndromes.
The differential diagnosis of these two conditions on the basis of clinical
or laboratory investigations in not possible. The aim of this report is
to discuss the similarities of and the treatment strategies on these two
disorders over a case of NMS , as well as the psychiatric follow up in the
intensive care unit (ICU).
Case: The patient who had been controlled for 10 years with the
diagnosis of schizophrenia was received at the emergency services with
symptoms of fever and severe rigidity. While being investigated he
became stuporous. His vital signs were not stabile. He was placed in
ICU and investigated for NMS and MC. Despite correction of the vital
signs the catatonic symptoms persisted and the patient was transferred to
the ECT unit. After 8 sessions of ECT catatonic symptoms disappeared
completely.
Discussion: Syndromes such as NMS and MC with high incidences of
mortality indicate the importance of investigating the general medical
condition of the patients arriving at emergency units with catatonia-like
symptoms. Many investigators regard NMS as a iatrogenic version of
MC and the treatment steps are basically the same. In both types of
cases the primary step is the supportive therapy under ICU conditions.
In NMS and other catatonic cases that do not respond to medical
treatment ECT appears to have life saving significance. Managing these
patients in the ICU in cooperation with a psychiatrist will enable better
use of the choice of treatments available.
References
Strawn JR, Keck PE Jr, Caroff SN (2007) Neuroleptic malignant
syndrome. Am J Psychiatry 164: 870-6.
Troller JN ve Sachdev PS (1999). Electroconvulsive treatment of
neuroleptic malignant syndrome: a review and report of cases: Aust
NZ J Psychiatry, 33: 650–659
Key Words: Catatonia, malignant catatonia, NMS, schizophrenia
50
PP2-52
DIFFICULTIES FACED IN PHARMACOTHERAPY OF
SCHIZOPHRENIA AND MYASTHENIA GRAVIS: CASE
PRESENTATION
Gizem Dönmezler, Ender Cesur, Çağatay Karşıdağ,
Nurhan Fıstıkçı
Aim: Miyasthenia gravis (MG) is a relatively rarely seen autoimmune
disease and its comorbidity with a chronic mental disorder is even rarer.
This report discusses the difficulties to be expected in the choice of
medication and treatment of a patient diagnosed with schizophrenia
and MG.
Case: The 34-year old female patient with a 13-year history of
schizophrenia was admitted to ward after consulting psychiatry with
symptoms of insomnia, loss of appetite, aggressiveness, persecutory
delusions and auditory hallucinations. She had been diagnosed with
ocular MG 5 months previously. Her medication had been altered due
to extrapyramidal system side effects. The patient did not regularly
comply with her pharmacotherapy.
Discussion: It may be difficult to discriminate the MG symptoms from
the extrapyramidal side effects of the antipsychotics which results in
prescription of anticholinergic agents. Although the anticholinergic
agents show high selectivity for the blockage of muscarinic receptors,
they may also slightly block the nicotinic acetylcholine receptors which
the MG associated antibodies interfere with. This slight blockage may
be clinically rather significant.
Key Words: Comorbidity, myasthenia gravis, schizophrenia
AUTHORS INDEX
AUTHORS INDEX
A
Akbaş, Seher 4
Akdede, Berna 5
Akdeniz, Fatma 13, 14, 25, 49
Akdur, Özgür 22
Aki, Özlem Erden 41
Akkaya, Cengiz 22
Aksoy, İhsan 32
Aksoy, Semra 30
Aktaş, Şule 44, 47
Akyel, Betül 33
Alçı, Deniz 13, 14, 25, 49
Aldemir, Ebru 33
Aldemir, Seçil 35, 44
Alıcı, Soner 29
Alpaslan, Güler 15
Alptekin, Köksal 5, 47
Altındağ, Abdurrahman 32
Altıntaş, Merih 22
Altıntoprak, Ayşe Ender 33
Altunkaynak, Yavuz 42
Aral, Gizem 12
Arık, Ali Cezmi 34
Arısoy, Özden 43
Arslan, Filiz Civil 6, 12, 39
Aşçıbaşı, Kadir 13, 14, 25, 40, 49
Aşık, Ecenur Aydın 13, 14, 25, 40, 49
Aşık, Kıvanç 40
Atagün, Murat İlhan 34
Atasayar, Gülfer 22
Atay, Emine Yağmur 37
Atgüden, Neslişah 11, 22
Atik, Serdar 26
Atilla, Ercan 33
Aydemir, Ömer 13, 14, 25, 49
Aydın, Mehmet Sinan 16
Aydın, Nazan 17, 36
Aydın, Orkun 13, 14, 25, 49
Ayhan, Yavuz 27, 38
Aysevener, Behice Elif Onur 22
B
Babadağı, Zehra 28
Babalıoğlu, Merve 29
Bağcaz, Arda 17, 27, 38
Bakır, Meryem Gül Teksin 42, 44, 47
Balaban, Özlem Devrim 45
Balıkçı, Adem 26
Balıkçı, Kuzeymen 13, 14, 25, 49
Bal, Zeynep Ezgi 17
Başar, Hatice Melek 36
Başar, Koray 3, 17, 27, 40
Baş, Özlem 31
Başsivri, Serra Yüzeren 13, 14, 25, 49
Batmaz, Sedat 4, 7, 15, 39
Belirgan, Sercan 29
Belli, Hasan 17
Berksun, Oğuz Erkan 11
Beştepe, Engin Emrem 37
Binbay, Tolga 47
Bora, İbrahim 22
Böke, Ömer 34
Bulut, Necati Serkut 6
Buturak, Şadiye Visal 26, 38, 46
C
Canbay, Cana 31
Can, Güneş Şayan 5
Can, Serdar Süleyman 31, 34
Cemil, Duran Berker 44
Cengiz, Gül Ferda Ş. 15
Cesur, Ender 21, 38, 50
Ceylan, Deniz 47
Cingi, Merve 50
Coşar, Fatma 40
Coşkun, Akın 19
Coşkun, Nihan 16
Coşkunol, Hakan 33
Ç
Çallı, Sümeyye Kurtuluş 22
Çaman, Özge Karadağ 3
Çam, Birmay 46
Çarpar, Elif 21, 32
Çayköylü, Ali 31, 48
Çeçen, Hülya 19
Çelikbaş, Zekiye 39
Çelikeloğlu, Gamze 38
Çeri, Veysi 24
Çetin, Turan 33
Çökmüş, Fikret Poyraz 13, 14, 25, 49
Çöldür, Emine Özge 13, 25, 27, 49
Çöldür, E. Özge 14
D
Dağ, Pelin 24
Dalbudak, Ercan 35, 44
Dallıoğlu, Çiğdem Kırcı 5
Değirmencioğlu, Banu 5
Demir, Aylin Bican 22
Demir, Bahadır 32
Demirci, Onur Okan 18, 19, 20
Demirtaş, Hatice Seda Norçin 34
Dereboy, Çiğdem 5
Dereboy, Ferhan 5
Dikici, Didem Sücüllüoğlu 13, 14, 25, 49
Donmezler, Gizem 21
Dönmez, Aslıhan 16
Dönmezler, Fadime Gizem 21, 38
Dönmezler, Gizem 50
E
Elbi, Hayriye 18
Eminagaoglu, Neslihan 22
Eradamlar, Nezih 43
Erdem, Murat 26
Ergelen, Mine 31
Ermiş, Berna 18, 19, 20
Eroğlu, Elçin Özçelik 41
Erpolat, Seval 35
Erten, Evrim 21
Ertuğrul, Aygün 38
Eskin, Mehmet 5
Evren, Ekrem Cüneyt 33
Ezer, Şule 27
F
Fıstıkçı, Nurhan 21, 38, 47, 50
G
Gökçe, Emre Cemal 44
Gökçelli, Duygu Keskin 33, 41
Göker, Zeynep 12
Göncü, Tuğba 11, 22
53
Güçyetmez, Volkan 32
Güleç, Gülcan 7
Gülsu, Emre 5
Gülsün, Murat 16
Gültekin, Bülent Kadri 11
Gümüş, Kübra 8, 28
Gümüş, Saliha Yalçın 15
Gündoğan, Meltem 7
Güneş, Aslıhan 26, 38
Güneş, Tufan 20
Gürcan, Ahmet 38
Gürel, Büşra 26, 35, 42
Gürel, Şeref Can 27, 38, 41
Gürgen, Atila 30
Güz, Hatice 34
H
Kuru, Erkan 15
Kutlu, Gamze 39
Küçükkarapınar, Melike 49
L
Levent, Esin 24
M
Maner, Ayşe Fulya 29, 31
Mısır, Emre 36
Mor, Sema 8, 28
Mutlu, Fezan 7
N
Nazlı, Irmak Polat 18
Nazlı, Şerif Bora 38, 46
Hepdurgun, Cenan 23
Herdem, Ahmet 13, 14, 25, 49
Hun, Şevin 41
Hurşitoğlu, Onur 26
Orhan, Fatma Özlem 29, 44
Ozan, Erol 27, 40
İ
Ö
İnkaya, Ahmet Çağkan 3
İslamoğlu, Sümeyye 34
K
Kabadayı, Esra 48
Kaçar, Ömer Faruk 8, 28
Kaçat, Ömer Faruk 28
Kaloğlu, Hatice Ayça 23
Kaptanoğlu, Cem 7
Kara, Fatma Karaca 12
Karşıdağ, Çağatay 26, 35, 50
Kaya, Burhanettin 19, 20, 23, 47
Kaymak, Semra Ulusoy 31, 34, 48
Kefeli, Mehmet Celal 19
Keyvan, Ali 21, 45
Kılınçel, Oğuzhan 22, 45
Kılınçel, Şenay 45
Kınalı, Ilgaz 44, 48
Kızılay, Pınar 6
Koçak, Orhan Murat 26, 38
Koçbıyık, Sibel 4, 7, 15
Kora, Kaan 3
Kök, Burcu 33, 45
Köroğlu, Ertuğrul 13, 14, 25, 49
Kunt, Sevilay 26, 35, 47
54
O
Öğüt, Dicle Bilge 31
Örsel, Sibel 15
Örüm, Tuna Güzide Yener 42
Öyekçin, Demet Güleç 30
Özben, Serkan 42, 44
Özdağ, Cem 43
Özdel, Kadir 15
Özdemir, Hatice 26, 46
Özdemir, İlker 15
Özdemir, Osman 19
Özdemir, Pınar Güzel 33
Özen, Şakir 44, 48
Özerdem, Ayşegül 36, 47
Özer, Ürün 24, 32, 44, 48
Özkorumak, Evrim 12
Özsoydan, Ebru Onrat 22
Öztekin, Siğnem 13, 14, 25, 27, 49
Özturan, Deniz Deniz 8, 28
Öztürk, Arif 8, 28
P
Pazvantoğlu, Ozan 34
Pırıldar, Şebnem 18
R
Rezaki, Hatice Özdemir 38
Rollas, Kazım 41
S
Saatçioğlu, İbrahim Ömer 21
Saatçioğlu, Ömer 21
Sağaltıcı, Eser 18, 19, 20
Sağır, Berkant 47
Sağlam, Fatih 30, 36
Sancak, Barış 24, 32
Sarıkavak, Talat 13, 14, 25, 49
Sarıoğlu, Mehtap 48
Sarısoy, Gökhan 8, 28, 34
Sayılgan, Nilüfer 11
Selük, Semiha 36
Semiz, Murat 16, 26
Sevinç, Buket 49
Songur, Emrah 39
Sönmez, Ekin 41
Sönmez, Hikmet Ekin 13
Söylemez, İbrahim 11
Sözer, Burçhan 42, 43, 47
Subaşı, Nilüfer 13
Sungur, Mehmet Zihni 6
Süner, Özgür 31
Ş
Şafak, Yasir 15
Şahin, Ahmet Rıfat 34
Şahin, Ardıl Bayram 17
Şahiner, Şafak Yalçın 50
Şahingöz, Mine 37
Şahin, Hamza 44
Şahin, Merve 44
Şenol, Gülizar 40
Şimşek, Emine 44
T
Taner, Mustafa Ender 49
Tan, Seda 35
Taycan, Serap Erdoğan 20
Teke, Halenur 30, 36
Teksin, Gülşen 31, 42
Terzi, Ayşe 11
Tiryaki, Ahmet 6
Topcu, Merve 35
Topuzoğlu, Ahmet 5
Tunas, Sabide Duygu 12
Tunca, Dilay 41
Tunçel, Özgür 4
Tunçtürk, Mustafa 26, 42, 43
Turan, Bahadır 32
V
U
Würz, Axel 6
Uğurlu, Görkem Karakaş 31, 48
Ulukaya, Sema 31, 42
Usta, Miraç Barış 4
Uygun, Ersin 35, 43, 47
Uzun, Özcan 26
Uzun, Utku 32
Y
Ü
Üçkardeş, Eda Aslan 24, 30, 36
Ünal, Özkan 48
Üneri, Özden Şükran 12
Vırıt, Osman 32
Vural, Pınar 45
W
Yakut, Eda 37
Yalçınoğlu, Nilgül 17
Yalın, Nefize 47
Yaşar, Alişan Burak 20
Yaylacı, Elif Tatlıdil 50
Yazıcı, Neslihan 8, 28
Yazıcıoğlu, Çiğdem 5
Yenilmez, Dicle 31, 34
Yerebakan, Melike 31
Yeşilyaprak, Nurgül 39
Yıldırım, Abdullah 18, 19, 20, 33
Yıldız, Mesut 39
Yıldız, Mevhibe İrem 3
Yılman, Tuba 8, 28, 34
Yılmaz, Ekrem 33
Yılmaz, Yücel 37
Yiğitbaşı, Nükhet 29
Yirün, Onur 50
Yorguner, Neşe 3
Yüksel, Özge 33, 45
Yüncü, Özgür Ahmet 4, 7, 15
Yüzeren, Serra 25
55
Yazarlara Bilgi
A.
Türk Psikiyatri Dergisi öncelikle klinik psikiyatri olmak üzere davranış bilimleri alanındaki çalışmalara yer verir. Dergiye gönderilen yazıların daha önce
yayınlanmamış ya da yayın için kabul edilmemiş olması gereklidir. Gözden
geçirme ve araştırma yazılarının uzunluğu, şekil ve tablolar dahil çift aralıklı
20 sayfayı geçmemelidir. Yazılara en az 150, en çok 200 sözcükten oluşan
Türkçe, en az 230, en çok 250 sözcükten oluşan İngilizce özet eklenmelidir.
Araştırma yazılarının Türkçe ve İngilizce özetleri, şu alt başlıklar ile yazılmalıdır: Amaç (Objective), Yöntem (Method), Bulgular (Results), Sonuç
(Conclusion).
1. ARAŞTIRMA YAZILARI
Bilimsel yöntem ve kurallara uygun olarak yapılmış araştırmaların bildirileri
bu bölümde yer alır.
2. GÖZDEN GEÇİRME YAZILARI
En yeni bilgileri kapsamlı olarak gözden geçiren ve tartışan yazılar bu bölümde yayınlanır.
3. OLGU SUNUMLARI
İlginç klinik olguların sunumları yer alır. Bu yazıların çift aralıklı 10 sayfayı
geçmemesi gerekir.
4. DİL SORUNLARI
Psikiyatri alanındaki dil tartışmaları bu başlık altında yayınlanır.
5. MEKTUP
Bu bölümde Dergide yer alan değişik konularda tartışma forumu oluşturabilecek mektup ve görüşler yayınlanır.
6. KİTAP TANITIMI
İlgili alanlarda yayınlanmış kitapların tanıtım ve eleştirisini içeren yazılar bu
bölümde yer alır.
B.
1. Türk Psikiyatri Dergisi’nde yayınlanması istenen yazılar çevrimiçi (online)
olarak gönderilmelidir. Çevrimiçi yazılar www.turkpsikiyatri.com adresindeki
çevrimiçi bağlantısından yüklenir.
2. Yazarlar doğrudan çalışmayı yapan ve yazan kişiler olmalıdır, çalışmayı destekleyen ya da çalışma ile ilgili danışılan kişilerin adları gerekliyse teşekkür
bölümünde anılmalıdır. Araştırma yazılarında çalışmanın yapıldığı kurum belirtilmelidir.
3. Yayınlanmak üzere gönderilen yazıların araştırma ve yayın etiğine uygun olmaları gereklidir.
4. Türk Psikiyatri Dergisi’ne gönderilen ölçek geçerlik-güvenilirlik çalışmalarının
yayına kabul edilmesi durumunda, ölçeğin kendisi (özgün ya da çeviri) Dergi
web sitesinde yayınlanacaktır. Ölçek çalışmaları ile ilgili yazıların değerlendirme için kabulü aşamasında, bu koşul yazarlara bildirilecek; yazı, yazarlar bu
koşulu kabul ettikleri takdirde değerlendirme sürecine alınacaktır. Dergi web
sitesinde ölçekle birlikte, ölçeğin kullanım ve telif hakları ile ilgili bilgiler de
verilecektir.
5. Çevrimiçi olarak yüklenen yazılarda ilk iki sayfada sırayla Türkçe ve İngilizce
özet yer almalıdır. Özetlerin başında yazının Türkçe ve İngilizce başlığı, sonuna ise mutlaka 3-6 anahtar sözcük konmalıdır. Türkçe anahtar sözcükler
http://www.bilimterimleri.com adresinden, İngilizce anahtar sözcükler ise
http://www.ncbi.nlm.nih.gov/mesh adresinden seçilmelidir. Özet sayfalarından sonraki sayfalar numaralandırılmalıdır. Başvurularda yazının eklendiği
dosyada yazar adı ve adresi bulunmamalıdır.
6. Yayınlanması düşünülen yazıların eleştiri ve öneriler doğrultusunda gözden
geçirilmesi yazarlardan istenebilir. Yazarların onayı alınmak koşulu ile yayın
kurulunca yazılarda değişiklik yapılabilir. Gönderilen yazı ile ilgili gelişmeler
e-posta adresine bildirilir. Dergide yayınlanan yazılar için ücret ya da karşılık
ödenmez.
7. Derginin yayın dili Türkçedir. Yazılar kolay anlaşılır olmalı, elden geldiğince
yabancı sözcüklerin Türkçe karşılıkları kullanılmalı, alışılmamış sözcüklerin
yabancı dildeki karşılıkları ilk kullanımlarında ayraç içinde verilmelidir. Yazı
içinde geçen ilaçların ticari adları yerine jenerik adları Türkçe okunduğu biçimiyle verilmelidir.
8. Yazılarda dipnot kullanılmamalı, açıklamalar yazı içinde verilmelidir.
9. Her şekil ve tablo ayrı bir sayfaya çizilmelidir. Şekiller fotoğraf filmi alınabilecek kalitede basılmalıdır. Tablolarla ilgili başlık ve bilgiler tablonun verildiği
sayfada yer almalıdır. Metin içinde de şekil ve tabloların yerleri gösterilmelidir.
10. Kaynaklar metin içinde yazarların soyadı ve yazının yayın tarihi ile belirtilmeli, yazar ve tarih arasında virgül konmamalıdır. İkiden fazla yazar varsa
birinci yazarın soyadı “ve ark.” ibaresiyle verilmeli, iki yazar varsa her ikisi
de belirtilmelidir.
Örnekler: Bu konuda yapılan bir çalışmada (Crow 1983)..., Crow ve Snyder
(1981) şizofreni konusunda..., ...ilgili çalışmalar (Synder ve ark. 1982)..., ...bir
çalışmada (Crow ve Synder 1981)...
Aynı yazarın aynı yıla ait değişik yayınları ise (Freud 1915a), (Freud 1915b) şeklinde belirtilmelidir. Aynı noktada birden çok kaynak belirtileceği zaman kaynaklar
aynı ayraç içinde, birbirinden virgül ile ayrılarak verilmelidir. Örnek: (Crow 1981,
Synder 1980); (Crow 1981, Synder ve ark. 1970)
11. Metin sonunda kaynaklar ayrı bir liste olarak alfabetik sıra ile verilmelidir.
Yazar(lar)ın soyad(lar)ı ve ad(lar)ının baş harf(ler)i arada nokta ya da virgül
olmadan belirtilmelidir. Bir kaynakta üçten çok yazar varsa üçüncü yazardan
sonra “ve ark” ibaresi yer almalıdır. Bunların ardından kaynağın basım tarihi
ayraç içinde verilmelidir.
a) Kaynak bir makale ise tarihin ardından makalenin tam adı, yayınlandığı derginin
adı (Index Medicus’daki kısaltmalardan yararlanılmalıdır), cilt no (cilt no belirtilmemişse ayraç içinde sayı no) ve sayfa numaraları yazılmalıdır.
Winokur G, Tsuang MT, Crowe RR (1982) The lowa 500: affective disorder in
relatives of manic and depressed patients. Am J Psychiatry 139:209-12.
b) Bir derginin ek sayısı (supplementum) kaynak gösterileceği zaman;
Kozkas HG, Homberg LK, Freed GD ve ark. (1987) A pilot study of MAOIs. Acta
Psychiatr Scand, 63 (Suppl. 290) 320-328.
c) Kaynak bir kitap ise yazar(lar)ın adı ve basım tarihinden sonra kitabın adı, (birden çok basımı varsa) kaçıncı basım olduğu, basımyeri, basımevi ve sayfası belirtilmelidir. Kitap bir çeviri ise hangi dilden çevrildiği ve çeviren(ler)in adı verilmelidir.
Mark IMJ (1987) Fears, Phobias and Rituals. New York Oxford University Press,
s. 97.
d) Kaynak çok yazarlı bir kitabın bölümü ya da bir makalesi ise bölümün ya da
makalenin yazarı, tarih, bölümün ya da makalenin adı, kitabın adı, kaçıncı baskı
olduğu, cildi, kitabın editörleri, basım yeri sayfaları yazılmalıdır.
Meltzer HY, Lowy MT (1986) Neuroendocrin function in psychiatric disorders.
American Handbook of Psychiatry, 2. Baskı, cilt 8, PA Berger, HKH Brodie (Ed),
New York. Basic Books Inc, s. 110-117.
e) Türkçeye çevrilmiş kitap ve dergileri kaynak gösterirken:
1. Hangi kaynaktan yararlandıysanız onu kaynak gösteriniz (Türkçesi veya aslı).
2. Türkçeye çevrilmiş kitaplar aşağıdaki şekilde kaynak gösterilmelidir.
Wise MG, Rundel JR (1994) Konsültasyon Psikiyatrisi (Çev. TT Tüzer, V Tüzer).
Compos Mentis Yayınları, Ankara, 1997.
Metin içinde “Wise ve Rundell (1994)” şeklinde verilmelidir.
3. Sık kullanılan çeviri kaynaklara örnekler:
Amerikan Psikiyatri Birliği (1994) Mental Bozuklukların Tanısal ve Sayımsal El Kitabı, Dördüncü Baskı (DSM-IV) (Çev. ed.: E Köroğlu) Hekimler Yayın Birliği, Ankara,
1995.
Metin içinde “Amerikan Psikiyatri Birliği (1994)” şeklinde belirtilmelidir.
Dünya Sağlık Örgütü (1992) ICD-10 Ruhsal ve Davranışsal Bozukluklar Sınıflandırılması. (Çev. ed.: MO Öztürk, B. Uluğ, Çev.: F. Çuhadaroğlu, İ. Kaplan, G. Özgen,
MO Öztürk, M Rezaki, B Uluğ). Türkiye Sinir ve Ruh Sağlığı Derneği Yayını, Ankara,
1993.
Metin içinde “Dünya Sağlık Örgütü (1992)” şeklinde yer almalıdır.
f) Sadece Internet üzerinden yayınlanan bir dergide yer alan makale kaynak olarak
gösteriliyorsa:
1. Tam yayın tarihi kullanılır.
2. Genellikle cilt ve dergi sayıları, sayfa numaraları yoktur.
3. Makaleye doğrudan ulaşım adresi ve indirilen tarih verilmelidir.
Frederickson BL (2000, Mart 7). Cultivating positive emotions to optimize health and well-being. Prevention & Treatment 3, Makale 0001a. 20 Kasım 2000’de
http://journals.apa.org./prevention/volume3/pre003000-1a.html adresinden indirildi.
12. Kaynakların doğruluğundan yazar(lar) sorumludur. Doğrudan yararlanılmayan ya da başka kaynaklardan aktarılmış kaynaklar belirtilmemeli, basılmamış eserler, kişisel haberleşmeler, Medline taramalarından ulaşılan makalelerin özetleri kaynak gösterilmemelidir.

2 Türk Psikiyatri Dergisi 2 - Turkish Journal of Psychiatry

Transcription

Similar documents

Fraiberg, Selma, Adelson, Edna and Shapiro, Vivian. 1975. “Ghosts

Understanding Bipolar Disorder Melvin McInnis, MD

Other Disorders

Promoting Maternal Mental Health During and After Pregnancy

MindTech HTC

Presentation on Positive Thinking, Cognitive Behaviour and

Common Behavioral Health Disorders

Evidence for the Benefits of Exercise in the Treatment of Mood

futurePsych - Royal College of Psychiatrists