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Sleep disorders increase the symptoms of attention deficit hyperactivity disorder (ADHD). The aim of this study was to investigate whether or not sleep related problems give rise to symptoms of attention deficit and hyperactivity-impulsivity in university students.The 252 university students between the ages of 18-25 years included in the study were assessed on the Pittsburgh Sleep Quality Index (PSQI), the Adult Attention-Deficit Hyperactivity Disorder Scale, the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI).The participants of the study comprised 38.5% males and 61.5% females with a mean age of 22.39 (±1.93) years. The mean score data were 5.78 (± 2.72) on the PSQI, 41.77 (± 20.38) on the Adult Attention-Deficit Hyperactivity Disorder Scale, 8.53 (± 6.97) on the BDI and 9.05 (± 7.92) on the BAI. The total score and the scores on the attention-deficit and the general problems subsections of the Adult Attention-Deficit Hyperactivity Disorder Scale were significantly higher in participants with poor sleep quality (P0.001). The PSQI and the Adult Attention-Deficit Hyperactivity Disorder Scale scores were significantly above the cut-off values in the participants with depression and anxiety symptoms as compared to those without these symptoms (P0.001). The PSQI total score positively correlated with the Adult Attention-Deficit Hyperactivity Disorder Scale total score (P0.001).University students with sleep disorder have more ADHD symptoms and poor quality of sleep increase ADHD sypmtoms. Therefore it's important to evaluate quality of sleep in young people suffering from attention problems in terms of treatment approaches and interventions.

The aim of this study was to obtain normative data for Verbal Fluency Test and investigate the effects of age, gender, and education on verbal fluency in native Turkish-speaking individuals.A pilot study was conducted to determine 3 letters with differing levels of difficulty for completing the phonemic fluency task. First names and animals were chosen for the semantic fluency task, and an alternating semantic task (first name-animal) was also used. In total, 415 participants (208 male and 207 female) were recruited and stratified based on the age and education levels.Level of education had a main effect on all verbal fluency tasks; people with higher education performed better. Age and gender were found to have no effect on phonemic verbal fluency. Only thename production task was affected by gender, women performed better. Younger age groups produced more words in name generation and semantic alternating fluency tasks.The effects of age, gender and education on verbal fluency are in accordance with many previous reports. Analysis of various errors were also conducted. Results for Turkish are presented and discussed in the light of literature.

Objective Neuropeptide Y (NPY) is a protein widely expressed in the central nervous system and involved in diverse physiological processes, such as emotional regulation, nutritional behavior, and stress. In some populations, studies on alcohol dependence (AD) and the NPY gene have found that NPY variations increase alcohol consumption and thus may potentially be associated with AD. In this study, we investigated the relationship between NPY gene promoter polymorphisms and phenotypes related to alcohol use. Method A total of 417 male participants comprising 252 individuals with AD and 165 healthy individuals were included in this study and phenotypic data were collected. Polymerase chain reaction-restriction fragment length polymorphism (PCR/RFLP) and DNA sequencing METHODS were used for genotyping the rs16147 and rs17149106 polymorphisms in the promoter region of the NPY gene. The data of 384 participants were analysed to evaluate the possible relationship between genotypes and the diagnosis of AD, family history of AD, the severity of AD using the Michigan Alcoholism Screening Test (MAST), the age of onset of problematic alcohol use, the average amount of alcohol consumed per day for the last six months and the lifetime maximum alcohol consumption in one day. Results A significant difference was found between the AD and control groups concerning rs16147 polymorphism genotype distribution (p=0.025). No association with polymorphisms and alcohol-related phenotypes were demonstrated in the AD group. Conclusion To our knowledge, this study shows for the first time in the literature that alcohol dependence is associated with NPY rs16147 polymorphism in the Turkish population.

We planned to compare individuals with alcohol dependence (AD) and healthy controls on the frequency of NOS1 exon 1f-VNTR gene polymorphism and to investigate the effects of this polymorphism on the clinical symptoms of alcohol dependence, impulsiveness and comorbid attention deficit hyperactivity disorder (ADHD) symptoms.A total of 282 participants consisting of 153 patients and 129 age and gender matched healthy individuals were inluded in the study. All participants were evaluated with Structured Clinical Interview for DSM-IV Axis 1 disorders (SCID-I) and Michigan Alcohol Screening Test (MAST), Barratt Impulsiveness Scale (BIS-11), UPPS Impulsive Behavior Scale, Adult Attention Deficit and Hyperactivity Diagnosis Scale (ADHDS), Family History Research Diagnostic Criteria (FHDRC). The QF-PCR fragment protocols were used for genetic analyses. Allele fragments of ≤176 bp and176 bp sizes were separated and 3 different genotypes were determined as the SS, SL and LL. Associations of these genotypes with symptoms of AD severity, impulsiveness and comorbid ADHD were investigated.The AD and control groups did not differ significantly on the basis of NOS1 exon 1f-VNTR gene polymorphism. Also, significant correlations between this polymorphism and symptoms of AD severity, impulsiveness and ADHD were not determined.Results of our study do not indicatea significant association between the NOS1 exon 1f-VNTR genotypes and AD, subgroups of AD, impulsiveness or comorbid ADHD semptoms.

Major depression (MD) is one of the common mood disorders. MD prevalence is 8–16% among reproductive women in United States of America and studies show that the prevalence of MD in pregnant women i...

study question: We aimed to determine the impact of an oral contraceptive (OC) treatment on health-related quality of life (HRQOL), depressive and anxiety symptoms in polycystic ovary syndrome (PCOS). summary answer: OC therapy in PCOS improves hirsutism and menstrual disturbances, along with HRQOL. This improvement is not associated with any change in the prevalence of depressive and anxiety symptoms. what is known and what this article adds: Limited data are available regarding the effects of an OC on HRQOL, and depressive and anxiety symptoms in PCOS. This study reports the effects of the ethinyl estradiol/drospirenone (EE/DRSP) OC on an HRQOL questionnaire for women with PCOS (PCOSQ), depressive and anxiety symptoms after 6 months of treatment. design: Prospective observational study. All participants completed PCOSQ, Beck Depression Inventory, Hospital Anxiety and Depression Scale and General Health Questionnaire. Serum androgens, fasting insulin, fasting and postload glucose values during an oral glucose tolerance test were measured. Changes in these variables and the scores of questionnaires were evaluated after 6 months of treatment with EE/DRSP (3 mg/30 mg). participants and setting: Thirty-six patients with PCOS without a previous psychiatric diagnosis were included in the study. main results and the role of chance: The main complaints of the patients were hirsutism and irregular menses. Accordingly, menstrual and hirsutism problems were the most serious concerns followed by emotional problems on the PCOSQ. Eight patients (22.2%) had clinical depression scores. After treatment, regular menstrual cycles were attained and hirsutism was significantly improved in all patients. Hirsutism and emotion domains of the PCOSQ improved at 6 months (P , 0.05 for both). Depression was improved in five of eight depressive patients and four new patients showed increased depression scores. Overall, depression, anxiety mean scores and depression rates did not show a significant change. bias, confounding and other reasons for caution: The study is subject to the strengths and limitations of observational study design. A limitation of our study is the small sample size and lack of data related to possible confounding factors. generalizability to other populations: Generalizable to Caucasian PCOS.

The aim of this study was to determine whether there was any relationship between hippocampal volume, and glucocorticoid regulation, and cognitive dysfunctions in drug-naïve major depressive disorder (MDD) patients during their first episode. Twenty drug-free female MDD patients in their first episode and 15 healthy females as control subjects were included in the study. All subjects underwent 3.0 Tesla (T) magnetic resonance imaging (MRI), comprehensive neuropsychological testing and dexamethasone suppression tests (DST). The volumes of the right and left hippocampus of the patients were found to be significantly smaller than those of the controls. Patients were found to have significantly lower scores on measures of attention, working memory, psychomotor speed, executive functions, and visual and verbal memory fields. The performance of the patients only in the recollection memory and memory of reward-associated rules were positively correlated with hippocampal volumes. The volumes of the left and right hippocampus did not correlate with basal or post-dexamethasone cortisol levels. Our findings indicate that depressed patients have smaller hippocampi even in the earlier phase of their illness. Further research efforts are needed to explain the mechanisms that are responsible for the small hippocampus in depressed patients.

Aim: Recent neuroimaging studies support functional and structural alterations in the dorsolateral prefrontal cortex (DLPFC), particularly on the left side in patients with major depressive disorders (MDD). The aim of the present study was to examine the biochemical characteristics of left DLPFC as measured on proton (1H) magnetic resonance spectroscopy (MRS) in patients with drug-naive first-episode MDD and a healthy control group. A second aim was to assess the effect of antidepressant treatment on the metabolites of DLPFC. Methods: Short-echo single-voxel 1H-MRS was done for the left DLPFC in 17 female drug-free MDD patients (mean age ± SD, 30.9 ± 6.9 years) and 13 matched control subjects (mean age ± SD, 29.1 ± 6.2 years) and was repeated at 8 weeks following antidepressant treatment. Results: Comparison of baseline values indicated that there were no significant differences in any of the metabolite ratios (N-acetyl aspartate/creatine [NAA/Cr], myoinositol [Ino]/Cr, and choline [Cho]/Cr) between patients and controls. Significant differences were detected between pre- and post-treatment Ino/Cr ratios (0.67 ± 0.13, 0.58 ± 0.22, P = 0.032, respectively), although there was no difference in NAA/Cr and Cho/Cr ratios. Conclusion: Although no significant metabolic alterations exist in female patients with drug-naive first-episode MDD as evaluated on 1H-MRS, an increase in Ino/Cr was observed following 8-week antidepressant treatment. These findings give rise to the possibility that non-neuronal cells, particularly glial cells that are probably damaged, play a role in the action of antidepressant treatment.

Thought–action fusion (TAF) refers to the belief that thoughts and actions are linked. While ‘Moral’ TAF refers to the belief that unacceptable thoughts are morally equivalent to overt actions, ‘Likelihood’ TAF is the belief that certain thoughts can increase the probability of some events (related to self or others) to occur. The objective of this study was to compare the schizophrenic patients with nonclinical controls in terms of TAF Likelihood and TAF Moral after controlling for the effects of obsessive compulsive and depressive symptoms, magical ideation and schizotypy. The sample was composed of patients hospitalised for schizophrenia (n = 45) and nonclinical control subjects (n = 41). Thought–Action Fusion Scale, Maudsley Obsessive–Compulsive Inventory, Magical Ideation Scale, Schizotypal Personality Characteristics Subscale and Beck Depression Inventory were administered. Results revealed that after controlling the effects of obsessive–compulsive and depressive symptoms, magical ideation and schizotypy, patients still had higher scores on TAF Likelihood Others but not on Self. Patients also had a tendency to get higher scores on TAF Moral. It is concluded that the study shows the presence of TAF Likelihood Others in schizophrenia even after controlling for the effects of magical ideation, depressive and OCD symptoms and schizotypal characteristics.

The purpose of this study was to investigate the influence of clozapine on plasma serotonin, platelet serotonin and monoamine oxidase (MAO) levels in schizophrenic patients and to compare their results with those of unmedicated healthy controls. Groups of 20 outpatients with schizophrenia and 20 healthy controls matched for age, sex and smoking status were recruited for the study. Psychopathology, neurocognitive functioning, plasma serotonin, platelet serotonin and MAO levels were assessed after 1-week drug free interval, and 8 weeks after initiation of clozapine treatment in an open design. The mean clozapine dose at week 8 was 382.5+/-96.4 (range: 250-600) mg/day. In the patient group, at baseline, plasma serotonin and platelet MAO levels were significantly lower, and platelet serotonin levels were significantly higher than in controls. After 8 weeks of clozapine treatment, plasma serotonin and platelet MAO levels increased significantly, while a significant decrease in platelet serotonin levels was detected compared with baseline values. Baseline platelet MAO levels explained 22% of the variance in Clinical Global Impression - Improvement (CGI-I) and improvement in attention, while baseline platelet serotonin predicted 23% of the variance in the improvement in positive symptoms during clozapine treatment. Our data indicate that clozapine may be reversing or compensating for a pre-existing alteration in serotonergic neurotransmission in schizophrenic patients. The prediction of response to clozapine through peripheral biochemical markers may have important clinical implications if repeated in larger samples.

Purpose Atypical antipsychotics (AAPs) are used as adjunct therapy in the treatment of resistant obsessive-compulsive symptoms (OCSs). Paradoxically other reports suggest that AAPs, particularly clozapine, risperidone, and olanzapine can induce de novo emergence or exacerbation of OCSs in psychotic patients. The authors present here the first report suggesting an association between de novo appearance of OCSs and quetiapine treatment in a schizophrenic patient. Case The patient was a 33-year-old woman with the diagnosis of paranoid schizophrenia, who displayed OCSs for the first time during treatment with quetiapine. The symptoms reduced remarkably when fluoxetine was added to her treatment regimen while keeping the quetiapine dosage unchanged. Conclusion AAP-induced OCSs merit consideration and early identification, as these drugs are now widely in use in clinical practice. This rare but disabling side effect should also be monitored in quetiapine treated schizophrenic patients.

A boxer's fracture (BF) is the most common type of metacarpal fracture and is usually an intentional injury. This study aims to investigate the severity of depressive and anxiety symptoms and evaluate the personality features of patients with BF in comparison with patients with fractures other than boxer's fractures [other fractures (OFs)] and a group of healthy controls (C). The study group was comprised of 14 patients who were diagnosed to have BF, 13 patients who were assessed due to OF and 11 C. Patients and controls were assessed with Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-2) was used to screen axis II, personality disorders' symptoms. The results showed that patients with BF had more anxiety as a trait and had higher mean scores for self-defeating, borderline and antisocial personality disorders than both the group of OF and C. Additionally, BF group had higher scores on the anger and cynicism subscales of MMPI-2. These results suggest that maladaptive personality traits and anxiety symptoms are common in patients with BF. Psychiatric assessment of patients who apply to orthopedy clinics with BF should be a part of their treatment plan.

Reduced and oxidized glutathione (GSH and GSSG), protein-bound glutathione, lipid peroxidation and antioxidant enzyme activities were determined in the erythrocyte lysates and membranes of type I and II alcoholics in order to clarify the effect of age-of-onset and the duration of the alcohol consumption on erythrocyte oxidant and antioxidant status. The osmotic fragility and susceptibility of the erythrocytes to haemolysis were also determined. Erythrocyte lipid peroxidation was significantly increased but, GSH and protein-bound GSH, GSH/GSSG ratio and antioxidant enzyme activities were markedly decreased in the erythrocytes of the alcoholic subgroups. Erythrocyte count and haemoglobin content in the blood of alcoholics were found to be decreased in accordance with the finding that erythrocytes were more fragile and less resistant to haemolysis particularly in type II alcoholics. The present study showed that ethanol-induced oxidative stress in erythrocytes can lead to haemolysis and membrane-specific injuries in erythrocytes of the alcoholic subtypes.

Many factors can affect the pressure pain threshold in the elderly population, especially those with cognitive impairment. The purpose of this study was to assess the pressure pain threshold (PPT) and its correlation with depression and anxiety status in geriatric nursing home residents with cognitive impairments. This study included 20 elderly subjects with cognitive impairment and 13 with normal cognitive functions. Cognitive function was assessed by Mini-Mental State Examination test. PPT of masseter and biceps brachii muscles were measured. Also, Geriatric Depression Scale (GDS) and Hamilton Anxiety Rating Scale (HAM-A) were used for screening depression and anxiety, respectively. PPT values did not differ significantly between the two groups. In the group with cognitive impairment, PPT and, depression and anxiety were not correlated. In subjects with normal cognitive function, PPT was positively correlated with depression and negatively with anxiety (p < 0.05). Subjects with cognitive impairm...

Twenty female patients with lumbar disc herniation were assessed in order to evaluate their depression, psychosocial status, and stress symptoms and to analyze the relation with activities of daily living, stair activity and walking speed, agility, disability, and occupational handicap. In addition, depression and stress symptoms were also assessed in 20 healthy female subjects. Statistically positive correlations were obtained. Depression was correlated positively with disability, functional limitation, stair activity and walking speed, social isolation, and stress symptoms; psychosocial status was correlated with disability, functional limitation, and pain.

Objective : (a) To investigate the prevalence of neurological soft signs (NSS) in schizophrenic patients and their nonpsychotic siblings and (b) to examine the clinical correlates of NSS in the schizophrenic group. Methods : Ninety-nine schizophrenic patients, 80 of their nonpsychotic siblings and 59 healthy controls were included in the study. NSS were assessed with the Neurological Evaluation Scale (NES). Psychiatric assessment of the patients was conducted with the Positive and Negative Syndrome Scale (PANSS). Siblings and the control group were evaluated with Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to determine the presence of any past or current psychotic disorder. Results : Schizophrenic patients had significantly higher scores overall and on each subscale of NES than the sibling and control groups. The sibling group's scores were intermediate between those of the schizophrenic patients and those of the healthy controls. All subscale scores and the total NES scores correlated positively with the negative symptoms subscale scores of PANSS. The general psychopathology subscale scores of PANSS also showed a positive correlation with all subscale scores of NES, except the ‘sequencing of complex motor acts’ subscale. The total NES scores of the patients as well as their scores for the ‘sequencing of complex motor acts’ and ‘others’ subscales were significantly correlated with the respective scores of their own siblings. Conclusions : These results support the findings of previous studies suggesting that there might be common genetic and/or environmental factors in the pathogenesis of neurological impairment in schizophrenic patients and their siblings. They also indicate that neurological soft signs in schizophrenic patients are associated with prominent negative symptoms.

Polymorphisms in the genes encoding alcohol metabolizing enzymes are associated with alcohol dependence.To evaluate the association between the alcohol dehydrogenase 1C (ADH1C) Ile350Val and aldehyde dehydrogenase 2 (ALDH2) Glu504Lys polymorphisms and alcohol dependence in a Turkish sample.235 individuals (115 alcohol-dependent patients and 120 controls) were genotyped for ADH1C and ALDH2 with PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism). Association between the polymorphisms and family history, daily and maximum amount of alcohol consumed was investigated. The associations between alcohol dependence, severity of consumption and family history and the polymorphisms were analyzed by chi-square or Fisher's exact test where necessary. Relationship between genotypes and dependence related features was evaluated using analysis of variance (ANOVA).The -350Val allele for ADH1C (ADH1C*2) was increased in alcohol-dependent patients (P = 0.05). In individuals with a positive family history, the genotype distribution differed significantly (P = 0.031) and more patients carried the Val allele compared with controls (P = 0.025). Genotyping of 162 participants did not reveal the -504Lys allele in ALDH2.These findings suggest that ADH1C*2 is associated with alcohol dependence in the Turkish population displaying a dominant inheritance model. ADH1C*2 allele may contribute to the variance in heritability of alcohol dependence. The ALDH2 -504Lys/Lys or Glu/Lys genotypes were not present in alcohol-dependent patients, similar to that seen in European populations and in contrast to the findings in the Asian populations.

Fifteen patients with DSM-III-R diagnosis of obsessive-compulsive disorder (OCD) were rated according to the Turkish version of the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and the US National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH-GOCS) by 7 raters independently from audiotaped interviews. Patients also completed the Maudsley Obsessive Compulsive Inventory (MOCI). Interrater reliability of Y-BOCS and NIMH-GOCS were very good as well as correlations between these two scales. The correlations of MOCI with Y-BOCS and NIMH-GOCS were not significant. We found Y-BOCS and NIMH-GOCS to be reliable and valid instruments in assessing the severity of OCD. These findings suggest that MOCI may not be a suitable instrument for assessing the severity of OCD.

background: Polycystic ovary syndrome (PCOS) is associated with psychological and metabolic disturbances. The aim of this study was to determine whether depression, anxiety and reduced health-related quality of life (HRQOL) are more common in women with PCOS and associated with metabolic risk. methods: The study included 226 PCOS patients and 85 BMI-matched healthy control women. All participants completed standardized questionnaires assessing depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory) and both depression and anxiety (Hospital Anxiety and Depression Scale and General Health Questionnaire). Patients also completed a PCOS HRQOL questionnaire. Hirsutism scores, serum androgens and lipids were obtained. All subjects underwent a standard oral glucose tolerance test. results: 28.6% of PCOS women versus 4.7% of control women had clinical depression scores indicating an 8.1-fold increased risk of depression in PCOS (P , 0.001). Depression and anxiety scores were higher in PCOS women than controls (P , 0.01 for all subscales). Obese PCOS subjects had higher depression scores and rates than non-obese PCOS women (P , 0.05). Depression scores were significantly correlated with insulin resistance and lipid parameters and with the number of components comprising the metabolic syndrome. Menstrual and hirsutism problems were the most serious concerns followed by emotional problems on the HRQOL. conclusions: Depression and anxiety are more common in patients with PCOS compared with healthy women. Depression in PCOS might be associated with obesity and metabolic abnormalities including insulin resistance and dyslipidemia.

Some patients with pervasive developmental disorders develop unusual talents, which are characterized as savant syndrome. Herein we present neuropsychological examination and brain imaging (fMRI and brain SPECT) findings of an 18-year-old male with Asperger syndrome and highly unusual calendar memory. Neuropsychological evaluation of the case indicated mild attention, memory, and problem solving deficits, and severe executive function deficits that included conceptualization, category formation, and abstraction. Functional MRI findings showed activation above the baseline level (P0.05) in the bilateral inferior parietal lobule, precuneus, superior and middle frontal gyri, and medial frontal cortex. Brain SPECT findings, in comparison to rest-SPECT findings, showed that there was hypoperfusion in some brain regions, including the right frontal cortex and right parietal cortex. Baseline blood perfusion in the left frontal cortex was also observed, as well as hypoperfusion in the right parietal-occipital cortex and in the right basal ganglion (compared to the left side). The results of the present study and further research will contribute to our understanding of calendar memory and savant syndrome.

The objective of this study was to investigate the relationship between sense of identity and depression in a group of adolescents. Thirty-one depressed adolescents and 31 control subjects were included in the study. They were evaluated using the Sense of Identity Assessment Form (SIAF), Hamilton Depression Rating Scale (HDRS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Depressed adolescents were reevaluated during the eighth week of antidepressant treatment. Higher baseline SIAF scores were detected in depressed adolescents as compared with non-depressed subjects. After antidepressant treatment, there was a significant decrease in SIAF scores in the depression group. Correlation analysis indicated that there are significant, positive relationships between SIAF, depression, and anxiety scores. The regression analysis results suggested that the change in SIAF scores can accurately predict 91.6% of the remitters and 42.8% of the non-remitters. Collectively, these findings indicate that there is a close association between depression symptoms and identity confusion-related distress in adolescents.

Recent neuroimaging studies support functional and structural alterations in the dorsolateral prefrontal cortex (DLPFC), particularly on the left side in patients with major depressive disorders (MDD). The aim of the present study was to examine the biochemical characteristics of left DLPFC as measured on proton ((1)H) magnetic resonance spectroscopy (MRS) in patients with drug-naïve first-episode MDD and a healthy control group. A second aim was to assess the effect of antidepressant treatment on the metabolites of DLPFC.Short-echo single-voxel (1)H-MRS was done for the left DLPFC in 17 female drug-free MDD patients (mean age +/- SD, 30.9 +/- 6.9 years) and 13 matched control subjects (mean age +/- SD, 29.1 +/- 6.2 years) and was repeated at 8 weeks following antidepressant treatment.Comparison of baseline values indicated that there were no significant differences in any of the metabolite ratios (N-acetyl aspartate/creatine [NAA/Cr], myoinositol [Ino]/Cr, and choline [Cho]/Cr) between patients and controls. Significant differences were detected between pre- and post-treatment Ino/Cr ratios (0.67 +/- 0.13, 0.58 +/- 0.22, P = 0.032, respectively), although there was no difference in NAA/Cr and Cho/Cr ratios.Although no significant metabolic alterations exist in female patients with drug-naïve first-episode MDD as evaluated on (1)H-MRS, an increase in Ino/Cr was observed following 8-week antidepressant treatment. These findings give rise to the possibility that non-neuronal cells, particularly glial cells that are probably damaged, play a role in the action of antidepressant treatment.

Background: Few studies have looked at healthcare professionals' knowledge of and attitudes to later life sexuality in both Western and Eastern cultures. Here we examine the attitudes and knowledge of Turkish medical doctors toward sexuality in older people. Method: Eighty-seven doctors, from various specialties, who were directly involved in the care of older people, were contacted by post and asked to complete the Turkish version of the Aging Sexual Knowledge and Attitudes Scale (ASKAS). Results: A majority of physicians indicated that they had limited information and knowledge regarding sexual health issues in older people (69%). Although a small percentage (14.5%) reported that they "always" discuss sexuality and sexual problems with older patients, the majority (69%) indicated that they "sometimes" raise questions about sexuality with these patients. A high percentage (81%) stated that they would be helpful and receptive should an elderly patient initiate a discussion about sexual issues. Most participants (77%) thought that the patient's gender was of no importance when taking a sexual history. Overall, the responses to ASKAS showed that physicians had limited knowledge but their attitude was positive toward sexuality in the elderly. Female physicians had less knowledge than males and had more negative attitudes toward sexuality in this age group. Total and knowledge subscale scores of ASKAS showed that older physicians had more knowledge than younger physicians but similar attitudes. A comparison of the knowledge and attitude scores of psychiatrists, surgeons and non-surgeons showed no significant difference among the three groups. Conclusion: This study identified a low level of awareness of later life sexuality among Turkish medical doctors. These findings identify a need to improve the education and training of doctors at both undergraduate and postgraduate levels to enable them to provide better sexual health care to older people.

Conversion disorder is defined as the presence of functional impairment in motor, sensory or neurovegetative systems which cannot be explained by a general medical condition. Although the diagnostic systems emphasize the absence of an organic basis for the dysfunction in conversion disorder, there has been a growing interest in the specific functional brain correlates of conversion symptoms in recent years, particularly by examining neuroimaging and neurophysiological measures. In this case report, regional cerebral blood flow changes and evoked potentials of a patient with conversion symptoms are presented. Somatosensory evoked potentials (SEP) of this patient with conversion disorder who had signs of movement disorder revealed that the latency to N20, P 25 waves were in normal limits while the amplitudes of the P25 and N33 components were extremely high (giant SEP). Regional cerebral blood flow assessment revealed hypoperfusion in the left parietal and temporal lobes of the brain. Three months after the first assessment, the control scans showed that the left parietal hypoperfusion disappeared while the left temporal hypoperfusion was still present. The following SEP evaluations which were repeated twice in three months intervals after the initial recordings, showed the persistence of the abnormalities in somatosensorial measures. The neurophysiological and neuroimaging findings in conversion disorder were reviewed and the results of the evaluations of this case were discussed in this article.

The purpose of this study was to investigate the effect of clozapine on regional cerebral blood flow (rCBF) and its relationship with response to treatment. In addition, we aimed to study the influence of clozapine on proton magnetic resonance spectroscopy (H-1-MRS) findings in the dorsolateral prefrontal cortex (DLPFC) in a subgroup of patients. Psychopathology, neurocognitive functioning, and SPELT imaging of 22 patients were assessed at the baseline and 8 weeks after the initiation of clozapine treatment. In 10 of these patients intermediate-echo (TE: 135 ms) single-voxel H-1-MRS was also performed at the baseline and after 8 weeks. Clozapine treatment increased the right frontal (superior and medial)/caudate perfusion ratio in the whole group, while it increased bilateral frontal (superior and medial)/caudate perfusion ratios in treatment responders. In addition, percentage changes in left and right frontal (superior and medial)/caudate perfusion ratios compared to the baseline were higher in treatment responders than in non-responders. The improvement in attention was related to the increase in percentage change in the right frontal (superior and medial)/caudate perfusion ratio, while the improvement in verbal fluency was related to the increase in percentage changes in both right and left frontal (superior and medial)/caudate perfusion ratios and to right frontal (superior and medial)/thalamus perfusion. Baseline frontal (superior and medial)/thalamus perfusion could explain 32% of the variability of percentage improvements in psychopathology. H-1-MRS showed that the baseline PANSS general psychopathology score was inversely correlated with the baseline NAA/Cre ratio. An increased NAA/Cre ratio in DLPFC after 8 weeks of clozapine treatment was also revealed by H-1-MRS. Our SPELT imaging results suggest the presence of an imbalance in fronto-striato-thalamic circuitry that changes with clozapine, especially in the responders, while H-1-MRS results indicate a supportive effect of clozapine on neuronal integrity. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Purpose Clozapine is indicated in the treatment of patients with tardive dyskinesia. However, there have been some reports of movement disorders associated with clozapine treatment in the literature. The authors report a patient who developed tardive dyskinesia 1 year after initiation of clozapine treatment. Case The patient was a 65-year-old male with diagnosis of schizophrenia who had used multiple typical and atypical antipsychotics for 30 years. Clozapine treatment was initiated for his resistant symptoms. He developed buccolingual dyskinesia of moderate severity, which started 1 year after the initiation of clozapine treatment and did not ameliorate during follow-up. Conclusion This case may contribute to existing knowledge by raising the possibility that clozapine can induce dyskinesia.

Reduced and oxidized glutathione (GSH and GSSG), protein-bound glutathione, lipid peroxidation and antioxidant enzyme activities were determined in the erythrocyte lysates and membranes of type I and II alcoholics in order to clarify the effect of age-of-onset and the duration of the alcohol consumption on erythrocyte oxidant and antioxidant status. The osmotic fragility and susceptibility of the erythrocytes to haemolysis were also determined. Erythrocyte lipid peroxidation was significantly increased but, GSH and protein-bound GSH, GSH/GSSG ratio and antioxidant enzyme activities were markedly decreased in the erythrocytes of the alcoholic subgroups. Erythrocyte count and haemoglobin content in the blood of alcoholics were found to be decreased in accordance with the finding that erythrocytes were more fragile and less resistant to haemolysis particularly in type II alcoholics. The present study showed that ethanol-induced oxidative stress in erythrocytes can lead to haemolysis and membrane-specific injuries in erythrocytes of the alcoholic subtypes.

The aim of the study was to investigate criterion-related validity, internal-consistency and diagnostic efficiency statistics of the three MMPI-2 addiction related supplementary scales i.e., MacAndrew Alcoholism Scale (MAC-R), Addiction Potential Scale (APS) and Addiction Acknowledgment Scale (AAS).Sixty-nine male chronic alcoholic patients and 51 male healthy control subjects were recruited for the study. All patients satisfied the diagnostic criteria of ICD-10 for alcohol dependence. Alcohol and drug modules of Schedules for Clinical Assessment in Neuropsychiatry (SCAN) were administered to each patient in order to give the diagnosis of alcohol dependency. The lifetime severity of drinking problems was assessed by the Michigan Alcoholism Screening Test (MAST).The comparison of the MMPI-2 results of the study groups revealed that chronic alcoholic patients had higher scores on MAC-R, APS and AAS. The investigation of the diagnostic efficiency statistics showed that MAC-R and AAS had satisfactory sensitivity and specificity for alcoholic patients. As a measure of internal-consistency, Kuder-Richardson coefficients were found to be satisfactorily high for each scale.The results of this study indicates that MMPI-2 based MAC-R and AAS scales are effective at differentiating between chronic alcoholic and control subjects. However, low specificity values of APS seemed to be damaging its diagnostic efficiency. Uniformly high Kuder-Richardson coefficients suggest that the items that comprise the MAC-R, APS and AAS are satisfactorily homogenous.

To compare late and early onset alcoholism with regard to neurocognitive functions.Using the age of alcoholism onset as a criterion, 20 late onset and 14 early onset male alcoholics were included in the study. Eleven healthy male volunteers with similar demographic features were included as a control group. Alcohol and drug modules of Schedules for clinical Assessment in Neuropsychiatry (SCAN) were administered to each subject in order to gather data on alcohol intake variables. The life time severity of drinking problems was assessed by the Michigan Alcoholism Screening Test (MAST). All patients met the diagnostic criteria of ICD-10 for alcohol dependence. The neuropsychological battery consisted of the Wisconsin Card Sorting Test, the Wechsler Memory Scale and Word Fluency Tests. The battery was administered to each patient 15 days after their entry into detoxification programme when the withdrawal syndrome ceased and all the psychotropic medications stopped for at least 1 week.Compared with the control group, both groups of alcoholic patients displayed impairment in frontal lobe functions and memory. Neuropsychological test performance did not differ between early and late onset groups.The results of this study suggest that subtypes of alcoholism based on a one-dimensional clinical application of Cloninger's typology are not associated with discriminatively different patterns of neuropsychological abnormalities.

Aims: The purpose of the present study was to compare alcoholic subtypes (type 1 versus type 2) with regard to platelet monoamine oxidase (MAO) activity. A possible relationship between enzyme activity, personality traits and executive functions was also investigated. Methods: Seventeen type 1 and 16 type 2 in-patient male chronic alcoholic patients and 17 healthy male volunteers were included in the study. The personality traits were investigated by the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Executive functions were assessed by the Wisconsin Card Sorting Test (WCST). Results: When compared to the healthy subjects, platelet MAO activity was reduced in both alcoholic groups. The enzyme activity of the type 2 group was significantly lower than that of type 1 patients. Both groups of alcoholic patients also displayed impairment in executive functions. The comparison of the MMPI-2 scores of the study groups revealed that type 2 alcoholics had more severe psychopathology. Conclusions: The results support previous evidence suggesting that platelet MAO activity is a useful biochemical measure for the subtyping of alcoholics.

The aim of the study was to compare late and early onset alcoholism with regard to regional cerebral blood flow (rCBF) and neuropsychological functioning. Ten late onset and 13 early onset male alcoholics were included in the study, the criterion being the age of onset for alcohol abuse. Six healthy male volunteers were included as a control group. Regional measures of cortical cerebral blood flow were assessed using Tc-99m-HMPAO single photon emission computed tomography (SPECT) after a detoxification period. When compared with the control group, the early onset group showed reduced relative perfusion in the left superior frontal region, while relative perfusion in the late onset group was deficient in both right and left superior frontal regions. Both groups of alcoholic patients also displayed impairment in frontal lobe functions and non-verbal memory. The results of this study indicate that early onset alcoholism is associated with hypoperfusion in the left superior frontal region while the late onset subtype is characterized by uniformly hypoperfused left and right superior frontal regions. Additionally, both groups of alcoholic patients exhibit an almost identical pattern of neuropsychological abnormalities mainly related to frontal lobe functions and non-verbal memory. Collectively these findings support previous evidence suggesting a key role of frontal lobe pathology in understanding the neurobiology of alcoholism.