2 Türk Psikiyatri Dergisi 2 Turkish Journal of

CİLT | Volume 27 GÜZ | Autumn 2016 EK | Supplement 2: 52. ULUSAL PSİKİYATRİ KONGRESİ TÜRKİYE SİNİR VE ABSTRACTS RUH SAĞLIĞI ISSN 1300 – 2163 DERNEĞİ 2 Türk Psikiyatri Dergisi 2

Mart, Haziran, Eylül ve Aralık aylarında olmak üzere yılda 4 sayı çıkar Turkish Journal of Psychiatry Four issues annually: March, June, September, December

CİLT | Volume 27 GÜZ | Autumn 2016 Türkiye Sinir ve Ruh Sağlığı Derneği EK | Supplement 2 tarafından yayınlanmaktadır. ISSN 1300 – 2163 www.turkpsikiyatri.com

Türk Psikiyatri Dergisi Bu Sayının Yayın Yönetmeni /Editor in Chief of this Issue Doç. Dr. Semra Ulusoy Kaymak Türkiye Sinir ve Ruh Sağlığı Derneği adına Sahibi ve Sorumlu Müdürü Kongre Başkanları Published by Turkish Association of Nervous and Prof. Dr. M. Orhan Öztürk E. Timuçin Oral - Ekrem Cüneyt Evren

Düzenleme Kurulu Yayın Yönetmeni/ Editor in Chief Ekrem Cüneyt Evren (Başkan) Prof. Dr. Aygün Ertuğrul Ercan Dalbudak Selim Tümkaya Yazışma Adresi / Corresponding Address Semra Ulusoy Kaymak PK 401, Yenişehir 06442 Ankara Sinan Aydın (Genç Üye)

Yönetim Yeri / Editorial Office Bu Sayının Yayın Yönetmen Yardımcıları Kenedi Cad. 98/4, Kavaklıdere, Ankara / Assoc. Editors in Chief of this Issue Telefon: (0-312) 427 78 22 Faks: (0-312) 427 78 02 Sinan Aydın Esra Kabadayı Yayın Türü / Publication Category Selim Tümkaya Yaygın, Süreli, Bilimsel Yayın Yayın Hizmetleri / Publishing Services Reklam / Advertisements BAYT Bilimsel Araştırmalar Basın Yayın ve Tanıtım Ltd. Şti. Reklam koşulları ve diğer ayrıntılar için yayın yönetmeniyle Tel (0-312) 431 30 62, Faks: (0-312) 431 36 02 ilişkiye geçilmesi gerekmektedir. E-posta: [email protected]

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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 16 - 20 Kasım 2016 Rixos Sungate Hotel, Antalya www.upk2016.org

ABSTRACTS A1 TÜRKİYE PSİKİYATRİ DERNEĞİ KURULLARI

2014-2016 YÖNETİM KURULU Merkez Yönetim Kurulu E. Timuçin Oral (Genel Başkan) Yıldız Akvardar (Genel Başkan Yardımcısı) Yunus Hacımusalar (Genel Sekreter) Ömer Böke (Sayman) Nurper Erberk Özen (Eğitim Sekreteri) Şahut Duran (Örgütlenme Sekreteri) Gamze Erzin Şahin (Asistan Hekimlik Sekreteri)

Merkez Denetleme Kurulu Meram Can Saka Ahmet Tiryaki A. Haldun Soygür

Merkez Onur Kurulu Hüseyin Soysal M. Sezai Berber Rukiye Peykan Gençoğlu Gökalp Aylin Uluşahin Süheyla Ünal

Yeterlik Yürütme Kurulu Eğitim Programları Akreditasyon Altkurulu Yeterlik Sınav Altkurulu (2015-2017) Geliştirme Altkurulu Nuray Atasoy (Başkan) Medine Güleç (Başkan) Numan Konuk Levent Atik Leyla Gülseren (Başkan) Hamid Boztaş (Başkan) Altan Eşsizoğlu Özlem Kuman Levent Atik (Başkan Yardımcısı) Leyla Gülseren Öykü Önal Musalar Pınar Çetinay Özlem Kuman (Sekreter) Ayşe Gül Yılmaz Özpolat Gökben Hızlı Sayar Damla İşman Haznedaroğlu Numan Konuk Halis Ulaş, Sibel Örsel Hüseyin Güleç Neslihan Kumsar Hamid Boztaş Kadir Özdel Ercan Altınöz Altan Eşsizoğlu Görkem Karakaş Uğurlu Medine Güleç Nuray Atasoy Ayşe Gül Yılmaz Özpolat (TPD MYK temsilcisi)

Psikiyatri Eğitim ve Toplantılar Yaygın ve Örgün Eğitim Kurulu Yayıncılık Kurulu Eşgüdüm Kurulu (PETEK) Koray Başar (Başkan) İ. Tolga Binbay (Başkan) Kurul Başkanı Kurul Üyeleri Kurul Üyeleri E. Timuçin Oral (İstanbul) Ayşe Devrim Başterzi (Adana) Ömer Aydemir (Manisa) Halis Ulaş (EPGAK) (İzmir) Kurul Üyeleri Adem Bayrakçı (İzmir) Evrim Tellioğlu (İstanbul) Ekrem Cüneyt Evren (İstanbul) Taner Yılmaz (İstanbul) Tuğba Özel Kızıl (Ankara) Nurper Erberk Özen (Ankara) Hatice Özdemir Rezaki (Ankara) Deniz Ceylan (İzmir) Ömer Böke (Samsun) Genç Üye Necip Çapraz (İzmir) Koray Başar (Ankara) Ekin Sönmez (İstanbul) Mehmet Yumru (Antalya) İ. Tolga Binbay (İzmir) Ersin Uygun (İstanbul) Erhan Ertekin (İstanbul) Leyla Gülseren (İzmir) Gökçen Yılmaz (İzmir) Murat Açar (AHK) (İzmir) Dış İlişkiler Grubu Genç Üye Genç Üyeler Ahmet Gürcan (Ankara) Ezgi İnce (İstanbul) Çiğdem Çelik (İstanbul) Elif Çarpar (İstanbul)

A2 TÜRKİYE 2 Türk Psikiyatri Dergisi 2 SİNİR VE RUH SAĞLIĞI Turkish Journal of Psychiatry DERNEĞİ

CİLT | Volume 27 GÜZ| Autumn 2016 İçindekiler | Contents EK | Supplement 2

52. ULUSAL PSİKİYATRİ KONGRESİ ABSTRACTS

A5 WELCOME E. Cüneyt Evren TPD-BTDK Başkanı

E. Timuçin Oral TPD Başkanı

A6 CONGRESS ORGANIZING COMMITTEES

1 RESEARCH AWARD CANDIDATES 43 ORAL PRESENTATIONS 69 POSTER PRESENTATIONS 179 AUTHOR INDEX

A3 A4 TÜRKİYE 2 Türk Psikiyatri Dergisi 2 SİNİR VE RUH SAĞLIĞI Turkish Journal of Psychiatry DERNEĞİ

CİLT | Volume 27 GÜZ| Autumn 2016 Hoş Geldiniz | Welcome EK | Supplement 2

52. ULUSAL PSİKİYATRİ KONGRESİ

Değerli meslektaşlarımız, Türkiye Psikiyatri Derneği’nin düzenlediği 52. Ulusal Psikiyatri Kongresi bu yıl Antalya’da gerçekleştirilecektir. Her yıl olduğu bu yıl da Türkiye psikiyatri topluluğunun bu en büyük kongresinde zengin bir bilimsel program için hazırlıklarımız sürmektedir. Başta Çalışma Birimlerimiz olmak üzere tüm üyelerimizden, meslektaşlarımızdan ve ruh sağlığı çalışanlarından gelecek öneriler Bilimsel Toplantılar Düzenleme Kurulumuz tarafından harmanlanacak ve yine nitelikli ve zengin bir program ortaya çıkacaktır. Bu yılın kongre ana başlığı ve teması “Daha Sağlıklı Bir Toplum İçin...” olarak belirlenmiştir. Temayı seçerken mesleki varlığımızın ve kimliğimizin en önemli hedefine, toplumsal sorumluluğumuza işaret etmeyi amaçladık. Bu başlık altında hastalıklara, hastalara, hasta yakınlarına ilişkin yapılacakları yani, doğru tanı koymayı, uygun tedavileri ve bunlara ulaşımı, rehabilitasyonu, toplum temelli hizmet yaklaşımlarını ve koruyucu psikiyatriyi ele almayı ülkemizde daha kaliteli ruh sağlığı hizmetleri için yapılacakları tartışmayı hedefliyoruz. O nedenle alt başlıklarımız da Güncel algoritmalar ışığında doğru tanı ve tedavi, Tedaviye ulaşım hakkı ve yolları, Psikiyatride Rehabilitasyon ve Toplum temelli yaklaşım, Koruyucu psikiyatri, Bireysel-Toplumsal Travma ve yas biçiminde oluştu. Bilimsel program, klinisyenlerin başta tanı ve tedavi olmak üzere pek çok alanda gereksinimlerini gözeten ana konferans, kurs, panel, çalışma grubu, münazara, on soruda bir konu, siz olsaydınız ne yapardınız, Sorular ve Olgularla Psikiyatride Güncel oturumları gibi birçok farklı biçimde eğitim etkinlikleri ile dolu olacaktır. Henüz program kesinleşmemiş olmakla birlikte, temamız ve alt başlıklarımızla ilişkili olarak yurtdışından konuklarımız olacak. İlerleyen günlerde sizlere de duyuracağız. Tüm üyelerimizi, meslektaşlarımızı ve ruh sağlığı çalışanlarını yılın en büyük ve bilimsel içeriği açısından en zengin kongresine katılmaya, uzmanlık ve uzmanlık sonrası eğitime yönelik birçok gereksinimi karşılayacak etkinliklerde yer almaya davet ediyoruz. Türkiye Psikiyatri Derneği’nin düzenlediği 52. Ulusal Psikiyatri Kongre’sinde buluşmak dileğiyle…

Prof. Dr. E. Timuçin Oral Doç. Dr. E. Cüneyt Evren Türkiye Psikiyatri Derneği Türkiye Psikiyatri Derneği Genel Başkanı Kongre Düzenleme Kurulu Başkanı

A5 52. ULUSAL PSİKİYATRİ KONGRESİ 16-20 Kasım, 2016 Rixos Hotel, Antalya, Türkiye

CONGRESS ORGANIZING COMMITTEES

KONGRE EŞBAŞKANLARI / CONGRESS CO-PRESIDENTS BİLİMSEL PROGRAM KURULU / SCIENTIFIC E. Timuçin Oral - Ekrem Cüneyt Evren PROGRAM BOARD Simavi Vahip (İzmir) DÜZENLEME KURULU / ORGANISING COMMITTEE Mehmet Murat Demet (Manisa) Kurul Başkanı Alp Üçok (İstanbul) Ekrem Cüneyt Evren (İstanbul) Kurul Üyeleri ARAŞTIRMA BİLDİRİ ÖDÜLÜ SEÇİCİ KURUL ÜYELERİ / Ercan Dalbudak (Ankara) RESEARCH PAPER PRIZE SELECTION COMMITTEE Selim Tümkaya (Denizli) Semra Ulusoy Kaymak (Ankara) Aygün Ertuğrul Ertuğrul Eşel Genç Üye Selçuk Candansayar Sinan Aydın (Ankara) Mehmet Emin Ceylan Özen Önen Sertöz

DANIŞMA KURULU / ADVISORY BOARD Aslı Aktümen Bilgin Eren Yıldızhan M. Kerem Doksat Sera Yiğiter Ayşe Devrim Başterzi Çıngı Erhan Akıncı Murat Semiz Serdar Nurmedov Ayşen Esen Danacı Erhan Ertekin Mustafa İlker Edebali Sezai Berber Bengi Semerci Esra Yazıcı Mustafa Sercan Sibel Çakır Berkant Yelken Ferhan Dereboy Neşe Direk Taner Yılmaz Burçin Çolak Gülay Oğuz Numan Konuk Umut Mert Aksoy Cem Kaptanoğlu Gülfizar Varma Nuray Atasoy Ürün Özer Cengiz Güneş Haldun Soygür Osman Özdel Yavuz Selvi Çezar Atasoy Hamdullah Aydın Rıdvan Üney Zerrin Oğlağu Doğan Şahin İlhan Atagün Sabri Hergüner E. Tuğba Özel Kızıl İsmet Kırpınar Şahut Duran Ejder Akgün Yıldırım Koray Başar Şebnem Parıldar

TPD ÇALIŞMA BİRİMİ KOORDİNATÖRLERİ / PAT WORKING UNIT COORDINATORS

Erhan Akıncı Ayşen Esen Danacı Numan Konuk Murat Semiz Umut Mert Aksoy M. Murat Demet Vahap Ozan Kotan Mustafa Sercan İlhan Atagün Ferhan Dereboy İlker Küçükparlak Haldun Soygür Çezar Atasoy Neşe Direk Serdar Nurmedov Rıdvan Üney Nuray Atasoy M. Kerem Doksat Zerrin Oğlağu Gülfizar Sözeri Varma Hamdullah Aydın Şahut Duran Osman Özdel Alişan Burak Yaşar Koray Başar Mustafa İlker Edebali Gülay Oğuz Özdemir Esra Yazıcı Ayşe Devrim Başterzi Çıngı Erhan Ertekin E.Tuğba Özel Kızıl Berkant Yelken Sezai Berber E. Cüneyt Evren Ürün Özer Sera Yiğiter Aslı Aktümen Bilgin Cengiz Güneş Şebnem Parıldar Ejder Akgün Yıldırım Sibel Çakır Sabri Hergüner Doğan Şahin Eren Yıldızhan Burçin Çolak Cem Kaptanoğlu Z. Bengi Semerci Taner Yılmaz Ercan Dalbudak İsmet Kırpınar Yavuz Selvi

A6 RESEARCH AWARD CANDIDATES

RESEARCH AWARD CANDIDATES

RAC-01 the subscales of SAPS scoring as the interconnectivity decreased in the cited region of the brain. COMPARISON OF THE FUNCTIONAL MAGNETIC DISCUSSION: Thalamus is an important region of the brain RESONANCE IMAGING OF THE BRAIN AT REST responsible for the filtration of arriving external information and BETWEEN INDIVIDUALS AT HIGH RISK FOR elimination of unnecessary and distracting signals in the process of

PSYCHOSIS AND HEALTHY CONTROLS modulating attention. The , rich in D2 receptors, functions CANDIDATES RESEARCH AWARD mainly in the regulation of dopaminergic activity and plays an Öznur Bülbül1, Elif Kurt2, Çiğdem Ulaşoğlu Yıldız2, 2 4 3 important role in the pathology of psychotic disorders. In previously Ani Kıçık , Tamer Demiralp , Handan Noyan , Nuran reported studies the reduction in the interconnectivity of the cited 1 1 1 1 Çağlar , Ceylan Ergül , Hatice Kaya , Çağdaş Yokuşoğlu , region has been associated with the negative and positive symptoms. 1 1 Uğur Çıkrıkçılı , Alp Üçok In our investigation we have observed, in addition to these findings, 1Istanbul University Istanbul Medical School, Psychiatry Department , that CDSS scores had increased and the SPS scores had decreased as the Istanbul regional interconnectivity decreased, suggesting an association of the 1Istanbul University Hulusi Behçet Life Sciences Research Laboratory, regional activity with depressive symptoms and the personal and social Neurosciences Unit, Istanbul functionality. 1Istanbul University Experimental Medicine Research Institute, Neurosciences Department, Istanbul Key Words: functional magnetic resonance imaging (fMRI), high risk 1Istanbul University , Istanbul Medical School, Physiology Department, for , resting condition Istanbul REFERENCES INTRODUCTION: Predicting the development of psychosis in high Dandash O, Fornito A, Lee J et al., (2013) Altered striatal functional risk groups by clinical and behavioral tests is difficult. Neuroimaging connectivity in subjects with an at risk mental state for psychosis. methods facilitate the direct evaluation of the in vivo brain structure Schizophr Bull 40:904-13. and function. Functional magnetic resonance imaging (fMRI) at rest Fornito A, Harrison BJ, Goodby E et al., (2013) Functional has become an important tool in analyzing the functional network of dysconnectivity of corticostriatal circuitry as a risk phenotype for the brain. This work has aimed at investigating the functional imaging psychosis. JAMA Psychiatry 70:1143-51. of the brain at rest in individuals with high risk of psychosis. METHODS: Our study enrolled 16 individuals with high risk for psychosis identified as the ‘high risk group’, together with 16 healthy RAC-02 controls. The high risk group was not under any pharmacotherapy. Two members of this group were excluded from the study on account of RELATIONSHIP OF COMT VAL158MET AND artifacts due to movement. Age range of the participants was 14–30 BDNF VAL66MET POLYMORPHISMS WITH THE years. Individuals in the high risk group were discerned on the basis of EXTENDED PSYCHOSIS PHENOTYPE the Comprehensive Assessment of At-Risk Mental States (CAARMS). 1 1 2 In order to make further detailed clinical evaluation, the high risk group İbrahim Tolga Binbay , Emre Mısır , Umut Kırlı , Hayriye 3 3 4 4 completed the Brief Psychiatric Rating Scale (BPRS), the Scale for the Elbi , Bülent Kayahan , Hüseyin Onay , Ferda Özkınay , Assessment of Positive Symptoms (SAPS), the Scale for the Assessment Köksal Alptekin1 of Negative Symptoms (SANS), the Calgary Scale for 1Dokuz Eylül University, Mental Health and Disorders Department, (CDSS) and the Personal and Social Performance Scale Izmir (PSP scale). Using the 3T MR imaging device (Achieva, Philips, Holland) 2Hakkari State Hospital , Mental Health and Disorders Clinics, all participants had the fMRI done at rest, and the acquired data was Hakkari processed through SPM software. For the purpose of independent 3Ege University, Mental Health and Disorders Department, Izmir component analysis, GIFT software operated in MATLAB toolbox was 4Ege University, Medical Genetics Department , Izmir used to assess the internal connection network at rest conditions of the INTRODUCTION: Psychotic disorders are psychiatric problems of brains of the high risk group and the controls, and the data on the unknown aetiology and fundamentally characterized with hallucinations two groups were compared using the t-test with basis on voxel-based and . Much as genetic liability has been accepted as the major morphometry. The relationship between the clinical parameters and the risk factor, the conversion of this liability to overt pathology is thought to fMRI findings was evaluated by the Spearman correlation analysis. depend on environmental factors. Milder forms of the symptoms such as RESULTS: Under resting condition there was significant decrease in delusions and hallucinations associated with psychotic disorders can be the functional interconnections of the midbrain region, at the region observed in the general population. Subthreshold psychotic experiences, of thalamus/ interface and especially on the thalamus and psychotic symptoms and the continuity resulting in psychotic disorders the right putamen of the high risk group as compared to the controls. can be described as the extended psychosis phenotype. A seen in In correlation with the reduction in the interconnectivity in these schizophrenia, many facets of the extended psychosis phenotype may regions, the scoring on the SANS subscale of avolution/apathy and the present after probable gene-environment interactions. Investigation of CDSS score were significantly increased while the score of the PSP was the repetition of transient psychotic experiences and their conversion to significantly lowered. Also there were increases close to significance in permanency and psychotic disorders together with gene-environment

3 interactions is important for understanding psychotic disorders such evaluation interviews were carried out by a clinician between January as schizophrenia. Among the genes probably associated with psychotic 2008 and January 2009. experiences and disorders are those coding for the catechol-o-methyl- The results indicated the extended psychosis phenotype to consist of four transferase (COMT) and the brain-derived neurotrophic factor groups: (i) lifelong without any psychotic experience; (ii) subthreshold (BDNF). Although there have been series of studies on the relation psychotic experiences (without determined psychotic disorder, but of COMT or BDNF polymorphisms with psychotic disorders and having experienced at least once an impairment in functionality; experiences, there have not been any reported investigation on the having experienced difficulty; and, having psychotic experiences not distribution of the cited genes in a patient sample encompassing all requiring help); iii) having psychotic experiences (without determined presentations of the extended psychosis phenotype ranging from psychotic disorder, but having experienced at least once an impairment subthreshold psychotic experiences to syndromal disorders. This study in functionality; having experienced difficulty; and, having psychotic has aimed to investigate the distribution of the COMT Val158Met and experiences requiring help); iv) having schizophrenia or other psychotic BDNF Val66Met polymorphisms by scanning the extended psychosis disorder on the basis of the DSM-IV criteria. RESEARCH AWARD CANDIDATES RESEARCH AWARD phenotype in a sample of the general population. Interviews have been carried out with 471 individuals and 437 have METHODS: Research data have been acquired within the scope of volunteered to give blood samples in order to evaluate the relationship the ‘TürkSch’ or the Mental Health Research for Gene-Environment of COMT and BDNF polymorphisms with the extended psychosis Interaction program. Psychotic experiences in the general population phenotype. All participants were tested for BDNF rs6265 genotyping of 15–64 years of age scanned by TürkSch were evaluated in terms of and only 366 individuals were tested for the COMT rs4680 genotyping. the psychometric properties of the Composite International Diagnostic Polymorphisms were detected with the polymerase chain reaction. Interview 2.1. (CIDI-2.1). A subpopulation selected from the general Analyses yielded the Val/Val, Val/Met and the Met/Met genotypic population sample scanned for the extended psychosis phenotype was polymorphisms of COMT and BDNF. Since the BDNF Met allele tested with the structured clinical interview 1 (SCID-1) for DSM-IV carriers were few in numbers, the genotype groups were formed as Val/ disorders and blood samples were obtained for genetic analyses. This Val and Met+ (homozygotes or heterozygotes). report is based on this investigation of the cited sample of subpopulation. The SPSS 15.0 package program was used for statistical evaluation of The research included cases representing the differing aspects of the data. For the relationships between categorical variables, χ² was the extended psychosis phenotype (ranging from the subthreshold used; for the relationships between continuous variables, the t-test was experiences to overt disorders) and the controls (those not expressing used; and, for the multiple variables linear or logistic regression analyses any psychotic experience). Psychotic experiences have been coded to were used. The calculated probability ratios were expressed with (PR) or show the presence or absence of psychotic experiences according to the coefficients (β) were expressed with 95% confidence intervals (CI). the CIDI clauses. For any reported psychotic experience additional The p value of 0.050 was taken as the lowest significance level and was queries on the frequency, duration, probable causes (e. g. , substance used in all the statistical tests. use), the adverse effects and outcomes, help seeking and impairment RESULTS: There were no statistically significant differences in the on functionality were provided. As a result of these queries on every sociodemographic details of the groups constituting the extended experience, the severity score for psychotic experiences ranged between psychosis phenotype apart from gender and family history of psychiatric 0 and 7. In the TürkSch sample investigated, those with a score above 3, disorders (Table 1). Excepting the schizophrenia group, number of the those reporting mood disorders exhibiting psychotic symptoms (e. g. , females significantly exceeded that of the males (χ²: 8.29; p=0.040). ), users of antipsychotic agents, or those reported by the In each three levels (ii, iii, iv-cited above) of the extended psychosis interviewer to have probable psychotic experiences were all evaluated phenotype, family history of psychiatric disorders was significantly as cases of psychotic disorders. These individuals were targeted for higher than in the group not reporting any psychiatric experience clinical interview and the volunteers were tested with the SCID-1 at (group i-cited above). In the schizophrenic psychosis group, family home or in the hospital. Approval of the Ege University and the written history of psychiatric disorders was significantly higher than that in the agreement of the volunteers were obtained for these interviews and subthreshold psychosis phenotype groups as well as that of the group other investigative procedures. The initial scanning interviews took not reporting any psychotic experiences (χ²: 17.593; p=0.007). There place between November 2007 and December 2008, and the clinical were not any significant differences between the extended psychosis

Variation of COMT and BDNF genotypes with Psychosis Phenotypes in the Groupings of the General Population Sample With Schizophrenia and Not Reporting With Subthreshold Psychotic With Psychotic other Psychotic disorders Total Psychosis (n:194) experiences (n:87) experiences (n:104) (n: 52)

N % N % N % N % N % Statistical p

BDNF rs6265

Val/Val 127 65,5 66 75,9 77 74,0 35 67,3 305 69,8 χ²:4,94 0,551

Val/Met 59 30,4 19 21,8 24 23,1 14 26,9 116 26,5

Met/Met 8 4,1 2 2,3 3 2,9 3 5,8 16 3,7

Total 194 100 87 100 104 100 52 100 437 100

COMT rs4680

Val/Val 61 41,2 37 48,0 40 44,9 22 42,3 160 43,7 χ²: 2,40 0,879

Val/Met 48 32,4 26 33,8 29 32,6 19 36,5 122 33,3

Met/Met 39 26,4 14 18,2 20 22,5 11 21,2 84 23,0

Total 148 100 77 100 89 100 52 100 366 100

4 Relationship of the COMT and BDNF genotype with Psychosis Phenotypes Not Reporting With Subthreshold With Psychotic With Schizophrenia and Psychosis Psychotic Experiences experiences other Psychotic disorders

OO %95 GA P OO %95 GA p OO %95 GA p OO %95 GA P

BDNF rs6265

Val/Val ref - - ref - - ref - -

Met+ 0,6 (0,3-1,1) 0,08 0,7 (0,4-1,2) 0,20 0,9 (0,5-1,8) 0,79

COMT rs4680

Val/Val ref ref

Val/ Met 0,9 (0,5-1,6) 0,66 0,9 (0,5-1,8) 0,95 1,1 (0,5-2,2) 0,80

Met/Met 0,6 (0,8-1,2) 0,15 0,9 (0,4-1,7) 0,70 0,8 (0,3-1,8) 0,55 RESEARCH AWARD CANDIDATES RESEARCH AWARD Since the BDNF Met/Met group was small in numbers (n=16), they were classified with ‘Met/Met’+‘Val/Met’ group Met carriers ( Met+).. Distribution of the COMT and BDNF genotypes with respect to the extended psychosis phenotypes in the population sample studied was prepared as a Figure, as tabular data presentation was limited by 2 Tables phenotype groups with respect to the BDNF rs6265 genotypes RAC-03 (Table 2). Also, there were not any significant differences between the extended psychosis phenotype groups with respect to the COMT INVESTIGATION BY MEANS OF FMRI OF THE rs4680 genotypes. Since the group with homozygous BDNF Met/Met NOUN-DERIVED AND VERB-DERIVED WORDS BY polymorphism was small in size (n= 16), the group was included as a INDIVIDUALS DIAGNOSED WITH SCHIZOPHRENIA ‘Met carrier’ (Met+) in the group with BDNFVal/Met polymorphism. A significant correlation was not obtained between the genotypes and the Şerif Bora Nazlı, Orhan Murat Koçak extended psychosis phenotypes by regression analyses on the respective Kırıkkale University Medical School data including the data on age and gender. In the group reporting INTRODUCTION: Despite the inclusion of linguistic problems subthreshold psychotic experiences only, the BDNF rs6265 genotype within the formal thinking disorder, Schizophrenia has been named as was less as compared to those not reporting any psychotic experiences ‘’the disease associated with language’’ or as ‘’logopathy’’ by some authors and the difference was close to statistical significance (PR: 0.6; % 95 CI: as there are symptoms of difficulty in finding words and impairment of 0.3–1.1; p: 0.08) (table 3). linguistic expression in association with the negative symptoms. This CONCLUSION: In this study on the distribution of the BDNF and study has aimed to find out the cortical mechanisms underlying the COMT genotypes in the extended psychosis phenotype within the negative symptoms through the investigation of the relation between general population, a significant difference was not demonstrable between the severity of the negative symptoms and the regions of the brain that the extended psychosis phenotypic groups and the group without any indicate changes in verb-derived expressions in comparison to healthy psychotic experiences with respect to distribution of BDNF rs6265 and controls. COMT rs4680 genotypes. Therefore, the controversial results of the METHODS: The study has enrolled 12 patients diagnosed with previous studies on the relationship of genotypes with phenotypes may Schizophrenia after consulting Kirikkale University Medical School and have been due incidences of gene-gene interactions, gene-environment 12 volunteering healthy individuals as the controls. After completing interactions and gene-gene-environment interactions. There is a great a sociodemographic form the participants were also asked to complete need for further investigations on the genetic variations of the extended the Positive and Negative Symptoms Scale (PANSS) and the Calgary psychosis phenotype in the general population. Depression Scale for Schizophrenia (CDSS). Subsequently, following Key Words: BDNF, COMT, extended psychosis phenotype, the necessary preparations, the participants were investigate with polymorphism, psychotic experience fMRI lasting some 45 minutes. With each participant 5 settings of T2 images and one T1 structural recording covering the entire brain REFERENCES were completed. During fMRI word choosing decisions (WCD) made Binbay T, Elbi H, Alptekin K et al.,(2011) Psikozlarda Gen-Çevre by the participants were recorded. Within the scope of the WCD, the Etkileşimi için İzmir Akıl Sağlığı Araştırması (TürkSch): Amaç ve participants were shown 240 words, 120 of which had a meaning in the Yöntem. (The Izmir Mental Health Survey (TürkSch) for Gene- Turkish language, 60 being verbs and 60 being nouns, with 30 being Environment Interaction) Turk Psikiyatri Dergisi 22: 65-76. abstract nouns and 30 being concrete nouns; while 120 of the words Binbay T, Drukker M, Elbi H et al., (2012) Testing the psychosis shown had no meaning (non-word). It has been shown statistically continuum: differential impact of genetic and nongenetic risk that the words used experimentally did not differ with respect to the factors and comorbid across the entire spectrum frequency of common usage, and the number of syllables involved. of psychosis. Schizophr Bull 38: 992-1002. The fMRI data were processed through the SPM12 software and the Gonzalez-Castro TB, Hernandez-Diaz Y, Juarez-Rojop IE et al., (2016) behavioral data were analyzed by means of the SPSS software. The Role of a Catechol-O-Methyltransferase (COMT) Val158Met Genetic Polymorphism in Schizophrenia: A Systematic Review and RESULTS: The study included a total of 24 participants, consisting of Updated Meta-analysis on 32,816 Subjects. Neuromolecular Med 12 patients with schizophrenia diagnosis and 12 health controls. Mean 18: 216-31. age of the total group was 32 years (SD ± 10.12; range 19–50 years). The Notaras M, Hill R, ve van den Buuse M (2015b) A role for the BDNF patient and the control groups did not differ significantly on the basis of gene Val66Met polymorphism in schizophrenia? A comprehensive age, gender, education, jobs, comorbidities and alcohol and substance review. Neurosci Biobehav Rev 51: 15-30. use. The scores on PANSS positive and PANSS negative, CDSS and Van Os J ve Linscott RJ (2012) Introduction: The extended psychosis the choice of hand were used as clinical data. With the exception of the phenotype relationship with schizophrenia and with ultrahigh risk choice of hand test (p: 0.822), significant differences were found between status for psychosis. Schizophr Bull, 38: 227-30. the scores of the patients and the controls in the other psychometric

5 tests used. The entire brain analysis on the ANOVA showed that the REFERENCES right brodmann area 10 (BA 10) in the anterior prefrontal cortex had Bleich-Cohen M, Sharon H, Weizman R et al., (2012) Diminished lower activity compared to the healthy controls. Also, apart from this, language lateralization in schizophrenia corresponds to impaired a significant group X word type interaction was determined. The BA40 inter-hemispheric functional connectivity. Schizophrenia Research and BA45 areas (inferior frontal gyrus pars triangularis) in the brains 134 131–136. of the schizophrenia patients showed a significantly higher activity in an Veelen NM, Vink NM, Ramsey NF et al., (2011) Reduced language comparison to the controls. However, the same significant interaction lateralization in first episode medication-naive schizophrenia. in the left BA44 area (inferior frontal gyrus pars opercularis) and the left Schizophrenia Research 127: 195–201. primary somatosensory area (BA 1) were less active in the usage of verbs Natsubori T,Hashimoto R, Yahata N et al., (2014) An fMRI study of as compared to the controls. Significant differences were not determined visual lexical decision in patients with schizophrenia and clinical between the two groups of participants on the basis of the behavioral high-risk individuals. Schizophrenia Research 157: 218–224. data, including word groups and types, reaction time and the counts of

RESEARCH AWARD CANDIDATES RESEARCH AWARD correct choices. There were negative correlations between the level of the BA40 area activation (discovered when looking at the differences in the RAC-04 processing of verb-derived words by the patient group in comparison to the processing of noun-derived words and also the processing of both the verb and the noun-derived words by the controls-Table 1) and COMPARISON OF THE FUNCTIONAL MAGNETIC the PANSS total score (p=0.008 r=-0.723), the PANSS negative score RESONANCE IMAGING DATA ON THE BRAINS OF (p=0.046 r=-0.583) and the PANNS general score (p=0.025 r=-0.639). OBSESSIVE-COMPULSIVE DISORDER PATIENTS The BA40 area activation did not show any correlation with the PANSS AND HEALTHY CONTROL INDIVIDUALS

positive score. A positive correlation was determined between the BA10 1 2 2 area activity in relation to the processing of the verb-derived words, and Hasan Bakay , Elif Kurt , Çiğdem Ulaşoğlu Yıldız , 1 the CDSS score (p=0.046 r=0.584). Raşit Tükel 11stanbul University Istanbul Medical School, Psychiatry Department, DISCUSSION: In the group with schizophrenia diagnosis, the BA44 Istanbul area which is a fundamental component of Broca’s area showed reduced 2Istanbul University Hulusi Behçet Life Sciences Research Laboratory, activity in processing verb-derived words, while the B40 area there was Neurosciences Unit, Istanbul an increased activity in comparison to the controls in the processing of the verb-derived words. The role of the B44 area in recognition of INTRODUCTION: Obsessive-compulsive disorder (OCD), activity and imitating by being a part of the mirror neuron system has recognized with repetitive and self enforced thoughts (obsessions) and been long known. On the other hand B40 area is a association area and/or repetitive behaviors or mental activities (compulsions), is a for the identification of the visual information. When combining the disorder that adversely affects the daily functionality of the individual. observations on the increased B40 activity associated with reduced Investigations on the areas of the brain associated with OCD symptoms, B44 activity in processing verb-derived words as compared to the to assess the functional connectivity at resting state, and activity changes controls, the negative correlation of the B40 activation with PANSS in the functions in relation to symptom provocation have been carried negative scores, and the lack of a significant difference in the tested out with brain imaging techniques now lead by the functional magnetic behavioral activity of the patient and the control groups, suggest the resonance imaging (fMRI). The reported fMRI studies have indicated possibility of there being a compensatory imaging activity to form the that there are changes in the brain interconnectivity network at resting mental representation of verbs in the brain in schizophrenia. When state, especially the default mode network and the executive control the activity of this region increases the negative symptom scores tend network. to decrease. In the brains of the schizophrenia patients activity of the BA45 area shows a parallel increase to that in B40 while processing A meta-analysis of 28 separate studies on the executive function duties verb-derived words while this activation of the B44 area is reduced in OCD patients, has reported reduced activity in the right caudate in comparison to the controls. It can be said that B40 displays a nucleus, claustrum, left cingulate gyrus, and compensatory over activity. the parietal cortex (left precuneus); and increased activity in the left thalamus, left insula, right dorsolateral prefrontal cortex, supplementary Key Words: fMRI, language in schizophrenia, word choosing decision motor area (SMA) and the motor cortex. Brain areas showing differences in the processing of verb-derived We have investigated comparatively in OCD patients and healthy words by schizophrenia patients in comparison to the processing of controls, the combined role of the dorsofrontal and the parietal areas of noun-derived words and also the processing of both the verb and the the brain in the pathogenesis and the neurobiology of OCD by fMRI noun-derived words by the control group on the entire brain during which a task was given to the participants known to activate the attention network with a signal relay to the Voxel pFWE Area Brodmann X Y Z counts in F value i cingulo-fronto-parietal areas. Also, we looked into the changes in the corrected the cluster internal connectivity network and the functional connectivity.

PARIETAL CORTEX Left BA 40 -48 -21 18 30 54.85 P<0.001 METHODS: The study enrolled 22 volunteering patients who consecutively consulted the Psychiatry Department at Istanbul INFERIOR FRONTAL GYRUS Left BA 44 -44 7 6 96 54.60 P<0.001 PARS OPERCULARIS University Medical School and were diagnosed with OCD on the DSM-IV criteria. The patients had not used any medication during Left Primary the 6 weeks (8 weeks for ) prior to the investigations and PARIETAL CORTEX Somatosensory -52 -18 46 83 48.15 P<0.001 Area (1) did not have any psychiatric comorbidities. The controls consisted of 22 healthy individuals matched with the patients for age, gender, INFERIOR FRONTAL GYRUS Left BA 45 -41 28 2 12 34.22 P =0.002 PARS TRIANGULARIS choice of hand and education. The criteria for exclusion from the study included having an acute or chronic physical illness interfering with

6 the general medical condition or a history of medical illness having in this network may be related to an insufficiency in eliminating the causative association with OCD, having fever, central nervous system internal mental stimuli and the secondary development of the executive infection, cerebrovascular disorders, a history of control problems. Under the interference condition we have detected or cranial trauma causing loss of consciousness longer than 30 minutes in the OCD group reduced activity, as compared to the controls, in the or requiring hospitalization, having a metallic prosthetic implant, such precuneus which is an important hub between the parietal and prefrontal as a cardiac pace maker, which is contraindicative for MRI, and being regions and functions in the local focusing of attention and self related pregnant or breast feeding. The study was given approval by Istanbul thoughts; and, also in the left supramarginal gyrus which is important University (2014/1719). A specially prepared informative consent in forming the mental design of movement and motor activity and in form was read and signed by all the participants. All participants went suppressing the invalid responses and activities and reprogramming of through fMRI investigation at resting state for whole brain analysis and activities. These observations support the view that the insufficiency of while performing a multiple sourced interference task leading to activity attention, response inhibition and activity planning (i. e. compulsions) in the cingulo-fronto-parietal circuits (MSIT). The investigation was in OCD may be associated with the abnormality in these networks. performed by a 3 Tesla MRI device (Philips-Achieva 3.0T Quasar Dual CANDIDATES RESEARCH AWARD Also, the observations in the OCD patients of reduced activity in the Gradient 32-channel MR system, Philips Healthcare, Best, Holland) at University of Istanbul, Hulusi Behçet Life Sciences Research left MTG, associated with visual-structural skills, and in the caudate Laboratory, Neurosciences Unit. The records were processed by SPM8 nucleus which is involved in inhibitory control and induction of the software (involving realignment, functional-structural compatibility, correct sheme of action according to the out comes, may be responsible segmentation, spatial normalization and ‘softening’). The GIFT for the insufficiency in the OCD patient of visual-motor integration, software package (working in the MATLAB tool box) was employed for of response inhibition and in the activation of the correct schemes of independent component analysis to determine the internal connectivity action. The other region where we have detected reduced activity under at resting state. The resting state connectivity networks (default mode the interference condition was the left SMA, associated with response network) of the two groups were compared using the t-test with basis inhibition, learning rules, and error supervision. This finding may on voxel-based morphometry. The cortical brain areas activated by the reflect the , inadequacies of inhibitory responding, interference task given to the participants were identified using the and the changes in susceptibility to gain and loss. linear model in the SPM8 software. Our results support the hypothesis that the dorsal regions of the brain RESULTS: There were no significant differences between the OCD and (supramarginal gyrus, precuneus, SMA, MTG) also play a role next the control groups with respect to age, gender, education, marital status, to the orbitofrontal regions in the pathophysiology of OCD. Also the employment and childhood diseases. results indicate that the executive control network plays a crucial role in In the OCD group the mean age of diagnosis was 22.5 (SD: ±8.12) the neurobiology of OCD. years, mean duration of the disorder was 5.36 (SD: ±6.47) years; the Key Words: fMRI, MSIT, Obsessive-compulsive disorder, resting state Yale-Brown Obsessive-Compulsive Scale (YBOCS) mean obsession score was 14.5 (SD: ±1.94), the mean compulsion score was 13.81 (SD: Psychometric Scales and the Behavioral Data ±3.51), and the mean total score was 28.31’di (SD: ±4.00). OCD Patients Healthy Controls

The total response of the OCD group to the MSIT included Age (y) 27.68±8.39 28.18±8.44 t=-.197 p=0.966 significantly more errors as compared to the controls (OCD: Education years 12.22±3.71 12.31±3.63 t=-.082 p=0.986

14.13±17.23; C: 6.00±5.18, p=0.04). There were not any significant HAM-A score 12.59±6.16 3.22±2.11 t=6.734 p<0.001 differences between the two groups during the control condition HAM-D score 9.54±5.21 1.81±1.29 t=6.743 p<0.001 (OCD: 2.77±4.15; C: 2.04±2.39, p=0.481). Under the interference condition the OCD group had more erroneous responses (OCD: QLES-Q score 39.95±7.56 52.36±4.15 t=-6.744 p<0.001 11.36±14.23; C: 3.95±3.70, p=0.023). Time taken to respond was Total error 14.13±17.23 6.00±5.18 t=2.121 p=0.04 similar between the two groups under the control condition (OCD: Intf. Total error 11.36±14.23 3.95±3.70 t=2.362 p=0.023 623.78±141.29, C: 588.01±66.89, p=0.289), but the OCD group Intf. Response time 1006.00±148.93 926.33±101.12 t=2.291 p=0.027 responded with significant delay under the interference condition OCD Duration (y) 5.36±6.47 (OCD: 1006.00±148.93, C: 926.33±101.12, p=0.027). Comparing the imaging data indicated that, as compared to the controls, REFERENCES interconnectivity in the OCD group under resting state was reduced in Bush G, Shin LM (2006) The Multi-Source Interference Task: an fMRI the ventral component of the executive control network in the medial task that reliably activates the cingulo-frontal-parietal cognitive/ frontal region, in the Brodmann 9 area (the medial and superior gyri). attention network. Nat Protoc 1: 308–313. A significant difference was not detected when comparing the two Cheng Y, Xu J, Nie B et al., (2013) Abnormal resting-state activities and groups on the difference between the connectivity changes under the functional connectivities of the anterior and the posterior cortexes control and the interference conditions (interference >control). Under in medication-naïve patients with obsessive-compulsive disorder. the control condition, activity was decreased in the supramarginal PLoS One 28;8(6): e67478. gyrus, the precuneus, the medial frontal gyrus (MFG) and the medial Del Casale A, Rapinesi C, Kotzalidis GD et al., (2015) Executive temporal gyrus (MTG) in the OCD brain as compared to the controls. functions in obsessive-compulsive disorder: An activation likelihood Under the interference condition, in comparison to the controls, the estimate meta-analysis of fMRI studies. World J Biol Psychiatry network activity was decreased in the precuneus, left inferior parietal 7:1-16. (supramarginal) lobe, the MTG, the left caudate nucleus and the left Göttlich M, Krämer UM, Kordon A et al.,. (2014) Decreased limbic and SMA of the OCD brain. increased fronto-parietal connectivity in unmedicated patients with CONCLUSIONS: In the OCD group our observation of reduced obsessive-compulsive disorder. Hum Brain Mapp 35(11):5617-32. interconnectivity in the ventral component of the executive control Shin DJ, Jung WH, He Y et al., (2014) The effects of pharmacological network in the medial frontal region, in the Brodmann 9 area agrees treatment on functional brain connectome in obsessive-compulsive with the recent studies by others. The reduced functional connectivity disorder. Biol Psychiatry 15;75(8):606-14.

7 RAC-05 decision making between the two groups when playing in group with others or when playing by themselves. It was observed that being obese DECISION MAKING IN OBESITY SINGLY AND or of normal weight did not affect the game performance. As regards the WITHIN GROUP imaging data, however, in both performances of the IGT, the control group had a higher activation in the left insular cortex, and the left 1 1 1 Irmak Polat Nazlı , Ali Saffet Gönül , Hayriye Elbi , anterior (ACC) as compared to the obese group. During Selin Bilgin2, Seda Eroğlu3, Gözde Kızılateş4 IGT played individually, the right insular cortex, left parahippocampal 3Ege University, Mental Health and Disorders Department, Izmir gyrus, left subcallosal gyrus (amygdala), right inferior parietal lobule (IPL) 4Ege University Literary Studies Department, Psychology Division, Izmir and the left caudate nucleus were more active in the control group as 3Dokuz Eylul University, Literary Studies Department, Psychology compared to the obese group. During the second IGT task performed Division, Izmir in group, activation in the left insular cortex, left temporopolar area, 4Ege University Health Sciences Institute, Neurosciences Depatment , right medial and inferior frontal gyri with the frontal eye fields, the left

RESEARCH AWARD CANDIDATES RESEARCH AWARD Izmir and right ACC of the control group exceeded that in the obese group. INTRODUCTION: Regarding the aetiology of obesity from a Significant differences were not determined in the IGT performance of psychiatric point of view, while eating abnormalities of different mental the obese and the control groups when playing by themselves or in group. disorders cause excessive eating and weight gain, individuals are unable CONCLUSION: The negative values of the IGT scores of both groups to perform and sustain the required changes resulting in introversion, in the first IGT indicated that all participants made the disadvantageous limited physical activity, weak control and problems of self choices more frequently. The scores of the second IGT showed that discipline. There have been reports that in the obese, in comparison to the participants continued making the disadvantageous choices. The individuals with normal body weight, there are changes of activity in similarity of the data indicated that the decision making in a group by the regions of the brain responsible for the control of mechanisms such as obese and the normal weight individuals were similar. The insular cortex those involved in dependency, sensitivity to reward, impulsivity, craving, activity involves processing of emotional responses to somatic sensations, satiety and motivation. There are distinct data on neuroimaging of obese and in the organization of social relationships. The higher activation individuals indicating decreased activation in the prefrontal cortex, in the insula of the controls suggests that information processing in amygdala, hippocampus, insular cortex and the cingulate cortex. At relation to the somatic stimuli, appropriate response formation, and the early stages of evolution, when eating was a physiological impulsive compliance with social norms are more effective as compared to the behavior to ensure survival, it has become in our day a choice to incur obese. The ACC plays a role in the storage of emotional knowledge, and excessive reward effect of a short duration despite its disadvantages in the formation of carefully made responses to tasks. Observation of higher long term. What distinguishes the human being from other living beings activation of the ACC during decision making by the normal weight in this respect is the cognitive control, albeit to a limit, of the decision individual suggests that they respond more carefully to memory tasks. to eat or not to eat. Recent studies have demonstrated the social norms about preferences on nourishment and body mass index (BMI). It has Parahippocampal gyrus is a hub responsible for the coding and the recall been argued on the basis of the social identity theory that the behavior of memory. Amygdala is the area coupling sensory entries with emotion, of compliance with eating norms affirms the sense of belonging to a but due to its close proximity to the hippocampus, it contributes to this social group. Recently reported functional magnetic resonance imaging coupling process by the use of memory. (fMRI) studies have indicated similarity of characteristics between social The relative increases in the activation of the cited sites of the brain in the interaction directed to stimuli related to eating and consolidation of controls as compared to the obese participants suggest that individuals learning. Within the limits of our knowledge, there is not a study on with normal body weight perform better in the transfer of information the compliance behavior among obese individuals with social norms. for processing, recognition of the environmental stimuli and in using the memory based on experience. On the other hand, the data on the The primary aim of this work was to investigate the neural projections obese participants suggest an insufficiency in recall of the information of the decision making process, under social effect, by the obese on emotional stimuli and formation of appropriate responses. individuals singly or in a group. The secondary aim of the work was to compare any detected outstanding characteristics of the obese with the The right inferior parietal lobule (IPL) is structured to consolidate normal weight individuals. perception of the external world, the body image and attention. Our results suggest that the individual with normal body weight are more METHODS: The study enrolled 22 obese and 22 normal weight capable of giving attention, as compared to the obese, to the stimuli individuals. Data, collected on the sociodemographic details and the directed to their body image and in processing these stimuli effectively. eating habits of the participants were scanned to exclude psychiatric The cauddate nucleus is structured to evaluate ‘’reward’’ and organize disorders. The participants, identified on the criteria of introverting- the effects of this reward on movement, behavior and learning. extroverting, were given twice, when alone and in a group, the Iowa The results are indicative of better management of the processes of Gambling Task-IGT on the computer to evaluate their decision making process during the fMRI investigation of their regional brain functions. learning, processing, evaluating the reward and directing the behavior Images have been processed by ‘the brain oxygen level variable’ method. appropriately by the individual with normal body weight. Analyses were done by the SPM program operating in the MATLAB The temporopolar area has been associated with social and emotional tool box. The paired samples t-test was used in order to assess the processing and the semantic memory. Our results show that individuals difference within two working groups; and, the split plot ANOVA was with normal body weight are more capable of coupling the sensory used to assess the interaction between two variables. stimuli with emotion and use their memory better when in a group. The frontal eye fields are part of the frontal cortex and function in the RESULTS : The two groups of participants did not differ in focusing of the eyes on a target and the selection of a target in all the sociodemographic particulars. Emotional eating in the obese group visible site. Our results suggest that the controls with normal body was in excess of that determined in the control group. The IGT data weight were better in detecting and following the movements in a group. of both groups were in negative values which indicates that they made disadvantageous choices more often than the advantageous choices. The The medial and inferior gyri are components of the prefrontal cortex IGT data of the two groups did not indicate significant differences in (PFC) and the orbitofrontal cortex (OFC). The PFC is a structure that

8 is responsible for executive functions, or in other words, declarative of phases of psychiatric experiences matching BD; and investigating memory and task management. Observation of decreased activation of the neurocognitive and neurobiological characteristics of these patients the region in the obese while involved in the IGT in a group is indicative after diagnosing BD; and comparing the data with age, gender and of less consultation of declarative memory and less usage of the center educationally matched healthy controls as well as with a patient group for higher cognitive processing. The OFC has been recognized as the with chronic BD; and, hence, determining the changes caused by BD in most important area for the processing of emotion. Reduced activation the brain and its functions by demonstrating the intergroup differences. of the OFC in the obese indicate that processing emotional information, METHODS: In order to detect young adults who have not been provision of the appropriate responses, planning of the appropriate diagnosed with BD but have a history of going through phases of BD behavior and taking advantageous decisions are skills that are used less. symptoms, 2757 first year students attending the various department Although the IGT scores of the obese individuals did not differ and professional schools of Celal Bayar University were asked to significantly when playing the IGT by themselves or in a group, and complete the revised Hypomania Check List (HCL-32 R1) which is changes in activation in brain regions when playing by themselves were a self rating questionnaire. The 1197 individuals who scored above 14 RESEARCH AWARD CANDIDATES RESEARCH AWARD not detected, the decision making when playing the IGT in a group and were accessible on the phone were given the SCI-MOODS-SR. demonstrated significantly reduced activations in many regions of the Those rated as within the risk group were invited to the hospital for brain as compared to the control individuals with normal body weight. one-to-one interview which was accepted by 52 individuals who were This finding is believed to be useful as the lodestar for the planning given the SCID-I by a psychiatrist as well as conducting a thorough of psychosocial ventures and therapeutic approaches to help the obese. psychiatric interview. In this group, 27 individuals who had previously Key Words: decision making, neuroimaging, obesity, , social effect experienced symptoms of BD and met the eutyhmia criteria by scoring <8 on HAM-D, <5 on the YMRS, accepted to participate in the study. REFERENCES They were diagnosed by BD and depicted as the ‘newly diagnosed Bechara A, Damasio H, Damasio AR (2000) Emotion, Decision Making BD’ patient group (nBD). As the healthy controls, 27 individuals age, and the Orbitofrontal Cortex. Cereb Cortex 10(3):295-307. gender and educationally matched with the ndBD and 26 chronic BD Clark DL, Boutros NN, Mendez MF (2010) The brain and behavior: patients (with at least 10 years of history and 5 episodes but meeting an introduction to behavioral neuroanatomy. Cambridge University the euthymia criteria) were included in the study. All three groups of Press. participants were asked to complete a sociodemographic questionnaire, Damasio AR (1996) The somatic marker hypothesis and the possible the Functioning Assessment Short Test) (FAST), the Hamilton functions of the prefrontal cortex. Philos Trans R Soc Lond B Biol Depression Rating Scale-Seasonal Affective Disorder (SIGH-SAD) Sci 351:1413–1420. structured interview and the Young Rating Scale (YMRS). In World Health Organization (2000) Obesity: preventing and managing order to evaluate the neurocognitive skills the WAIS digit symbol the the global epidemic. Report of a WHO consultation. World Health WAIS digit span, the Stroop Test and the Wisconsin Card Sorting Organ Tech Rep Ser, 894:i–xii, 1–253. Test (WCST), the Continuous Performance Test (CPT), the Tracking Yücel B, Akdemir A, Gürdal Küey A et al., (2013) Yeme Bozuklukları ve test (TT) and the Rey Auditory Verbal Learning Test (RAVLT) were Obezite Tanı ve Tedavi Kitabı (The book on Eating Disorders and employed. For the purposes of neurobiological evaluation blood samples Obesity Diagnosis ), Ankara. were obtained from each participant and the serum nitric oxide (NO), superoxide dismutase (SOD), catalase (CAT) and Thiobarbituric acid reactive substances-TBARS were estimated by the ELISA method. Also RAC-06 all participants had cranial MRI to compare the structural differences in A COMPARATIVE STUDY ON THE regions of the brain. Statistical analyses on the data included the Chi- square test, independent variables t-test, and ANOVA. Brain MRI data NEUROCOGNITIVE, NEUROBIOLOGICAL AND were loaded to the Freesurfer Software Package version v5.3.0 image NEURODEVELOPMENTAL CHARACTERISTICS OF analysis program and were analyzed by means of the Qdec tool. NEWLY DIAGNOSED AND UNTREATED PAITENTS WITH EARLY PHASE BIPOLAR DISORDER RESULTS: Significant differences between the demographic details of the nBD and the controls were not detected. The cBD group Siğnem Öztekin1, Fatma Akdeniz2, Arzu Oran3, consisted of older age patients. The cognitive performances and the Fatma Taneli3, Gülgün Yılmaz Ovalı4, Ömer Aydemir1 neurobiological data of the three groups of participants are presented 1Celal Bayar University, Psychiatry Department, Manisa in Table 1 and Table 2. Comparison of the neuroimaging analyses of 2Bolvadin Halil İbrahim Özsoy State Hospital, Afyonkarahisar the nBD and the controls demonstrated losses of cortical volume and/ 3Celal Bayar University, Clinical Biochemistry Department, Manisa or thickness in the nBD in the areas of the brain specially including 4Celal Bayar University, Radiodiagnostic Department, Manisa the orbitofrontal region of the prefrontal cortex, the pars opercularis, precuneus and the subgroups were compared, supramarginal areas in INTRODUCTION : Studies in the literature have reported the the parietal lobe, superior, inferior and medial regions of the temporal prevalence of bipolar disorder (BD) to be 0.8%-1.6% in the general lobe parahippocampus of the limbic system. When Compared to population; and that up to a delay of 10 years may pass between the the nBD group, neuroimaging on the cBD group showed significant presentation of the first symptoms of BD and its diagnosis in order cortical volume and/or thickness in the prefrontal cortical regions, such to initiate the appropriate treatment. Studies carried out in the recent as the caudal medial frontal and the orbitofrontal areas, and the superior years on the aetiology, pathophysiology and the prognosis of BD frontal areas, the superior and the supramarginal areas of the parietal have presented evidence on cognitive losses, especially of executive lobe, and the cingulate cortex of the limbic system. functionality, verbal memory, psychomotor speed and sustained attention, and on the alteration of the intracellular oxidant-antioxidant CONCLUSIONS: In comparison to the healthy controls the test scores of balance in favour of the oxidative , and structural changes in the ndBD group on executive functions (total WCST scores), functioning brain regions, especially in the cortical, subcortical and limbic areas. memory and attention (WAIS and reverse test scores), verbal learning In distinction from the reports in the literature, our study has aimed (RAVLT scores) and the scores on the Stroop word and word-colour tests selecting young adults not yet diagnosed with BD and having a history indicated a loss of performance reflecting the effects of BD on cognitive

9 functions even at the very early stages of the disorder. The further loss Comparison of the Biological parameters of the Patient and Control of performance observed in the attention, functioning memory and Groups executive functions as assessed by the scoring on the Stroop colour, nBD Control cBD ANOVA word-colour and Difference3 scores and the TT, may be indications of (n=26)a (n=27) (n=26) p

the progressive loss of cognitive skills with the duration of the disorder, SOD (ng/ ml) ±SD 15,1±12.9 16.9±7.3 25.8±8.2 ,000* but the cBD group being an older age group under the effects of long Catalase (nmol/ ml) ±SD 65.8±21.7 50.1±19.0 70.5±28.2 ,005* term pharmacotherapy constitute confusing factors. The SOD enzyme TBARS (nmol/ ml)±SD 2,0±2,1 1,4±0,9 1,5±0,6 ,207 level of the cBD group was elevated in comparison to those of the ndBD and the control groups; and the CAT enzyme levels of the nBD and NO (µmol/L) ±SD 11,3±7,4 9.3±3.3 10.4±5.9 ,455 the cBD groups were elevated in comparison to that of the controls. TBARS: thiobarbituric acid reactive substances; NO: nitric oxide; SOD: Although statistically significant differences were not determined in the superoxide dismutase; nBD: newly diagnosed BD patient; Controls; cBD: TBARS results which represent lipid peroxidation, and in the NO levels, Chronic BD patient; a: loss of data on 1 nBD patient*: p<0,05 RESEARCH AWARD CANDIDATES RESEARCH AWARD indicator for oxidative stress, both parameters were found to be higher in the nBD group, which may have biological significance in indicating REFERENCES an intracellular oxidative damage and the antioxidant defence developed Brown NC, Andreazza AC, Young LT (2014) An updated meta-analysis against it. Observing by neuroimaging loss of cortical volume and of oxidative stress markers in bipolar disorder. Psychiatry Research thickness in the prefrontal cortex, the parietal, temporal and the limbic 218(1): 61-68. regions of the nBD group brains as compared to the healthy controls Hirschfeld R, Lewis L, Vornik LA (2003) Perceptions and impact demonstrate that structural changes are initiated at the early stages of BD. of bipolar disorder: how far have we really come? Results of the Although advanced age is a complicating factor, observation of further national depressive and manic-depressive association 2000 survey of loss of volume and thickness in the prefrontal, parietal and the limbic individuals with bipolar disorder. J Clin Psychiatry 64(2):161-74. areas of the cBD group brains suggest that the structural changes progress Latalova K, Prasko J, Diveky T et al., (2011). Cognitive impairment with the duration of the disorder. In conclusion, when all the data are in bipolar disorder. Biomed Pap Med Fac Univ Palacky Olomouc taken together, they support the view that the observed neurobiological Czech Repub 155(1):19-26. changes and the cognitive function impairment present at the early phase Lim CS, Baldessarini RJ, Vieta E et al (2013) Longitudinal neuroimaging of BD independently of pharmacological treatment and progress with the and neuropsychological changes in bipolar disorder patients: review duration of the disorder. of the evidence. Neuroscience & Biobehavioral Reviews 37(3): 418- 435. Key Words: Bipolar disorder, cognitive function, early phase, magnetic Tohen M, Grundy S (1999) Management of acute mania. J Clin resonance imaging (MRI), neuroimaging, oxidative stress Psychiatry 60(suppl5):31-4 Comparison of the Neurocognitive Performance of the Patient and Control groups RAC-07 nBD (n=27) Control (n=27) cBD (n=26) ANOVA Tukey post hoc Mean.±sd Mean±sd Mean Ort.± sd p Executive Functions RELATION BETWEEN SERUM LEVEL OF GLIAL Wisconsin Card Sorting Test CELL DERIVED NEUROTROPHIC FACTOR AND Total errors 29.4±11.0 17.5±3.7 31.1±8.3 ,000 SK

10 one of the neurotrophic factors of the central nervous system, is a potent impulsiveness. Clarification of the role of GDNF in the aetiology of protector of dopaminergic neurons, playing a restorative role on the substance dependency will facilitate overcoming the current limitations damaged dopaminergic neurons. Also, studies on animal models have to treatment. Investigation of GDNF in the brain with neuroimaging indicated that GDNF modulates dependency behaviour and plays a and further advanced techniques would well give clues to be used for the moderate, negative role on the biochemical and behavioural adaptation treatment of other psychiatric disorders associated with impulsiveness. to substance dependency. One GDNF genotype has been determined to Key Words: Glial cell derived neurotrophic factor (GDNF), heroin be associated with a significant increase in the risk for heroin dependency. dependency, impulsiveness, reward deficiency syndrome Our study has aimed at comparing the serum levels of GDNF in heroin dependents (HD) and healthy controls, to investigate the relationship Serum GDNF Levels and the Barratt Impulsiveness Scale Scores of between the GDNF levels and the severity of impulsive behaviour in Heroin Dependent Group and the Healthy Control Group heroin dependency and, finally, to contribute to the research on the Heroin Dependents Controls place of GDNF in the pathophysiology of heroin dependency. Variables p* (Mean ± SD) (Mean ± SD) RESEARCH AWARD CANDIDATES RESEARCH AWARD METHODS: This is a cross sectional, event control study carried out at the Ankara Numune Training and Research Hospital and the Alcohol Serum GDNF level 472.2 ± 272.7 583.1 ± 235.2 0.002 and Substance Dependency Research, Treatment and Training Centre (AMATEM) in Ankara. The data was acquired from volunteering Impulsiveness score on Attention 15.4 ± 4.6 11.1 ± 3.3 <0.001 129 heroin dependents who had recovered from craving symptoms after treatment on an inpatient basis at the AMATEM in Ankara, and Motor Impulsiveness score 22.6 ± 8.7 15.2 ± 4.9 <0.001 consisted of sociodemographic details, serum GDNF levels, scores on the Barratt Impulsiveness Scale (BIS) and on the Hospital Anxiety and Unplanned Impulsiveness score 25.6 ± 9.4 17.9 ± 6.2 <0.001 Depression Scale (HADS). The exclusion criteria for the study included presence of comorbid psychiatric disorder, mental retardation or chronic Total Impulsiveness score 63.5 ± 21.8 44.3 ± 13.4 <0.001 physical illness and having used heroin or other substances in the previous one month. Age and gender matched 90 healthy individuals GDNF: Glial Cell Line-Derived Neurotrophic Factor; SD: Standard made up the control group of the study. Serum GDNF was measured by Deviation, the commercial ELISA kit (BOSTER, Boster Biological Technology Co. * p value for significance . Ltd, Fremont, CA, Code: EK0362, LOT: 851034314901). Statistical evaluations of the data were carried out with parametric and non- Variables Related to the Serum GDNF Level in Heroin Dependents parametric exploratory analyses. Normality was tested by the Shapiro Correlation with Wilk test. Continuous variables without a normal distribution were GDNF level p* VARIABLES tested with the Mann-Whitney U test; categorical data were analyzed by r the Pearson Chi square test, the Fisher-Freeman-Halton test and Fisher’s Attention related Impulsiveness -,725 <0.001 exact Chi square test. Correlations between variables were evaluated Motor Impulsiveness -,757 <0.001 with the Spearman correlation analysis. A p value of <0.05 was accepted as statistically significant. Unplanned Impulsiveness -,805 <0.001 RESULTS: Mean ages of the heroin dependent (HD) group and of the Total Impulsiveness -,808 <0.001 control group were, 25.1 (± 6.3) and 24.9 (± 6.5) years, respectively. HAD-A score -,461 <0.001 The female to male ratio in both groups was = 0.08, and significant HAD-D score -,550 <0.001 differences were not detected between the groups with respect to the level of education, marital status, employment, monthly income, Heroin consumed (gram/day) -,414 <0.001 alcohol and cigarette use. History of imprisonment and family history Dependency duration -,515 <0.001 of dependency were significantly higher in the HD group (p<0.001 and p=0.024, respectively). Mean amount of heroin usage by the HD group HAD-A: Hospital Anxiety Scale ; HAD-D: Hospital Depression Scale; r: was 2.2 (± 1.4) gram/day; and the mean duration of usage was 4.5 (± Spearman correlation coefficient; ,* p value for significance . 2.9) months. The serum GDNF level of the HD group was significantly REFERENCES lower (p=0.002) and the scores on impulsiveness (attention related, Aoi M, Date I, Tomita S et al., (2001) Single administration of GDNF motor, unplanned and total impulsiveness scores) were significantly into the striatum induced protection and repair of the nigrostriatal higher (p<0.001) as compared to the controls (Table 1). A significant dopaminergic system in the intrastriatal 6-hydroxydopamine negative correlation was determined between the serum GDNF levels injection model of hemiparkinsonism. Restor Neurol Neurosci and the HADS and the impulsiveness scores in the HD group (Table 17(1):31-38. 2) but not in the control group. Also, similarly, negative correlations Blum K, Thanos PK, Oscar-Berman M et al., (2015) Dopamine in were found between the serum GDNF level and the daily heroin the Brain: Hypothesizing Surfeit or Deficit Links to Reward and consumption and dependency duration (Table 2). Addiction. J Reward Defic Syndr 1(3):95-104. CONCLUSIONS: Lowered serum GDNF level and its association Bowirrat A, Oscar-Berman M (2005) Relationship between with the duration of the dependency and the amount consumed per dopaminergic neurotransmission, alcoholism, and Reward day are data related to the biological basis of the dependency, given Deficiency syndrome. Am J Med Genet B Neuropsychiatr Genet the important role of GDNF in neuronal and synaptic plasticity and 132B(1):29-37. especially in the protection of the dopaminergic neurons. Lowered Ma XC, Chen C, Zhu F et al., (2013) Association of the GDNF gene GDNF levels may be a cause an/or a result of heroin dependency. with depression and heroin dependence, but not schizophrenia, in a Observation of increased impulsiveness in heroin dependency and Chinese population. Psychiatry Res 210(3):1296-8. the undefined underlying mechanisms of this impulsiveness suggest Ron D, Janak PH (2005) GDNF and addiction. Rev Neurosci that GDNF may play a role in the neurobiological aetiology of 16(4):277-85.

11 RAC-08 significant, post-hoc analyses were carried out with Mann-Whitney test. Correlations between the clinical psychometric scale scores and the COMPARISON OF THE PRE-STIMULUS MEDIATED cognitive test parameters analyzed by the Spearman test. The correlation INHIBITION IN GROUPS WITH CLINICAL OR analyses were repeated for the female/male subgroups of the three FAMILIAL RISK FOR PSYCHOSIS groups. RESULTS: Number of males exceeded the females in the CRG, FRG Bilge Togay1, Uğur Çıkrıkçılı2, Handan Noyan3, 2 2 2 and the CG (19/6, 13/11 and 15/10, respectively). Mean age of the Hatice Samanlı , Nuran Çağlar , Çağdaş Yokuşoğlu , CRG, FRG and the CG were 20.2 (±4.4), 27.6 (±5.2) and 23.7 (±5.8) 2 2 2 Öznur Bülbül , Ceylan Ergül , Alp Üçok years, respectively and the duration of education for the CRG, FRG 1Antalya Training and Research Hospital, Psychiatry Clinic, Antalya and the CG were 11.5, 12.3 and 12.8 years, respectively. There were 2Istanbul University , Istanbul Medical School, Psychiatry Department , not any correlations between the PMI parameters investigated and the Istanbul age and education years of the three groups. The data on S1, S2 and RESEARCH AWARD CANDIDATES RESEARCH AWARD 3Istanbul University , Experimental Medicine Research Institute, PMI% are given on Table 1. Between the three groups PMI% differed Neurosciences Department, Istanbul significantly. Post hoc analyses showed that the PMI in the CRG was significantly lower than that for FRG (z=2.27, p=0.02) and that for CG INTRODUCTION: Pre-stimulus mediated inhibition (PMI) of the (z=2.53, p=0.01), but there was not a significant difference between startling reflex, which is one of the endophenotypes for psychosis is an the FRG and the CG. The mean S1 was higher in FRG than in the important function of the sensory motor gate system saving the weak CRG (z=2.23, p=0.02), but there was not other intergroup differences. stimuli from the effects of stronger stimuli. Impairment of IPM in A negative correlation was determined between the RAVLT subscore for psychosis has been known but when this impairment is initiated has correct remembering and the PMI parameters in the CRG (rho=-0.524, not been understood, and can only be clarified by research on PMI in p=0.01); but similar correlations between the PMI data and the other individuals with the genetic or clinical risk of psychosis. cognitive parameters were not detected. . In this study we have investigated the relationship of the PMI of the DISCUSSION: It has been shown by many studies that PMI reflects startling reflex between three groups formed by individuals with clinical the sensory motor filtration of the brain and that this phenomenon and familial liability to psychosis and normal healthy controls. The aim is impaired in psychosis. PMI deficits reflect the impairment of the of the study was to test the detectability of the impairment in PMI before cortico-striato-pallido-thalamic circuit and the tegmentopontin the overt presentation of psychosis, and to find out in the group with projection of the data released from here. Since the PMI deficit reflects familial risk for psychosis the presence or absence of this impairment. the frontal brain function, our results indicate that these functional METHODS: The study was carried out with 25 individuals, 16–35 deficits determined in schizophrenia are also present in the young years of age, believed to have a clinical risk of presenting with psychosis, individuals of the clinical risk group. Finding differences with respect to and depicted as the clinical risk group (CRG); 24 individuals, the 16 PMI between the FRG and the CRG indicate that the deficit in the cited to 35-year old siblings of individuals diagnosed with schizophrenia on circuits cannot surface only with genetic risk and that there are other the DSM-IV criteria, and depicted as the familial (genetic) risk group variables which must enter these circuits to bring the individual closer (FRG); and 25 normal healthy individuals age and gender matched with to psychosis. Although PMI was accepted as an endophenotype and was the risk groups, depicted as the control group (CG). determined in the FRG, we could not find in our study any differences between the FRG and the CG. This may have resulted from the limited The CRG consisted of 3 subgroups on the basis of the criteria used number of experimental samples. This study is the first in comparing in our previous study (3). Individuals who experienced psychotic the FRG and CRG with CG; and the CRG being investigated before symptoms lasting less than one week and clearing on their own, or any treatment and the FRG being only the siblings of schizophrenia those having longer lasting subthreshold psychosis symptoms and those patients are the strong points of this study. In the following stages of with first degree relatives diagnosed with schizophrenia and also having this investigation we are aiming at increasing the numbers of the three distinct functionality loss were placed in this group. To evaluate the PMI groups to estimate the relationship between the incidence of conversion of the startling reflex electrophysiological measurements were made by to overt psychosis in the CRG and the PMI deficit. placing two electrodes on the right orbicularis oculi muscle and making the participant receive a sounds arrangement on earphones in a sound Key Words: Endophenotype, pre-stimulus mediated inhibition, insulated room. The sound arrangement consisted of a stimulus named psychosis, prodrome S1, with 115-decibel (dB) loudness and lasting 40 milliseconds (ms) Pre-stimulus mediated inhibition and the stimulation wavelengths followed after a 120-ms interval by S2, with 86 dB loudness, lasting in the Patients and the Controls 20 ms and basal noise (white noise) of 70-dB loudness. These sound stimuli were arranged randomly with 16-second intervals between the S1 wavelength S2 wavelength PMI %

stimuli. The CRG group were not using psychotropic agents during Clinical risk group for psychosis (n=25) 23.1± 38.1 15.5±25.1 %19.8±41.3 the investigations. The mean severity of startlement without a pre- stimulus (mean S1), the mean severity of startlement when there was Familial risk group for psychosis (n=24) 30.2±28 14.5±19.1 % 46±40.1 pre-stimulus (mean S2) and the percentage of the change between the Healthy control group (n=25) 24.7±33.1 11.9±19.7 %46.7±38.7 responses to S1 and S2 (PMI%) were calculated. The cognitive test χ2 =6.25, df=2, χ2 =1.49, df=2, χ2 =8.02, df=2, İntergroup differences battery completed by all participants included the Rey Auditory Verbal p=0.04 p=0.4 p=0.01 Learning Test (RAVLT), the Wisconsin Card Sorting Test (WCST), the Tracking Test (TT), the Stroop Test, the Digit Symbol Coding Test. REFERENCES The CRG were also asked to complete the Brief Psychiatric Rating Scale Braff DL, Geyer MA, Swerdlow NR (2001) Human studies of (BPRS), the Scale for the assessment of negative symptoms (SANS) and prepulse inhibition of startle: normal subjects, patient groups and the Scale for assessment of positive symptoms (SAPS). Since the data on pharmalogical studies. Psychopharmacology 156:234–258. PMI did not comply with normal distribution, Kruskal-Wallis test was Cadenhead KS, Swerdlow NR, Shafer KM et al. , (2000) Modulation of used in the comparison of the three groups. When the differences were the startle response and startle laterality in relatives of schizophrenic

12 patients and in subjects with schizotypal : alexithymic processes. These experimental results suggest that HG is a evidence of inhibitory deficits. Am J Psychiatry 157:1660–1668. clinical condition presenting after processes related to continuous and Turetsky BI, Calkins ME, Light GA et al. , (2007) Neurophysiological concentrated anxiety experience. endophenotypes of schizophrenia: the viability of selected candidate Key Words: Alexithymia, anxiety, hyperemesis gravidarum, , rumination measures. Schizophrenia Bulletin 331:69–94. Ucok A, Direk N, Koyuncu A et al. , (2013) Cognitive deficits in clinical REFERENCES and familial high risk groups for psychosis are common as in first Erginbaş-Kender E, Yüksel G, Ger C ve ark. (2015) The eating episode schizophrenia. Schizophrenia Res 151:265–269. habits, depression and anxiety levels of inpatients admitted to Ziermans TB, Schothorst PF, Sprong M (2001) Reduced prepulse the maternity services with reasons of hyperemesis gravidarum . inhibition as an early vulnerability marker of the psychosis Düşünen Adam(The Thinking Man) - The Journal of Psychiatry prodrome in adolescence. Schizophrenia Research 49:10–15. and Neurological Sciences 28(2): 119-126. Verberg MF, Gillott DJ, Al-Fardan N ve ark. (2005) Hyperemesis

gravidarum, a literature review. Hum Reprod Med Update CANDIDATES RESEARCH AWARD RAC-09 11(5):527–39.

THE ROLE OF COGNITIVE AND EMOTIONAL PROCESSESS IN HYPEREMESIS GRAVIDARUM RAC-10

1 2 1 Kasım Fatih Yavuz , Esra Cebeci , Sevinç Ulusoy , COMPARISON ON PSYCHOPATHOLOGICAL 1 Şahap Erkoç GROUNDS THE PSYCHOLOGICAL RESILIENCE, 1 Bakirköy Mazhar Osman Ruh Sağliği EAH ATTACHMENT STYLES, COPING BEHAVIOUR OF 2Kartal Yavuz Selim Devlet Hastanesi WOMEN WHO HAVE MOVED TO A SHELTER HOME INTRODUCTION: Hyperemesis gravidarum (HG), without a known AND WOMEN WHO HAVE REMAINED AT HOME aetiopathology, is characterized with persistent nausea and vomiting AFTER EXPOSURE TO FAMILY VIOLENCE and can lead to dehydration and disorders of electrolyte balance, metabolic and nutritional problems that can require bed treatment. In Çetin Irmak, Merih Altıntaş the recent years research has increased on the relationship of HG with Erenköy Ruh ve Sinir Hastaliklari E. A. H. psychopathological conditions. However, there is not yet a prospective INTRODUCTION-AIM: Violence against women has been described research on the mechanism underlying HG. This study has aimed to as ‘’action whether occurring in public or in private life, to inflict investigate the relationship between HG and cognitive and emotional physical, sexual or psychological pain in women or one that will result processes such as rumination, anxiety and alexithymia and whether they in such pain or to challenge or threaten with such an action or to have a place in the aetiopathogenesis of HG. violate their freedom on arbitrary grounds ‘’. This study has aimed to METHODS: The study has been carried out with volunteering 350 compare from a psychopathological angle the psychological resilience, pregnant females in the 6th week of pregnancy. The participants were asked attachment styles, coping behaviour of women, who, after exposure to to complete a sociodemographic questionnaire, the Toronto Alexithymia domestic violence have either taken refuge in a shelter home or have Scale (TAS), the Ruminative Thought Style Questionnaire (RTSQ), the remained at home and continued to face violence without any venture State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory to stop or to reduce the effects of such violence. (BDI). Among those who joined the study at the first examination for METHODS: The study included a total of 150 women exposed pregnancy and completed the psychometric tests, 40 individuals were to domestic violence, 50 of whom had remained at home and had diagnosed with HG and were asked to complete the psychometric tests continued facing violence and 100 of whom were living at two separate for the second time. Individuals (n=40), not diagnosed with HG and with shelter homes in Istanbul. The inclusion criteria of the study consisted pregnancies synchronized with those diagnosed with HG, were randomly of having been exposed to violence in the family and to give written selected from the participants to make up the controls and were also asked consent to join the study. The exclusion criteria included being outside to complete the tests for the second time. the age limits of 18–60 years, staying at the shelter for reasons other RESULTS: There were not any significant differences in the scores on the than domestic violence, having mental retardation, , psychosis, BDI and the RTSQ of the HG diagnosed participants and the controls in bipolar manic episode diagnosis; and, for those women who had not the first round of the tests, but the scores on the BDI and the RTSQ of applied for shelter home, not having stayed at a shelter previously. The the HG group on the second round of tests were significantly increased as participants were asked to complete a sociodemographic questionnaire, compared to the controls whose scores did not change significantly from a Violence Data Form, the Resilience Scale for Adults (RSA), the those recorded in the first round. At the time of HG diagnoses, the total Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), TAS scores of the HG and the control groups on the second round of the Patient Health Questionnaire-Somatic, Anxiety, and Depressive psychometric tests were found to be increased as compared to the scores Symptoms (PHQ-SADS), the Adult Attachment Scale (AAS) and the of the first round of tests, but a significant intergroup difference was not Coping Styles Questionnaire (CSQ). detected. The STAI scores of the HG and the control groups at the first RESULTS: Mean age of the women at the shelter homes was round of test differed significantly. The STAI scores of both groups were significantly lower than that of those remaining at home whose found to be elevated in the second round of tests at the stage of HG educational level was significantly below those in the shelter homes. diagnoses, the HG scores being higher and the intergroup difference also Of the women staying at shelter homes 62% were married, 18% were being statistically significant at this stage of pregnancy. divorced and 20% were single; while 88% of the women remaining at CONCLUSION: Our prospective study is the first of its kind in the home were married, 8% were divorced and 4% were single. There were literature demonstrating that anxiety and related processes play a more not significant differences on the basis of the types of marriage bond in effective role in the aetiology of HG as compared to ruminative and the two groups of women. There was significantly higher incidence of

13 interfamily marriage among the women remaining at home (31.3%) in • Psychological resilience of the women in shelter was higher as comparison to those in the shelter homes (12.5%). Only 53% of the compared to the women remaining at home and facing violence. women in the shelter homes had social security provision as compared Total score on psychological resilience, and scores on the subscales to 86% for those remaining at home, the difference being statistically of perception of self, structured style and family cohesion were significant. At least one psychiatric disorder had been diagnosed in 76% significantly higher among women in shelter as compared to of the women in shelter, the diagnoses consisting of post traumatic the other group. The scores on the other subscales on social stress syndrome (PTSS-35%), major depression (30%), specific competence and social resources did not differ between the two (18%), otherwise unexplained depression (10%), general groups of women studied. anxiety (8%), (7%), social (7%), (7%), (7%), undifferentiated somatoform disorder • The women in shelter homes used more of the active coping (5%), somatisation disorder (4%). In the group of women remaining strategies as compared to the women remaining at home. at home, 90% had at least one diagnosis of psychiatric disorder, the • The women exposed to violence by choosing to remain at home RESEARCH AWARD CANDIDATES RESEARCH AWARD incidences including major depression (66%), PTSS (30%), general resorted more to nonfunctional coping strategies and ignored the anxiety (30%), specific phobias (30%), somatisation disorder (24%), situation as compared to those in shelter. dysthymia (14%), panic disorder (12%), undifferentiated somatoform disorder (12%) and social phobia (8%). The incidences of major • There were not significant differences in the attachment styles of depression, somatisation disorder and general anxiety were significantly the women in shelter or the women remaining at home. higher in the group remaining at home. The total scores on the PHQ- • Psychological resilience of women is lowered by remaining at SADS and scores on the subscales of somatisation, general anxiety, home by continual exposure to violence which affects mental panic, depression, impairment of functionality recorded by the women health adversely. Women exposed to violence need psychiatric remaining at home were significantly higher than the corresponding scores of the other group. Total score on psychological resilience, and intervention and treatment. Strategies of evaluation and scores on the subscales of perception of self, structured style and family intervention have to be developed by a multidisciplinary approach cohesion; and the scores on active coping strategies were significantly to terminate violence and cycles of violence prevalent in the entire higher among women in shelter as compared to the other group (Table population. 1). The scores of the women remaining at home on nonfunctional Key Words: Attachment, coping, domestic violence, psychological coping and ignoring the situation were significantly higher as compared resilience, shelter homes for women to women in shelter (Table 2). Comparison of the attachment styles of women exposed CONCLUSION: There are research reports on domestic violence and to domestic violence and taking refuge in shelter homes or psychiatric disorders carried out with different types of experimental remaining at home populations, reached by population scans, mental health scans among

women in shelter homes, women consulting the family violence advice Women in Shelter Women at home P centers or consulting psychiatric treatment centers on an outpatient or (N=100) (N=50) inpatient basis. Despite the growing information and interest in the recent years on domestic violence in Turkey, there are only few research Avoidant attachment 4.3±1.2 4.2±1.4 0.749 reports on the mental health of women victimized by domestic violence. We have not met any study in the literature on the comparison of Insecure attachment 2.6±1.5 2.8±1.4 0.326 psychological resilience, attachment and coping styles among the women staying in shelter homes with termination of exposure to domestic Secure attachment 2.4±1.7 2.7±1.7 0.328 violence and the women remaining at home an enduring continued domestic violence. Therefore, we believe that the evaluations carried Comparison of the Scores on the Resilience Scale for Adults (RSA) out over 2 to 2.5-hour interviews with the cited groups of women are recorded by women in shelter homes and women remaining at important in being the results of a first study of its kind. The study home included a total of 150 women exposed to domestic violence, 50 of Women in shelter Women at home P whom had remained at home and continued facing violence and 100 of (N=100) (N=50) whom were living at two separate shelter homes in Istanbul; with 76% of women in shelter and 90% of women remaining at home having at Perception of Self 22.5±5 18.9±5.3 0.000* least one diagnosis of psychiatric disorder on the basis of the SCID-1. Planned future 14.8±4.1 9.4±4.9 0.000* • The most frequently made diagnosed psychiatric disorder was PTSS among the women in shelter homes and major depression Structural style 15.3±3.3 12.4±3.5 0.000*

among the women remaining at home. Social competence 21.5±4.9 19.9±5.5 0.081

• Incidences of major depression, somatisation disorder and general Family cohesion 18.3±6.5 15.5±5.2 0.016* anxiety were significantly higher in the group of women remaining at home. Social resources 23.5±6.1 21.9±5.7 0.121

• Among the women remaining at home the scores on the symptoms Total 116.2±20.6 98.6±17.9 0.000* of somatisation, depression, panic and anxiety were higher and had caused a greater impairment of functionality as compared to the women in shelter. REFERENCES • Comparably, a very low percentage of the women in shelter and Cesario SK, Nava A, Bianchi A et al. , (2014) Functioning outcomes the women remaining at home had made psychiatric consultations for abused immigrant women and their children 4 months after with the complaint of having experienced domestic violence. initiating intervention. Rev Panam Salud Publica 35:8–14.

14 Gezen M, Oral ET (2013) Kadin Siğinma Evinde Yaşayan Kadinlar chronic physical illness, neurological illness, being pregnant or breast Ile Şiddet Gördüğü Evde Yaşamaya Devam Eden Kadinlarin feeding and having any condition or reason contraindicative for MRI. Bağlanma Biçimlerinin Ve Ruhsal Belirti Düzeylerinin Incelenmesi. Healthy volunteers (n=21) age, gender and educationally matched (Investigation of the Attachment Styles and Symptoms of Mental with the patients were enrolled as the control group. All participants Health of Women Continuing to Live at home and the Women were interviewed on the SCID-I/CV, and were asked to complete the Staying in Shelter Home After Exposure to Domestic Violence) Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Düşünen Adam The Journal of Psychiatry and Neurological Scale (HAM-D), Contentment with life Assessment Scale-Short Form Sciences 26:65–71. (CLAS), and the Global Assessment of Functioning (GAF). Also, the McFarlane J, Symes L, Maddoux J et al. , (2014) Is Length of Shelter SAD group were asked to complete the Liebowitz Scale Stay and receipt of a Protection Order Associated With Less (LSAS), the Sheehan Disability Scale (SDS), and the Clinical Global Violence and Better Functioning for Abused Women?. Outcome Impressions Scale (CGS). All participants went through a 15-minute Data 4 Months After Receiving Services. J Interpersonal Violence fMRI session at resting state; and during the anatomical recording at

29:27–48. the first half of the session, the eyes could be closed or open, but during CANDIDATES RESEARCH AWARD the latter half of the session the participants were asked to keep the eyes closed but not to sleep. The fMRI data were processed through the SPM software, and to determine the internal connectivity network RAC-11 at resting state, the data were analyzed on the GIFT package operating in the MATLAB tool. The data on the two groups were compared INVESTIGATION OF THE FUNCTIONAL MAGNETIC using t-test based on voxel morphometry. Two clusters emerging as RESONANCE IMAGING DATA ON PATIENTS statistically significant as a result of two sample t-tests, were turned into DIAGNOSED WITH SOCIAL ANXIETY areas of interest by the MarsBaR software. The mean connectivity values belonging to these areas of interest were obtained and the correlations 1 2 3 Ceylan Ergül , Ahmet Koyuncu , Elif Kurt , between these values and the psychometric scale scores were anaylsed Çiğdem Ulaşoğlu Yıldız3, Anı Kıçık3, Tamer Demiralp3, using the SPSS Statistics 21.0.0.0 program. When comparing two Raşit Tükel1 groups of data, Chi-square test was used for the categorical variables; 1Istanbul University, Istanbul Medical School, Psychiatry t-test was used for continuous variables complying with normal Department, Istanbul distribution, and the Mann-Whitney U test was used to analyse those 2Academy Social Phobia Centre not complying with normal distribution. In all results the p value of less 3Istanbul University, Hulusi Behçet Life Sciences Research than 0.05 was accepted as statistically different. Laboratory, Neurosciences Unit, Istanbul RESULTS: Significant differences with respect to age, gender, marital INTRODUCTION: The effects of genetic factors, social experiences of status, employment, cigarette smoking and alcohol and substance use the individual and the cultural characteristics of the population on social were not determined between the SAD and the control groups (Table (SAD) have been known. The neurological aspects of 1). All patients had general type SAD. By single step independent the disorder are being researched by neuroimaging techniques. Etkin component analysis applied to the functionality data clusters of and Wager (2007) have formulated a neurobiological model by meta- the 42 participants, the functional images were separated to 30 analysis of all functional magnetic resonance imaging (fMRI) studies. components. The compliance of the anatomical patterns obtained This model has shown that all of the fear circuit (amygdala, insula, with the coordinates indicated in the literature were checked and 15 inferior frontal gyrus, fusiform gyrus, superior temporal gyrus) was components were determined to meet the IBAs; and these components highly activated in SAD. Brühl et al. (2007–2014) have also made a were used for voxel bas analyses for comparisons between the SAD and meta-analysis of neuroimaging studies on SAD, which has confirmed the control groups. Significant differences were found between the two the hyperactivation model of the fear circuit. Subsequent investigations participant groups in two clusters in the left orbitofrontal cortex and on functional connectivity and task based functions have demonstrated the left supramarginal gyrus (Table 2). In comparison to the controls, hyperactivation in the medial parietal and the occipital regions and the connectivity was reduced in the left orbitofrontal cortex of the decreased connectivity in the parietal and the limbic areas as well as the SAD group, while the connectivity in the left supramarginal gyrus was areas involved in regulating executive functionality. Also, undetectability increased. These two clusters were used as the areas of interest to obtain of the regulating and controlling effects of the prefrontal area on the the mean interconnectivity values of all participants in the voxels. amygdala reflects the decrease in the connectivity between these areas Correlation analyses carried out between these values and the scores on since the prefrontal area remains active in SAD. . the psychometric scales completed by the SAD group indicated that as the connectivity in the left orbitofrontal cortex decreased the scores Initially the emphasis was on the fear circuit with neuroimaging on the CLAS were also decreased (p=0.007) and the score on the SDS techniques, but the paradigm shifted with the changes in the subscale of family life disability was increased (p=0.027). imaging and analyzing techniques. As not only the areas planned by CONCLUSION the researcher but the whole brain circuits and the interconnectivity : The orbitofrontal cortex is a prefrontal cortical area between these were investigated by the resting state analyses, and new believed to be responsible for decision making, forming interpersonal data in differing areas emerged. In addition to the hyperactivation in the relationships and behavioural skills appropriate to context. Reduced fear circuit, reduction in the interconnectivity between this circuit and activity found in this study has been reported by other studies and support the notion that the inhibitory influence of the orbitofrontal the areas with inhibitory effect on this circuit were visualized. This study cortex on the amygdala is impaired in SAD. The supramarginal gyrus has aimed at the formative neurological mechanisms resulting in SAD. localized in the parietal lobe is a hub for sensory association playing a role METHODS: This study included 21 individuals between the ages of in mental theorizing and empathy formation. When there are lesions in 18 and 50 years, with a dominant right hand, diagnosed with SAD on the area the skills in empathy forming are affected. The observation the basis of SCID-1/CV and not using any psychotropic medication in this study of increased connectivity in the left supramarginal gyrus at least for the 6 weeks previously to the study. The exclusion criteria was not reported in previously made studies by others. Since the left were having a comorbid psychiatric disorder, a history of dependency, orbitofrontal cortex and the left supramarginal gyrus have appeared

15 in the brain computer interface as the parts of the central executive REFRENCES network, combined evaluation of the findings on these two clusters Bruhl AB, Delsignore A, Komossa K et al. , (2014) Neuroimaging in suggests a functional impairment in the central executive network. -a meta-analytic review resulting in a new Such an impairment supports the view that the inhibitory control by neurofunctional model. Neurosci Biobehav Rev 47:260–280. the prefrontal areas of the limbic system, the basis of the mechanisms Ding J, Chen H, Qiu C et al. , (2011) Disrupted functional connectivity behind anxiety disorders, has been impaired in SAD, characterized by in social anxiety disorder: a resting-state fMRI study. Magn Reson inability to regulate fear and worry which increase without control. Imaging 29 (5): 701–711. Etkin A, Wager TD (2007) Functional neuroimaging of anxiety: a meta- Hyperactivity in the limbic region depicted as the fear circuit has been analysis of emotional processing in PTSD, social anxiety disorder, demonstrated by many studies. These demonstrations have been made and . Am J Psychiatry 164 (10): 1476–1488. by imaging studies during an activity causing anxiety in the patient. Geiger MJ, Domschke K, Ipser J et al. , (2016) Altered executive control Our study has not shown significant differences in these areas probably network resting-state connectivity in social anxiety disorder. World

RESEARCH AWARD CANDIDATES RESEARCH AWARD on account of having made the imaging at resting state. The results J Biol Psychiatry 17 (1): 47–57. obtained when triggering anxiety in the patient are related to the Hahn A, Stein P, Windischberger C et al. , (2011) Reduced resting-state experimental condition of the patient, whereas the observations made functional connectivity between amygdala and orbitofrontal cortex in the resting state are believed to be related to structural changes that in social anxiety disorder. Neuroimage 56 (3): 881–889. may have prepared the basis of SAD. The main conclusion of our study is the determination of an impairment in the central executive network of the patient diagnosed with SAD RAC-12 which affects adversely the life quality of the patient. In this respect, our results are in agreement with the generally accepted point of view EVALUATION OF THE NEGATIVE THOUGHTS that there is reduction in the downward control by the central executive ABOUT TREATMENT BY THE PATIENT IN THE network which plays an important role in the neurobiology of SAD. INITIAL CONSULTATION Key Words: Functional magnetic resonance imaging, resting state, social Barış Sancak1, Ender Cesur1, Özlem Altuntaş1, Ürün Özer2 anxiety disorder 1Bakirköy Prof. Dr. Mazhar Osman Mental Health and Neurological Comparison of the sociodemographic and the clinical details of Diseases and Research Hospital, Psychiatry Department, Istanbul the SAD patients and the control group 2Acibadem University Atakent Hospital, Psychiatry Department, Istanbul INTRODUCTION: Despite there being many methods of treatment SAD group Control group p value for psychiatric disorders, many afflicted individuals are still abstaining Age (years) 27.7 ± 6.5 27.6 ± 6.5 t=0.024 p=0.981 from seeking medical help. Among the reasons considered about this attitude is the general lack of knowledge in the public about psychiatric 2 Gender n=7 (% 33) n=7 (% 33) x =0.001 p=1.000 disorders. One of the factors that adversely affects seeking medical help

Education years 14.4 ± 2.8 15.1 ± 2.7 t=-0.777 p=0.422 and compliance with the treatment given is the impressions and thoughts of the individuals about psychiatric therapy. It is important for the sake Rette smokers n=12 (% 57) n =8 (% 38) x2=1.527 p=0.217 of maintenance of therapy in chronic disorders or disorders with the risk of becoming chronic, by defining these thoughts and attitudes that Alcohol users n=13 (% 62) n=10 (% 48) x2=0.865 p=0.352 emerge as a result of inadequate education and the trends of labelling Substance users n=3 (% 14) yok x2=3.231 p=0.072 by the public and the individuals. Labelling, which is one of the reasons behind prejudgement on therapy, can be classified as the ‘’collective’’ Having relatives n=2 (% 10) yok x2=2.100 p=0.147 and ‘’self’’ labelling. While collective labelling causes discrimination and with SAD social division by creating stereotypes and prejudgments, self labelling is Having relatives mediated by negative thoughts. It can be seen in the literature that, due with psychiatric n=10 (% 48) n=8 (% 38) x2=0.389 p=0.533 to this reason, at least 40% of the patients on antipsychotic agents fail to Disorders comply regularly with their therapy. It may be possible to put in place HAM-A score 8.8 ± 5.6 3.1 ± 2.3 t=4.317 p=0.001 more functional thinking during the treatment process by identifying the negative thoughts about psychiatric therapies. In this study it has been HAM-D score 4.3 ± 2.2 2.2 ± 1.9 t=3.308 p=0.002 aimed to identify the automatic negative thoughts of psychiatric patients

GAF score 75.0 ± 6.5 83.1 ± 4.3 t=-4.747 p=0.001 not yet put under any treatment by using the Automatic Thoughts Related to Treatment (ATRT) questionnaire developed and validated by Life quality (CLAS) 50.4 ± 7.5 57.1 ± 8.4 t=-2.760 p=0.009 Meriç et al. , (2014). score METHODS: Patients consulting the Psychiatry Department of Bakirköy Entire brain comparison of the SAD and the control groups on Mental and Neurological Disorders Hospital, during June, July and voxel basis August 2016, and confirming that they had not previously taken any psychiatric pharmacotherapy were asked to complete a sociodemographic p at apex Cluster MNI p at apex level Contrast (Voxel apex T level questionnaire and the ATRT questionnaire, a Likert type questionnaire (not number). coordinates (corrected) corrected) evaluating 27 automatic thoughts with 1–5 points per item. The

x y z participating patients were also queried on their diagnoses, the nature and the duration of their complaints, whether they came to the polyclinics by Left control>SAD 17 -28 22 -18 5.12 0.001 0.048 orbitofrontal themselves, and about the existence of psychiatric disorders in their first Left SAD>control 83 -64 -42 28 5.88 0.001 0.006 and second degree relations and in their friends and neighbors. The data supramarginal gathered were statistically analyzed on the SPSS program.

16 RESULTS: Among the patients arriving at the psychiatry polyclinics foster more labelling thoughts against mental disorders. When viewed between the cited dates 84 were found to meet the criteria of inclusion from the collective point of view, presence of mental disorders among of this study. The group consisted of 52 (61.9%) females and 32 males women is more tolerable given the more fragile and weak nature of the (38.1%); with a mean age for all the group being 33.8 (18–67, SD female gender, which may also reflect the presence of less tendency to 12.17); 52.4% being married, 54.8% being regularly employed, 95.2% labelling disorders among the females. When the ATRT questionnaire living in the inner city areas and 57.1% admitting to arrive at the hospital was being developed, the mean score of the control group, made up by by themselves. Alcohol, cigarette and psychoactive substance use was the patients diagnosed with chronic disorders by the internal diseases determined to be 11.9%, 44% and 3.6%, respectively. The known rates department, was 43.4 while the mean score on automatic negative of drug usage by the first and second degree relatives and friends of the thoughts of the general anxiety patients was 56.9. In our study this was patients were estimated to be 28.6%, 23.8% and 32.1%, respectively. determined to be 58.23 in patients at first consultation, which supports Among the patients the most frequently diagnosed disorder was major the point of view that there are more negative thoughts oriented to depression (53.6%) followed by general anxiety (10.7%), and panic psychiatric disorders. In conclusion, the labelling attitudes against disorder (9.5%), while 21 (25%) patients had an additional chronic mental disorders and psychiatric treatments can impede seeking medical CANDIDATES RESEARCH AWARD disorder and 21.4% were using medicines for nonpsychiatric reasons. The help and compliance with the treatment given. Therefore, accelerating mean duration of the complaints of all the group before consultation had the studies against labelling and informing the public appropriately on been 18.4 months. The 27 items in the ATRT questionnaire were placed psychiatric treatments bear great importance. When the importance of under 3 headings as ‘’self labelling’’, ‘’collective labelling’’ and ‘’automatic compliance with treatment at the first consultation is remembered, it thoughts about drugs used’’. Among the 27 thoughts, the ones most is realized that there is need for further research in this field. marked y the participants ranked as ‘’To continue using medicines one Key Words : automatic thoughts, compliance with treatment, first has to believe in getting cured’’, ‘’medicines cannot be used lifelong’’ and consultation, labelling ‘’ using drugs in not something that anybody would desire’’. The mean score on the self related automatic thoughts was 2.35; the mean score on REFRENCES the collective labelling thoughts was 1.88; and the mean score on drugs Andrews G (2000) Unmet Need In Psychiatry: Problems, Resources, was 2.18. The mean total score of the male subgroup were 64.5, and that Responses. New York, Cambridge University Press, p. 11. of the female subgroup was 54.3. In the three subscales on automatic Bilge A, Çam O (2010) Ruhsal hastaliğa yönelik damgalama ile thoughts (self, collective and drugs) the male subgroup had higher scores, mücadele. (Fight against the labelling on mental illnesses) TAF Prev the respective male/female ratios being 2.55/2.24 (p=0.06), 2.12/1.73 Med Bull 9 (1): 71–78. (p=0.073) and 2.43/2.02 (p= 0.012). Those patients using alcohol and Corrigan PW, Watson AC (2007) The stigma of psyciatric disorders and cigarettes had significantly higher scores on the collective category of the gender, ethnicity, and education of the perceiver. Community automatic thoughts (p=0.034 and 0.016, respectively). In reference to the Ment Health J 43 (5): 439–458. educational level of the patients, those who had university education had Cramer JA, Rosenheck R (1998) Compliance with medication significantly lower scores in all three categories of automatic thoughts as regimends for mental and physical disorders. Psychiatr Serv 49 (2): compared to the others of lower educational background. 196–201. Jorm AF, Nakane Y, Christensen H et al. , (2005) Public beliefs about DISCUSSION : The difficulties of maintaining regularity in using treatment and outcome of mental disorders: a comparison of medicines in the cases of chronic illnesses has been well known. Psychiatric Australia and Japan. BMC Medicine 3 (1): 1. medicines have a different position when compared to other categories Kozuki Y, Schepp KG (2005) Adherence and nonadherence to of drugs. One of the targets of our study was to obtain the profile of the antipsychotic medications. Issues Ment Health Nurs 26 (4): 379– negative thought burden at the first consultation. The most frequently 96. made diagnoses are on major depression and anxiety disorders. The Meriç M, Oflaz F, Ak M (2014) Tedavi ile ilgili otomatik düşünceler collective prejudgements of the western populations are also present in ölçeğinin geliştirilmesi, geçerlili ve güvenilirlik çalişmasi. (Study on ours. Publications have shown that these prejudgements cause delays in the development and validation of the scale for automatic thoughts medical consultations and decrease compliance with drug therapy. In our on treatment) Literatür Sempozyum 1 (4): 25–30. study it was seen that the highest scorings were on automatic thoughts Rüsch N, Angermeyer MC, Corrigan PW (2005) Mental ilness stigma: about drug side effects and drug dependency. Lowering of the scores concepts, consequences, and initiaves to reduce stigma. Eur with the increase in education among the patients is indicative of the Psychiatry 20 (8): 529–539. lack of adequate public information about psychiatric drugs. Our study has also shown that the negative automatic thoughts about self came before those in the collective category of thoughts. Studies evaluating the labelling attitude under two headings have shown that the process RAC-13 of collective labelling spirals to a self labelling process. The individual who internalizes the collective prejudgements starts developing negative PREVELANCE AND CLINICAL FEATURES OF NIGHT thoughts about self, primarily about inadequacy, character weakness and being undesirable, which result in definitely decreased tendency to EATING SYNDROME IN BIPOLAR DISORDER seek help. This is confirmed by the determination in this study that the Onur Bilgiç1, Numan Konuk2, Güzin Mukaddes Sevinçer3 participating patients arrived at the decision to seek medical help after 1Bağcilar Training and Research Hospital, Mental Health and Diseases a mean delay as long as 18.4 months. While the females took a mean Department, Istanbul 16.2 months to make the first consultation, the males took 22 months 2Istanbul University Cerrahpaşa Medical School, Mental Health and to take the same decision. Hence, another noteworthy finding of this Diseases Department, Istanbul study is the higher frequency of harboring all types of negative thoughts 3Istanbul Gelişim University, Applied Sciences Professional School, Public by the male patients as compared to the females and indicates that the Relations and Advertising Department, Istanbul collective and self labelling have a stronger effect on the male gender. Studies similar to ours have shown that males are more exposed to INTRODUCTION: Comorbidity with bipolar disorder (BD) has been labelling than females. There are also studies demonstrating that males accepted as a rule as against an expected condition. Life long probability

17 of comorbidity with BD exceeds the probability of the absence of RESULTS: An incidence of 19.04% of NES was determined in the comorbidity. Anxiety disorders, alcohol and substance use, eating participating BD group, without differences of incidence between the disorders, impulse control disorders, attention deficit and hyperactivity type I and type II BD patients (p>0.05). Also, differences of incidence disorder and personality disorders are among the life long observed with respect to gender were not found (p>0.05). Mean age of the comorbidities with BD. Incidences of diagnosis of BD in patients with patients diagnosed with NES was significantly above those without eating disorders (ED) and vice versa are very high, the reported incidence NES diagnosis (p=0.047<0.05). However, there were not significant of at least one lifelong ED comorbidity in BD being 15–21%, with differences between the mean ages of the type I and type II patients the binge being the most frequently observed disorder despite the relatively earlier presentation of BD in the type I BD followed by bulimia and . Presence of ED comorbidity (p>0.05). The comorbidity of NES did not vary with respect to the in BD patients may lead to obesity or, in reverse, the presence of BD comprehensive clinical data of the patients including frequencies of comorbidity in ED patients may contribute to treatment resistance. manic attack, hypomanic attack and depression attacks, the duration Night eating syndrome (NES) is another condition predisposing and the counts of the attacks, the fast cycling of the attacks and the

RESEARCH AWARD CANDIDATES RESEARCH AWARD to obesity and. appears to be associated with the severity of obesity. mean score on the Global Assessment of Functioning (GAF) Scale Research on NES, started in cases of obesity, has revealed an incidence (p>0.05). Age at the first attack episode in the BD patients diagnosed of 6–16%, which has been confirmed by many other studies. When with NES was significantly higher as compared to the BD patients considering the health concerns created by the currently widespread without NES diagnosis (p=0.50≤0.05). There were more incidences obesity, further research on this condition is undeniably necessary. of attacks in the BD patients with NES The observed two fold increase in the prevalence of ED and obesity (p=0.016<0.05). Regression analyses showed that the risk of NES in BD in BD cases as compared to the general population has oriented us to with history of melancholic depression attacks increased by 11.17 fold work in this field. Our study is the first of its kind in investigating the (p=0.041<0.05). Significant differences were not determined between incidence of NES comorbidity in BD, the relationship of the clinical the BD groups with and without NES comorbidity on grounds of the characteristics of BD with NES, and the contribution of NES to the seasonal variation of attacks, presence of psychotic symptoms during incidence of obesity. attacks, , having had attacks of mixed characteristics or of atypic depression, peripartum presentation of the attacks and of manic/ METHODS: The study enrolled 63 euthymic BD patients, diagnosed hypomanic shift due to antidepressant use (p>0.05). Obesity related with BD on the DSM-V criteria, consulting Cerrahpaşa Medical data including body weight (p=0.005<0.05), BMI (p=0.000<0.05), School, Mental Health and Diseases Department general polyclinics waistline circumference (p=0.009<0.05), and the highest body weight between April 2015 and September 2015. attained (p=0.008<0.05) were significantly higher in the BD patients The participant inclusion criteria of the study were: with NES as compared to those without NES comorbidity. It was shown 1. Being euthymic with BD diagnosed on the DSM-V criteria, by logistic regression analyses that in patients with elevated BMI, the 2. Being in the age range of 18–65 years, risk of NES was increased 1.56 fold (p=0.026<0.05). The mean scores 3. Being literate, on the ‘’worries on eating’’ (P=0.017<0.05), ‘’worries on body shape’’ 4. Having volunteered to join the study and signed the informed (P=0.003<0.05), ‘’worries on body weight’’ (P=0.014<0.05) subscales consent form. of the EBIT and the total EBIT score (P=0.014<0.05) were significantly higher in the BD patients with NES comorbidity as compared to those The exclusion criteria of the study were: without. However, there was not a significant difference between Having a psychiatric comorbidity other than eating disorders on the the scores of the two groups on the ‘’restriction’’ subscale of EBIT (p>0.05). Comorbidity of endocrine, cardiac, neurological and other basis of the DSM-V criteria, medical disorders did not show a significant difference between the 5. Having sleep related eating disorders as classified on the groups (p>0.05). Details related to the menstrual cycle did not differ International Classification of Sleep Disorders (ICSD), between the two groups (p>0.05). Also, the two groups did not differ 6. Having impaired cooperation and cognitive functions due to with respect to the data on psychological trauma, cigarette smoking and conditions such as mental retardation, neurological illness, being alcohol and substance use (p>0.05). under alcohol or substance effects, CONCLUSION: It can be seen from the results of our study that the 7. Having a history of brain surgery or psychosurgery, incidence of NES in BD patients is quite elevated and represents a 8. Having a history of cranial trauma, significantly increased risk factor for the development of obesity, although 9. Fasting or on special diets for weight loss or weight gain, it does not affect the clinical characteristics of BD. Keeping in mind the health concerns caused by obesity, the investigation of comorbidity of 10. Having to remain awake through the night due to employment NES in BD patients should be taken seriously on clinical grounds. in shift work. Key Words 11. Patients meeting the inclusion criteria were interviewed to assess : Bipolar disorder, body mass index (BMI), night eating comorbidities on the DSM criteria and for the differential diagnosis syndrome, obesity of NES, by investigating the presence of anorexia nervosa, bulimia REFRENCES and binge eating disorders. During the clinical interviews, NES MacQueen GM, Marriott M, Begin H et al., (2003) Subsyndromal was diagnosed on the basis of the criteria established by Allison et symptoms assessed in longitudinal, prospective follow-up of al. , (2010). The participants were put through an interview for a cohort of patients with bipolar disorder. Bipolar Disord 5 (5): completing a sociodemographic questionnaire, and completed the 349–55.3. Night Eating Symptom Scale (NESS) and the Eating Behaviour McElroy SL, Kotwal R, Keck PE Jr et al., (2005) Comorbidity of Inventory Test (EBIT) on a self-report basis. Measurements were bipolar and eating disorders: distinct or related disorders with recorded on the height (without shoes), weight and the waistline shared dysregulations?. J. Affect Disord 86:107–27. circumference (after termination of the expiration and on the McElroy SL, Kotwal R, Keck PE (2006) Comorbidity of eating naked abdomen at the horizontal plane antero-superior to the disorders with bipolar disorder and treatment implications. Bipolar right iliac crest) of the patients. Disorders 8:686–695.

18 Arker GB (2010) Comorbidities in bipolar disorder: models and year were determined and the patients were divided into two groups. management. Med J Aust, 193 (Suppl 4): P18–20. The renal function test results of those patients with mean serum Stunkard A, Berkowitz R, Wadden T ve ark. (1996) Binge eating lithium level of 0.8 mEq/L were compared with the renal function disorder and the night eating syndrome. Int J Obes Relat Metab test results of the patients with mean serum lithium level above 0.8 Disord 20:1–6. mEq/L. Serum creatinine and PTH levels were found to be significantly elevated in the latter (p< 0.05). Renal function tests and measurement of the biochemical parameters of the patient group were repeated after RAC-14 excluding the patients on oral antidiabetic agents with HBA1C level > 5.6 mg/dl and/or those on antihypertensive agents. Serum creatinine, EFFECTS OF LONG TERM LITHIUM TREATMENT Ca, PTH and uric acid variables were significantly increased and the ON RENAL FUNCTIONS OF BIPOLAR DISORDER eGFR, 25-OH D3, urinary density, urinary creatinine and HGB were PATIENTS. found to be significantly decreased as compared to the controls (p< 0.05). Significant differences were not detected in any variable when the CANDIDATES RESEARCH AWARD Batuhan Ayık1, Sibel Çakır1, Halil Yazıcı2 data on the biochemical parameters of the 17 patients well responding 1 Istanbul University, Istanbul Medical School, Physiology Department, to lithium were compared with the corresponding parametrical data of Istanbul the remaining 34 patients with moderate and bad response to lithium 2 Istanbul University, Istanbul Medical School, Internal Diseases (p> 0.05). In 8 of the 51 patients eGFR was below the limit of 60 ml/ Department, Istanbul min/1.73 m2 accepted as the limit for chronic renal failure. These 8 INTRODUCTION: The effects of lithium on tubular functions of the patients were referred to the nephrology unit for further investigations kidneys and the resulting reduction in the urine concentration ability and treatment. have been known. Although renal insufficiency caused by lithium CONCLUSIONS: The median value for eGFR in the BD group was therapy have been reported in the literature, data on the type of renal disorder, incidence, severity and duration of lithium usage have not 95.00 ml/min/1.73 m2, while this was 108.16 ml/min/1.73 m2 in the been specified. This study has aimed at evaluating the course of renal control group. Serum creatinine of the BD patients was significantly in failure starting with impaired renal functions in bipolar disorder (BD) excess of that of the controls (p<0.001), and the median value was 0.8 patients who have been treated with lithium regularly for at least 6 years mg/dl for the patient group and 0.67 mg/dl for the control group. The after the diagnosis of BD. eGFR of 8 (15.68%) patients were below the value of 60 ml/min/1.73 m2 standing for chronic renal failure, and in 3 of these patients the MRETHODS: This research was carried out with 51 patients eGFR values were below 40 ml/min/1.73 m2, the results accumulated diagnosed with BD and followed regularly at the Istanbul University, by the study indicating that glomerular function is significantly reduced Istanbul Medical School, Psychiatry Department, Mood Disorders by lithium treatment. The appearance of the glomerular pathology Unit, and 38 age and gender matched healthy controls. Data on serum increased with the prolongation of the lithium therapy, as seen in the BUN, creatinine, uric acid, electrolytes, calcium (Ca), phosphorous patient group with higher serum levels of lithium. These observations (P), vitamin D (25-OH D3), glomerular filtration rate (eGFR) were are in agreement with those in the literature reporting impairment of estimated in the two groups. Additionally, the relationship between glomerular function after long term lithium usage. Studies reporting the renal function tests of the BD group and the mean lithium levels, unaffected glomerular function generally involve shorter mean duration of the lithium therapy and the scores on the Global Assessment durations of lithium usage, suggesting that glomerular pathology of Functioning (GAF) Scale were investigated surfaces more clearly after long term lithium usage. Serum uric acid RESULTS: Mean age of the 51 BD patients and of the control group levels of the BD group were significantly increased (p< 0.001). Increases were 51.47 (±11.41) and 48.92 (±11.77) years respectively the difference in serum uric acid levels is believed to be related to the impairment of being statistically insignificant (p=0.307). Of the 51 patients, 35 were renal metabolism, and the results support the view on impairment of euthymic, while 4 were in manic episode and 12 were in depressive the glomerular function in the BD group. There are no studies in the episode. Mean duration of lithium usage was 205.41 (±95.83) literature demonstrating a direct relationship between hyperuricemia months; the minimal duration being 72 months for 1 patient, and the lithium usage. Serum BUN levels did not significantly differ between maximal duration being 396 months for 1 patient. Good response to the patients and the controls (p> 0.05). Serum BUN level is not by lithium therapy was seen in 17 patients, with 31 giving medium level itself an indicator of the glomerular filtration rate, and can vary response, while the remaining 34 patients had to use at least one other independently of GFR. Comorbidities such as diabetes or hypertension psychotropic agent next to lithium. When the biochemical test results do affect the glomerular function, which is why statistical analyses on of the two groups were compared, the eGFR of the BD patients were the data have been repeated after eliminating patients on antidiabetics significantly lower (p= 0.001) and serum creatinine, uric acid, Ca, CI, or antihypertensives with HBA1C levels>5.6 mg/dl and controls with Mg, and parathormone (PTH) variables were significantly elevated as HBA1C level of >5.6 mg/dl. The second set of biochemical analyses compared to the controls (p< 0.05). 25-OH D3, HGB, HCT, urinary were carried out with 36 patients and 30 controls, and it was shown density and urinary creatinine variables were significantly lowered statistically that eGFR of the BD group was significantly reduced (p= (p<0.05). Whereas proteinuria was determined in 4 patients, this was 0.001). serum creatinine and uric acid levels were significantly elevated not observed in the controls, but the intergroup difference was not in the patient group (p< 0.05). By eliminating factors other than lithium significant (Table 1) The relationship between renal function test data that may affect glomerular function, it was possible to demonstrate that and the duration of lithium therapy was assessed by the Spearman test. the distinct loss of glomerular function in the BD group indicating A weak correlation between duration of lithium usage and BUN, Ca, that lithium is a serious risk factor for the impairment of glomerular WBC and the urinary density, and a moderate correlation with uric function. acid, serum creatinine and the eGFR levels were determined (Table 2). A weak correlation between the mean serum lithium levels and PTH, Key Words: Bipolar disorder, eGFR, glomerulus, eGFR, HGB, serum creatinine and eGFR was determined with the Spearman test. The mean serum levels of the BD patients over the previous one

19 Comparison of biochemical test results of the BD patient and the resembling physical disorder, and cognitive symptoms such as fear of control groups death and of losing control. Although the role of mean platelet volume MPV has been investigated in PD, the results are discrepant. We could BD-Control BD-Control P Mean value Median value not find a study in the literature on red cell (erythrocyte) distribution

AGE 51-49 53-47 0,307 width (RDW) levels in panic disorder. Hence, this study has aimed at investigating the relationship between panic disorder and MPV and BUN 13,78-13,48 12,15-13.08 0,786 RDW. CREATININE 0,91-0,70 0,8-0,67 < 0,001

URIC ACID 5,8-4,7 5,9-4,5 <0,001 METHODS: This was a retrospective study carried out with 30

eGFR 87,47-103,68 95,0-103,16 0,001 untreated PD patients and 25 age and gender matched healthy controls. PD diagnosis was made by a psychiatrist on the criteria of DSM-V. NA 140,78-141,26 141-141 0,306 The control group consisted of individuals with normal physical K 4,5-4,4 4,6-4,45 0,164

RESEARCH AWARD CANDIDATES RESEARCH AWARD examination findings and nonspecific medical history, none of them CL 104,05-102,0 104,0-102,0 0,001 having an acute or chronic illness, or taking any medical treatment or CA 9,88-9,46 9,9-9,5 <0,001 antioxidant vitamins such as vitamin E or C. P 3,4-3,5 3,3-3,5 0,149 RESULTS: The two groups did not differ significantly with respect MG 0,94-0,83 0,89-0,84 0,023 to age and gender distribution. Mean WBC, MPV and RDW values PTH 79,92-48,46 69,0-44,08 <0,001 for the PD group were, respectively, 9173.03±2400.31, 8.19±1.13 and TOTAL PROTEİN 7,2-7,1 7,2-7,1 0,604 12.47±1.14; while the same parametric values for the control group ALBUMIN 4,56-4,60 4,53-4,68 0,557 were, respectively, 7090.24±1032.61, 6.85±0.67 and 11.63±0.85. 25-OH D3 16,7-23,4 9,8-18,6 0,002 WBC, MPV and RDW levels of the PD group were significantly URINE DENSITY 1010-1016 1008-1015 <0,001 higher than those of the control levels (p=0.001, p=0.001 and p=0.003, Relation ship between lithium usage duration and serum uric respectively). Thrombocyte counts of PD patients and the controls did acid, creatinine ,BUN, Ca, urine density and eGFR not differ significantly (p>0.05).

Correlation CONCLUSION: This study is first to show that RDW is increased in between lithium Spearman URIC PD patients in comparison to normal levels. Further, WBC and MPV usage duration BUN CA DENSITY CREATININE eGFR test ACID and renal function levels were also found to be significantly elevated above the control test results values in PD. Earlier work had shown that after using Correlation ,515 ,481 ,427 -,245 ,698 -,571 coefficient 5-HT releasing agents, thrombocyte and synaptosomal 5-HT P 0,001 0,001 0,002 0,045 0,001 0,001 reabsorption and 5-HT level of the cerebrospinal fluid change in parallel to the 5-HT levels in the brain and blood. Some researcher have REFERENCES argued that there is a relationship between depression and increased risk Aiff H, Attman PO, Aurell M et al. , (2015) Effects of 10 to 30 years of vascular disease due to thrombocyte function disorder. Also, a meta- of lithium treatment on kidney function. J Psychopharmacol 29 analysis has concluded that thrombocyte 5-HT reabsorption is related to (5): 608–14. depression. It has been hypothesized that biological mechanisms would Azab AN, Shnaider A, Osher Y et al. , (2015) Lithium nephrotoxicity. be affected under conditions of stress as a results of which cardiovascular Int J Bipolar Disord 3 (1): 28. functions would worsen. Thrombocyte activity increases with emotional Behl T, Kotwani A, Kaur I et al. , (2015) Mechanisms of prolonged stress and coronary events such as myocardial infarction. MPV is a lithium therapy-induced nephrogenic diabetes insipidus. Eur J marker showing thrombocyte function. Our study probably reflects Pharmacol, 755:27–33. the increase in thrombocyte counts rather than thrombocyte anomaly. Markowitz GS, Radhakrishnan J, Kambham N et al. , (2000) Although studies other than ours have investigated MPV levels in PD, Lithium nephrotoxicity: A progressive combined glomerular and the results are limited and controversial. Kokacya et al. have determined tubulointerstitial nephropathy. J Am Soc Nephrol, 11:1439–1448. higher levels of MPV in PD as compared to their controls. We also Presne C, Fakhouri F, Noel L et al. , (2003) Lithium-induced have found significantly increased MPV in the PD patients. Hence, we nephropathy: Rate of progression and prognostic factors. Kidney have concluded that the abnormal 5-HT metabolism in thrombocytes Int, 64:585–592. manifests itself with impaired thrombocyte function and elevation of MPV. RDW can be used in general population as a sign of mortality. In our RAC-15 study the RDW levels differed significantly between the PD and control groups. Our study is the first to assess the RDW level in PD. At the same MEAN VALUES OF THROMBOCYTE VOLUME AND time, it is the first study to show the increase in the MPV and RDW ERYTHROCYTE DISTRIBUTION WIDTH IN INITIAL levels together in PD patients. We have attributed the increased levels PHASE OF PANIC DISORDER of RDW and MPV to increased sympathetic activity; and we believe that increased RDW and MPV are new markers for PD. Estimation of Mehmet Asoğlu, Ülker Fedai, Mahmut Katı, Özlem RDW and MPV are cheap and simple procedures and we expect that Beğinoğlu, Öznur Akıl, Meltem Göbelek, Ismail Karka these estimations will be used in the diagnosis and the assessment of the Mental Health and Disorders Department, Şanliurfa prognosis of PD patients. There is however need for prospective studies to confirm these findings. INTRODUCTION: Panic disorder (PD) is characterized with unexpected attacks of panic. It is a clinical condition when simultaneously Key Words: Mean erythrocyte distribution width, mean thrombocyte with severe sense of fear there is tachycardia and excessive sweating volume, panic disorder, white blood cell count (WBC)

20 REFERENCES RESULTS: The sociodemographic details of the patients, siblings Alpert JS, Thygesen K, Antman E et al. , (2000) Myocardial infarction and controls, including age, gender, marital status and educational redefinedea consensus document of the Joint European Society of background have bee summarized in Table 1. Significant differences Cardiology/American College of Cardiology Committee for the were not determined between the three groups on the scores of BIS/ redefinition of myocardial infarction. J Am Coll Cardiol 36:959– BAS. The BIS-11 scores on the ‘attention’ subscale were significantly 969. higher (p=0.025) in the patients (16.35±3.94) as compared to their Brown S (1997) Excess mortality of schizophrenia. A meta-analysis. Br siblings (14.06±2.68), but there were not statistically significant J Psychiatry 171:502–508. intergroup differences between the patients and controls (p=0.182) and Kokacya MH, Copoglu US, Kivrak Y et al. , (2015) Increased mean between the siblings and the controls (p=1). The total BIS-11 scores platelet volume in patients with panic disorder. Neuropsychiatr Dis of the patients (62.35±10.82) were higher than those of their siblings Treat 11:2629–2633. (56.72±7.83), the difference being close to statistical significance (p Scharinger C, Rabl U, Kasess CH et al. , (2014) Platelet serotonin = 0.058). Mean percentages of ‘correct determination’ in the IMT transporter function predicts default-mode network activity. PLoS were 55.66 ± 23.85 for the patient group, 79.74±14.2 for the sibling CANDIDATES RESEARCH AWARD One 9 (3): e92543. group and 82.40±12.68 for the control group, the percentage value of Zalawadiya SK, Veeranna V, Panaich SS et al. , (2012) Gender and the patients group was significantly lower as compared to that of the ethnic differences in red cell distribution width and its association siblings (p = <0.001) as well as the controls (p = <0.001), but there was with mortality among low risk healthy United State adults. Am J not a similar difference between the siblings and the controls (p = 1). Cardiol, 109 (11): 1664–1670. The longest time of response determined in SKIP was 157.35± 236.98 for the patients; 112.5±142.58 for their siblings and 250.58±268.57 for the controls, the data on the patients and their siblings being RAC-16 significantly lower than that of the controls (p=0.032 and p=0.003, respectively), without any significant difference between the patients IMPULSIVENESS AS A CHARACTERISTIC AND and their siblings (p=0.333). The mean responding times in SKIP being ENDOPHENOTYPE IN BIPOLAR DISORDER 48.93±101.37 for the patient group, 30.58±42.53 for their siblings and 79.47±147.04 for the controls; the difference between the sibling 1 2 2 Çağla Bilgin Telatar , Serhan Işıklı , Ercan Durmaz , group and the control group being statistically significant (p=0.027), 2 Nabi Zorlu the difference between the patient group and the controls being close 1 Bodrum State Hospital, Psychiatry Clinic, Muğla to significance (p=0.065) but the difference between the patient and 2 Izmir Katip Çelebi University, Atatürk Training and Research Hospital, the sibling groups being insignificant (p=0.888). The comparison of the Psychiatry Clinic, Izmir scores of the participants on the BIS-11, the IMT and the SKIP have INTRODUCTION: Impulsiveness is a multi-directional cognitive been summarized in Table 2. and behavioural concept included in the diagnostic criteria of many CONCLUSIONS: This study has aimed to determine, by the use of psychiatric disorders. Although it is included among the diagnostic psychometric self-report scales and behavioural tests completed by criteria for the manic phase of bipolar disorder (BD), there are research patients with BD diagnoses the unaffected siblings of the patients based arguments that it is a personal characteristic independent of the and healthy controls, whether impulsiveness is an endophenotype. phases of BD. Impulsiveness has been found to be associated with the On the basis of the scoring on the self report psychometric scales, severity of BD, increase in the risk of suicidal behaviour, impairment impulsiveness has not appeared as an endophenotype, but the scoring of functionality and increased frequency of hospitalization. The aim of has suggested that siblings with the characteristics of impulsiveness may this study has been to investigate whether impulsiveness is by itself a personal characteristic independent of the attack periods of BD, and be liable to BD. It was observed in the results of the behavioural tests whether it has an increased prevalence as an endophenotype in the that the symptoms of impairment of the cognitive functions related to healthy siblings of BD patients in comparison to healthy controls. sustaining attention (the lowered IMT data) persisted even during the euthymic phase of BD, in agreement with the previous reports in the METHODS: The study enrolled a total of 92 individuals consisting of 31 literature. A significantly increased impulsiveness (as compared to the type I BD patients who had been euthymic for at least the 8 previous weeks; controls) in the BD group and in the siblings group was observed on 29 healthy unaffected siblings of the selected BD patients and 32 healthy the basis of the scores on ‘impulsiveness to delay reward’ (the longest controls without a history of psychiatric disorders in their first degree response in SKIP). Hence, in our study, impulsiveness only with respect relatives. These participants were asked to complete a sociodemographic to the ‘ impulsiveness to delay reward’ (but not all of its identified questionnaire, the SCID-I, the Hamilton Depression Rating Scale components) was interpreted as having the characteristic of being rated (HAM-D), the Young Mania Rating Scale (YMRS), the Barratt as an endophenotype. Impulsiveness Scale (BIS-11), the Behavioural Inhibition System and Behavioural Activation System (BIS/BAS) scales, the Immediate Memory Key Words: Bipolar disorder, endophenotype, impulsiveness Task-(IMT) and the Single-key impulsivity paradigm (SKIP). Data were Sociodemographic data on the participants of the study statistically analyzed using the SPSS 21 program. Numerical values were tested with the Kolmogorov-Smirnov test for normal distribution, and BD Patients Siblings of BD Controls F x² p those complying a with normal distribution were analyzed with the Age 40.81±11.22 40.21±12.12 41.13±10.53 0.051 0.95 one-way ANOVA test. Bonferroni post-hoc test was used to compare Gender K=16 E=15 K=16 E=13 K=17 E=15 0.076 0.963 the data showing significant differences between two groups. Variables, Married=23 Married=16 Married=17 not normally distributed, were analyzed by the non-parametric Kruskal- Single=5 Marital status Single=8 Single=8 2.542 0.281 Divorced=3 Wallis test to assess the group effects of the data followed by the Mann Divorced=7 Divorced=4 Widowed= 1 Whitney-U post-hoc test to make intergroup comparisons using the values indicating statistically significant groups effects. Education years 10±4.025 11.24±4.085 10.69±3.822 0.736 0.482

21 ANOVA/Kruskal Wallis tests-based comparisons of the mean limited. However, it has been emphasized that to be able to investigate scores on the psychometric test BIS-11, IMT and SKIP of the metacognition in BD, there has to be more research on the phenomenon participating groups itself. The number of studies on comparison of metacognition in BD and unipolar depression (UD) are also very few. This study has aimed BD Patients Siblings of BD Controls F/x² P to investigate the differences in metacognition in BD and UD patients BIS-11 Attention 16.35±3.94 14.06±2.68 14.78±3.06 3.84 0.025 METHOD: Having obtained the approval of our hospital, and established the inclusion and the exclusion criteria of the intended BIS-11 Motor 20.12±5.14 17.75±3.55 18.9±3.75 2.36 0.09 study, 70 BD patients in the euthymic period, and 56 UD patients in BIS-11 No planning 25.87±4.1 24.89±3.99 24.53±3.57 0.99 0.376 remission were included in the study. The participants were asked to complete a sociodemographic questionnaire, the SCID-1, the Young BIS-11 Total score 62.35±10.82 56.72±7.83 58.21±8.46 3.08 0.051 Mania Rating Scale (YMRS), the Beck Depression Inventory (BDI) and IMT Correct the Metacognition Scale (MS). RESEARCH AWARD CANDIDATES RESEARCH AWARD 55.66±23.85 79.74±14.2 82.40±12.68 21.59 <0.001 Determination RESULTS: Statistically significant differences between the three IMT Comic errors 26.11±14.97 35.31±18.38 38.63±19.89 4.1 0.02 groups were determined in the MS scores related to ‘uncontrollability’ (p=0.000), the UD scores being the highest; but differences were not IMT Corr. Det. /Rev. Errors 0.49±0.2 0.44±0.21 0.47±0.23 0.27 0.759 determined on the ‘positive beliefs’ (p=0.07). There were significant SKIP Total Response Time 292.42±859.3 130.93±242.59 59.28±67.59 2.51 0.28 intergroup differences in the ‘cognitive confidence’ scores (p=0.000), and the scores related to ‘need for controlling thoughts’ (p=0.012), ; SKIP Longest Resp. Time 157.35±236.98 112.5±142.58 250.58±268.57 9.7 0.008 the scores of the PD and the UD groups in both respects being higher

SKIP Shortest Resp. Time 6.36±19.62 4.65±6.79 34.07±135.79 1.5 0.47 than those of the controls. There were significant intergroup differences in the scores on ‘cognitive awareness’ (p=0.001), the UD scores being SKIP Mean Resp. Time 48.93±101.37 30.58±42.53 79.47±147.04 5.58 0.061 higher than those of the BD patients and the controls. Scores of the three groups on MS are given in Table 1 and the comparison of the REFERENCES significant differences are given in Table 2. Duek O, Osher Y, Belmaker RH et al. , (2014) Reward sensitivity and anger in euthymic bipolar disorder. Psychiatry Res 215 (1): 95–100. CONCLUSIONS: Very few studies exist on the differences of Moeller FG, Barratt ES, Dougherty DM et al. , (2001) Psychiatric metacognitive awareness between BD and UD patients. One aspects of impulsivity. Am J Psychiatry 158 (11): 1783–1793. comparative study carried out in the depressive period of the disorders Saddichha S, Schuetz C (2014) Is impulsivity in remitted bipolar did not show any differences in the positive beliefs and metacognitive disorder a stable trait? A meta-analytic review. Comprehensive awareness. In our study significant differences were not seen only in Psychiatry 55 (7): 1479–1484. relation to the positive beliefs. The results indicate the importance of Swann AC, Lijffijt M, Lane SD et al. , (2009) Severity of bipolar understanding the differences between BD and UD and the necessity of disorder is associated with impairment of response inhibition. J further research for the repetition of the findings. Affective Disord 116 (1): 30–36. Key Words: Bipolar Disorder, metacognition, unipolar depression Swann AC, Lijffijt M, Lane SD et al. , (2011) Interacting mechanisms of impulsivity in bipolar disorder and antisocial personality disorder. J Metacognition scores of the BS, UD and the Control groups Psychiatr Res 45 (11): 1477–1482. (One-Way Anova)

Bipolar Unipolar Control Disorder Depression RAC-17 Min-Max Mean±SD Min-Max Mean±SD Min-Max Mean±SD p

COMPARISON OF METACOGNITIVE AWARENESS Positive beliefs 5.00–21.00 11.91±4.19 6.00–21.00 13.21±3.66 6.00–22.00 10.86±3.94 0.007

Uncontrollability BETWEEN PATIENTS WITH BIPOLAR DISORDER 6.00–22.00 13.37±3.98 8.00–23.00 15.10±3.65 6.00–24.00 11.93±4.03 0.000** AND UNIPOLAR DEPRESSION and danger Cognitive 6.00–22.00 12.21±3.80 7.00–21.00 13.37±3.67 6.00–16.00 10.31±2.21 0.000** Özge Şahmelikoğlu Onur, Çağatay Karşıdağ confidence Bakirköy Mental Health and Neurological Diseases Hospital, Psychiatry Need to control 6.00–21.00 13.01±3.84 8.00–20.00 13.94±3.27 6.00–22.00 11.93±3.49 0.012** Department, Istanbul thoughts

Cognitive INTRODUCTION: The concept of metacognition can be described 6.00–24.00 13.10±4.02 9.00–28.00 15.37±3.75 6.00–21.00 12.98±3.38 0.001** Awareness as the upper cognitive structure, knowledge and processes involved in the control, regulation and evaluation of cognition. In terms of most Intergroup Comparisons (Post-Hoc Tukey) basic description, it is the ‘upper system’ behind the awareness of the individual of the events and functions in his/her mind, and the ability BD vs/UD BD vs Control UD vs Control to direct these with purpose. Hence, these mental processes recognised Positive beliefs 0.162 0.295 0.005** as metacognition incorporate many intricate and interrelated cognitive processes. It is thought that metacognition, by plays a very active role Uncontrollability and danger 0.037** 0.097 0.000** in the establishment all the newly acquired processes as ‘’mental habits’’. Cognitive confidence 0.131 0.004** 0.000** The beliefs named as metacognitive knowledge can be of positive and negative context. The statement ‘’suffering would be helpful to solve Need to control thoughts 0.314 0.204 0.008

my problems’’ would be an example to the positive and the statement ‘’ Cognitive Awareness 0.003** 0.983 0.002** anxiety is dangerous’’ would be an example to the negative metacognitive knowledge. Studies on metacognition in bipolar disorder (BD) are UD: Unipolar Depression, BD: Bipolar Disorder

22 REFERENCES METHODS: The study was carried out with women giving normal Matthews G, Wells A (2004) Rumination, depression, and birth or by the caesarean section at the 5Selçuk University Medical metacognition: The S-REF model. Depressive rumination: nature, School, Women’s disease and maternity department. Of the 185 gravids theory and treatment 125–151. who came to the hospital for follow up in the last trimester, 136 gravids Sarisoy G, Pazvantoğlu O, Özturan DD (2014) Metacognitive beliefs between the ages of 20–40 years were found eligible for inclusion in in unipolar and bipolar depression: A comparative study. Nordic the study. The exclusion criteria of the study included having serious Journal of Psychiatry 68 (4), 275–281. cardiovascular, pulmonary and endocrinological problems, gestational Tosun A, Irak M (2008) Adaptation, validity and reliability of the meta- hypertension and/or diabetes, placenta previa, vaginal haemorrhage, cognitions questionnaire-30 in Turkish culture; and its relationships multiple pregnancy, intrauterine growth retardation, malformations with anxiety and obsessive-compulsive symptoms. Turk Psikiyatri of the foetus, toxoplasmosis HSV, cigarette and alcohol use, bipolar Derg 19:67–80. disorder, schizophrenia or other psychotic disorders. After admission Wells A, Fisher P, Myers S et al., (2009) in as inpatient the participants were conducted through the SCID-I and

recurrent and persistent depression: A multiple-baseline study of a all completed the Hamilton depression rating scale (HAM-D), and the CANDIDATES RESEARCH AWARD new treatment. Cognitive Therapy and Research 33 (3): 291–300. Edinburgh Postnatal Depression Scale (EPDS). Laboratory Tests: The cord blood samples taken by the paediatrist during normal birth or the caesarean sections were analysed biochemically. The RAC-18 sera were centrifuged (10 min at 300xg at 4°C) and stored at −80°C. Serum concentrations of BDNF, NT-3, FGF-2, TNF-α and neopterine, NEUTROPHILS AND NEUROINFLAMMATION IN serum were analysed by the ELISA method (RayBiotech, Inc. ). THE FOETUSES EXPOSED TO THE DEPRESSION AND ANXIETY OF THE MOTHER DURING: A Statistical Analyses: Data were analysed using the SPSS 15.0 program. Kolmogorov-Smirnov test was used to test normal distribution. The COMPARATIVE STUDY IN UMBILICAL CORD categorical variables were analysed by the Chi-square test and the BLOOD continuous variables were analysed by the ANOVA. The p value of < Bilge Burçak Annagür1, Nursel Akbaba2, Ali Annagür3, 0.05 was accepted for statistically significance. Fikret Akyürek4, Çetin Çelik RESULTS: Of the total participants, 43 (31.6%) were diagnosed with 1Selçuk University Medical School, Psychiatry Department Konya at least one depression or anxiety diagnosis; 25 (18.4%) had only Major 21Selçuk University Medical School, Psychiatry Department Konya depressive disorder (MDD) and 18 (13.2) only had anxiety disorder (AD). 3 Selçuk University Medical School, Neonatology Department, Konya But a psychiatric disorder was not diagnosed in the other 93 women and 4Selçuk University Medical School, Biochemistry Department, Konya were accepted as the internal control group. The psychiatric disorders 5Selçuk University Medical School, Women’s disease and maternity diagnosed can be ranked as MDD (n=25, 18.4%), general anxiety department, Konya disorder (n=10, 7.4%), panic disorder (n=5, 3.7%), obsessive-compulsive disorder (n=2, 3.7%) and social phobia (n=1, 0.7%). The participants INTRODUCTION: Research in recent years on psychiatric disorders were grouped as the MDD, the AD and the control groups. Significant and their foetal effects has focused on biochemical indicators, with differences were not determine in the sociodemographic details of the neurotrophic factors and neuroinflammatory processes being the most participants, with the exception of a high incidence of psychiatric history investigated biological phenomena. Brain derived neurotrophic Factor in the AD group (Table 1). The neonates of the three groups did not (BDNF) which plays a fundamental role on neuronal plasticity, neuronal differ with respect to birth week, birth weight, head circumference, growth, neuronal survival and development, is the most investigated and Apgar scores. However, the birth length of the AD group neonates factor. The neurotrophins (NT) consist of BDNF, NT-1, NT-3 was significantly less (p=0.014) (Table 2). In the comparison of the and NT-4. Fibroblast growth factor (FGF) is active in angiogenesis, neurotrophic and the neuroinflammatory indicants, BDNF level was embryonic development, axonal growth and different hormonal lower in the MDD group but not significantly. The three groups did not pathways, and continues to be released post partum. In the recent years differ significantly with respect to BDNF, NT-3 and TNFα levels. In the there have been many studies on the FGF family of parameters and multiple comparisons the FGF-2 and neopterin levels of the neonates of their relation with psychiatric disorders. Also, it has been shown that the AD group of mothers were significantly increased. FGF can be affected by environmental factors. Neuroinflammation plays an important role in the acute and chronic disorders of the central CONCLUSIONS: The important finding of this study is the nervous system. Pro-inflammatory cytokines can impair neurogenesis determination of raised levels of FGF-2 and neopterin in the cord and the hippocampal plasticity. They include the acute phase reactants blood of mothers with AD as compared to the mothers with MDD IL-1β, IL-6 and TNF-α, and the cell derived activators such as IFNγ, and the controls. The mechanism underlying the elevated FGF-2 neopterin, and IL-12. Experimental studies have shown that TNF-α has is not very clear. Glucocorticoids are known to increase the FGF-2 negative effects on neurogenesis in the embryonic and adult brains. The expression. Increased corticosteroid levels are associated with acute or proinflammatory cytokines do not only respond to inflammatory stimuli chronic stress. Increased glucocorticoid levels have damaging effects on such as infection of trauma, but also respond to environmental stimuli. the central nervous system (CNS) and especially on the hippocampus. For example, stress during pregnancy does play a role in triggering post Given the neurodevelopmental effects of FGF, the increase in the FGF- partum depression in liable women. Perinatal psychiatric disorders, and 2 levels with stress may be of compensatory significance against the especially mood disorders, have been widely investigated with respect damage caused by the glucocorticoids. FGF-2 may be raised to correct to BDNF and TNF-α. However, there are not studies on combined the induced neuronal atrophy and damage of the glucocorticoids. investigation of neurotrophic and neuroinflammatory factors in the However the neuronal protective role of FGF-2 has not been clearly perinatal period. Therefore, we have aimed at comparing the BDNF, demonstrated throughout stress. However, it could be said in reference NT-3, FGF-2, TNF-α and neopterin in the cord blood of the neonates to the results of the study that FGF-2 levels are raised in the circulation of women with major depressive disorder (MDD) and anxiety disorders of the foetus exposed to perinatal anxiety. Neopterin is a cell derived (AD) throughout their pregnancy and compare the observations with immune activation product and is synthesised in monocytes and the neonates of mothers without any psychiatric disorders. macrophages after gamma interferon stimulation. Raised levels of

23 neopterin are associated with reactive oxygen types and oxidative stress. Comparison of the obstetrical characteristics of gravid women Observed increase in foetal proinflammatory indicants in the absence of with major depression disorder (MDD), anxiety disorder (AD) infection is due to perinatal stress, neonatal hypoxia and tissue damage. and Controls without any psychiatric disorders A recent study has shown that neopterin levels are increased in mothers Control MDD AD F P with gestational diabetes, spectrum disorder and post partum (n=93) (n=25) (n=18)

depression, the levels in the foetal circulation exposed to stress have not Neonatal gender, n (%) a 43 (60.6) 15 (21.1) 13 (18.3) been determined. Our study is first to investigate the subject and the 0.089 Female 50 (76.9) 10 (15.4) 5 (7.7) results indicate that neopterin levels in their culation of foetuses exposed Male

to perinatal stress, the probable underlying mechanism maybe the stress Birth week, mean 38.97 ±0.98 38.60±1.15 39.00±1.13 1.379 0.256 induced increased oxidative stress resulting in the increase of neopterin ± SD level. Another important finding of our study is the significantly lower Birth weight, 3305.37±341.92 3166.28±324.63 3303.05±393.35 1.641 0.198 birth length of the neonates of the AD group of mothers. The foremost mean ± SD

RESEARCH AWARD CANDIDATES RESEARCH AWARD Length at Birth, factors affecting the body length of the neonate are genetic factors, but 49.36 ± 1.32 48.92±1.25 48.00±3.94 4.183 0.017* mean ± SD factors including age, educational level, medical problems, alcohol and Head substance use and can also be responsible. circumference, 34.31 ± 0.96 34.00±1.11 35.00±3.39 2.302 0.104 mean ± SD Despite the lowered BDNF levels observed in the cord blood for 1-min Apgar, 7.01 ± 0.34 7.00±0.40 6.94±0.23 0.277 0.759 the neonates of the MDD group of mothers our results this was not mean ± SD

statistically significant, and we also did not observe a relationship 5-min. Apgar, 9.04 ± 0.25 9.04±0.35 9.00±0.00 0.214 0.808 between TNF-α levels and perinatal exposure to stress, although its mean ± SD relation with AD has been implicated by earlier studies in the literature. BDNF level, ng/ml 229.04 ± 73.41 193.56±65.04 214.94±70.81 2.483 0.087 However, the number of cases in our study is not high enough to NT-3 level, pg/ml 9.45 ± 5.87 9.54±4.26 8.09±1.01 0.544 0.582

arrive at generalisation on all the AD population. Also, as this was a FGF-2 level, 185.17±100.95 175.10±108.30 340.07±243.65 11.553 0.000* cross sectional study we did not investigate the effect of anxiety level pg/ml TNF-α level, on the neurotrophic and neuroinflammatory factors throughout the 8.77 ± 5.86 9.48±5.61 8.66±4.44 0.172 0.842 pregnancy. Future studies could evaluate the effects of these factors on pg/ml Neopterin level, 15.27 ± 5.07 14.41±6.70 18.99±6.56 4.617 0.012* the neurodevelopment of the foetus. ng/ml

Key Words: neuroinflammation, neurotrophins, perinatal anxiety, REFERENCES perinatal psychiatric disorders Ipekci SH, Kebapcilar AG, Yilmaz SA et al. , (2015) Serum levels of Comparison of the sociodemographic and clinical characteristics neopterin in gestational diabetes mellitus: the relationship with of gravid women with major depression disorder (MDD), anxiety Apgar scores. Arch Gynecol Obstet 292 (1): 103–9. disorder (AD) and Controls without any psychiatric disorders Kubera M, Obuchowicz E, Goehler L et al. , (2011) In animal models, psychosocial stress-induced (neuro) , apoptosis and Control MDD AD P reduced neurogenesis are associated to the onset of depression. Prog (n=93) (n=25) (n=18) Neuropsychopharmacol Biol Psychiatry 35 (3): 744–59. Age, mean ± SD, years 27.25 ±5.51 29.08±4.32 28.55±5.38 0.252 Numakawa T, Richards M, Nakajima S et al. , (2014) The role of Education, mean ± SD, years 7.96 ± 2.81 7.84±3.83 8.33±2.76 0.861 brain-derived neurotrophic factor in comorbid depression: possible Marital status n (%) b married 93 (68.4) 25 (18.4) 18 (13.2) linkage with steroid hormones, cytokines, and nutrition. Front

Employment, n (%) b Psychiatry 26; 5:136. 6 (85.7) 0 (0) 1 (14.3) Working 0.430 87 (67.4) 25 (19.4) 17 (13.2) Terwisscha van Scheltinga AF, Bakker SC, Kahn RS (2010) Fibroblast Not working growth factors in schizophrenia. Schizophr Bull 36 (6): 1157–66. Socio-economic Level, n (%) b 64 (68.1) 17 (18.1) 13 (13.8) Uguz F, Onder Sonmez E, Sahingoz M et al. , (2014) Neuroinflammation Low 26 (66.7) 8 (20.5) 5 (12.8) 0.820 Medium in the fetus exposed to maternal obsessive-compulsive disorder 3 (100) 0 (0) 0 (0) High during pregnancy: a comparative study on cord blood tumor Psychiatric disorder history, n (%) b 3 (23.1) 4 (30.8) 6 (46.2) necrosis factor-alpha levels. Compr Psychiatry 55 (4): 861–5. There is 0.000* 90 (73.2) 21 (17.1) 12 (9.8) There is not

Omega-3, n (%) b 5 (55.6) 3 (33.3) 1 (11.1) Yes 0.488 88 (69.3) 22 (17.3) 17 (13.4) RAC-19 No

Folic Acid, n (%) b 67 (69.8) 18 (18.8) 11 (11.5) Yes 0.638 SOCIODEMOGRAPHIC AND CLINICAL 26 (65) 7 (17.5) 7 (17.5) No CHARACTERISTICS OF SYRIAN IMMIGRANT Β-methasone, n (%) b 3 (60) 1 (20) 1 (20) Yes 0.887 PATIENTS TREATED AT PSYCHIATRY SERVICES 60 (68.7) 24 (18.3) 17 (13.0) No Özge Şahmelikoğlu Onur, Merve Çukurova, Çağatay Birth process, n (%) b 63 (75) 13 (15.5) 8 (9.5) Normal 0.095 30 (57.7) 12 (23.1) 10 (19.2) Karşıdağ Caesarean 1Bakirköy Mental Health and Neurological Diseases Hospital, Psychiatry Anaesthesia type, n (%) b 63 (75.9) 13 (15.5) 7 (8.4) There is not Department, Istanbul 3 (60) 0 (0) 2 (40) 0.051 General 27 (56.3) 12 (25) 9 (18.8) Local INTRODUCTION: Historically, epidemic diseases and wars rank as Offspring Counts, mean ± SDa 2.04 ± 0.91 2.40±0.81 2.50±1.24 0.075 the leading causes of death. Wars, despite being preventable, still persist as one of the most serious public health concern of our day despite the Number of pregnancies, mean ± SDa 2.08 ± 0.95 2.40±0.81 2.50±1.24 0.136 deaths, disablements, damage to the environment and economies caused.

24 When the first 10 causes of death of humans over the world countries consultations it can be said that these patients face difficulty in seeking in the year 2013 are inspected, wars are with in the first 10 causes and psychiatric help. When scanning the hospital files on these patients, the first position is that of our neighbour Syria. There are many studies limitations are faced in reaching some information to be able to make in the literature on the adverse psychiatric effects of war and migration. retrospective interpretations. Also communicating with the patients is There are only limited studies on the mental condition of the Syrian war limited by language barriers and may have led to different interpretations refugees who have become a serious current concern in Turkey. This study of during the processes of diagnosis and treatment. Nevertheless, we has aimed at studying the psychiatric situation of the Syrian war refugees believe that the data we have acquired is important for the psychiatric being treated in the psychiatry clinic of our hospital on inpatient basis. perspective in the problematic Syrian refugee population in Turkey. METHOD: The study has been conducted retrospectively by scanning Key Words: Immigration, psychiatry, war the hospital files of 48 patients admitted to our hospital from January Diagnoses made on the Syrian inpatients. 2013 onwards, for treatment in the psychiatric services and who have met the inclusion criteria of the study. A purpose made sociodemographic Diagnosis n % RESEARCH AWARD CANDIDATES RESEARCH AWARD and clinical questionnaire, prepared by the researchers, has been used. Bipolar Disorder 30 % 62.5 RESULTS: The 48 patient group consisted of 38 females (79.2%) and Psychotic Disorder 10 % 20.8 10 (20.8%) males, had a mean age of 32.7 (± 9.9) years and 37.5% had Unipolar Depression 3 % 6.3 arrived from the capital Aleppo. Educationally, 6 (12.5%) were illiterate; Personality Disorder 1 % 2.1

15 (31.3%) ere primary school educated; 8 (16.7%) were middle high Alcohol-Substance Use 1 % 2.1 school and 3 (6.3%) were lycée educated, and 9 (18.8%) had been to Other 3 % 6.2 university. The education language was Arabic for 39 (81.3%) and Turkish for 3 (3%). Employment wise, 33 (68.8) had never worked, n: number of patients 7 (14.6%) were employed in the past; and, 6 (12.5%) were working. Past psychiatric diagnoses made on the Syrian in patients With respect to marital status, 19 (39.6%) were single, 21 (43.8%) were married, 3 (6.3%) were divorced and 1 (2.1%) was widowed. As regards Diagnoses n % their psychiatric history, for 18 (37.5%) this was the first consultation; Bipolar Disorder 20 41.7 20 (41.7%) had bipolar ((BMD) diagnosis; 1 (2.1%) had Psychotic Disorder 3 6.3 unipolar depression; 3 (6.3%) psychotic disorder (PD) and 2 (4.2%) had Unipolar Depression 1 2.1 alcohol and substance use (ASU) diagnosis; with 8 (16.7%) having a Alcohol-Substance Use 2 4.2 history of suicidal attempt, 2 (4.2%) by jumping from elevated height, 1 First Psychiatric Consultation 18 37.5 (2.1%) by hanging and 1 (2.1%) with pointed and cutting instruments. other 4 8.2 The total duration of the psychiatric disorders in the group was 62.3±73.7 months, and the mean previous hospitalisations were 1.85 (±1.14); with REFERENCES 4 (8.3%) having been given ECT. In their previous consultations, 16 Türkay M (2014) Günümüz Savaşinin Özellikleri ve Halen Savaşan (33.3%) complained of hysteria and delusions; 13 (27.1%) had delusions Bölgeler. Halk Sağliği Uzmanlari Derneği, Çocuklar ve Savaş s. 1–8. only. Previous drug treatment had caused adverse side effects such as UNHCR Mid-Year Trends 2014.[Internet] http://unhcr. org/54aa91 extrapyramidal symptoms in 3 (6.3%), amenorrhea and galactorrhoea in d89. html. 1 (2.1%). There had been a mean of 3.5 (±4.2) months since their last Summerfield D (1997) ‘The impact of war and atrocity on civilian attacks. Among those followed up, 30 (62.5%) were diagnosed with BMD, population’ psychological trauma. A Developmental Approach 3 (6.3%) with depression, 10 (20.8%) with PD, 1 (2.1%) personality 140–155. disorder and 1 (2.1%) with ASU. The data on psychotic symptoms while in hospital. were20 (41.7%) had hallucinations and delusions, 15 (% 31.3) had only hallucinations and 3 (6.3%) had delusions. The mean RAC-20 hospital stay of all the patients was 14.6 (±10.7) days; when 7 (14.6%) were treated with ECT, the mean number of sessions being 6.87 (±1.5); PROFILES OF THE PATIENTS CONSULTING THE and 39 (81.3%) were treated with pharmacotherapy, 8 (% 16.7) with SPECIALTY POLYCLINICS FOR THE IMMIGRANTS pharmacotherapy +ECT, and 1 (2.1%) had only been kept under AND REFUGEES IN A MENTAL HEALTH HOSPITAL observation. The psychiatric history of the refugees and and diagnoses made in hospital are summarised in Tables 1 and 2. Ersin Uygun1, Ürün Özer2, Veysi Çeri3 1Bakirköy Prof. Dr. Mazhar Osman Mental Health and Neurological CONCUSIONS: Turkey is both a target and a bridging country for Diseases and Research Hospital, Psychiatry Department, Istanbul the refugees and the immigrants. The Units States High Commission 2Acibadem University Atakent Hospital for Refugees (UNHCR) has reported that the increasing wars in the 3Marmara University Pendik and Research Hospital Middle East, Africa and other regions of the world has resulted in the displacement of some 5.5 million people from their homeland in the INTRODUCTION: Immigration is defined as the process of social first 6 months of 2014. The number of displaced Syrian has exceeded change determined by the displacement of an individual from one cultural the number of refugees from Afghanistan in the areas operated by the environment to another for a long period or for the purposes settlement. UN over the last 30 years (3). There are many studies in the literature on This displacement may be due to economic, political or educational the adverse psychiatric effects of wars and displacement. As the anxiety reasons. While the increased differences in the living conditions between symptoms of people living under war and terror conditions surface, rich and the poor countries, restrictions in the homeland to survival these people are seen to face high risks of suicidal attempts, helplessness by hunger or war, and the availability of the technology for reaching and depression. The results reported here indicate that the incidence information and making contact accelerates the migratory movements, of suicidal attempts among the patients admitted to hospital after while the surveillance and controls put to practice by border controls psychiatric consultations is very high, and support the results reported in and policing on such movements have led to the use of illegal ways of the literature. Given the time span between the last attacks and hospital immigrating next to following the legal procedures.

25 Due to its geographical position, Turkey is exposed to heavy circulation of CONCLUSIONS: Not only acute psychiatric disorders surfaced after migrations, by formings a bridge between the rich northern and western displacement in immigrants and refugees but also the past problems countries and the poor southern and eastern countries. Since the beginning were triggered. The clinical findings included psychiatric results of of 1980 s, many immigrants have arrived in Turkey from Iran, Iraq, traumatic experiences and disorders such as bipolar disorder and Afghanistan and African countries due to different political and economical psychotic disorders. The necessity of starting units giving psychiatric and reasons. The civil war started in 2011 and still continuing in Syria is psychosocial support becomes obvious when the language and cultural reported to have caused nearly one half of the population to leave their differences, the bureaucratic and economic difficulties and the resultant places of settlement seeking refuge in safer cities of the country, and nearly impediments to delays in consulting health care centres is taken into 2.5 million people having made to leave the country (IDMC 2014). Turkey consideration. Diagnosis, treatment and follow up of these patients will having accepted the largest number of Syrian refugees also had to accept be normalised with the possibility of consulting in their own language Ezidi refugees with the spread of the armed conflicts and terror to northern the same physician at the same premises, and with the facilitation of Iraq (UNHCR 2014). In view of the events in the Middle East, it can be contact and making appointments. It is important to train as well as to

RESEARCH AWARD CANDIDATES RESEARCH AWARD said that the refugee and immigrant numbers will increase and that they assign experienced psychiatrists, social workers and interpreters in order will reside in Turkey for a long period. It has been reported that a greater to widen the intervention with the mental traumas and health of the incidence of psychiatric problems are observed in immigrant groups. It is immigrants and refugees, and also to develop social and health policies argued that not only the stressful procedure of immigration itself can play to prevent the traumatisation of these individuals by local factors after a role in the presentation of psychiatric problems, but also the traumatic arrival at the country of new settlement. experiences such as war, confrontations, torture faced in the country of Key words: immigration, mental health, refugee/immigran origin prior to migration, as well as the complications faced in the countries entered and the manner of local response, discrimination, prejudgement, Sociodemographic data social support systems, economical and environmental conditions would accelerate the appearance of mental disorders. The personal characteristics N=24 Mean±SD Range Age (years) 31.7±1.7 18–52 and the cultural background of the immigrants also play a role in this. The N % study by Pernice and Brook (1994) has shown that the factors related to Gender female 8 33.3 discrimination and social support are more effective than sociodemographic male 16 66.7 characteristics such as age, gender, marital status or educational background Marital status single 11 45.8 in the appearance of mental disorders. married 11 45.8 divorced/widowed 2 8.3 METHODS: A special polyclinic facility was started at the beginning Education illiterate 3 12.5 of 2016 for the psychiatric needs of the gradually increasing numbers primary school 10 41.7 of immigrants and refugees consulting the Bakirköy Prof. Dr. Mazhar high school 5 20.8 Osman Mental Health and Neurological Diseases and Research university 6 25.0 Hospital in Istanbul, to meet the language problems, the need for Living status alone 1 4.2 interpreters, the need for premises for detailed family interviews, and with family 19 79.2 permanency of place and physicians for the indicated purposes. The other 4 16.7 service was provided within the hospital complex, once a week with the Occupational status unemployed 15 62.5 assignment of an assistant physician fluent in Arabic and of a consultant working regularly 9 37.5 physician fluent in English and experienced in working with refugees Speaking Turkish no 20 83.3 and immigrants. This study has aimed at assessing retrospectively yes 2 8.3 the sociodemographic details, experiences related to trauma and insufficient 2 8.3 immigration, clinical characteristics and psychiatric diagnoses of the Migration and trauma related features patients arriving at the specialty polyclinics between January and March 2016 at the specialty polyclinics. N=24 Mean±SD Range Residency in Turkey (months) 22.1±4.8 2–120 RESULTS: A total of 24 patients were evaluated within the 3-month Duration of abnegation (months) 24.3±4.8 2–120 period cited. The origins of the patients changed, with 15 (62.5%) being Number of transit countries 1.2±0.1 1–3 from Syria, 4 (16.7%) from Iran, 2 (8.3%) from Iraq and 3 (12.5%) N % from Afghanistan. Most of the patients had a history of traumatic Traumatic experience no 1 4.2 experiences and exposure to war conditions. These experiences and the yes 21 87.5 sociodemographic details of the patients are summarised in Table 1. no information 2 8.3 While some patients consulted the polyclinics for acute problems, there War experience no 2 8.3 were patients with chronic health problems lasting up to 4 years. The yes 21 87.5 clinical and psychiatric observations have been presented in Table 2. no information 1 4.2 Among the 24 patients evaluated, the number of the patients on regular Death of a relative no 15 62.5 follow up prior to consulting the specialty polyclinics was 4 (16.7%, yes 6 25.0 ) while those on regular follow up after arriving at the polyclinics was no information 3 12.5 14 (58.3%), the difference being statistically significant (p<0.05). Injury no 19 79.2 The most frequently made diagnosis was bipolar disorder (BD) in 9 yes 5 20.8 (37.5%) patients, followed by atypic psychosis in 3 (12.5%) patients, Retention no 13 54.2 and post traumatic stress syndrome (PTSS), and yes 5 20.8 general anxiety disorder, each diagnosis made in 2 (8.3%) patients. The other cases consisted of unipolar depression, adjustment disorder, grief no information 6 25.0 and mourning reaction, and . One diagnosis of Torture/Prison experience no 14 58.3 comorbidity made in 4 patients, consisted of PTSS, depression, mental yes 4 16.7 retardation and epilepsy. no information 6 25.5

26 Clinical features RAC-21

N=24 Mean±SD Range FACTORS PREDICTING THE DEVELOPMENT OF Duration of illness (months) 44.2±19.8 1–480 POST TRAUMATIC STRESS DISORDER (PTSD) IN Hospitalizations 1.0±0.2 0–4 INDIVIDUALS EXPOSED TO TERRORIST ASSAULT N (24) % AND THE RELATIONSHIP OF PTSD WITH THE Alcohol use no 22 91.7 yes 2 8.3 EFFECTS OF THE PUBLIC ATTITUDE TO THE Psychoactive substance use no 23 95.8 ASSAULT ON THE VICTIMS. yes 1 4.2 Altan Eşsizoğlu, Harun Olcay Sonkurt, Muratcan Kaya, Smoking no 13 54.2 Ali Ercan Altınöz, Ferdi Köşger, Cem Kaptanoğlu yes 11 45.8 Eskişehir Osmangazi University Medical School, Psychiatry Department, Suicide attempt no 18 75.0 Eskişehir CANDIDATES RESEARCH AWARD yes 6 25.0 Self-mutilation no 21 87.5 INTRODUCTION: Post Traumatic Stress Disorder (PTSD) is the yes 3 12.5 most frequently observed psychiatric disorder following exposure to calamities including terrorist assaults; and its development due to acts General medical condition no 18 75.0 of terror has been studied in Ireland, France, Spain, Norway, the USA, yes 6 25.0 Kenya and Tanzania. Some of these studies have investigated the risk Psychiatric application no 6 25.0 factors for the development of PTSD. Factors found to be related to yes 18 75.0 the development of PTSD after exposure to acts of terror were found Psychiatric follow-up (before)* no 20 83.3 to include being female, being single, having low level education, being yes 4 16.7 in the vicinity of the terror act, witnessing the act, getting wounded, Psychiatric follow-up (after)* no 10 41.7 not having recovered from the bodily damages and not being able to yes 14 58.3 work, experiencing economic difficulties after the act and being in grief for killed relations or friends. The aims of this work have been to assess Clinical details and psychiatric follow up data of the patients the incidence of PTSD in inhabitants of Eskişehir joining the ‘’Labour, N=24 Mean±SD Interval Peace and Democracy Meeting’’ in Ankara on 10 October 2015 (when Duration of Illness (month) 44.2±19.8 1–480 a disastrous bomb explosion took place), to compare the individuals Times hospitalised 1.0±0.2 0–4 who developed PTSD with those who did not in order to determine N % the factors predicting the development of PTSD, and to find out the relationship between the effect on the PTSD patients of public attitude Alcohol Use no 22 91.7 to this act of terror and the development of PTSD. The fundamental yes 2 8.3 hypothesis of the study was that the level of the effects of public opinion Cigarette Use no 13 54.2 on acts of terror predicted the development of PTSD in the individuals yes 11 45.8 exposed to these acts. Suicidal attempt no 18 75.0 yes 6 25.0 METHODS: The study aimed at including individuals who had gone Self Harming behaviour no 21 87.5 from Eskişehir to the ‘’Labour, Peace and Democracy Meeting’’ held yes 3 12.5 in Ankara on 10 October 2015. The local representatives of political party offices, clubs, professional associations and labour unions were General physical illness no 18 75.0 approached for access to the individuals who had joined the meeting yes 6 25.0 through their channels and were believed to constitute nearly all those Psychiatric consultation No 6 25.0 who went to this meeting in Ankara. Out of 400 individuals assumed yes 18 75.0 to have joined the meeting, 120 received in closed envelope the Psychoactive agent use no 23 95.8 psychometric test and other forms, including the written consent form, yes 1 4.2 to be completed. Of these 120 individuals, 17 failed to return the forms, Previous psychiatric follow up No 20 83.3 and 10 failed to complete them properly and were excluded from the yes 4 16.7 study. Thus 93 participants who complied with the inclusion criteria Psychiatric follow up (current) No 10 41.7 comprising being 18 years of age or above and literate, and not having yes 14 58.3 any physical or psychotic disorder or mental retardation affecting cognitive functions. The participants completed a sociodemographic REFERENCES questionnaire, the Posttraumatic Cognitions Inventory (PCTI), the Bhugra D, Jones P (2001) Migration and mental illness. Advances in Posttraumatic Stress Diagnostic Scale (PDS), the Beck Depression Psychiatric Treatment; 7:216–222. Inventory (BDI), and the Public Attitude Effects Questionnaire (PAEQ) Internal Displacement Monitoring Center (2014) Syria: Internal prepared by the researchers. Displacement in Brief. IDMC http://www. internal-displacement. RESULTS: Among the 93 participants of this study, 23 (24.7%) were org/middle-east-and-north-africa/syria/summary/ (Ulaşim tarihi diagnosed with PTSD, with the incidence among females (37.5%), 21/04/2016). exceeding the incidence among the males (18.0%) the difference Pernice R, Brook J (1996) Refugees’ and immigrants’ mental health: being statistically significant (X2=4.273 and p=0.039). Also, it was association of demographic and post-immigration factors. The determined that among those participants who had been exposed to Journal of Social Psychology 136 (4): 511–519. bomb explosion previously (54%), the frequency of PTSD diagnoses Tekin U (2007) Avrupa’ya göç ve Türkiye. IÜ Siyasal Bilgiler Fakültesi significantly exceeded the diagnoses of PTSD in those participants Dergisi 37:43–56. who had not been exposed to bomb explosion previously (X2=5.957

27 and p=0.015). PTSD diagnoses among those who witnessed events of REFRENCES getting wounded (34.9%) exceeded the diagnoses among those who had Filkukova P, Jensen TK, Hafstad GS et al. , (2016) The relationship not witnessed (16.0%) such events (X2=4.429 and p=0.035). Incidence between posttraumatic stress symptoms and narrative structure of PTSD development among the participants who had increased among adolescent terrorist-attack survivors. Eur J Psychotraumatol alcohol use after exposure to the bomb event (55.0%) was significantly 7. higher as compared to those (16.4%) who had not. (X2=12.541 and Galea S, Nandi A, Vlahov D (2005) The epidemiology of post-traumatic p<0.001). Participants needing psychological help (54.5%) after the stress disorder after disasters. Epidemiol Rev 27:78–91. event as compared to those who did not (15.5%), and those who had Solomon Z, Mikulincer M, Flum H (1988) Negative life events, coping suicidal ideation (77.8%) as compared to those who had not (19.0%), responses, and combat-related psychopathology: a prospective PTSD development was significantly increased (respectively, X2=13.761 study. J Abnorm Psychol 97:302–307. and p<0.001, p=0.001). Comparing the scores of the participants on Ullman SE, Filipas HH, Townsend SM et al. , (2007) Psychosocial the psychometric tests, the (PAEQ) score (t=-4.441 and <0.001), BDI correlates of PTSD symptom severity in sexual assault survivors. J

RESEARCH AWARD CANDIDATES RESEARCH AWARD total score (z=5.361 and <0.001), PDS total score (z=7.177 and <0.001 Trauma Stress 20:821–831. and scores on the ‘negative cognition about self’ (z=5.059 and <0.001), ‘negative cognition about the world’ (z=4.615 and <0.001) and the ‘self blaming’ subscale (z=4.916 and <0.001) of the group with PTSD RAC-22 were significantly higher than those without PTSD. Regression analysis carried out to determine the predictive factors for PTSD development RELATIONSHIP OF DEPRESSION AND LIFE STYLE: indicated that the BDI total score (OR=1.212 and p<0.001) and ARE THE PSYCHIATRISTS APPROVING THE the PAEQ score (OR=1.370 and p=0.005) predicted the PTSD development (Table 1). CHANGE? 1 1 1 CONCLUSIONS: The most important outcome of our study is Gizem Dönmezler , Cansu Çakır , Ender Cesur , 2 1 finding that the adverse effects on the victims of the negative public Selçuk Şen , Çağatay Karşıdağ attitude towards the victims of acts of terror is predictive of the 1Bakirköy Prof. Dr. Mazhar Osman Mental Health and Neurological development of PTSD in the victims. The inadequacies of the social Diseases and Research Hospital, Psychiatry Department, Istanbul 2 support given to the victims and the existence of negative reactions Istanbul University, Istanbul Medical School, Medical Pharmacology on part of the public to the victims have been found to be predictive Department, Istanbul for PTSD development (Ullman et al. , . 2007). This finding of our INTRODUCTION: Despite the technological and medical study emphasises that the public attitude to the victims of acts of terror developments offered by modernity, including the extension of human as well as getting adversely affected by this attitude on the part of the life span, the life style changes that have accompanied these developments victims have a special significance with respect to the development have costed heavily through the worsening of mental health. There is of PTSD. Being in a social environment understanding the trauma, undeniable and worrying evidence that life expectancy of those with accepting and giving support to the victims accelerates the recovery of mental illnesses has been curtailed with increasing prevalence of the the trauma victims (Solomon et al. , 1988). When the public cannot events of death as compared to the general population. Approximately show an understanding of the experiences of the victims and extend 80% of the deaths among this subpopulation is not due to suicidal the appropriate support to them, the victim gets isolated and left attempts but comorbid physical illnesses and factors of life style. Health with the memories of the adverse experiences. Our study proves the care workers are clearly underestimating the importance of life style in importance of the social ability to display appropriate support to those maintenance of mental health. The mental health care workers, on the exposed to acts of terror. There are limitations to this study in being other hand, are overlooking the definite effects of life style on mental cross sectional and including the inhabitants of Eskişehir only, and health and the necessity of a healthy living style that should take place also by evaluation of the public response to an act of terror through in the treatment of many , protection of cognitive the means of a questionnaire prepared by ourselves and not tested for capacity and neural functions and in the maintenance of psychological validity or reliability. In conclusion, our results show that the adverse and social well being. Currently two focal points, pharmacotherapy effect of public attitudes to the victims of acts of terror is predictive of and psychotherapy, are emphasized in the treatment of depression, the development of PTSD in the victims exposed to such acts. Thereby while neglecting the role of the reversible elements of life style on the the study not only draws attention to the necessity of considering the development and the treatment of depression. Changing life style in the effect of public attitude on the victims in any study to be undertaken treatment of depression, alongside drug and psychotherapy, presents a after acts of terror, but also the need for further studies evaluating our potentially reliable and cheap approach. Control of life style does not results and the design of psychometric tests to assess public attitude and take place in routine therapy despite the increasing interest in topics the effects of the public attitude on the victims. on nourishment and cigarette smoking and the widescale and strong evidence for the contribution of inadequate physical activity, alcohol Key Words: Acts of terror, post Traumatic Stress Disorder, public attitud and to the risk for depression. Details of the regression analysis carried out to determine the The aims of this study include assessment of cigarette and alcohol predictive factors for PTSD development. use, physical activity and approaches to healthy nourishment by the

Independent variables B P OR % 95 CI patients being followed with diagnosis of depression; finding out whether references to life style adjustments, which are required in the BDI total score 0.192 <0.001 1.212 1.105–1.329 first line of intervention in the treatment of depression, are included in PAEQi 0.315 0.005 1.370 1.100–1.706 the psychiatric interviews; and if included, then the effects on life style

Constant -10.639 <0.001 —— —— of patients; and lastly, if changes have been made, then querying the contribution of these changes to the treatment of the patients in order PTSD: Post Traumatic Stress Disorder, ; CI: Confidence Interval; Overall to increase the importance given by psychiatry to altering life styles for percentage=% 87.1; Nagelkerke R Square= 0.591 therapeutic and preventive purposes.

28 METHODS: This cross sectional, descriptive and comparative study compared to the population with normal body weight. There are studies was carried out with 80 outpatients diagnosed with depression and arguing obesity to be related to the development of depression while followed at the Psychiatry Department of Bakirköy Mental Health and others propose that depression results in obesity. Losing weight, even Neurological Diseases Hospital. Written informed consent forms were if remaining in the scale of obesity, results in improvement of mental obtained from the participating patients. These participants completed health. Therefore, recommendation of healthy eating especially to obese a sociodemographic questionnaire, the Beck Anxiety Inventory (BAI) patients, even if the topic has not been studies extensively, should be and the Beck Depression Inventory (BDI) and their physical length included in the practice. Our results have shown that the BDI scores of and body weights were measured. They were asked if topics of life style those patients who made life style changes were significantly lower than adjustments were mentioned in the psychiatric interviews they have those of the rest. Not adapting advice for life style changes in practice attended within the previous one year. In the cases when life style changes rests on various reasons concerning the patients, the psychiatrists and were recommended, the changes they were able to implement and the the general population, and it is recommended that effective public contribution of these changes to their treatment were investigated. The health plans should explicate these reasons.

SPSS 21 package program was used for statistical analyses of the data CANDIDATES RESEARCH AWARD Key Words: cigarette, depression, lifestyle, nourishment, obesity, acquired. Normal distribution was tested with the Shapiro-Wilk test. physical activity Independence of the variables with normal distribution were tested with the independent sample t-test and the Pearson correlation analysis Comparison of the data on patients who made and not made tests. Variables not complying with normal distribution were analysed lifestyle changes by the Mann-Whitney U test and the Spearman’s RHO correlation Patients who Patients who did not analysis tests. Statistical significance was accepted with a p<0.05 value. implement lifestyle implement lifestyle Parametric test results were expressed in terms of the mean and ± changes (n=10) changes (n=70) standard deviation; and, the non-parametric test results were expressed Gender 3 male/7 female 13 male/57 female with the 25th-75th percentile median value. Age 35 (24.5–63.75) 36 (29.0–45.25) p>0.05 RESULTS: The mean age of the 64 females and 16 males participating Education (years) 11 (8.75–13.5) 8 (5–11) p>0.05 in the study was 38.60 (±12.71) years, the mean education years being Income (TL) 1250 (687.5–2000) 1145 (500–2000) p>0.05 9.09 (± 3.69). . The mean duration of treatment received by the entire Therapy duration (month) 8 (1–24) 5.5 (1–13.5) p>0.05 group was 22.50 (±49.77) months. It was found out that 12 (15%) BMI 26.38 (23.59–31.31) 25.09 (22.41–27.49) p>0.05 participants had been recommended to change their life style, and 10 of BAI score 23.5 (7.5–23.5) 20.5 (10.5–33.0) p>0.05 these had benefited from these changes. There were 39 cigarette smokers, BDI score 11.3± 8.23 22.76 ± 13.09 p= 0.002 and 1 alcohol user in the group and 3 (7.69%) of the smokers, but not the alcohol user, had been recommend to make life style change. Only REFERENCES 16 participants followed a regular nourishment diet, but 64 patients did Berk M, Sarris J, Coulson CE et al. , (2013) Lifestyle management of not follow any dietary protocol; and 15 of the patients exercised regularly unipolar depression. Acta Psychiatrica Scandinavica 127 (s443), and 6 without regularity, but 59 were not involved with any physical 38–54. activity. Body mass index (BMI) of 12 patients exceeded 30, with 9 Fabricatore AN, Wadden TA, Higginbotham AJ et al. (2011) Intentional of these patients reporting not having been recommended any lifestyle weight loss and changes in symptoms of depression: a systematic changes while 2 of these patients reported regular physical activity and review and meta-analysis. International Journal of Obesity 35 (11), 1 reported both regular physical activity and programmed nourishment. 1363–1376. When the participants of the study were grouped separately, on having Mitchell AJ, Vancampfort D, DeHert M et al. , (2015) Do people and not having made life style changes, 10 of the patients who had with mental illness receive adequate smoking cessation advice? A implemented the changes had significantly lower scores on the BDI systematic review and meta-analysis. General Hospital Psychiatry as compared to the 70 other participants (p=0.002), but significant 37 (1), 14–23. differences were not observed in the BAI scores (Table 1). Sarris J, ONeil A, Coulson CE et al. , (2014) Lifestyle medicine for depression. BMC Psychiatry 14 (1), 1. CONCLUSIONS : The practice in treatment of depression, aetiology Walsh R (2011) Lifestyle and mental health. American Psychologist 66 of which includes genetic factors, personal characteristics, cognition, (7), 579. environmental stressors and life style that interactively influence each other, still has not taken into its scope considerations of life style despite the evidence for it, having currently focused on drug use and psychotherapy. Observing that only 15% of the participants had been RAC-23 recommended to make amendments of life style proves the situation. EVALUATION OF THE EFFECTS OF THE Approaches for life style changes should be included in psychiatric PREVALENCE OF SPOUSE/PARTNER VIOLENCE interviews with patients. Among the life style factors in the aetiology AND INTIMIDATION ON PSYCHIATRIC SYMPTOMS of depression, physical activity has been accepted as the most beneficial in treating depression, as well as physical illnesses, with its protective AMONG THE FEMALE PHYSICIANS, NURSES AND and therapeutic effects. In our study 73.75% of the depression patients SUBCONTRACTED PERSONNEL OF DOKUZ EYLÜL did not have any regular or irregular implementation of physical UNIVERSITY HOSPITAL activity. Cigarette smoking is a potential risk factor in the development Havva Afşaroğlu1, Halis Ulaş2 of depression and evidence is available on the improvement of health 1Şanliurfa Suruç State Hospital and social functionality after cessation of smoking. Although this 2Dokuz Eylül University, Psychiatry Department, Izmir necessitates the routine recommendation to patients of giving up smoking, only 7.69% of the cigarette smoking participants of our study INTRODUCTION: Violence, with profound psychological and had been recommended to give up this habit. The probability of being physical effects on the individual in every aspect of life, results in more diagnosed with lifelong depression is 20–50% higher in the obese as than 1.6 million deaths per year. Violence is mostly known in family and

29 against women. Violence against women, as the reflection of established incidence of exposure to violence may have led to wrong perceptions by inequality of power in the interrelationship between men and women the women about the behaviours they have been exposed to. There were in society, is a gender related violation of human rights and prevails not any significant differences in psychological violence between the all over the world irrespective of cultural, economical and geographical data gathered from assistant medical staff, nurses and the subcontracted differences. The aim of this study was to evaluate the prevalence of personnel. Differences in the levels of education and economical spouse/partner violence among the female staff of a medical school standard of living my not affect the level of the behaviour interpreted by hospital with differing economical and professional classes and to assess the women as psychological violence. When compared on the basis of the effects of this violence on the observed psychiatric symptoms. professional differences, prevalence of physical and sexual violence was significantly elevated in the group of subcontracted personnel, which METHODS: The study was carried out with female physicians, may be related to the educational and economical level. When levels nurses and subcontracted female personnel of Dokuz Eylül University of violence were compared on the basis of economic standards of the Hospital, using methods of stratified and clustered sampling methods participants, although physical and psychological violence was more progressively. It has been aimed to reach 620 individuals. Data was RESEARCH AWARD CANDIDATES RESEARCH AWARD prevalent in the subgroup with low income, the intergroup differences acquired by means of a sociodemographic form, and a questionnaire were not statistically significant. Studies have shown that although including the Symptom Checklist-90-Revised (SCL-90-R) and a form violence is more prevalent in families of low income, it is nevertheless on domestic violence scan against women. present in families of middle and upper income as well. RESULTS: Among the 620 individuals contacted, a total of 428 CONCLUSION: The results of our study are in agreement with individuals, consisting of 106 assistant physicians, 33 physicians in the previously made studies in showing that spouse/partner violence and academic staff, 190 nurses and 99 contracted personnel completed the intimidation against working women is frequent and that it is reflected questionnaires. The questionnaire on violence included the physical, more strongly in the psychiatric symptoms among women exposed to psychological, sexual and economical aspects of lifelong violence against this violence. There is, however, need for further studies to specify the women. The results indicated that 23.4% of women were subjected areas for preventing family violence. to at least one life long incidence of physical violence, 74.5% to psychological violence, 34.3% to economical violence and 24.5% to Key Words: Family violence, psychiatric symptoms, spouse/partner sexual violence. The question asked the participants before completing violence against women the forms, whether they had been treated with violence by their current Comparison of violence against women on the basis of the or past spouse/partner, was answered positively by 76 (17.8%) and professions of the participants negatively by 352 (82.2%) of the participants. However, it has been seen that, of the women who responded negatively to this question, Consultant Assistant physician- Nurse Personnel 11% had marked physical violence, 69% psychological violence, . physician Academic Staff p* (n=190) (n=99) 27.6% economical violence and 15.6% sexual violence queried on the (n=106) member (n=33) questionnaire. Significant differences in the scores on the four types of Physical Violence +and 24, % 22.6 4, % 12.1 36, % 18.9 36, % 36.4 0.003 spouse/partner violence against women were found when compared on n=, % Psychological Violence +and 145, % the basis of professions. As the professional level of the women increased, 79, % 74.5 17, % 51.5 78, % 78.8 0.015 incidences of subjection to all forms of violence were reduced. As the n=, % 76.3 Economical Violence +and 23, % 21.7 6, % 18.2 72, % 37.9 46, % 46.5 <0.001 level of education of women increased, their exposure to economical, n=, % physical and sexual violence decreased; as the economic level of women Sexual Violence +and 21, % 19.8 7, % 21.2 39, % 20.5 38, % 38.4 0.004 increased, exposure to economical and sexual violence decreased n=% and as the education level of the spouse/partner increased, exposure * Chi square test, n: number of to economical, physical and sexual violence decreased. Psychiatric symptoms of women who experienced violence by spouse/partner were Correlation between the SCL scores and the spouse/partner significantly raised. A statistically significant positive correlation was violence

determined between the SCL scores and the incidence of exposure of Physical Psychological Economical Sexual Spouse/Partner SCL the participants to spouse/partner violence. Violence violence Violence Violence Violence (general) r=0.231 r=0.156 r=0.205 r=0.231 r=0.173 Somatisation DISCUSSION: Studies on violence have been carried out in various p=<0.001 p=0.001 p=<0.001 p=<0.001 p=<0.001 r=0.335 r=0.197 r=0.195 r=0.346 r=0.206 settings such as population scans, on smaller groups, with women in Anxiety shelter homes and the outpatients and inpatients of psychiatry clinics. p=<0.001 p=<0.001 p=<0.001 p=<0.001 p=<0.001 r=0.331 r=0.220 r=0.190 r=0.297 r=0.237 Obsession In our study 428 women (69% of the total approached) employed p=<0.001 p=<0.001 p=<0.001 p=<0.001 p=<0.001 at a university hospital with different professional status and hence r=0.406 r=0.266 r=0.252 r=0.371 r=0.288 Depression belonging to different educational and economical levels were evaluated. p=<0.001 p=<0.001 p=<0.001 p=<0.001 p=<0.001 Interpersonal r=0.326 r=0.172 r=0.227 r=0.316 r=0.272 The availability of 69% cooperation is in agreement with other works Sensitivity p=<0.001 p=<0.001 p=<0.001 p=<0.001 p=<0.001 in the literature, given the privacy and secrecy of difficult topic such r=0.360 r=0.172 r=0.252 r=0.371 r=0.196 Psychotic as domestic violence. Hence, those individuals who verbally denied p=<0.001 p=<0.001 p=<0.001 p=<0.001 p=<0.001 r=0.294 r=0.206 r=0.165 r=0.303 r=0.215 having faced any type of domestic violence had responded (69%) Paranoid p=<0.001 p=<0.001 p=0.001 p=<0.001 p=<0.001 positively on exposure to types of violence queried in the questionnaire. r=0.298 r=0.230 r=0.197 r=0.301 r=0.232 Anger It is noteworthy that these women regarded only the physical type of p=<0.001 p=<0.001 p=<0.001 p=<0.001 p=<0.001 r=0.258 r=0.172 r=0.174 r=0.243 r=0.185 violence as real violence; most of them not equating economical and Phobia psychological maltreatment to violence. In comparison to population p=<0.001 p=<0.001 p=<0.001 p=<0.001 p=<0.001 r=0.324 r=0.168 r=0.206 r=0.352 r=0.186 Additional scans, this study has shown a lower prevalence of physical violence and a p=<0.001 p=<0.001 p=<0.001 p=<0.001 p=<0.001 higher prevalence of psychological violence in this hospital setting. The r=0.350 r=0.246 0.247 0.339 0.264 General lower incidences of physical violence may be attributed to the higher p=<0.001 p=<0.001 p=<0.001 p=<0.001 p=<0.001 general level of education and economical standards. The observation Spearman correlation analysis has been used; r: correlation coefficient; , p of higher prevalence of psychological violence by querying at least one statistical significance level; . SCL: symptoms Scan List

30 REFERENCES mental disorders, which characteristic of alexithymia may be used as a Altinay AG, Arat Y (2008) Türkiye’de kadina yönelik şiddet, 2. baski, transdiagnostic factor. ACT theory also approaches on a transdiagnostic (Violence Against Women in Turkey) Punto Baski Çözümleri, basis to explaining mental disorders and presents an opportunity for Istanbul s. 4. evaluating the relationship of alexithymia with the concepts in the core Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü-Aile ve Sosyal of ACT theory. This work has aimed to investigate the relationship Politikalar Bakanliği (ASPB), Türkiye’de Kadina Yönelik Aile içi of alexithymia with cognitive fusion (CF) and experiential avoidance iddet Araştirmasi (2014) (Hacettespe University Population Studies (EA), the assumption being that EA and CE scores of individuals with Institute-The Ministry for Family and Social Politics [MASP], alexithymia will be higher and that significant relationships between Violence Against Women in Turkey) Elma Teknik Basim, Ankara. these concepts of ACT and alexithymia will be unravelled. Özçirpici B, Akin M, Içbay E et al. , (2011) Bir Tip Fakültesi ve Hastanesinde Çalişan Kadinlarin Eş/Partner Şiddetine Maruziyet METHODS: 1. Participants-the study was carried out with 133 Durumlari ve Etkileyen Faktörler. (Exposure to Spouse/Partner participants consulting the psychiatry department of a university hospital

Violence by Women Working at a University Medical School on outpatient basis, who were not diagnosed with any or CANDIDATES RESEARCH AWARD Hospital and the Affecting Factors) Sosyal Politika Çalişmalari did not have any psychotic, bipolar, major neurocognitive or substance Dergisi 7 (25): 97–112. use disorder among any primary mental disorder diagnoses, and also Saribiyik M (2012) Malatya merkez sağlik ocaklarinda çalişan hekim, did not have mental retardation or a physical illness underlying the hemşire ve ebelerin şiddet deneyimleri ve kadina yönelik şiddetle observed mental disorder, and gave consent to participate in the study ilgili tutum ve davraniş düzeyleri. Yüksek lisans tezi, s. 101. on a volunteering basis. Mean age of the participants was 25.84 (±8.78, (Experiences of physicians, nurses and midwives with violence and SD) years and 74% were females. 2. Procedure-The participants after a their attitudes and behaviour related to violence against women- face to face interview on the DSM-V criteria conducted under polyclinic Diploma Thesis, p 101) conditions and getting informed on the aims of the study were asked World Health Organization, Multi-country study on women’s health to complete the self report scales used within the scope of the study. 3. and domestic violence against women: summary report of initial Evaluation tools-Sociodemographic and clinical questionnaire to record results on prevalence, health outcomes and women’s response the age, gender, educational background, marital status and, if given, (2005) Geneva. their primary psychiatric diagnosis; the Toronto Alexithymia Scale (TAS) consisting of 3 subscales: (1) difficulty identifying feelings (IDE), (2) difficulty communicating feelings (COM), and (3) externally oriented RAC-24 thinking (EOT). ; the Acceptance and Action Questionnaire-II (AAQ- II), high scores indicating psychological hardness; the Cognitive Fusion RELATION BETWEEN ALEXITHYMIA AND Scale-(CFS), high scores indicating increased cognitive entanglement; COGNITIVE FUSION AND EXPERIENTIAL the Hospital Anxiety and Depression Scale (HADS) to assess anxiety AVOIDANCE: VIEWING FROM THE WINDOW and depression level; the Ten-Item Personality Inventory-(TIPI) testing ACCEPTANCE AND COMMITMENT whether the individual is ‘Extraverted’’ ‘‘Agreeable, warm’’ ‘‘Conscientious’’ ‘‘Emotionally stable, ’’ and ‘‘Open to new experiences. ’’ Sedat Batmaz1, Emrah Songur1, Mesut Yıldız2, Zekiye Çelikbaş1, Nurgül Yeşilyaprak1, Hanife Kocakaya1, Statistical Analyses-Statistical analyses were carried out using the SPSS 22 package program. Data gathering was continued until reaching Meral Oran Demir3 a participant count of 123, for an accepted statistical significance 1Gaziosmanpaşa University, Medical School, Mental Health And Diseases allowing 5% type I error, 80% statistical power of determining the Department, Tokat medium effect size. On the basis of the cut off score of the TAS, those 2Marmara University, Medical School, Mental Health And Diseases participants with and without alexithymia were determined and the Department, Istanbul demographic characteristics were analysed with exploratory statistics. 3Dr. Cevdet Aykan Mental Health And Diseases Hospital, Psychiatry The scores used in this two-group participant study were analysed either Clinic, Tokat by the independent variables t-test or the Chi-Square test. The effect INTRODUCTION: According to the theory of acceptance and size was determined for the scores showing differences The relationship commitment therapy (ACT), there is a psychological hardness at between the scales used were analysed for correlations separately on the kernel of all mental disorders. The core components of the lost data of all participants and of the group diagnosed with alexithymia. To psychological flexibility are cognitive defusion (disentanglement) of assess the relationship between the different dimensions of alexithymia personal experiences from self, acceptance of thoughts, focusing on the and the experimental data, progressive linear regression analyses were present moment, a transcendent awareness of self, values important carried out. Also, demographic data, personality dimensions and the to one’s true self; and committed action with goals according to these scores on depression and anxiety were controlled, and hierarchic linear values. Experimental avoidance (EA) is one of the areas ACT depends regression analyses were carried out to demonstrate the effects of the on to evaluate the loss of psychological flexibility. EA also expresses CE and EA on predicting the total score of alexithymia. In order to see the individual’s avoidance of the internal experiences/thoughts and how well belonging to the alexithymia group could be determined, dual the inability to accept these. Cognitive Fusion (CF) (or cognitive regression analyses were carried out. entanglement) is the inability of the individual to put a space between the external realities and the self, entangled in the internal experience/ RESULTS: 1. Characteristics of the participants-Psychiatric disorders thoughts. CF has a more specific place in the ACT concept in being an were not diagnosed in 49.6% of the participants. The disorders impediment to acting in the direction of ones true values, instead of diagnosed on the others were depressive disorders (22.5%), anxiety remaining directly tied to thoughts and their effects. Alexithymia, in the disorders (15.5%), obsessive-compulsive disorder (7.8%), trauma and simplest terms, is the inability to understand or recognise the emotions of related disorders (1.6%), physical symptoms and related disorders other individuals, or to ascribe them any significance. Individuals unable (2.3%), and other mental disorders (% 0.8). Of the participants, 37 to distinguish internal experiences from one another, can experience were alexithymic and 26 were not. The educational level and responsible difficulty in emotion regulation and have increased liability to other personality scores of the alexithymic group were low, but their scores

31 on anxiety and depression, experiential avoidance and cognitive fusion RAC-25 were elevated. . 2. Correlation analyses-In the analyses on data of all participants, with SITUATION AWARENESS IN OBSESSIVE- the exception of the scores on the) ‘externally oriented thinking’ (EOT) COMPULSIVE DISORDER PATIENTS AND subscale of TAS, statistically significant positive correlations were THEIR FIRST DEGREE RELATIONS: A STUDY ON determined between the total score and the scores on the other two ENDOPHENOTYPE subscales of TAS and the CE and EA scores. When only the data on the patients diagnosed with alexithymia were used these correlations were Didem Tezcan, Selim Tümkaya not statistically significant. Pamukkale University, Psychiatry Department, Denizli 3. Regression analyses-Using the linear regression analysis models formed INTRODUCTION: Obsessive-compulsive disorder (OCD) is a in order to predict the total and subscale scores of TAS, all variables mental disorder characterised by repetitive and persistent thoughts and/ or illogical or excessive repetitive behaviours the patients cannot avoid. RESEARCH AWARD CANDIDATES RESEARCH AWARD were entered the model and at every stage insignificant variables were excluded by the stepwise backward analyses. The last step results showed OCD is both a phenotypic and genetic disorder with a controversial that low level of education, and high score on the cognitive fusion scale aetiology that is still being investigated. In the recent years the studies (CSF), small age for the ‘difficulty identifying feelings’ (IDE) subscale on the pathogenesis of OCD have focused on endophenotype with score, low level of education together with high CSF score, low level objective and measurable parameters. Neuropsychological deficits in of education for the IDE subscale, small age and low anxiety score for different psychiatric disorders have been argued to be endophenotypic EOT subscale were significantly predictive (Table 1). It was shown that indicants. In this context, the neurocognitive deficits in the OCD high scoring on the CSF scale was a significant predictor of the total patients and their first degree relations are thought to be potential alexithymia score also in the model for the hierarchic regression analyses phenotypic indicants which can be used to clarify the genetic mechanisms (Table 2). Statistically significant relationship between the EA score underlying OCD. In previous neuropsychological studies comparing and the alexithymia scores could not be determined in both models of OCD patients and their first degree relatives, the observed executive regression analysis. In the last step of the dual logistic regression analyses function disorders including response-inhibition, cognitive flexibility, completed on all variables with the stepwise backward method, only planning, decision making and memory have been proposed to be the high scores on the CSF scale were predictive for belonging to the phenotypes for OCD. These cognitive abilities we mistakenly assume alexithymia group. This variables contained by this model were able to to function independently of each other are actually frequently active predict belonging to the alexithymia group with 84.8% certainty. together in daily living. The traditional neuropsychological tests have been developed to enable the evaluation of these functions separately. CONCLUSIONS: This study has confirmed the existence of significant Is it necessary to test separately these interactive abilities, which are relationship between the CF component of the ACT theory and capable of altering each others effects in daily living? Evaluation of these alexithymia, but a similar relationship between alexithymia and the EA functions together may be more important in assessing the individuals component of ACT could not be detected except the demonstration of real performance in daily tasks. Therefore, tests for situation awareness high EA scores in the alexithymia diagnosed group. This means that in that can evaluate a range of functions from early perception to upper explaining alexithymia, CF will aid the traditional behavioural theory, level working memory may be more useful determinants. In a previous and that EA will not make an additional contribution. The existing study on OCD patients, impairments in the stages of combined findings indicate that in the course of applying ACT, the CF dimension interpretation of early visual perception and attention mediated visual should be handled with more emphasis. stimuli had been reported. In this study it has been aimed to compare Key Words: alexithymia, cognitive fusion, acceptance and commitment OCD patients, their first degree relatives and healthy controls on the hypothesis that situation awareness may be an endophenotypic REFERENCES indicator of OCD. Darrow SM, Follette WC (2014) A Behavior Analytic Interpretation of Alexithymia. J Contextual Behav Sci 3 (2): 98–108. MEHTODS: This study has included 67 OCD patients consecutively Gillanders DT, Bolderston H, Bond FW et al. , (2014) The Development arriving at the Pamukkale University, Psychiatry Hospital polyclinics and Initial Validation of the Cognitive Fusion Questionnaire. between 24.12.2014 and 30.12.2015, and 50 individuals among their Behavior Therapy 45:83–101. healthy first degree relatives, and also randomly chosen 41 healthy Yavuz KF, Ulusoy S, Iskin M et al. , (2016) Turkish version of individuals, without a family history of psychiatric disorders, as the Acceptance and Action Questionnaire-II (AAQ-II): A reliability control group. and validity analysis in clinical and non-clinical samples. Klinik Illiterate individuals, and patients with psychotic disorders, bipolar Psikofarmakoloji Bulteni-Bulletin of Clinical Psychopharmacology. disorder, mental retardation, alcohol-substance use disorder, organic Güleç H, Köse S, Güleç MY et al. , (2009) Reliability and factorial mental disorder (such as dementia, , and cranial trauma), validity of the Turkish version of the 20-item Toronto alexithymia comorbidity of serious medical or neurological diseases, and having had scale (TAS-20). Bulletin of Clinical Psychopharmacology 19:214– electroconvulsive therapy (ECT) or transcranial magnetic stimulation 220. (TMS) in the previous 6 months, and finally, those who scored 17 or above in the Hamilton Depression Rating Scale (HAM-D) were excluded from the study. In order to evaluate situation awareness, the patients completed the Situation Awareness Task (SAT) in The Psychology Experiment Building Language (PEBL) Test Battery version 0.13. (See: https://www. youtube. com/watch?v=zfFRQqFTC-Q &sns=em). Here the test is performed on a HP Pro One 400 series computer, with 15.4 inch touchmatic and 1440×900 pixel screen, and the tests are under the visual surveillance of the researcher from a distance of 25 cm. SAT is made up of 3 stages, with the first stage (SAT- 1) evaluating the awareness of clues in the environment; the second

32 stage (SAT-2) combining the information perceived in the first stage any significant differences on grounds of correctness between the and interpreting these by evaluating the individual’s associations with performances of OCD patients and their relatives. These results partly his/her targets and attributing a significance; and the final stage (SAT-3) support our hypothesis that situation awareness is an endophenotype being the uppermost level of awareness, evaluating the ability to predict for OCD. This study is the first to investigate the situation awareness the projection of the present situation of the target in the near future. At in OCD patients and their first degree relatives. While this result points each stage, in the first block of the test attention is ‘’target oriented’’ or towards a new endophenotype candidate for OCD, there is need for directed at the active target while in the final block the test is ‘’stimulus further studies in this field. oriented’’ with the active target being determined by the orientation of environmental clues. The 3 stages of the test are evaluated on the basis Key Words: Endophenotype, obsessive-compulsive disorder, situation of the correctness and the time parameters of these two blocks. The low awareness, working memory scores obtained by taking the logarithms of each of the two parameters indicate the high level of awareness by the participant. Statistical Comparison of the test scores of the OCD patients, first degree analysis of the study findings were carried out by the ‘’SPSS version relatives of the OCD patients and the controls on the situation CANDIDATES RESEARCH AWARD 22.0 for Windows” package program. The scores on the neurocognitive awareness test (SAT). tests were analysed by the MANOVA test and Post-Hoc comparisons Statistical were made by the Bonferroni corrections. Statistical significance was Analysis accepted as p<0.05. Also, for all three experimental subject groups the Mean±Standard MANOVA relationship between the target oriented and stimulus oriented blocks of deviation the SAT were analysed for calculating the effect size which was ‘small’’, SAT Scores OCS Relation control F d. f. p ‘’medium’’ or ‘’big’’ by corresponding to Cohen’s d values of 0.2, 0.5 and SAT-1 > 0.8, respectively. Correctness target -0.249±0.11 -0.290±0.11 -0.308±0.10 3.832; 2 0.02 OCDControl* 3.741±0.18 3.667±0.15 3.638±0.12 6.083; 2 0.003 the basis of correctness were not observed between the groups. focused OCD>Relation*

Time stimulus (Table 1). In all the three groups, presence of a significant effect was 3.770±0.15 3.723±0.14 3.707±0.13 2.777; 2 0.06 focused determined in the target and the stimulus oriented blocks of SAT-1 and the SAT-2 stages of the test. At the SAT-1 stage, a effect size of SAT-2 Correctness target big dimension was found between the two blocks in the OCD, First -0.168±0.09 -0.179±0.07 -0.191±0.08 0.907; 2 0.40 oriented Degree Relations and Control groups (Cohen’s d:-0.95;-0.94;-1.13 and Correctness -0.134±0.06 -0.142±0.06 -0.143±0.06 0.306; 2 0.73 r:-0.43;-0.42;-0.49, respectively). In the Sat-2 stage the corresponding stimulus oriented effect size was of big-medium dimensions (Cohen’s d:-0.95;-0.56;- Time target 3.778±0.17 3.729±0.15 3.692±0.09 4.479; 2 0.013 OCD>Control* 0.67 and r:-0.43;-0.27;-0.32, respectively). Finally, in the SAT-3 stage oriented the corresponding effect size was determined to have been reduced to Time stimulus 3.788±0.18 3.737±0.14 3.708±0.11 3.632; 2 0.02 OCD>Control* medium-small dimensions (Cohen’s d:-0.29;-0.25;-0.53 and r:-0.14;- oriented 0.12;-0.26, respectively). SAT-3

Correctness target 1.861±0.10 1.803±0.16 1.822±0.12 2.973; 2 0.054 CONCLUSION: Results have shown that the OCD group have oriented displayed a significantly worse performance in comparison to the Correctness 1.892±0.11 1.840±0.13 1.875±0.07 2.789; 2 0.06 controls at both blocks of the SAT-1 stage. Also, despite not reaching stimulus oriented the significance level, the relations of the OCD have also performed Time target 3.731±0.14 3.689±0.16 3.669±0.13 2.564; 2 0.08 worse than the controls. SAT-1 is a primitive process evaluating oriented Time stimulus the localisation of a visual stimulus. Determination of differences 3.718±0.15 3.699±0.15 3.655±0.11 2.516; 2 0.08 oriented between the patients and the controls in both of the blocks requiring and not requiring the effective use of attention, suggest that in OCD, *p<0.05 independently of attention, there may be impairment of the low level sensory functions. The finding of early perception related impairments REFERENCES in studies on OCD patients using visual and auditory evoked potentials Endsley MR (1998) Design and evaluation for situation awareness support our proposal. Although at the SAT-2 and SAT-3 stages the enhancement. In Proceedings of the Human Factors and performance by the OCD patients and their relatives were worse than Ergonomics Society Annual Meeting. SAGE Publications 32 (2): that of the controls, the differences did reach the significance level. 97–101. Combining, consolidating and projecting to future of the place and Menzies L, Achard S, Chamberlain SR et al. , (2007) Neurocognitive the depictive characteristics of the target. in these two stages are closely endophenotypes of obsessive-compulsive disorder. Brain 130 (12): related to visual-spatial working memory and the upper level cognitive 3223–3236. mechanisms. Hence, the OCD patients have performed closer to the Tumkaya S, Karadag F, Mueller ST et al. , (1983) Situation awareness controls in these stages requiring more cognitive awareness as compared in obsessive-compulsive disorder. Psychiatry Res 209 (3): 579–588. to the SAT-1 stage. This may be the result of a cognitive effort at the higher level to compensate the lower level information processing Beech HR, Ciesielski KT, Gordon PK (1983) Further observations failures. In conclusion, the first degree relations of OCD patients have of evoked potentials in obsessional patients. Br J Psychiatry 142 displayed a test performance in between the levels of performance of (6): 605–609.5. Viswanath B, Reddy YJ, Kumar KJ et al. , (2009) the OCD patients and the controls, especially at the SAT-1 and SAT- Cognitive endophenotypes in OCD: a study of unaffected siblings 2 stages. Also, in contrast to the statistically significant differences in of probands with familial OCD. Prog Neuropsychopharmacol Biol the performances of the OCD patients and controls, there were not Psychiatry 33 (4): 610–615.

33 RAC-26 RESULTS: Incidence of MetS among the schizophrenia patients was found to be 44.3%. Patients with MetS, as compared to those without INVESTIGATION OF THE EFFECTS OF METABOLIC MetS, had significantly higher scores on the VMPT learning error (p: SYNDROME AND RELATED PARAMETERS ON 0.023) and perseverance (p: 0.029). However the two groups did not COGNITIVE FUNCTIONS OF SCHIZOPHRENIA differ significantly on the scores of the WMS-R IV-visual reproduction PATIENTS (VR) and VI-logical memory (LM), the ST and the VADSP. Multivariate linear regression model was used to analyse the effects of the parameters Zekiye Çelikbaş1, Mesut Yıldız2, Osman Demir3, related to MetS on the cognitive test scores. The increase in serum Emrah Songur1, Sedat Batmaz1, Hanife Kocakaya1 HDL increased the VMPT learning score (β: 0.308, p: 0.019) and the 1 Gaziosmanpaşa University, Medical School, Mental Health And Diseases total memory score (β: 0.270, p: 0.038), but decreased the learning Department, Tokat error score (β:-0.286, p: 0.028). Increased BMI, on the other hand, 2Marmara University, Mental Health And Diseases Department, Istanbul decreased the total memory score (β:-0.413, p: 0.018) and increased RESEARCH AWARD CANDIDATES RESEARCH AWARD 3Gaziosmanpaşa University, Biostatistics Department, Tokat the error recognising score (β: 0.401, p: 0.022). Friedman et al. , have shown that BMI was associated with weak verbal memory in INTRODUCTION: Studies on the relation between metabolic both the schizophrenia patients and the controls, and hypertension in syndrome (MetS) and cognitive functions in schizophrenia patients schizophrenia patients was associated with weaker memory (2). Lancon have increased in the recent years. This study has aimed to investigate et al. have found a relationship between MetS and verbal learning and the effects of MetS and related parameters on cognitive functions in the short and long term memory estimations. According to their work, schizophrenia. while hypertriglyceridemia, abdominal obesity, low HDL cholesterol METHODS: This study, after approval by the Dean of Medical School were the most important factors related to memory impairment, there and Clinical Research Unit of Gaziosmanpaşa University, has enrolled was not a significant relationship between cognitive impairment and 82 patients between the ages of 18 and 65 years, diagnosed with hyperglycaemia and hypertension. (3). Our study has also not found schizophrenia or schizoaffective disorder on the basis of DSM-V criteria a significant relationship between hypertension and hyperglycaemia at Gaziosmanpaşa University Medical School, Mental Health And and verbal memory, visual memory, logical memory (LM), intrasensory Diseases Department polyclinics between 02.12.2015 and 29.04.2016. fusion, and intersensory fusion. On the other hand, increased HDL was β β The study has been completed with 79 patients as 2 did not give consent related to decreased the VR-I ( : 0.2, p: 0.046) and VR-II scores ( : and 1 did not have the required blood parameters. The inclusion criteria 0.312, p: 0.018) on the WMS-R; these results being in agreement with were: the age range of 18–65 at the symptomatic remission period, a total those in the literature (3). Also, increased BMI decreased the total score β score of <60 on the Positive and Negative Symptoms Scale (PANSS), a on the WMS-R ( :-0.423, p: 0.015). total score of > 24 on the Mini Mental Test (MMT), regularly using As BMI increased the ST scores were increased significantly: ST I antipsychotic agents at least for the previous 4 weeks. The exclusion (Factor 3, speed) (β: 0.413, p: 0.017); ST II (β: 0.557, p: 0.001),, ST criteria were: illiteracy, being of age below 18 or above 65years, III (β: 0.449, p: 0.011), ST IV (β: 0.65, p <0.001) and ST V (β: 0.556, comorbidity of mental retardation, cranial trauma history, organic p: 0.001) indicating that obesity caused a reduction in the speed of brain syndrome, degenerative neurological disease, alcohol-substance processing. dependency, unstable cardiovascular, renal, gastrointestinal or hepatic Similarly increases in BMI correlated with reduced VADSP subscale diseases, unregulated diabetes mellitus, unregulated hypertension, scores β β pregnancy or breast feeding. Patients were interviewed face to face and : auditory verbal ( :-0.500, p: 0.005), visual verbal ( :-0.419, β were asked to complete a written consent form, a sociodemographic p: 0.021), auditory written ( :-0.441, p: 0.014), auditory stimulation β β questionnaire, the Positive and Negative Symptoms Scale (PANSS), and ( :-0.441, p: 0.014), visual stimulation ( :-0.417, p: 0.021), verbal β β the Calgary Depression Scale for Schizophrenia (CDSS), scores being explanation ( :-0.506, p: 0.005), written explanation ( :-0.424, p: β determined by the interviewer. Also, waist line circumference, height 0.018), intrasensory fusion ( :-0.469, p: 0.009), intersensory fusion β β and body weight measurements were made. The BMI was evaluated on ( :-0.469, p: 0.005) and total VADSP score ( :-0.492, p: 0.006). the WHO criteria. Blood biochemistry tests including the lipid profile Abnormalities of the frontotemporal cortex network in Schizophrenia patients during verbal working memory, word coding and words and fasting serum glucose as well as routine blood tests for those using recognition processing; and also of the early phase of auditory processing antipsychotic agents were completed. Care was taken to use the test have been observed. Micro and macro vascular alterations caused results of the patients within the previous 6 months. In a quiet and non- by metabolic changes may be affecting the integration of the neural distractive environment The participants took the following tests in the network cycles participating in sensory gating. A study by Labousse given order: VMPT (Öktem-VerbalNOT Memory Processes Test), PRESENTED WMS-R et al. has demonstrated that feeding mice with a high fat diet impairs (Wechsler Memory Scale-Revised) and the subtests Visual Reproduction sensorimotor gating. These impairments are especially associated with (VR) (I & II) and Logical Memory (LM) (I & II), the Stroop Test (ST), neurotransmitter anomalies the striatal dopaminergic cycles (5). Our and the Visual and Auditory Digit-Span Performance (VADSP). Scores observations suggest that increasing BMI in Schizophrenia increases the were determined by the interviewer. Patients were informed on all the problems of auditory processing. procedures. Patients diagnosed with MetS were referred to the Internal Diseases Unit polyclinics. The IBM SPSS Statistics 19, (SPSS Inc. , an CONCLUSIONS: We have observed in schizophrenia patients with IBM Co. , Somers, NY) was employed for statistical analyses of the data. MetS, as compared to those without MetS, that scores on the VMPT Exploratory analyses were carried out on the general characteristics of subscales on learning error and perseverance were significantly increased; the participants. When comparing the means of numerical variables, but the two groups did not differ significantly on the scores of the test for significance of the difference between two means was used. WMS-R IV-visual reproduction (VR) and VI-logical memory (LM), the Cross-tabulation analysis and Chi-square test were used for evaluating STand the VADSP tests. . Multivariate linear regression analysis showed the relationship between categorical values. The Pearson correlation important effects of obesity and low HDL on attention, momentary and coefficient was used to assess the linear relationship between numerical long term memory, executive functions and cognitive flexibility. When variables; and, the ‘p’ value under 0.05 was accepted to give statistical evaluating the results of the study, the limitations also have to be taken significance. . into account. Small experimental sample, there being a subpopulation

34 of patients diagnosed with schizoaffective disorders (15.2%); cross Distribution of the Test Scores in Relation to BMI sectional case evaluation, inability to predict the effects of probable BMI <18.5 25–25.9 30–34.9 35–39.9 >40 vascular changes due to obesity, impaired glucose regulation, insulin (kg/m2) resistance and decreases in cardiovascular functionality on cognitive Meant±SD Meant±SD Meant±SD Meant±SD Meant±SD F P functions, not knowing the actual time of existence of the parameters WMS-R IV Visual 1±1.41 1.9±1.37 1.32±1.52 0.42±1.16 1±0 3.056 0.022 related to MetS; and the use of antipsychotic, mood stabilising and reproduction antidepressant medication in different groups may have affected the VR-I experimental results. Despite the limitations, this study is important WMS-R Total 3±1.41 4.59±2.32 3.73±2.35 2.08±2.15 2.33±0.58 3.165 0.019 in being the first among the studies on the relation between MetS and ST I Error count 0±0 0±0 0±0 0.08±0.29 0.33±0.58 4.277 0.004 the cognitive functions in schizophrenia to use the VMPT and VADSP ST II Total time 19.5±9.19 13.17±5.74 16±7.25 20.83±9.29 27±21.66 4.087 0.005 psychometric forms and to assess the relation between MetS and the ST III Total time 16±5.66 18.73±7.92 24.27±14.19 29.5±11.13 23.33±7.57 2.891 0.028 cognitive functions in the Turkish population. ST IV Total time 29±1.41 24.34±8.42 30.18±13.92 43.33±11.96 38.33±18.34 7.241 <0.001 ST IV Error CANDIDATES RESEARCH AWARD 0±0 0.2±0.71 0.73±1.35 1.58±2.39 1±1.73 2.830 0.030 Key Words: Cognitive functions, metabolic syndrome, schizophrenia count ST IV Effects of Metabolic Syndrome and the Related Parameters on Correction 3±4.24 0.51±0.93 0.64±1.18 1.92±2.11 1.33±2.31 3.791 0.007 Test Scores on Cognitive Functions count ST V Total time 51.5±9.19 37.12±12.05 36.73±14.64 62.75±22.77 58±35.59 7.574 <0.001

Unstandardized Unstandardized Standardized ST V Correction Model t P 6.5±4.95 2.46±2.2 1.68±1.36 3.58±2.61 5.67±2.52 4.798 0.002 Coefficients Coefficients Coefficients count

Factor 2 Dp IV B Std. Error Beta (damaging 35.5±14.85 18.55±10.14 12.45±13.58 33.25±18.7 34.67±28.22 6.241 <0.001 effect)

VMPT Highest learning HDL 0.051 0.021 0.308 2.405 0.019 VADSP Verbal 4.5±0.71 5.22±1.06 4.59±1.1 4.17±1.4 4±1 2.737 0.035

VADSP Auditory 9.5±2.12 10.59±2.02 9.23±2.02 8.83±2.21 8.67±1.53 2.571 0.045 VMPT Total Recall HDL 0.044 0.021 0.270 2.116 0.038 stimulus

VADSP VMPT Total Recall BMI -0.190 0.079 -0.413 -2.416 0.018 Verbal 9.5±0.71 11.63±2.24 10.41±2.06 9.67±2.64 9±1 2.951 0.025 explanation

VMPT Wrong recognition HDL -0.046 0.020 -0.286 -2.244 0.028 REFERENCES

VMPT Wrong recognition BMI 0.183 0.078 0.401 2.436 0.022 Fisher M, Holland C, Merzenich MM et al. , (2009) Using neuroplasticity-based auditory training to improve verbal memory WMS-R IV Visual HDL 0.023 0.011 0.255 2.033 0.046 reproduction I in schizophrenia. The American Journal of Psychiatry 166 (7): 805–11. WMS-R IV Visual BMI -0.098 0.043 -0.383 -2.273 0.026 reproduction I Friedman JI, Wallenstein S, Moshier E et al. , . (2010) The effects of

WMS-R IV USB Visual hypertension and body mass index on cognition in schizophrenia. HDL 0.028 0.011 0.312 2.424 0.018 reproduction II The American Journal of Psychiatry 167 (10): 1232–9.

WMS-R IV Total BMI -0.180 0.072 -0.423 -2.497 0.015 Lancon C, Dassa D, Fernandez J et al. , (2012) Are cardiovascular risk factors associated with verbal learning and memory impairment in ST I Total time taken BMI 0.501 0.206 0.413 2.438 0.017 (Factor 3, speed) patients with schizophrenia? A cross-sectional study. Cardiovasc Psychiatry Neurol. ST II time taken BMI 0.813 0.242 0.557 3.351 0.001 Micoulaud-Franchi JA, Faugere M, Boyer L et al. , (2015) Association

ST III time taken BMI I 0.874 0.335 0.449 2.607 0.011 of metabolic syndrome with sensory gating deficits in patients with chronic schizophrenia. Psychoneuroendocrinology 57:125– ST IV time taken BMI 1.360 0.361 0.605 3.765 <0.001 33.5) Xiaofeng Guo ZZ, Qinling Wei, Hailong L et al. , (2013) The relationship between obesity and neurocognitive function in ST V total time taken BMI 1.830 0.547 0.566 3.345 0.001 Chinese patients with schizophrenia. BMC Psychiatry 13:6.

VADSP Auditory Verbal NOTBMI -0.104 0.036PRESENTED-0.500 -2.875 0.005

VADSP Visual Verbal BMI -0.105 0.044 -0.419 -2.369 0.021 RAC-27

VADSP Written BMI -0.088 0.035 -0.441 -2.528 0.014 RED CELL DISTRIBUTION WIDTH, MEAN VADSP Verbal BMI -0.189 0.065 -0.500 -2.889 0.005 PLATELET VOLUME AND VITAMIN B12 LEVEL IN VADSP BMI -0.206 0.087 -0.417 -2.356 0.021 Visual stimulation SCHIZOPHRENIA PATIENTS: AN OBSERVATIONAL STUDY VADSP BMI -0.209 0.072 -0.506 -2.911 0.005 Verbal Explanation Mehmet Asoğlu, Ülker Fedai, Mahmut Katı, Özlem VADSP BMI -0.189 0.078 -0.424 -2.414 0.018 written explanation Beğinoğlu, Öznur Akıl, Meltem Göbelek, Ismail Karka,

VADSP Faruk Pirinççioğlu BMI BMI-0.208 0.078 -0.469 -2.677 0.009 intrasensory fusion Harran University, Mental Health and Disorders Department, Şanliurfa VADSP Waistline 0.061 0.030 0.381 2.039 0.045 Intersensory fusion circumference INTRODUCTION: Evidence is being presented to suggest that

VADSP immunological and inflammatory mechanism may have an important BMI -0.194 0.067 -0.496 -2.876 0.005 Intersensory fusion role in the pathophysiology of schizophrenia. Mean platelet volume VADSP BMI -0.399 0.141 -0.492 -2.832 0.006 (MPV) is being widely used as the marker for thrombocyte function Total score and reactivation. Recent studies have pointed to increased MPV values

35 in schizophrenia. In many diseases the red cell distribution width Duchnowski P, Szymański P, Orłowska-Baranowska E et al. , . (2016) (RDW) has been related to inflammatory markers. We have not met Raised red cell distribution width as a prognostic marker in aortic any study in the literature on the relation between RDW levels and valve replacement surgery. Kardiol Pol 74:547–52. schizophrenia. Also, results of studies on B12 levels in schizophrenia Rothermundt M, Arolt V, Bayer TA (2001) Review of immunological have been controversial, being reported as increased, decreased or and immunopathological findings in schizophrenia. Brain Behav unaltered. Studies on schizophrenia and inflammation are continually Immun 15:319–339. increasing. We have aimed to evaluate MPV and RDW levels reported Saedisomeolia A, Djalali M, Moghadam AM et al. , (2011) Folate to be related to inflammatory markers together with B12 levels in and vitamin B12 status in schizophrenic patients. J Res Med Sci schizophrenia patients. 16:437–41. Semiz M, Yücel H, Kavakçi O, Yildirim O et al. , (2013) Atypical METHODS: This study has been carried out with 56 schizophrenia antipsychotic use is an independent predictor for he increased mean inpatients (29 females, 27 males; mean age 34± years) being treated platelet volume in patients with schizophrenia: a preliminary study.

RESEARCH AWARD CANDIDATES RESEARCH AWARD at the Harran University Training and Research Hospital, Psychiatry J Res Med Sci 18:561–566. Services. Patients who developed physical and mental comorbidities during the course of the study were excluded from the program. As the control group, 30 volunteers with normal physical examination results and without any physical or mental disorders or history were included RAC-28 in the study. The control group of participants were not using any type of medication, antioxidants or vitamins. The study was carried out EFFECTS OF THE GROUP THERAPY GIVEN TO in accordance with the criteria of the Helsinki Declaration revised in EARLY PHASE SCHIZOPHRENIA PATIENTS ON 2000, and all participants were informed of the study protocol and each THE QUALITY OF LIFE, FUNCTIONALITY, AND participant signed a written consent form. Comprehensive haemograms THE SYMPTOMS OF THE DISORDER: FOLLOW UP (ie, inclusive of RDW, MPV) were produced on the automatic Coulter STUDY WITH RANDOMISED WAITING LIST Counter (Beckman-Coulter, LH 780, USA). Serum vitamin B12 levels were measured on the automatized chemilluminescence analyser (Roche Filiz Şükrü Gürbüz1, Hayriye Mihrimah Öztürk2, Diagnostic, Elecsys E170, Germany). Özge Kılıç3, Sena Güneytepe4 1Beykent University Psychology Department, Istanbul RESULTS: The mean patient group age was 34 ±, the control mean 2 Ministry of Health University Numune Training and Research Hospital, age was 33 (±10) years; and the groups did not differ significantly on Psychiatry Clinic, Ankara grounds of age and gender. When compared, thrombocyte counts and 3Koç University Hospital, Psychiatry Department, Istanbul RDW values of the schizophrenia patients were significantly elevated 4 Private Avrasya Meditech Hospital Psychiatry Clinic, Ordu as compared to the controls. MPV was also high in the patient group but the difference with the control value was not significant (P>0.05). INTRODUCTION: Researchers have argued that the early phase of However, B12 levels of the patient group were significantly lower than schizophrenia is predictive of the long term course and the outcomes those of the controls (P<0.001). of the disorder. Knowing that response to therapy is faster and better at the early phase demands extra care in this phase of treatment. One of CONCLUSION : Our study is the first to demonstrate a significant the psychosocial interventions argued to be useful in schizophrenia is increase in the RDW levels of the schizophrenia patients. The MPV the group therapy. Our study has aimed to investigate the effects of the levels were also increased albeit not significantly. On the other hand, group therapy focused on interaction on the functionality, life quality the B12 levels of the schizophrenia patients were significantly lower and the symptoms of schizophrenia patients. than those of the controls. Evidence is being presented to suggest that immunological and inflammatory mechanism may have an important METHOD: This research has been conducted with the design of a role in the pathophysiology of schizophrenia. Recent studies have follow up study with randomised control. The identity and addresses pointed to increased MPV values in schizophrenia. In many diseases the of schizophrenia patients who have been to Bolu Public Mental Health red cell distribution width (RDW) has been related to inflammatory Centre within the first 5 years of their illness have been listed. Among markers. The results on increased levels of RDW and MPV in this study these 60 patients who had not been given rehabilitation service were may represent the reported increased inflammation in schizophrenia. visited at home to explain the study and to invite the patients and their These data need to be supported with widerscale prospective studies. families to the centre. The participants were randomly distributed in Vitamin B12 has an important role in formation of red blood cells and the order they arrived such that 20 individuals were assigned to group the maintenance of a healthy nervous system. Many disorders including psychotherapy once a week and 20 individuals were put on the waiting dementia, depression, schizophrenia and other psychotic disorders, list for the painting arts work shop as part of the rehabilitation service alcohol dependency, mania and obsessive-compulsive disorder can be and 20 individuals were put on waiting list for psychotherapy. At associated with vitamin B12 deficiency. Therefore, scanning vitamin the very start (0) and at the 6th month, the participants were tested B12 levels in schizophrenia patients may produce the indication psychometrically for symptoms, functionality and quality of life. In of a relationship with the pathophysiology of the disorder such that order to avoid bias in the measurements and evaluations, these were replacement therapy may result in dramatic improvements. carried out by a ‘blind’ psychiatrist not informed of the study design and protocols. The participating patients continued to consult weekly Keywords: Atherosclerosis, mean thrombocyte volume, red cell the physician conducting their follow up controls, and the psychiatrists distribution width, schizophrenia, thrombocyte counts were instructed to inform the research group of any incident of flare up and any pharmacotherapy given to the patients. REFERENCES Carmel R, Gott PS, Waters CH et al. , (1995) The frequently low RESULTS: The data accumulated by the study have shown that the cobalamin levels in dementia usually signify treatable metabolic, three groups did not differ significantly on grounds of age, gender, level neurologic and electrophysiologic abnormalities. Eur J Haematol of education, marital status, socioeconomical level and the duration of 54:245–253. the disorder. The regular follow up on the three patient groups over 6

36 months has shown that their scores on functionality, life quality and the controls (C). The Verbal Memory Processes Test (VMPT) was used symptoms of all groups improved significantly as compared to the in order to assess the verbal memory and the learning functions of the corresponding scores before joining the study. Intergroup comparisons of participants, and the Digists Backwards Test (DBT) was used to assess the scores showed that the improvement in the functionality, life quality the working memory. and symptoms scores of the group assigned to group psychotherapy RESULTS: Sociodemographically, the three groups of participants were significantly higher than those of the groups assigned to painting did not differ significantly with respect to age and level of education work shop and psychotherapy waiting lists. (p>0.05). On the VMPT, the scores of the SC user group on the CONCLUSION: This study has demonstrated that all regular subscales of maximal learning (p<0.001), total learning (p<0.001) and interventions made to improve the condition of schizophrenia patients recall (p=0.003) were significantly lower; and their scores on the repeat have resulted in improvements in the functionality, life quality and counts (p<0.001) and recognition (p=0.003) were significantly higher symptoms of the disease. It has been shown that when group therapy when compared to the corresponding scores of the control group. These focused on interaction is added on a regular basis to the routine follow results may be explained as being the indication of a bad performance RESEARCH AWARD CANDIDATES RESEARCH AWARD up control and treatment of schizophrenia patients, the improvement relying on repetitive attempts to reach maximal learning, and as less observed in the functionality, life quality and symptoms is significantly words are remembered on their own, more attempts to recognise words different from that seen after individual clinical interviews and routine through clues (and hence the high scores). Also the SC user group had rehabilitation services. significantly higher scores on the wrong learning (p<0.001) and wrong recall (p<0.001) VMPT as compared to the control group. Studies in Key Words: Early phase schizophrenia, functionality, group therapy, the literature on memory, the determined multiple intrusion errors were quality of life attributed to bad performance. In the NC user group, the scores on REFERENCES the maximal learning (p=0.010) and total learning (p=0.003) subscales De Bosset F (1991) Group psychotherapy in chronic psychiatric were also significantly lower compared to the controls, while the scores outpatients: a Toronto model. International Journal of Group on wrong learning (p<0.001), total repetitions (p=0.003 and wrong recall Psychotherapy 41:65–78. (p=0.006) were significantly higher than those of the controls. The SC De Chavez MG (2000) Comparative study of the therapeutic factors of user and the NC user groups did not differ significantly on the scores group therapy in schizophrenic inpatients and outpatients. Group related to memory function tests (p>0.05) (Table 1). In the DBT, as Analysis 33:251–64. distinct from the Digits Forward Test, it becomes necessary to store Seikkula J, Aaltonen J, Alakare B et al. , (2006) Five-year experience some data and the formation of a new digit span using the working of first-episode nonaffective psychosis in open-dialogue approach: memory, requiring the simultaneous activation of both the working treatment principles, follow-up outcomes, and two case studies. memory and the recall processes (Karakaş et al. , . 2002). In the DBT, Psychotherapy Research 16:214–28. scores of the SC user group were significantly lower as compared to both Smith J (1999) Five questions about group therapy in long-term the control group (p<0.001) and the NC user group (p=0.010); whereas schizophrenia. Group Analysis 32:515–24. similarly significant differences were not determined between the latter two groups (p>0.05) (Table 1). Comparison of the Participants’ Scores on the WMPT and the DBT RAC-29 Control gp Natural C (NC) n: 145 SC gp (n: 52) (n: 48) gp (n: 45)

χ2 EVALUATION OF THE VERBAL LEARNING AND Mean ±SD Mean ±SD Mean ±SD p MEMORY PROCESSES OF INDIVIDUALS USING (df: 2) Verbal Memory SYNTHETIC CANNABINOIDS AND COMPARISONS Processes Test MADE WITH INDIVIDUALS USING NATURAL (VMPT) Momentary CANNABINOIDS 4.89±1.43 4.19±1.59 4.22±1.59 5.838 0.054 learning Hanife Yilmaz Çengel, Müge Bozkurt, Ekrem Cüneyt Evren Maximal learning + 12.72±1.93 10.96±2.03 11.60±2.03 16.500 0.001* Maximum Bakirköy Prof. Dr. Mazhar Osman Mental Health and Neurological 7.70±2.01 7.61±2.13 8.26±1.76 2.743 0.254 Diseases and Research Hospital, Psychiatry Department, Istanbul Repetiton Repetion counts++ 9.33±1.29 9.94±0.41 9.93±0.33 18.937 0.001* INTRODUCTION : Synthetic cannabinoid (SC) use is steadily Total Learning+# 98.14±16.94 84.00±16.71 87.73±16.65 9.384 (F) 0.001* increasing worldwide and confronts us as a very serious public health Recall+++ 10.79±2.22 8.55±2.59 9.44±2.67 17.678 0.001* problem (Evren et al. , 2013). The alterations caused by natural cannabinoids (NC) and other similarly used substances in the brain Recognising++++ 3.89±2.14 5.32±2.27 5.00±2.30 9.776 0.008* have been demonstrated by many studies. In a recent review evaluating Total Recall 14.68±0.74 13.86±2.31 14.46±1.03 4.949 0.084 Wrong Learning the acute and the chronic effects of NC concluded that the most distinct 0.16±0.47 1.96±2.37 1.82±1.66 41.150 0.001* ++ impairment was seen in verbal learning and memory functions. These functions have not been studied comparatively in SC users, a well Wrong Recall++ 0.06±0.24 0.50±0.75 0.37±0.71 14.314 0.001* Digits Backwards matched control group and NC users. The aim of our work was to 4.72±1.08 3.82±0.90 4.40±1.03 15.509 0.001* Test+++++ (DBT) investigate the likely deficits of verbal learning and memory functions in individuals with SC use disorder and to compare the results with those Statistical Analyses Used: Kruskal Wallis, # One Way ANOVA, (F) F of NC users and healthy volunteering controls not using any substances. value, *p<0.01, +SC, CC, +++SCC, +++++SC

37 on storing data and the subsequent recall of the stored data, the SC user Harvard Medical School and 21 healthy controls were enrolled in group displayed a worse performance as compared to the controls and this study. By means of a psychometric battery of tests the following the group using natural cannabinoids. However, not observing similar five separate visual functions were evaluated: Visual-spatial working impairment of the short term (momentary) memory component of memory (VSWM); speed discrimination (SpD), side binding (SB), the working memory suggests that the recall component of working dimensional perception (DP) and backward visual masking (BVM). memory rather than the storage component is affected in the SC user. Severity of schizophrenia was assessed by the Positive and Negative Impairment of the learning functions independently from the effects Symptoms Scale (PANSS) and the schizotype in the control group was of recall has also been observed in the natural cannabinoid user. As the assessed by the Schizotypal Personality Questionnaire (SPQ). observed losses in verbal memory and learning functons in the SC user RESULTS: Schizophrenia patients performed significantly worse in are expected to lead to social, academic, professional and communication problems as well as the success of any therapy given, directing these the VSWM, SpD and SB tests as compared to the controls (p<0.005); patients to different and, particularly, personalised psychotherapeutic but significant differences between the patients and the controls were not determined in the DP and BVM tests. The VSWM and SpD RESEARCH AWARD CANDIDATES RESEARCH AWARD methods, and also development of academic and professional programs adjusted to these patients may be important. performances were found to be correlated in both the patient and the control groups. The models obtained by discriminant function analysis Key Words: Cannabis, synthetic cannabinoid, learning, verbal memory, indicated that evaluation of the VSWM and SB test performances working memory together provided the highest discriminatory power with 71% REFERENCES specificity and 73% sensitivity in separating the patient and the control Evren C, Bozkurt M (2013) Sentetik kannabinoidler: son yillarin krizi. groups. Evaluation of the SpD and SB test performances yielded a Düşünen Adam Psikiyatri ve Nörolojik Bilimler Dergisi 26:1–11. discriminatory power with 66% specificity and 73% sensitivity. Given Broyd SJ, Van Hell HH, Beale C et al. , (2016). Acute and chronic that schizophrenia is a spectrum disorder, it appeared that the control effects of cannabinoids on human cognition-a systematic review. group was actually a heterogeneous group, including individuals Biological psychiatry 79 (7): 557–567. with neurodevelopmental and cognitive characteristics in common Ilan AB, Smith ME, Gevins A (2004). Effects of marijuana on with psychosis patients but not having developed psychosis. Since a neuropsychological signals of working and episodic memory. method intended to assess risk factors must identify individuals with Psychopharmacology (Berl) 176 (2): 214–22. a neurocognitive profile that is common with psychotic individuals, Karakaş S, Yalin A, Irak M et al. , (2002) Digit span changes from . a second discriminative analysis was carried out to reach a more puberty to old age for different levels of education. Developmental homogenous group of controls whose cognitive profiles did not include Neuropsychology 22 (2): 423–453. similarities to that of the psychosis patients in having a SPQ score under the 75th percentile. In the second analysis the SpD and the SB test scores together were found to discriminate the patient and the control group with 75% specificity and 88% sensitivity. The combined scores RAC-30 of SpD and SB correlated significantly with the negative symptoms of schizophrenia (p=0.004) and of schizotypal characteristics of psychosis HOLISTIC EVALUATION AND INVESTIGATION patients (p=0.005). OF THE RELATION WITH CLINICAL CONCLUSION: This study has shown that the combined visual- CHARACTERISTICS OF THE VISUAL PERCEPTION perceptual working memory and speed discrimination functions and CHANGES IN SCHIZOPHRENIA the combined side binding and speed discrimination functions had the Halide Bilge Türközer1, Volkan Topçuoğlu1, Yue Chen2, power to discriminate the psychosis patients from healthy individuals. Tuna Hasoğlu2, Emre Kale3, Zahide Pamir4, Hüseyin The correlation of these combined scores, obtained from the specific tests, with the symptom severity are not only useful for assessment of Boyacı4, Gina Kuperberg5, Eve Lewandowski2, Dost Öngür2 disease state but also to assess the liability of the individual to psychotic 1Marmara University, Psychiatry Department disorders. These finding indicate that the combined investigation 2McLean Hospital, Harvard Medical School of visual perception impairments can easily enable evaluation of the 3Ankara University, Brain Research, Applications and Research Centre neurodevelopmental spectrum of psychotic disorders. The future aims 4Bilkent University, Psychology Department; National MRI Research include the use of these combined visual perception tests as indicants for Centre (UMRAM) the identification of individuals under risk, for early diagnosis and the 5Department of Psychology, Tufts University; Department of Psychiatry, prediction of the course and the response to treatment of the psychotic Massachusetts General Hospital disorders. . INTRODUCTION: A high prevalence of multiple changes in the Key Words: Cognitive symptoms, psychosis, schizophrenia, schizotype, different functions of visual perception in schizophrenia, which are visual perception partly observable in the early stages of the disorder before the appearance REFERENCES of psychotic symptoms, has been reported. However, these changes, 1Herzog MH, Kopmann S, Brand A (2004) Intact figure-ground which take place in a very intricate setting, do not have a predictive segmentation in schizophrenia. Psychiatry Research 129, 55–63. significance by themselves. This study has aimed to find out which Silverstein SM, Keane BP, Barch DM et al. , (2012) Optimization and of the visual perception alterations when investigated in combination validation of a visual integration test for schizophrenia research. would provide the most distinct discrimination between the patient Schizophrenia Bulletin 38:125–34. and the control groups, and to investigate the relationship between the Solanki RK, Swami MK, Singh P et al. , (2012) Identification combined visual perception performance indicators and the severity and of Vulnerability among first-degree relatives of patients with schizotypal characteristics of schizophrenia. schizophrenia. East Asian Archives of Psychiatry 22:118–25. METHODS: With the above cited aim of the study, 26 schizophrenia Yang E, Tadin D, Glasser DM et al. , (2013) Visual context processing and schizoaffective disorder patients consulting McLean Hospital, in schizophrenia. Clinical Psychological Science 1:5–15.

38 Yoon JH, Sheremata SL, Rokem A et al. , (2013) Windows to the METHODS: Our study enrolled 51 patients arriving consecutively soul: vision science as a tool for studying biological mechanisms of at out polyclinic between February and June of 2015 and 51 healthy information processing deficits in schizophrenia. volunteers who were did not to have any psychiatric disorders. Diagnostic evaluations were made on the SCID-I. Subsequently the participants were asked to complete a sociodemographic questionnaire. Clinical evaluations were made on the Liebowitz Social Anxiety Scale (LSAS), RAC-31 the State-Trait Anxiety Inventory (STAI) and the Beck depression Inventory (BDI). In order to evaluate the cognitive characteristics, the COGNITIVE DISTORTIONS IN PATIENTS WITH Assessment of Thinking Styles Inventory (ATSI), and the Automatic SOCIAL ANXIETY DISORDER Thoughts Scale (ATS) were used. All data were coded numerically and statistically analysed on the SPSS 15.0 program. Erkan Kuru1, Yasir Şafak2, İlker Özdemir3, Kadir Özdel2, Sibel Örsel2, Hakan Türkçapar4 RESULTS: The patient and control groups did not differ significantly RESEARCH AWARD CANDIDATES RESEARCH AWARD 1Karamürselbey Training Centre Command Headquarters/Gölcük on grounds of age, gender, marital status and the level of education. Military Hospital The patient group consisted of 33 (64.7%) males, 35 (68.6%) single 2Ankara Dişkapi Yildirim Beyazit Training and Research Hospital individuals; 43 (84.3%) with comorbid Axis-I diagnoses, in the order 3Tavşanli Doç Dr. Mustafa Kalemli State Hospital of frequency: dysthymia additional SCID diagnosis, simple phobia, and 4Hasan Kalyoncu University depression. INTRODUCTION: Social anxiety disorder (SAD) has been described Mean total score of the patient group on LSAS was 123.19 (±27.14). as the behaviour of abstention from behaving in a manner that can be When the patient and the control groups were compared on the bases of criticised or refrainment from exhibiting signs of such abstention or depression, state-and trait anxiety, cognitive distortions and automatic worry under conditions of exposure to evaluation by others. Although thoughts, the scores on all the tests differed significantly (Table. 1). the role of many variables have been specified to explain the underlying The ATSI which evaluates cognitive distortions according to types, the causes of SAD, the models which explain the cognitive-behavioural highest scores on the social situations were on interpreting feelings, reading processes have been found to be more related to the development minds, labelling; and the highest scores on the personal achievement of chronicity in SAD. According to the cognitive model developed subscale were on reading minds, labelling and catastrophizing. Significant to explain SAD, individuals, who worry about being in a social differences were determined between the scores of the patients and the environment, have non-functional thoughts and beliefs about their type controls in all subscale items (p<0.05). When the patients were divided of behaviour and the manner of the judgement by others. These non- into two groups as those with and without comorbidities, significant functional evaluations make the individual to systematically evaluate differences were determined in scores of the two patients groups and the and restructure experiences leading to cognitive distortions which controls (p<0.05). Correlations existed between the ATSI score which are cognitive structures based on the individual’s important beliefs or assesses the cognitive distortions and the ATS, state-trait anxiety levels, schemas, and become apparent when information processing is wrong social anxiety and depressive symptoms (Table 2). or ineffective. Beck had proposed 7 cognitive distortions characteristic of individuals with depression which were expanded to 10 by the CONCLUSION: In this study on the cognitive processes in the subsequent studies of Burns. Individuals diagnosed with anxiety were SAD clinic, when testing our hypothesis by evaluating the cognitive also found to make more cognitive distortions than healthy individuals. processes and cognitive distortions according to the ATSI, significant There are limited studies on SAD in the literature, and none identify differences were found between the patients and the controls on the the more characteristic cognitive distortions in SAD. In some studies, mean total score, mean subscale scores and the material mean scores SAD patients have been reported to exaggerate some social events as assessed separately. This suggested that cognitive distortions became catastrophes in comparison to patients with other anxiety disorders. manifest more frequently in the SAD group as compared to the control group. Despite the differences between some of our obervations and the Cognitive behavioural therapy (CBT) for SAD is based on finding more previous studies in the literature investigating the cognitive processes functional evaluations in agreement with reality instead of those which in SAD, there is agreement in our finding that cognitive distortions are non-functional. One of the fundamental components of CBT is are associated with social worry. When evaluated on the basis of on awareness of cognitive distortions and changing them. Studies have ATS, determination of statistically significant differences between the referred to the importance of changing cognitive distortions by BDT. In patients and the controls indicate that non-functional thoughts are a study carried out with adolescents, using the scale for non-functional more frequent in the SAD patients as compared to healthy individuals. cognitive errors in children comprising catastrophizing. personalisation, There were correlations between the ATSI total and subscale scores and filtering and overgeneralising, the BDT given patients and the control the STAI state and trait subscales, the correlations with the STAI trait patients were compared, and BDT was found to result in significant subscale being higher. The correlation between the ATSI total score reduction of the scores on the four tested cognitive distortions. The and STAI trait was also higher than the correlation with the LSAS total most important intervention in SAD is to determine the frequently score and the correlation with BDI total score. In the study by Özdel observed non-functional cognitive distortions in the cognitive area et al. , (2014) on depressive patients and healthy controls, it has been concerned, which significantly contributes to the process of treatment. emphasised that cognitive distortions were more associated with the Understanding SAD from the angle of cognitive distortions could general anxiety level as against depression. Alsen et al, also reported be an effective area for intervention easing the process of treatment. that the tendency to negative interpretations were not associated with Hence, the hypothesis of our study was that patients with SAD had depression. These observations have suggested to us that the social more cognitive distortions than healthy individuals and that this worries are associated with the meaning given by the individual (non- was associated with their anxiety level. The aims of our study was to functional beliefs-cognitive distortions) to social experiences, rather determine the role of cognitive distortions and automatic thoughts, to than to their depressive symptoms. We have found that the cognitive investigate the relationship of these with the severity of anxiety, and distortions generally studied in depression patients were related to assess the differences in the cognitive distortions between the SAD not only to social anxiety but also to general anxiety, which has also patients and healthy individuals. been reported recently by others, and may change the views about

39 cognitive distortions. Although our study is the first of its kind on SAD RAC-32 patients in Turkey, it has limitations. The presence of high scores on all the cognitive distortions tested in the study in the patient group as INCIDENCE AND CHARACTERISTICS OF BODY compared to the controls did not give us clues as to which cognitive DYSMORPHIC DISORDER IN PSYCHIATRIC distortion was specific to SAD. One of the reasons for this is the high INPATIENTS: A CROSS SECTIONAL STUDY IN A incidence of comorbidities in the SAD group leading to the question REGION OF TURKEY whether the high scoring was the result of social anxiety symptoms or the comorbidities. Relationship between SAD and cognitive distortion Yasin Taşdelen1, Yüksel Kıvrak2, Mehmet Aşoğlu3, should be studied by eliminating these limitations. Rugül Köse Çınar4, Ercan Abay5 1 Key Words: Anxiety, cognitive behavioural therapy, cognitive distortion, Edremit State Hospital Psychiatry Clinic, Çanakkale 2 social phobia Kafkas University Medical School, Psychiatry Department, Kars 3Harran University Psychiatry Department, Şanliurfa

RESEARCH AWARD CANDIDATES RESEARCH AWARD The mean, standard deviation and p values on the scores of the 4Trakya University Psychiatry Department, Edirne SAD group and the control group on the BDI, STAI, ATSI and 5Kemerburgaz University Psychiatry Department, Istanbul ATS tests INTRODUCTION: (BDD) is a condition SAD Group SAD Group Control Group Control Group of worry and mental obsession about a perceived body imperfection s.

Test Scales Mean Std. Devn. Mean Std. Devn. p value Patients with BDD do not attempt to seek psychiatric treatment for their anxiety about their appearance. Due to the reduction in their Beck Depression 23.66 10.97 4.83 4.68 <0.001 insight, they seek other than psychiatric interventions to correct the Inventory perceived flaw. Many expose themselves unnecessarily to dermatological STAI-State 96.55 11.73 86.86 11.99 <0.001 interventions or cosmetic surgery. Due to BDD, their life quality suffers

STAI-Trait 90.04 10.28 73.98 9.93 <0.001 and their mental health scores are worse than those of patients who have had recent cardiac infarction, or patients with depression, obsessive- ATSI total 83.43 25.17 58.45 23.22 <0.001 compulsive disorder, bipolar disorder, schizophrenia and diabetes. ATSI Social Many cannot attend school or go to work. Wanting to be hospitalised, 42.00 13.05 29.41 11.58 <0.001 Situation suicidal ideation and suicidal attempts are quite frequent. Completed ATSI Personal suicidal attempts exceed those seen in eating disorders, major depressive 41.43 12.79 29.04 11.99 <0.001 Achievement disorder and bipolar disorder and is 40 fold higher than in the general

ATS total 84.71 32.21 51.11 22.48 <0.001 population. Prevalence of BDD in the general population changes in the range of 1.7–2.4%, but the prevalence is higher in the patient Correlations Between the ATSI score and the Scores on AST, subpopulation, such that, it is 1.8-% 6.7% in outpatients, 13.1-% STAI and BDI of the SAD group 16.0% among inpatients and can reach 25% among the plastic surgery patients. Among psychiatry outpatients BDD prevalence varies in the Assessment of range of 0.8 with% 3.2%. In the sources we have reached, there are only ATS- STAI- STAI- Thinking LSAS BDI Total Trait State four studies carried out in Europe or the USA evaluating the prevalence Styles Inventory of BDD among psychiatry outpatients. The situation in Turkey is not Total , 656 (**) , 405 (**) , 684 (**) , 491 (**) , 634 (**) known. The reported prevalence in the western countries range between 1.9% and 16%. One reason for the difference in the% values may be Social Situation , 662 (**) , 380 (**) , 676 (**) , 462 (**) , 614 (**) the different methods of determination, another may be the cultural Personal differences. We have planned this study to find out the prevalence of , 616 (**) , 408 (**) , 657 (**) , 494 (**) , 621 (**) Achievement BDD in Turkey as well as to reduce this uncertainty in the literature. ** p<0.01 METHODS: REFERENCES Sample: Criteria for enrolment in the study were being an inpatient Aydin A, Tekinsav-Sütçü S, Sorias O (2010) Ergenlerde Sosyal Anksiyete and volunteering to participate; and the criteria for exclusion were being Belirtilerini Azaltmaya Yönelik Bilişsel-Davranişçi Bir Grup Terapisi above 65 years of age or below 18 years of age, in the acute psychotic Programinin Etkililiğinin Değerlendirilmesi. Türk Psikiyatri Dergisi phase, acute manic phase, mentally retarded and unable to understand 21:25–36. the tests and make an interview. Fistikçi N, Keyvan A, Erten E et al. , (2015) Sosyal Anksiyete Bozukluğunda Bilişsel Davranişçi Terapi: Güncel Kavramlar. Evaluation Tools: The SCID-I and the SCID-II Implementations: Psikiyatride Güncel Yaklaşimlar 7:229–243. Approval was obtained for the research and it was carried out with O’Toole MS, Mennin DS, Hougaard E et al. , (2014) Cognitive and inpatients of the Trakya University Mental Health and Diseases emotion regulation change processes in cognitive behavioural department Services between the dates of 15.01.2012 and 15.07.2012 therapy for social anxiety disorder. Clinical Psychology & when 160 patients were admitted to the clinic. The committee decisions Psychotherapy 22 (6), 667–676. were accepted for the diagnoses. Patients were invited to the examination Özdel K, Taymur I, Guriz SO et al. , (2014) Measuring cognitive errors room and informed of the study. Psychiatric interviews were carried out using the cognitive distortions scale (CDS): psychometric properties with the patients consenting to participate in the study. Of the patients in clinical and non-vlinical samples. PLoS ONE 9 (8): e105956. admitted, 40 did not meet the study criteria, 15 refused to participate and 5 failed to complete the questionnaires, and were excluded from the study which was conducted with 100 patients. . RESULTS: Mean age of the patients being 37.4 (±10.6), 51% were females and 49% were males; 64% were married; 36% were single; 2% were just able to read and write; 29% had primary school, 32

40 had middle school, 28% had lycée; and 6% had a 2-year professional this study in a single region of the country and in a third degree health education and 3% had a university diploma. The most frequently care institute is a limitation in not reflecting the situations in the wards diagnosed disorder among the inpatients were bipolar disorder acute of treatment centres in other regions of the country. manic attack, major depressive disorder, psychotic depression, alcohol In conclusion, according to our study none of the inpatients with BDD dependency and schizophrenia, with the other disorders being of 3% are diagnosed with this disorder. All patients with BDD have appearance incidence or lower (Table 1). anxiety and mirror control, and attempt to conceal the flaw or spend For those who were and were not diagnosed with BDD comorbidity the more than one hour with body image anxiety. parameters of (1) age, (2) BMI and (3) the number of hospitalisations Key Words: Body dysmorphic disorder, body image, inpatient, Turkey were found to be, respectively, (1) 36.6±13.4, 37.4±10.5, p=0.607; (2) 23.7±4.5, 26.5±5.8, p=0.337; and (3) 1.86±1.46, 1.88±1.86, p=0.942. Diagnoses for admitting the patients to hospital ward

When those who were and were not diagnosed with BDD comorbidity Diagnosis n % were compared with respect to gender (male 6.1% vs% 93.9; female% Psychotic depression 10 10 CANDIDATES RESEARCH AWARD

7.8 vs, % 92.2, p=1.000), place of birth (town, 8.3% vs 91.7% ; district, General anxiety disorder 2 2 10.8% vs 89.2% ; village 100%, p=0.282), marital status (single 8.3% vs Bipolar disorder acute manic attack 33 33 91.7% ; married 6.3% vs 93.8%, p=0.700) significant differences were Schizophrenia 9 9 not found. When compared with respect to anxiety about appearance (100% vs 0, p<0.001), mirror control (100% vs 0, p<0.001), behaviour to Atypic Psychosis 1 1 conceal the flawed body area (100% vs 0, p<0.001) significant differences Major depression 15 15 existed. While personality disorder was found in all of those with BDD Affective disorder 3 3 comorbidity, personality disorder was found in 59.1% of those without Post Traumatic stress Disorder 1 1 the BDD comorbidity (p<0.05). No differences were found with respect Bipolar disorder depressive attack 1 1 to prevalence of personality difference in the two groups (p<0.05) (Table Alcohol dependency 10 10 1). While 71% of those with BDD comorbidity spent over 3 hours on Alcohol abuse 1 1 anxiety about appearance, only 1 person (1.1%) in the group without Substance dependency 2 2 BDD comorbidity spent time on this and the prevalence was significantly different in the two groups (p<0.05) (Table 2). Anorexia nervosa 2 2 Obsessive-compulsive disorder 2 2 CONCLUSION: This is the first study to show that the BDD Adjustment disorder 1 1 prevalence among inpatients of a psychiatry clinic in Turkey was 7% Schizophrenia +body dysmorphic disorder 3 3 ; and it is the fifth study on the subject in the world and the first in a muslim country. The study confirms that not only clinicians other Alcohol dependency + body dysmorphic disorder 1 1 Bipolar disorder manic attack+ body dysmorphic than psychiatrists but also the psychiatrist are unable to diagnose BDD. 1 1 disorder If the patients are questioned with this objective, frequency of the diagnoses increase. The study demonstrates that all of those with BDD Major depression+ body dysmorphic disorder 1 1 comorbidity have anxiety about appearance, mirror control, attempt Somatoform disorder+ body dysmorphic disorder 1 1 to conceal the perceived flaw, personality disorder diagnosis and spend Total 100 100 more than 1 hour with appearance anxiety. None of the patients, unless Time spent by BDD patients due to appearance anxiety and asked questions specifically about BDD, have given information on this personality disorder subject. When the inpatients have been queried with this objective it was possible to discover BDD. We have discovered in our study that BDD comorbidity all patients with BDD had anxiety about appearance, mirror control None n (%) There is n (%) p and the behaviour of concealing the perceived body flaw. This indicates Personality disorder that next to querying anxiety about a bodily flaw, it would be useful to None 38 (100) 0 (0) 0.042 query the other two characteristic behaviours as well. We believe that There is 55 (88.7) 7 (11.3) this study will have some effects such as, firstly, as a useful guide to psychiatrists. Since BDD escapes the attention unless queried, it should Time spent also be queried with outpatients attending the psychiatry polyclinics. None 92 (97.9) 2 (2.1) <0.001 Secondly, the findings of this study may be useful for academicians There is 1 (16.7) 5 (83.3) giving psychiatry and medical training. During the psychiatry course REFERENCES it could be lectured with emphasis that BDD escapes the eye and is Fang A, Wilhelm S (2015) Clinical features, cognitive biases, and not diagnosed unless queried. Thirdly, the findings could be useful treatment of body dysmorphic disorder. Annu Rev Clin Psychol for plastic surgeons. They may know that BDD is easily skipped by 11:187–212. the psychiatrists and can ask for psychiatry consultation. Fourthly, the Fang A, Matheny NL, Wilhelm S (2014) Body dysmorphic disorder. results of this study may be useful for the researchers in psychiatry. Psychiatr Clin North Am 37 (3): 287–300. Although we have demonstrated the presence of appearance anxiety, Phillips KA (2006) The Presentation of Body Dysmorphic Disorder in mirror control, attempts to conceal the perceived flaw in all BDD Medical Settings. Prim Psychiatry 13 (7): 51–9.3. patients who also spend more than 1 hour on worries about appearance, these behaviours may not be typical in other geographical areas and cultures. Studies made in culturally different settings to repeat this study may confirm the findings and open the way for easier diagnosis of the disorder. The study has limitations. First of all the sample size is small. This may not be important when considering that the two of the other studies were conducted with 100 and 101 participants. Carrying out

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ORAL PRESENTATIONS

ORAL PRESENTATIONS

43

ORAL PRESENTATIONS

OP-001 DISCUSSION: It has been determined in this study that the obese candidates for BS were significantly more depressive and more anxious INVESTIGATION OF DEPRESSION AND as compared to individuals with normal body weight and their MMPI ANXIETY SEVERITY AND PERFORMANCE ON profiles were also significantly more pathological. We believe that THE MINNESOTA MULTIPHASIC PERSONALITY investigation of the obese patient before BS will not only assist the selection of the correct patient but also contribute to the success of INVENTORY OF OBESE INDIVIDUALS CANDIDATE weight losing for the treatment of the observed pathologies. FOR BARIATRIC SURGERY. Keywords: Anxiety, bariatric surgery, depression, MMPI, obesity Esra Ekinci1, Pervin Sevda Bıkmaz1, İskender Ekinci2, Seda Turgut2, Mahmut Muzaffer İlhan3, Özcan Karaman4, References Ertuğrul Taşan4 Beck AT, Brown G, Epstein N et al., (1988) An Inventory for Measuring Clinical Anxiety: Psychometric Properties. Journal of Consulting 1Haliç University, Social Sciences Institute, Psychology, Istanbul and Clinical Psychology, 56(6):893-897. 2Bezmialem Vakıf University, Internal Diseases Department, Istanbul Graham, J. R., Schroeder, H. E., Lilly, R. S. (1971). Factor Analysis of 3Ümraniye Training and Research Hospital, Endocrinology and Metabolic Items on The Social İntroversion and Masculinity- Feminity Scales Diseases Department, Istanbul of the MMPI. J Clin Psychol, 27:367-370. 4Bezmialem Vakıf University, Endocrinology and Metabolic Diseases Hisli, N. (1989). Beck Depresyon Envanterinin Üniversite Öğrencileri Department, Istanbul İçin Geçerlilik ve Güvenilirliği. (Validity and Reliability of the Beck AIM: To determine the depression and anxiety severity in obese Depression Inventory for University Students), Türk Psikoloji

individuals and investigate their personality characteristics on the Dergisi, 7:3-13. ORAL PRESENTATIONS Minnesota Multiphasic Personality Inventory (MMPI). METHODS: This study was carried out at Bezmialem Vakıf University with 60 obese (44 females, and mean age of 39.8 years) and 63 normal OP-002 individuals with normal body weight (49 females, and mean age 35.3 years). The participants were asked to complete the Beck depression STRESS RESILIENCE OF THE PARENTS OF inventory (BDI), the Beck anxiety inventory (BDA) and the MMPI. The SUBSTANCE DEPENDENT INDIVIDUALS BDI and BDA consist of 21 questions with 0-63 scores (1,2). MMPI 1 2 has 566 questions, including the validity subscales L(lie),F (infrequent), Suat Ekinci , Hanife Uğur Kural 1 K(defensiveness) and CNS (can not say), and the clinical subscales Avrupa MYO 2 on (Hs), depression(D), hysteria (Hy), psychopathic Fransız Lape hospital deviate (Pd), masculinity/femininity (MF), (Pa), psychastenia AIM: The aims of this study were to investigate the stress resilience (SR) (Pt), schizophrenia (Sc), hypomania (Ma) and social introversion (Si). level in the parents of individuals with and the T scores of <45 or >70 on any subscale are accepted as pathological. relationship between the SR level and the depression-anxiety severity. RESULTS: BMI in the obese was elevated as compared to the controls METHODS: The 40 parents of substance dependent inpatients at (respectively, 45.4kg/m2 vs 22kg/m2; (p<0.001). Obese group scores on Balıklı Rum Vakıf Hospital formed the SDP group and 40 healthy the BDA and BDI were significantly higher than those of the controls individuals, without any axis-I psychiatric disorders, and age and gender (respectively, 17.7±9 vs 8.5±6.7, p<0.001; and 18.4±10.5 and 8.1±5.8, matched with the SDP group,formed the control group. All participants p<0.001). In the obese group the T score on MMPI validity subscale completed a sociodemographic questionnaire, the Beck depression K was significantly lower as compared to the controls (45.3±10.3 vs inventory (BDI), the Beck anxiety inventory (BAI), the State-Trait 49.2±9.5 (p;0.033); but the T scores were significantly higher on the Anxiety Inventory(STAI), and the distress tolerance test (DTT); and following subscales: the validity subscale F (53.7±11.5 vs 49.2±9.8; were also interviewed on the Structured Clinical Interview for DSM-IV p;0.02); and the clinical subscales Hs(59.1±11.7 vs 50.9±8.6; p<0.001); Axis I Disorders (SCID-I) with a psychiatrist to assess any psychiatric D(59.1±11.5 vs 47.6±9; p<0.001); Hy(65.7±11.7 vs 55.9±8.9; disorder. p<0.001); Pd(57.4±11.3 vs 49.5±8.9; p<0.001); Pa(59.5±9.7 vs RESULTS 50.7±9.3; p<0.001); Pt(58.7±9.8 vs 49.8±8.3; p<0.001); Sc(57.7±11.1 : A significantly lower SR level was determined in the SDP vs 47.5±8.9; p<0.001); and Si(59.1±10.7 vs 50.5±8.1; p<0.001). The group as compared to the controls. Negative correlations were observed between the performance on the DTT and the performances on the pathological score incidence in the obese group were significantly BDI and BAI. At least one Axis-I disorder was diagnosed in 20 (50%) elevated as compared to the controls on the MMPI (%71.7 vs %14.3; individuals of the SDP group. A significant difference in SR between p:<0.001), on the BAI (20.7±10.6 vs 12.4±7.8; p<0,001) and on the those with and without psychiatric comorbidity was not detected. BDI (20±8.9 vs 11.9±6.3; p<0,001.). The T scores on the MMPI The SDP group had lowered SR level, and increased depression and validity subscale F and the clinical subscales Hs, D, Hy, Pd, Pa, Pt and anxiety levels, with a negative correlation between the SR level and the Sc were positively correlated with the BAI and the BDI scores. The BAI depression and the anxiety levels. score was also positively correlated with the T score on the clinical Ma subscale of MMPI; whereas the BDI scores were positively correlated DISCUSSION: The adverse effects of emotional disorders in the parents with the T score on the MMPI clinical subscale Si and negatively of substance dependent patients on the course of the treatment given correlated with the T score on the validity subscale K. to the patients were observed in studies on the subject. Therefore, we

45 believe that SR, and the levels of depression and anxiety in the parents DISCUSSION: It has been determined that individuals with substance of substance dependent individuals should be routinely investigated. dependency have more childhood experiences of exposure to physical abuse, and hence lower self-esteem and greater tendency to use Keywords: Anxiety, depression, parent, stress resilience, substance substances. The traumas experienced by the substance dependent dependency individuals adversely affected their relations and were reflected in their References personality construct. Fals-Stewart W, Kelley ML, Cooke CG et al., (2003) Predictors of the Keywords: Personality, substance dependency, Trauma, psychosocial adjustment of children in which fathers abuse drugs. Addict Behav, 28:1013–1031. 2. References Swendsen JD, Conway KP, Rounsaville BJ et al., (2002) Are personality Arıkan, G., Karancı, N. (2012) Attachment and coping as facilitators of traits familial risk factors for substance use disorders? Results of a posttraumatic growth in Turkish university students experiencing controlled family study. Am J Psychiatry, 159: 1760-1766. traumaticevents, Journal of Trauma&Dissociation, 13:2, 209-225 Gürol, D.T., Ögel, K. (2015) Aile ve Bağımlılık. (Family and Dependency). 02.09.2016 tarihinde (reached at) http://www.ogelk. net/Dosyadepo/aile.pdf adresinden erişildi. OP-003 Toker, T., Tiryaki, A., Özçürümez, G., İskender, B. (2011) Madde kullananlarda çocukluk örselenme yaşantılarının, madde kullanma INVESTIGATION OF THE TRAUMATIC eğilimi, benlik saygısı ve başaçıkma tutumları ile ilgisi. (Relationship EXPERIENCES AND THE BASIC TRAITS OF THE between of the childhood abuse experiences of substance users and RELATIONS OF INDIVIDUALS WITH SUBSTANCE their laibility to use substance, self esteem and coping strategies) DEPENDENCE Türk Psikiyatri Dergisi, 22(2):83-92 Hande Çelikay, Ebru Aldemir Ege University Substance Dependency, Toxicology and Drug Sciences OP-004 Institute, Substance Dependency Consultancy, Izmir

ORAL PRESENTATIONS AIM: Family relationships play a leading role in determining the INVESTIGATION OF THE LEARNED HELPLESSNESS social life experiences of the individual. Studies have been made on PATTERNS AND THE AUTOMATIC THOUGHTS OF the effectiveness of family attitudes in child raising on the acquisition INDIVIDUALS WITH A HISTORY OF SUBSTANCE of dependency behavior by the individual. This study has aimed at USE investigating the traumatic experiences and the traits of the relations of individuals with substance dependencies. Hande Çelikay, Ebru Aldemir Ege University Substance Dependency, Toxicology and Drug Sciences METHODS: This study was carried out with the relations of 103 Institute, Sunstance Dependence Consultancy, Izmir inpatients being treated for alcohol-substance dependence at the Ege University Medical School Hospital, Mental Health and Disorders AIM: Learned helplessness (LH) expresses the state of inaction as a Department, Substance Dependence Unit. The patients consisted of result of the belief by individuals in their lack of control and helplessness 13 (12.6%) females, and 89 (84.6%) males, with a mean age of 30 in the outcomes of their behavior on the face of events. The learned (±12); 29 (28.2%) being married, 61 (59.2%) being single; 54 (52.4%) helplessness scale (LHS) has been developed to assess the increasing educated at least up to the middle school level. The mean duration feeling of helplessness on face of events by the scientific weighting of substance use was 10.26 (±10.18) years, and 37 (32%) had a method. In this study the LH patterns and automatic thoughts of history of psychiatric treatment while 29 had been previously treated individuals on probation and being treated for substance use were on an outpatient (35.9%) or inpatient (28.2%) basis for substance investigated. dependency. The participants consisted of mothers (n=36, 35%), fathers METHODS: The participants consisted of a group of 212 males and (n= 15, 14.6%), wives (n= 15, 14.6%) and siblings (n=37, 35.9%) of 8 females on probation to be treated for substance dependence at Ege the patients, with 45% (n=46) educated at least up to the middle school University Substance Dependency, Toxicology and Drug Sciences level and 64.1% (n=66) being married. The participants completed a Institute, Substance Dependence Polyclinics. Mean age of the group was sociodemographic questionnaire, the Basic Traits Inventory (BTI) and 28.46 (±8.97); 58.6% were single; 68.2% were educated maximally up the Trauma Symptom Checklist-40 (TSC40). to the middle school grade; 78.3% had an income of 0-2000 TL; 74.1% RESULTS: The emotional instability scores of those participants, who lived with parents and 69.5% lived with wives. All participants were described their relationship with their substance dependent relations given a sociodemographic questionnaire and subsequently interviewed as bad, were significantly elevated (F (4, 92) =3.717, p=0.008). As on their history of substance use; and lastly asked to complete the compared to the male participants, the emotional instability scores of Learned Helplessness Scale (LHS) and the Automatic (negative) the female participants who complained of severe helplessness on the Thoughts Questionnaire- (ATQ). Least one type of prohibited substance face of trauma they experience was significantly high (F(1,94)=11.186, was found in the urine samples of the participants. p=0.001 vs F(2,86)=3.905, p=0.024). The negative self-esteem scores RESULTS: It was found out that the LHS scores of the participants were of the participants positively correlated with the increased duration of significantly decreased, as their own educational level and also those substance used by the dependent relations (r=0.21, N=96, p<0.05). of their mothers and fathers increased (respectively, F(6,202)=3.699, and were also significantly elevated with high counts of hospitalization p<0.01), F(5,198)=4,925, p=0.000) and F(5,194)=3.923, p<0.01). by the dependent relations (F (3, 89) =3.274, p=0.025). Scores on Also the LHS scores of the participants significantly decreased extraversion (F (4,83)=3.025, p=0.022) and openness to experience when their mothers and fathers were gainly employed (respectively, F(4,84)=3.531, p=0.010). Of those who experienced repeating traumas F(1,190)=3.844, p=0.05) and F(1, 176)=6.543, p=0.01). Correlation were significantly decreased. analyses showed significant positive correlations between the LHS

46 total score and the scores on ATS-N subscales negative emotions and history of psychiatric consultation and those who reported an increased thoughts (r=0.39, N=205, p=0.000); confusion and escape phantasies urge to smoke when drinking coffee or tea were also significantly (r=0.30, N=204, p=0.000); personal incompatibility (r=0.34, N=207, higher in comparison to the rest of the group (respectively, (p=0,02 p=0.000), loneliness (r=0.31, N=203, p=0.000); and helplessness and p=0,01). Among those who had previously attempted to give up (r=0.39, N=206; p=0.000). smoking (n=112, 78.3%), 104 (92.9%) had not taken any professional help, and the FNBT score of those who had been able to give up DISCUSSION: It has been known that cognitive-behavioral smoking for >1 year was significantly lower than those who had given interventions result in the reduction in the days of substance use, and up smoking for 1-3 months (p=0,01) or <1 month (p=0,01). the improvement of symptoms specific to substance dependence and comorbid disorders. Investigation of the cognitive functions of substance DISCUSSION: It was seen that severity of dependence was users is important for the implementation of treatment programs. associated with the numbers of cigarette smoked daily and the duration Keywords: Automatic negative thoughts, learned helplessness, of the attempts at giving up smoking. Also, drinking caffeine rich probation, substance dependency drinks such as tea and coffee increased the desire to smoke in those with high levels of dependency. It is proposed that, as the majority of References the participants had not received professional help in previous failed Anur H (2014) Anne-Babaların Yaşam Tutumu ile Çocukların attempts to give up smoking, specialized polyclinics for cessation of the Öğrenilmiş Çaresizlik Düzeyi Arasındaki İlişkinin İncelenmesi. smoking habit should be made available on a wider scale. (Investigation of the Relationship between Parental Attitude to Life and the Level of Learned Helplessness of the Children) Yüksek Keywords: Cigarette smoking dependence, Fagerstrom, nicotine Lisans Tezi, Mersin Üniversitesi, Mersin. dependence, smoking cessation polyclinics Boysan, M. (2006) Çok Örneklemli Yapısal Eşitlik Modelleri. (Multi Sampled Structural Equivalence Models) Yüksek Lisans Tezi, Yüzüncü Yıl Üniversitesi, Van. 3. Quinless, F.W., Nelson, M.A., OP-006 (1988) Development of a Measure of Learned Helplessness. Nurs. Res. 37,11–15. EFFECT OF CHRONIC CIGARETTE SMOKING ON COGNITIVE FUNCTIONS ORAL PRESENTATIONS

OP-005 Gülcan Güleç, Özlem Akarsu, Ferdi Köşger, Altan Eşsizoğlu, Erdi Sezer, Olcay Sonkut COMPARISON OF INDIVIDUALS CONSULTING Eskişehir Osmangazi University Medical School, Psychiatry Department, SMOKING CESSATION POLYCLINICS (QUIT Eskişehir SMOKING SERVICES IN HOSPITALS) ON THE BASIS AIM: The aim of this study was to evaluate the cognitive functions of OF THE LEVEL OF THEIR NICOTINE DEPENDENCE individuals who smoked cigarettes, who had given up smoking and those who had never smoked, in order to investigate the effects of 1 2 1 Dilek Sarıkaya Varlık , Cenk Varlık , Özgür Çağla Cenker , the wide spread cigarette smoking habit on cognitive functions in the 3 Cenk Ercan general population. 1Kaçkar State Hospital, Psychiatry Department, Rize 2Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological METHODS: This study included individuals between the ages of Diseases and Research Hospital, Psychiatry Department, Istanbul 18 and 55 years, with at least primary school education, and without 3Recep Tayyip Erdoğan University, Psychiatry Department, Rize any axis-1 psychiatric disorders, and any substance dependence except cigarette smoking, any neurological disorders or history of cranial AIM: Nicotine dependence is one of the most important factors in trauma and not on any drug treatment effective on the cognitive the maintenance of the smoking habit and the failure of the treatment functions. The participants consisted of 71 cigarette smokers who had intervention. In this study we have aimed at investigating the nicotine smoked at least 10 cigarettes per day for over 2 years; 39 individuals dependence severity of the patients consulting hospital polyclinics for who had given up smoking after having smoked for at least 2 years 10 quitting smoking and the factors associated with the smoking habit. cigarettes per day or more, and 49 individuals who had never smoked METHODS: This study has enrolled 143 volunteers out of the 160 cigarettes, making up three groups. All participants were conducted patients consulting the smoking cessation polyclinics a state hospital through the structured clinical interview for DSM-IV axis-1 disorders between December 2015 and February 2016. The participant group and also completed the Hospital Anxiety Depression Scale (HADS) and consisted of 49 (34.3%) females, 107 (74.8%) married individuals, with a battery of neurocognitive tests. The three groups were compared using 75 (52.4%) educated to lycee level or above, 66 (46.2%) with regular the 3-factor covariance analysis in order to eliminate the effects of the employment, 21 (14.7%) on continuous drug treatment, 36 (25.2%) intergroup differences with respect to age, gender and level of education with a history of psychiatric consultation, 13 (9.1%) using psychiatric on the experimental results. medicines, 104 (72.7%) having had cigarette smoking parents and RESULTS: According to the results of the 3-factor covariance analyses, 33(36%) having cigarette smoking spouses. The participants were asked scores of the smokers on HAD-anxiety subscales, HAD-depression to complete a sociodemographic questionnaire and the Fagerstrom subscales and the Auditory-Verbal Learning Test (AVLT) subscale on Nicotine Dependency Test (FNBT). verbal learning were significantly higher as compared to the other RESULTS: In the participant group, FNBT scores did not significantly two groups. While the Stroop Test-ST-4 scores on duration were vary on the basis of age, gender, marital status, profession, and level significantly higher as compared to the nonsmokers, the Tacking of education. A positive correlation was seen between the FNBT score Test –B duration scores were significantly higher in both the smoker and the number of cigarettes smoked per day (r=0,68, p<0,001)., and group and in the group who had given up smoking as compared to the a negative correlation was seen between FNBT score and the age of nonsmokers. Relationships were not determined between the anxiety starting to smoke (r=-0,34, p<0,001). FNBT scores of those who had a and depression scores and the AVLT-verbal learning score, the Stroop

47 Test ST-4 duration score and the Tracking Test –B duration score in the DISCUSSION: We have determined in this study that the MDD and cigarette smoking group. the OCD patients did not differ significantly on the basis of the total CTQ score and also the CTQ subscale scores. DISCUSSION: Results of the study indicate that cigarette smoking can cause slowing down in the performance of cognitive functions and Keywords: Childhood traumas, major depressive disorder, obsessive a degree of impairment in verbal learning. This study is the first of its compulsive disorder kind in Turkey on the effects of cigarette smoking on the cognitive References functions of the healthy members of the population Copeland WE, Keeler G, Angold A. Traumatic events and posttraumatic Keywords: Cigarette, neurocognitive, nicotine Stress in childhood. Arch Gen Psychiatry 2007; 64 (5):577-84. Heim C, Nemeroff CB. The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies. Biol Psychiatry 2001; 49:1023-1039. OP-009 Şar V, Akyuz G, Kundakci T, Kiziltan E, Dogan O. Childhood trauma, dissociation, and psychiatric comorbidity in patients with COMPARISON OF THE CHILDHOOD TRAUMATIC conversion disorder. Am J Psychiatry. 2004; 161(12):2271-6. EXPERIENCES OF PATIENTS DIAGNOSED WITH Turner HA, Butler MJ. Direct and indirect effects of childhood OBSESSIVE-COMPULSIVE DISORDER AND MAJOR adversity on depressive symptoms in young adults. J Youth Adolesc DEPRESSIVE DISORDER 2003; 32(2):89-103. Zlotnick C, Johnson J, Kohn R, et al. Childhood trauma, trauma in Nermin Gündüz1, Hatice Turan2, Zeynep Yıldız Akbey3, adulthood, and psychiatric diagnoses: results from a community Erkal Erzincan4, Celaleddin Turgut5 sample. Compr Psychiatry 2008; 49:163-169. 1Erzurum District Training and Research Hospital, Psychiatry Department, Consultant Dr 2 Moodist Neurology and Psychiatry Hospital, Psychiatry Clinic, Istanbul, OP-010 Consultant Dr 3

ORAL PRESENTATIONS Hereke State Hospital, Psychiatry Clinic, Adapazarı, Consultant Dr 4Erenköy Mental and Neurological Diseases Hospital, Istanbul, Consultant ADULT SEPARATION ANXIETY IN PANIC DISORDER Dr AND INVESTIGATION OF THE ATTACHMENT 5Göksun State Hospital, Psychiatry Clinic, Kahramanmaraş, Consultant STYLES Dr Tonguç Demir Berkol1, Ayşe Selbes2, Simge Seren Kırlıoğlu1, AIM: Data obtained from the literature show that exposure to stress Yasin Hasan Balcıoğlu1, Pınar Gökçeimam3 at early stages of life is an important risk factor for the development 1Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological and chronicity of mental disorders (1). The risk of developing major Diseases and Research Hospital, Psychiatry Department, Istanbul depressive disorder (MDD), post-traumatic stress disorder (PTSD), 2Beykoz State Hospital obsessive-compulsive disorder (OCD) and other behavioral disorders is 4Erenköy Mental and Neurological Diseases Training and Research increased in children with a history of maltreatment (2). It is reported Hospital, Istanbul that complaints of depression and anxiety, frequent suicidal attempts, AIM: Attachment processes, starting to function in the early stages panic disorder, and PTSD are observed in individuals with a history of of life and maintain their importance lifelong, present a theoretical childhood abuse. The aim of this study is to compare the incidences of framework for understanding psychopathological developments. childhood traumas in patients diagnosed with OCD and MDD in the Insecure attachment style has been associated with the emergence of psychiatry polyclinics by a psychiatrist. psychopathology in the later stages of life. This study has investigated METHODS: Patients who consulted Erzurum District Training the adult separation anxiety and attachment styles in patients with panic and Research Hospital, Psychiatry polyclinics between the dates of disorder (PD). 15.11.2015 and 15.02.2016 and were diagnosed with OCD or MDD METHODS: The study has enrolled 65 individuals who were diagnosed on the basis of SCID-I were enrolled in this study on a volunteering basis. with panic disorder on the criteria of DSM-IV at Haydarpaşa Training A psychiatrist completed the Hamilton Anxiety Rating Scale (HAM-A) and Research Hospital, Psychiatry polyclinics and 65 healthy control and the Hamilton Depression rating scale (HAM-D). The participants individuals as the control group. After the diagnostic SCID-I interview, were asked to complete the Childhood Traumas Questionnaire (CTQ) the patients completed the Panic and Scale (PAS) in order comprising 28 items, on a self-report basis. to assess their clinical conditions, and both the patients and the controls RESULTS: Our study included 37 patients diagnosed with MDD, 55 were asked to complete the Adult Separation Anxiety Questionnaire - patients diagnosed with OCD, and 39 individuals without MDD or ASA-27 in order to assess the separation anxiety symptoms in adulthood, OCD diagnoses. Two-group comparisons between the MDD and the and the Relationship Scales Questionnaire; (RSQ) to find out the type control groups, and between the OCD and the control groups indicated of attachment style they had. differences in the CTQ emotional neglect and the emotional abuse RESULTS: A significant relationship has been determined between scores, but the same differences were not found between the MDD adult separation anxiety and the presence or absence of panic disorder and the OCD groups. On the same basis of comparison, there were no when the groups were compared. On the basis of the mean scores on differences between the three groups on the CTQ physical neglect and RSQ subscales, scores of the two groups were significant only on the sexual abuse scores. A significant difference was observed in the CTQ ‘’preoccupied’’ style of attachment. In patients with PD, significant physical abuse scores between the OCD and the control groups. The relationships were determined between the presence of adult separation MDD and the OCD groups did not differ with respect to the CTQ anxiety and the factors of gender and presence or absence of agoraphobia. total score. In both the PD and the control groups, having lost a parent at early

48 age or having experienced separation of parents, was associated with DISCUSSION: Our study has shown that the incidence of ADHD increased mean scores on the RSQ subscales of fearful attachment and was significantly higher in the PD group as compared to the controls preoccupied attachment. and that all PD patients with agoraphobia had ADHD comorbidity. This result will contribute significantly to the literature on the topic DISCUSSION: In PD, especially when there is agoraphobia, there is research on PD and ADHD, which are only few in numbers. significant coexistence of adult separation anxiety, which was seen more frequently in the female gender. The preoccupied style of attachment was Keywords: Adult attention deficit and hyperactivity disorder, more prevalent in comparison to the other styles of attachment in both comorbidity, panic disorder the PD group and the control group. Also, in the PD group, significant correlations were determined between adult separation anxiety and/ or agoraphobia presence and the attachment styles. When PD and OP-012 adult separation anxiety were present together, increased incidences of depression and anxiety disorder comorbidities are observed. EVALUATION OF COGNITIVE DISTORTIONS, Keywords: Attachment styles, panic disorder, separation anxiety AUTOMATIC THOUGHTS AND NON-FUNCTIONAL ATTITUDES IN PANIC DISORDER PATIENTS Erkan Kuru1, İlker Özdemir2, Yasir Şafak3, Türkan Doğan4, OP-011 Hakan Türkçapar5 1Karamürselbey Training Centre Command Headquartes / Gölcük COMORBIDITY OF ADULT ATTENTION DEFICIT Military Hospital AND HYPERACTIVITY DISORDER IN PATIENTS 2 Tavşanlı Doç Dr. Mustafa Kalemli State Hospital WITH PANIC DISORDER 3Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital 4Eskişehir State Hospital 1 2 Tonguç Demir Berkol , Pınar Gökçeimam , Simge Seren 5Hasan Kalyoncu University Kırlıoğlu1, Yasin Hasan Balcıoğlu1, Ayşe Selbes3 1 AIM: According to the cognition theory panic disorder (PD) is induced

Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological ORAL PRESENTATIONS Diseases and Research Hospital, Psychiatry Department, Istanbul by the wrong interpretation of the physical or mental sensations as 2Beykoz State Hospital signs of catastrophes. Cognitive behavioral therapy (CBT), a widely 4Erenköy Mental and Neurological Diseases Training and Research used therapeutic approach with proven fast effectiveness, restructures this misinterpretation (Kin et al.,2011). Distorted automatic thoughts, Hospital, Istanbul cognitive distortions and non-functional schemas are the episodes AIM: Incidences of comorbidity of other psychiatric disorders are focused on by CBT. As one of the fundamental components of CBT increased in patients with panic disorder (PD. This study has aimed at is detecting the wrong cognitions and to change them, it is believed investigating the comorbidity of adult attention deficit and hyperactivity that identification of erroneous cognitions will contribute to CBT disorder (ADHD) in patients diagnosed with PD and the chracteristics scope. Despite the studies on identifying which cognitive distortions are of this condition. associated with anxiety and which with depression, there are very few studies on cognitive distortions specific to PD. Our study has aimed METHODS: The study has enrolled 65 individuals, who were at investigating in the PD clinic the role of the automatic thoughts, diagnosed with panic disorder on the criteria of DSM-IV at Haydarpaşa cognitive distortions and non-functional actions and their relationship Training and Research Hospital, Psychiatry polyclinics, and 65 healthy with anxiety severity. control individuals as the control group. The patient group completed the Panic and Agoraphobia Scale (PAS) in order to assess their clinical METHODS: Our study enrolled 30 PD patients consulting our conditions. Both groups were asked to complete a sociodemographic polyclinics and 60 healthy volunteering controls. The participants questionnaire, the Wender Utah Rating Scale (WURS) and the Adult completed a sociodemographic questionnaire, the Panic Disorder ADHD Self-Report Scale (ASRS). Severity Scale (PDSS), Thinking Styles Inventory (ATSI), the Automatic Thoughts Scale (ATS), Non-Functional Attitudes Scale (FOTO), and RESULTS: Our study has shown that majority of the patients diagnosed the State-Trait Anxiety Inventory (STAI). with PD were of the female gender which was statistically significant in comparison to healthy controls. In the PD groups the incidences of RESULTS: Among the enrolled participant group of PD patients, 19 ‘unemployment or not being able to work’ were higher as compared to (63,3%) were females; 16 (53.3%) were married; the mean age of the the healthy controls, who were found to be ‘working’ at a higher ratio. group was 32.2 years; and the mean years of education was 11.5 years. The PD and the control groups did not differ significantly on grounds When compared on the basis of age, gender, marital status and level of of mean age, marital status and level of education. The incidence of education, the PD and the control groups did not differ significantly. ADHD comorbidity in the PD diagnosed group was determined to Regarding the performances on the ATS and the FOTO, evaluating the be 15.4%; and the distribution of the ADHD subscale characteristics cognitive distortions made by the PD patients, the highest scores were were predominantly the ‘combined type’ (60%), ‘hyperactivity and on catastrophizing, overgeneralization and reading minds. In the PD impulsiveness’(20%), ‘inattention’ (20%) and this distribution was group, correlations were determined between the ATS and the FOTO scores and the state and anxiety severity and panic severity. significant. In the PD group the level of education of those with ADHD comorbidity differed significantly. However, a similar statistical DISCUSSION: On the basis of the ATS and FOTO scores there were difference between the PD group and the control group was not significant differences between the PD group and the control group. determined. PD patients with ADHD comorbidity as compared to Observing that there were not statistically significant differences those without PD but with ADHD diagnosis were found to change between the PD group and the controls on some of the subscale scores employment significantly more frequently. ADHD was not determined suggested that cognitive distortions are prevalent in undiagnosed in the subgroup with age over 40 years. individuals as well. Finding that cognitive distortions, so far mainly

49 studied in depressive patients, were related to anxiety level, which agree OHdG levels of female BD patients in manic and depressive episodes with the recent reports, suggests that the point of view on cognitive were also higher (p=0,04). Than those of the females in the control distortions may be altered. group. Among the healthy controls, cigarette smokers had higher levels of 8-OHdG as compared to the non-smokers (p=0,001) and 8-OHdG Keywords: Anxiety, automatic thoughts, cognitive-behavioral therapy, levels of cigarette smoking BD patients were also significantly higher cognitive distortion, panic disorder as compared the BD patients not smoking cigarettes (p=0,017). After References comparing 8-OHdG levels in BD patients and controls not smoking Casey LM, Oei TP, Newcombe PA (2004) An integrated cognitive model cigarettes, the levels were found to be higher in the manic and depressive of panic disorder: The role of positive and negative cognitions, episode patients as compared to the euthymic patients (p=0,03) and the Clinical Psychology Review, 24:529-555 control group (p=0,02). Kin ALS, Valença AM, Melo-Neto VLD ve ark. (2011) Efficacy of DISCUSSION a specific model for cognitive-behavioral therapy among panic : DNA methylation did not differ among the disorder patients with agoraphobia: a randomized clinical trial. Sao investigated BD patient groups and the controls. However, DNA Paulo Medical Journal,129: 325-33. oxidation, as assessed by the 8-OHdG level, was found related to the Leahy RL, Holland SJ, McGinn LK (2011). Treatment plans and manic, depressive and euthymic episodes, the gender of the patients and interventions for depression and anxiety disorders, NewYork, the presence or absence of cigarette smoking habit. Future studies on Guilford press. DNA oxidation damage in BD should take into account the effects of Özdel K, Taymur I, Guriz SO, Tulaci RG, Kuru E, Turkcapar MH gender, disease episode and cigarette smoking. (2014) Measuring Cognitive Errors Using the Cognitive Distortions Keywords: Bipolar Disorder, DNA damage, 8-OHdG, oxidation, and Scale (CDS): Psychometric Properties in Clinical and Non-Clinical methylation Samples. PLoS ONE 9 (8): e105956 Schwartz JS, Maric M. (2015) Negative Cognitive Errors in Youth: References Specificity to Anxious and Depressive Symptoms and Age Andreazza AC. Combining redox-proteomics and epigenomics to Differences.Behavioural and cognitive psychotherapy, 43: 526-537. explain the involvement of oxidative stress in psychiatric disorders. Mol BioSyst 2012; 8(10): 2503-2512. Brown NC, Andreazza AC, Young LT. An updated meta-analysis ORAL PRESENTATIONS of oxidative stress markers in bipolar disorder. Psychiatry Res OP-016 2014;218(1-2):61-68. Black CN, Bot M, Scheffer PG, Cuijpers P, Penninx BW. Is depression DNA OXIDATION AND METHYLATION IN BIPOLAR associated with increased oxidative stress? A systematic review and DISORDER: EFFECTS OF DISEASE EPISODE AND meta-analysis. Psychoneuroendocrinology 2015;51. GENDER Deniz Ceylan1, Gustavo Scola2, Zeliha Tunca3, Cameron Isaacs Trepainer2, Güneş Can3, Ana Cristina Andreazza2, OP-017 Trevor Young2, Ayşegül Özerdem3 1Gümüşhane State Hospital, Gümüşhane/ Dokuz Eylül University, Health PARAOXONASE GENE 1 Q192R POLYMORPHISM IN Sciences Institute, Neural Sciences Department, İzmir BIPOLAR DISORDER, UNIPOLAR DEPRESSION AND 2University of Toronto, Departments of Pharmacology and Psychiatry and SCHIZOPHRENIA

Centre for Addiction and Mental Health, Toronto, Canada. 1 2 3 3Dokuz Eylül University, Psychiatry Department, İzmir Murat İlhan Atagün , Serhat Tunç , Murat Alışık , Özcan Erel3 AIM: Despite much evidence on the impairment of DNA oxidation 1Yıldırım Beyazıt University Medical School, Psychiatry Department, and methylation mechanisms in bipolar disorder (BD), information on Ankara the effects of gender and disease episodes on these mechanisms is very 2Kafkas University Medical School, Psychiatry Department, Kars limited [1-3]. This study has aimed at investigating the effects of gender 3Yıldırım Beyazıt University Medical School, Biochemistry Department, and disease episodes on DNA oxidation and methylation in BD. Ankara METHOD: Levels of 5-metylcytosine (5-mC), 5-hydroxymethylcytosine AIM: Paraoxonase 1 enzyme activity displays distinct differences (5-OHmC) and 8- hydroxydeoxyguanine (8-OHdG) have been of activity according to the QQ, QR and RR genotypes seen in the estimated in 75 individuals diagnosed with BD (37 euthymic, 20 PON 1 Q192R region. The aim of this study has been to evaluate any manic, 18 depressive) and 60 healthy individuals. DNA samples have differences in phenotypic expression between bipolar disorder (BD), been isolated from whole blood. DNA 5-mC, 5-OHmC and 8-OHdG unipolar depression (UD) and schizophrenia patients. levels have been measured by the ELISA technique. Statistical analyses consisted of parametric tests. Data not exhibiting normal distribution METHODS: We have included in this study 50 BD, 43 major depression have been analyzed by suitable transformations, such that logarithmic (MD), 37 schizophrenia (Sc) patients and 43 healthy individuals transformation has been used for 5-mC and square root transformation as the controls. Serum paraoxonase, salt-stimulated paraoxonase was used for 5-OHmC and 8-OHdG data. and arylesterase levels were measured on the automatic analyzer. Stimulated paraoxonase/arylesterase ratio is accepted as a phenotype RESULTS: Statistically significant differences were not determined since it shows a distribution compatible with the PON1 Q192R between the BD patients and the controls on the levels 8-OHdG, 5-mC genotype. Clusters in this ratio have been evaluated as the QQ, QR and and 5-OHmC.; and significant relationships have not been determined RR phenotypes between the 5-mC and 5-OHmC levels and the disease episodes and patient gender. In female BD patients OHdG levels 8-OHdG levels were RESULTS: In BD group the RR phenotype was present in significantly higher as compared to the females in the control group (p=0.02) and higher level as compared to the other groups. (Fisher’s Exact: 18.96,

50 p=0.003). The stimulated paraoxonase activity was also found to be OP-019 higher in the BD group of patients. DISCUSSION: Observing in this study the RR phenotype IS MAJOR DEPRESSIVE DISORDER (MDD) AN predominance in the BD group as compared to MD and Sc groups may INFLAMMATORY PROCESS?: EVALUATION OF be the reflection of the reports by previous studies on the prominence of THE INFLAMMATORY MARKERS NEUTROPHIL/ RR genotype in BD; and this apparent specificity to BD suggest that it LYMPHOCYTE RATIO (NLR), PLATELET/ may play a role in the aetiopathogenesis of BD. LYMPHOCYTE RATIO (PLR), MEAN PLATELET Keywords: Bipolar disorder, major depression, paraoxonase, PON1 VOLUME (MPV) AND ERYTHROCYTE Q192R polymorphism, schizophrenia DISTRIBUTION WIDTH (RDW) IN MDD DIAGNOSED PATIENTS References Eckerson HW, Wyte CM, La Du BN (1983) The human serum Nermin Gündüz1, Celaleddin Turgut2, Hatice Turan3, paraoxonase/arylesterase polymorphism. Am J Hum Genet Zeynep Yıldız Akbey4, Ümit Tural5 35:1126-1138 1Erzurum District Training and Research Hospital, Psychiatry Jarvik GP, Rozek LS, Brophy VH, Hatsukami TS, Richter RJ, Department, Consultant Dr Schellenberg GD, Furlong CE (2000) Paraoxonase (PON1) 2Göksun State Hospital, Psychiatry Clinic, Kahramanmaraş, consultant phenotype is a better predictor of vascular disease than is Dr PON1(192) or PON1(55) genotype. Arterioscler Thromb Vasc 3Moodist Psychiatry and Neurology Hospital, Psychiatry Clinic, Istanbul, Biol 20:2441–2447 Consultant Dr 4Hereke State Hospital, Psychiatry Clinic, Adapazarı, Consultant Dr 5Kocaeli University Medical School Hospital, Psychiatry Department, Kocaeli, Prof. Dr OP-018 AIM: In Major Depressive Disorder (MDD), the central nervous ISCHEMIA MODIFIED ALBUMIN LEVEL IN system, important in the emergence of the systemic inflammation, has been found involved in the immune response and vascular reactivity.

SCHIZOPHRENIA AND BIPOLAR DISORDER ORAL PRESENTATIONS Studies have demonstrated the relationship between depression and Serhat Tunç1, Murat İlhan Atagün2, Salim Neşelioğlu3, the inflammatory markers C-reactive protein (CRP), interleukin-6 Özcan Erel3 and interleukin-1. In addition to these inflammatory markers, new 1Kafkas University Medical School, Psychiatry Department, Kars biological inflammatory markers such as the RDW, MPV and the NLR 2Yıldırım Beyazıt University Medical School, Psychiatry Department, and the PLR have also been investigated in patients as the indicators of Ankara immune response. It has been the aim of this study to investigate the 3Yıldırım Beyazıt Üniversitesi Medical School, Biochemistry Department, levels of these inflammatory markers in MDD patients. Ankara METHOD: Patients, between the ages of 18 and 75 years, arriving AIM: Cobalt ion binds avidly to the N-terminal of the albumin at Erzurum District Training and Research Hospital, Psychiatry molecule. Under conditions of Ischemia, hypoxia, acidosis and polyclinics were included in the study after diagnosis of MDD on endothelial damage this avidity is reduced. The resultant is the ischemia the basis of the SCID-I and ascertainment of eligibility on the basis modified albumin (IMA) and is detected in many disorders. This study of the exclusion criteria for the study including: comorbid psychiatric has aimed at investigating the IMA levels in schizophrenia (Sc) and diagnosis, being on psychotropic agents, disabling neurological illness, bipolar disorder (BD). mental retardation, psychotic disorder, disorder, bipolar disorder, alcohol-substance use disorder, chronic diseases (such METHODS: This study was carried out with 27 BD, 26 Sc patients and as COPD, DM, hypertension, chronic cardiac failure, diabetes mellitus, 27 healthy individuals. In order to measure the IMA level, a standard dyslipidemia, organic brain damage, additional cardiac disease), obesity, amount of cobalt ion was added to serum samples and the unbound cigarette smoking, pregnancy and breast feeding. Participants completed cobalt ion was measured calorimetrically. The data accumulated were a sociodemographic questionnaire prepared by the researchers, the compared by using the Kruskal-Wallis and post-hoc Mann-Whitney U Hamilton Depression Rating Scale, the Hamilton Anxiety Rating test. Scale, and the Clinical Global Impressions Scale (CGS). Hemogram RESULTS: The IMA level was found to differ significantly between data on blood samples included hemoglobin, hematocrit, total WBC, the groups (χ2=6.26, p=0.044). Comparisons by post hoc analyses neutrophil, total lymphocyte and platelet counts, RDW and MPV. indicated that IMA level was significantly raised in the Sc (Z=-2.05, RESULTS: In our study significant differences in NLO, PLO, and p=0.040) and the BD Z=-2.24, p=0.025) groups as compared to the RDW were not detected between the groups. The only significant control level. difference found between the groups was in the MPV values. DISCUSSION: Raised levels of IMA in Sc and BD groups suggest that DISCUSSION: We have seen in the literature a few studies on the these patients have local and/or general ischemic, hypoxia, acidosis and NLO, RDW, PLO and MPV values in MDD. Future investigation of endothelial damage. The results of this study are the first reported on the relationship between MDD and the inflammation will be facilitated the IMA levels in psychiatric disorders. by preparing the inflammatory parameters by the simple and cheap Keywords: Bipolar disorder, ischemia, modified albumin, schizophrenia procedure of obtaining the hemogram. Keywords: Major depressive disorder, mean platelet volume, neutrophil/ lymphocyte, platelet/lymphocyte ratio, red cell distribution ratio

51 References the general functionality level, duration of illness, physical illness, BAI Canan F, Dikici S, Kutlucan A, Celbek G, Coskun H, Gungor A, Aydin and BDI ratings (p<0.05). Y, Kocaman G., Association of mean platelet volume with DSM- DISCUSSION: MetS is observed to be increasing even in healthy IV major depression in a large community-based population: the members of the population. It is believed that understanding the effects MELEN study, J Psychiatr Res. 2012 Mar;46(3):298-302. of MetS on quality of life and functionality of the subtypes of bipolar Cepeda MS, Stang P, Makadia R. Depression is associated with high disorder should contribute to the course of the disorder, treatment levels of C-Reactive Protein and low levels of fractional exhaled compliance and prevention of the comorbidities. nitric oxide: results from the 2007-2012 National Health and Nutrition Examination Surveys. Aust N Z J Psychiatry. 2016 Jun Keywords: functionality, metabolic syndrome, quality of life 16. pii: 0004867416652736. [Epub ahead of print] References Liu CS, Adibfar A, Herrmann N, Gallagher D, Lanctôt KL Evidence for Aydemir O, Eren İ, Savaş H, Oğuzhanoğlu NK, Kocal N, Oezgueven Inflammation-Associated Depression. Curr Top Behav Neurosci. HD, et al. Development of a Quesonnaire to Assess Inter-Episode 2016 May 25. [Epub ahead of print] Funconing in Bipolar Disorder: Bipolar Disorder Funconing Sunbul M, Gerin F, Durmus E, Kivrak T, Sari I, Tigen K, et al. Quesonnaire. 2007. Neutrophil to lymphocyte and platelet to lymphocyte ratio in Hung C-I, Liu C-Y, Hsiao M-C, Yu N-W, Chu C-L. Metabolic patients with dipper versus non-dipper hypertension. Clin Exp syndrome among psychiatric outpatients with mood and anxiety Hypertens. 2014; 36:217–221. disorders. BMC psychiatry. 2014;14(1):1. Varol E, Akpinar A, Relationship between mean platelet volume and Rosa AR, Reinares M, Franco C, Comes M, Torrent C, Sánchez‐Moreno major depression, J Clin Psychopharmacol. 2013 Oct;33(5):723. J, et al. Clinical predictors of functional outcome of bipolar patients in remission. Bipolar disorders. 2009;11(4):401-9. Silarova B, Giltay EJ, Dortland AVR, Van Rossum EF, Hoencamp OP-021 E, Penninx BW, et al. Metabolic syndrome in patients with bipolar disorder: Comparison with major depressive disorder and non-psychiatric controls. Journal of psychosomatic research. RELATIONSHIP OF METABOLIC SYNDROME 2015;78(4):391-8. ORAL PRESENTATIONS WITH QUALITY OF LIFE AND FUNCTIONALITY IN Yumru M, Savas HA, Kurt E, Kaya MC, Selek S, Savas E, et al. Atypical BIPOLAR DISORDER antipsychotics related metabolic syndrome in bipolar patients. Hanife Kocakaya1, Emrah Songur1, Osman Demir2, Journal of affective disorders. 2007;98(3):247-52. Sedat Batmaz1, Zekiye Çelikbaş1 1Gaziosmanpaşa University Medical School Research and Application Hospital, Psychiatry Department, Tokat OP-024 2Gaziosmanpaşa University Medical School Research and Application Hospital Biostatistics Departmentı, Tokat THIOL-DISULFIDE BALANCE IN BIPOLAR AIM: Bipolar disorder (BD) is a chronic disease with progressive loss of DISORDER PATIENTS functionality that is frequently seen with comorbid medical conditions Gamze Erzin1, Vahap Ozan Kotan2, Emre Ürer3, Canan such as cardiovascular diseases, diabetes, thyroid diseases and metabolic Topçuoğlu4, Rabia Nazik Yüksel5, Güven Özkaya6, syndrome (MetS). In this study it has been aimed to compare the Makbule Çiğdem Aydemir5, Erol Göka5 incidence of MetS in euthymic BD I and BD II patients with that in 1Dışkapı Yıldırım Beyazıt Training and Research Hospital, Psychiatry healthy individuals, and to assess the effects of MetS on life quality and Clinic, Ankara functionality. 2Başkent University Medical School Hospital, Psychiatry Clinic, Ankara METHODS: The study included 210 participants constituted by 70 3Ankara University Medical School Hospital, Child and Adolescent BD I patients, 70 BD II patients and 70 healthy controls. All three Psychiatry Department, Ankara 4 groups completed a sociodemographic and clinical questionnaire, the Ankara Numune Training and Research Hospital, Biochemistry Clinic, Young Mania Rating Scale (YMRS), the Beck Depression Inventory Ankara 5 (BDI), the Beck Anxiety Inventory (BAI), the Bipolar Depression Ankara Numune Training and Research Hospital, Psychiatry Clinic, Rating Scale (BDRS), the Bipolar Disorder Functioning Questionnaire Ankara 6 (BDFQ), the International Physical Activity Questionnaire (IPAQ), Uludağ Üniversitesi Medical School, Biostatistics Department, Bursa and the Global Assessment of Functioning (GAF) Scale. The Quality AIM: Although the neurochemical mechanism underlying bipolar of Life Assessment – short form (LQA). The data were analyzed on the disorder (BPD) has not been understood, there is increasing data on SSPS 19.0 package program. the effects of oxidative stress on the pathophysiology of the disorder. RESULTS: MetS parameters were found significantly increased in the Thiol groups are among the important antioxidants in the body and can BDI group as compared to the BD I and the control groups (p<0.001). enter reactions with the free radicals in order to protect the tissue and The incidence of MetS was 57% in the BD I group, 30% in the BD prevent cellular damage caused by these reactive oxygen products. With II group and 35.7% in the control group. In evaluating functionality the aim to contribute to the understanding of the etiology of BPD, we compared the serum thiol and disulphide levels in BPD patients at significant correlations were determined between the subscales of remission and manic episode with healthy controls. BDFQ and the number of depressive attacks, general functionality level, duration of illness, BDI, BDRS and BAI ratings, number of the METHODS: The study enrolled patients consulting our psychiatry past hypomanic episodes, number of hospitalizations, employment polyclinics after diagnosis of BPD on the DSM-IV criteria and obtaining and having BB II diagnosis (p<0.05). In evaluating the quality of life, their consent to participate on a volunteering basis. The participants significant correlations were observed between the subscales of LQA and consisted of 54 BPD patients at manic phase, 40 BPD patients in

52 remission and also 44 healthy controls. Next to the routine biochemistry known whether these anomalies were present before the presentation of tests, the serum native thiol, total thiol, disulphide, disulphide/native MDD, contributing to the disease pathophysiology or developed with thiol ratio, disulphide/total thiol ratio, and the native thiol/total thiol the degenerative processes associated with MDD. Studies made on high ratio were evaluated. Laboratory test results were analyzed by the risk groups, as aimed here, have value for the solution to the problem. Shapiro-Wilk test, one way variance analysis, Mann Whitney U test and METHODS: This study enrolled, as the ‘high risk group’, 11 young the Kruskal Wallis test. Spearman correlation coefficient was used for women of 18-25 years of age, without a history of any ailment, whose comparison of the variables. mothers were diagnosed with chronic depression and with a positive RESULTS: Significant differences were not observed between the family history of depression; together with 16 young women (the remission, manic and control groups with respect to age, gender, level control group) without a personal history of any ailment and of family of education, marital and employment states, body mass index (BMI), history for psychiatric disorders. The uncinate fasciculi of the two and cigarette smoking. Native thiol level in the manic group was lower groups were examined by diffusion tensor magnetic resonance imaging than that of the remission group, and the remission group level was (DT-MRI) and the data were compared. below that of the control group (p<0.001). Total thiol was highest in the RESULTS: In this study statistically significant differences were not controls and lowest in the remission group (p<0.001). The remission determined in the fractional anisotropy data on the high risk and group had the lowest disulphide level, and the manic group had the control groups. highest level (p<0.05). There were not significant differences between the groups with respect to the other parameters. DISCUSSION: The results of this study are in agreement with the point of view that the uncinate fasciculus anomalies frequently observed DISCUSSION : It is thought that when the pathological processes in MDD develop with the degenerative processes taking place in the of accumulated oxidative damage and the triggering of cell death, course of the disease. White mater changes observed in MDD may aggregation of oxidized proteins and the realization of cell death take develop as a result of the inflammatory activity, impairment of the place in the central nervous system regions controlling emotions hypothalamohypophysial axis and the lowered levels of brain-derived and motor behavior, and the character controlling mechanisms are neurotrophic factor (BDNF). impaired, the symptoms of BPD emerge. Determination of the oxidative molecules will be especially useful for the treatment of BPD Keywords: Diffusion tensor imaging, magnetic resonance imaging, and reduce the possible morbidities. Although the existing evidence major depressive disorder, uncinate fasciculus ORAL PRESENTATIONS is not adequate, the data in the literature and the results of our study References indicate that thiol and disulphide levels are important for BPD, and Chen MC, Hamilton JP, Gotlib IH. Decreased hippocampal volume these markers can be said to be the therapeutic targets of the future in healthy girls at risk of depression. Arch Gen Psychiatry. pharmacological modulations. 2010;67(3):270-276. doi:10.1016/j.ypsy.2010.09.016. Keywords: Bipolar disorder, disulphide, mania, remission, and thiol Gotlib IH, Hamilton JP, Cooney RE, Singh MK, Henry ML, Joormann J. Neural processing of reward and loss in girls at risk References for major depression. Arch Gen Psychiatry. 2010;67(4):380-387. Berk M, Kapczinskie F, Andreazzae AC, Deana OM, Giorlando F, doi:10.1001/archgenpsychiatry.2010.13. Maesg M, Yücel M, Gamae CS, Dodda S, Deand B, Magalhãesa Joormann J, Gilbert K, Gotlib IH. Emotion identification in girls at PVS, Ammingerb P, McGorryb P, Malhi GS. Pathways underlying high risk for depression. J Child Psychol Psychiatry Allied Discip. neuroprogression in bipolar disorder: Focus on inflammation, 2010;51(5):575-582. doi:10.1111/j.1469-7610.2009.02175. oxidative stress and neurotrophic factors. Neuroscience and Liao Y, Huang X, Wu Q, et al. Is depression a disconnection syndrome? Biobehavioral Reviews 2011; 35:804-17. Meta-analysis of diffusion tensor imaging studies in patients with Erel O., A brand new biochemical test; thiol disulphide homeotasis), MDD. J Psychiatry Neurosci.2013;38(1):49-56. doi:10.1503/ Turk J Biochem, 2015; 40. jpn.110180. Steckert AV, Valvassori SS, Moretti M, Dal-Pizzol F, Quevedo J. Role Wong ML, Licinio J. Research and treatment approaches to depression. of oxidative stres in the pathophysiology of bipolar disorder. Nat Rev Neurosci. 2001;2(5):343-351. doi:10.1038/35072566. Neurochem Res 2010; 35:1295-301. Zarate CA, Singh J Jr, Manji HK. Cellular plasticity cascades: targets for the development of novel therapeutics for bipolar disorder. Biol Psychiatry 2006; 59:1006-20. OP-026

COMPARISON OF THE DECISION MAKING SKILLS AND ANXIETY SEVERITY BETWEEN BIPOLAR OP-025 DISORDER PATIENTS IN REMISSION AND HEALTHY CONTROLS COMPARISON OF THE STRUCTURAL INTEGRITY OF THE UNCINATE FASCICULUS IN YOUNG Oğuzhan Kılınçel1, Şenay Kılınçel2, Cengiz Akkaya3 FEMALES WITH AND WITHOUT RISK OF MAJOR 1Bursa Training and Research Hospital, Psychiatry Clinic, Bursa DEPRESSIVE DISORDER 2 Uludağ University Child and Adolescent Mental Health Department, Bursa Cenan Hepdurgun, Özgün Özalay, Fatma Şimşek, Şebnem 3Uludağ University Medical School Mental Health And Diseases Tunay, Ömer Kitiş, Ali Saffet Gönül Department, Bursa Ege University Medical School SoCAT Laboratory AIM: Existence of a distinct clinical relation between major depressive AIM: Different studies have demonstrated abnormalities in the white disorder and anxiety disorders has long been known. However, relation matter circuits enabling cooperative functioning between different parts of anxiety to bipolar affective disorder (BAD), which is another mood of the brain in major depressive disorder (MDD). However, it is not yet disorder, has not been as well investigated. Since it is known that every

53 attack results in neuronal destruction, studies have been made on the of self labelling on part of the relatives of bipolar mood disorder (BMD) decision making skills of patients. Observation of anxiety comorbidity patients with their suicidal ideations and reasons of hospitalization. in BAD underlies our attempt to investigate the anxiety severity and the METHODS: The study enrolled patients newly diagnosed with decision making skills of patients diagnosed with the disorder. (BMD) and under follow up after consulting the BMD polyclinics METHODS: Patients (n=50) included in this study were in the 18-65 of Kırıkkale University Medical School Psychiatry Department, and years of age range, diagnosed with BAD on the basis of DSM-V criteria, their relations after an interview on the SCID-I. Sociodemographic in remission and without any other axis-1 psychopathological disorders. and clinical data were gathered on the SKIP-TÜRK form, and the Patients with organic brain pathologies, mental retardation or alcohol- participants also completed the Self-Stigma of Seeking Psychological substance abuse/dependency were excluded from the study. A healthy Help Scale (SSPHS). Statistical analyses were performed on a package group of 50 individuals were also enrolled as the control group. All program. participants completed a sociodemographic and clinical questionnaire, RESULTS: The study included 39 BMD patients, of whom 9 (23.1%) the Beck anxiety inventory (BAI) and the Wechsler Adult Intelligence Scale-revised (WAIS-R). had a history of one or more suicidal attempts. The mean scores on the SSPHS of those with and without past suicidal attempts were, DISCUSSION: The BAI score of the BAD group was found to respectively, 27.33 (± 5.5) and 21.50 (± 5.3), (p=0.007). The SSPHS be significantly higher than that of the control group (p=0.044). scores of the relations of patients with and without past suicidal attempts Anxiety symptoms observed during the remission phase of BAD were were, respectively, 23.0 (± 5.8) and 22.2 (± 6.41), and a significant independent of gender, level of education, number of depressive attacks, difference between the patient and relation groups did not exist. A and history of hospital admissions. The scores of the BAD group on statistically significant correlation between the age of onset of BMD the WAIS-R were significantly lower than that of the control group and the SSPHS scores of the relations group was not also determined (P<0,001). (p=0.28). DISCUSSION: It has been determined here that anxiety in the DISCUSSION: BMD is a disorder that leads to labelling of the relatives remission phase of BAD is a factor that discriminates the healthy of the patients among whom the most important factor of self-labelling population from the patients. Also, the results have suggested that severity may be suicidal attempts. As this is a preliminary study, the decision making skills have been impaired probably due to the neuronal results need to be confirmed on a wider scale.

ORAL PRESENTATIONS damage that have taken place with the past attacks. It appears that concentration on the affective symptoms can lead to overlooking the Keywords: Bipolar mood disorder, labelling, suicide anxiety symptoms. Diagnosis and treatment of anxiety at the early stage References of BAD is very important. Organization of the psychoeducation given Yıldız M, Özten E, Işık S ve ark. (2012) Self-labelling Among to the patient according to the decision making level of the patient Schizophrenia Patients, Their Relatives and Among Major would be an important step in the treatment of BAD: Depressive Disorder Patients. Anadolu Psikiyatri Dergisi 13:1-7. Keywords: Anxiety, bipolar, decision making, psychoeducation, WAIS-R References OP-028 Issler CK, Sant’anna MK, Kapczinski F ve ark. (2004) Anxiety disorders comorbidity in bipolar disorder. Rev Bras Psiquiatr, 26(Suppl 3): EVALUATION OF SLEEP QUALITY IN BIPOLAR 31-36. DISORDER PATIENTS Boylan KR, Bieling PJ, Marriott M ve ark. (2004) Impact of comorbid anxiety disorders on outcome in a cohort of patients with bipolar Necla Keskin, Lut Tamam, Nurgül Özpoyraz disorder J Clin Psychiatry, 65:1106-1113. Bremner JD, Krystal JH, Çukurova University Medical School, Psychiatry Department South 3-Stephan M. Stahl Temel Psikofarmakoloji-Noröbilimsel ve AIM: Sleep quality is adversely affected in all phases of bipolar Pratik Uygulamalar 2005 s:509. disorder (BD), including the euthymic periods. This study has aimed at evaluating sleep quality in euthymic BD patients, determining the clinical symptoms related to sleep quality and the effects of sleep quality OP-027 on the course of the disease and functionality of the patient. METHODS: The study included 122 BD outpatients between the FACTORS RELATED TO LABELLING OF THE ages of 18 and 65 years, consulting the Çukurova University Mental RELATIONS OF BIPOLAR DISORDER PATIENTS: A Health and Diseases Department Bipolar Disorder Unit. Euthymia PRELIMINARY STUDY was established by the Hamilton Depression Rating Scale (HAM-D) and the Young Mania Rating Scale (YMRS). The patients completed a 1 1 Şadiye Visal Buturak , Gamze Özçiçek , Hatice Özdemir sociodemographic questionnaire, and the BD Data Form. Comorbidities Rezaki1, Orhan Murat Koçak1, Ayşe Gül Yılmaz Özpolat1, were determined by the SCID-I for DSM-IV Axis I Disorders and the Ömer Oğuztürk2 SCID-II for the DSM-IV Axis II disorders. Sleep quality was assessed 1Kırıkkale University Medical School Psychiatry Department on the General Sleep Quality Questionnaire. All participants completed 2Karabük University Medical School Psychiatry Department the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS) and also the Bipolar Disorder Functioning Questionnaire AIM: Labelling can be described as the abasement of an individual or (BDFQ). group on the basis of a characteristic and can be made not only on a specifically individual basis, such as the labelling of a psychiatric RESULTS: Mean age of the 122 BD patients included in the study patient, but also can be extended to those related to the labelled. It is was 38,7 (±10,8 years), and 56.5% had bad sleep quality. Majority of known that many people related to a psychiatric patient are blamed and the group (63.9%) were females, and 75.4% had education at middle- excluded by the society. This study has aimed to investigate the attitude school or above, and 75.4% had middle-upper socioeconomic level. The

54 group with bad sleep quality took longer time to go to sleep and woke Sensitivity Index (ASI), the Toronto Alexithymia Scale (TAS) and the up frequently during sleep. In this group, the incidences of cigarette Somatosensory Amplification Scale (SAS). and caffeine use, history of suicidal attempts, seasonality, antidepressant RESULTS: In our study the patient group with migraine included 65 use and history of electroconvulsive therapy (ECT), lifelong anxiety, (65%) females and 35 (35%) males with a group mean age of 37.87 comorbidities of somatoform, impulse control and personality disorders (±7.8 ; 25-56) years; and the control group included 57 (57%) females were significantly higher as compared to those with good sleep quality. and 43 (43%) males with a group mean age of 36.91 (±6.2; 25-55) years. On the other hand, the group with bad sleep quality had lower scores The mean scores of the patient group on the ASI, SAS and the TAS on emotional and mental functionality, intrafamilial relationships, were, respectively, 25.69±13.46, 25.78±4.43 and 50.07±5.32, being using initiative and personal potentiality and total functionality in significantly higher as compared to the controls with corresponding comparison to the group with good sleep quality. scores of, respectively 18.14±13.68, 23.11±5.58 and 47.85±6.08. DISCUSSION : It has been seen that sleep quality is impaired during the DISCUSSION: It has been found out in this study that patients euthymic phase of BD and may cause the observed loss of functionality. with migraine type headaches have multiple psychological symptoms It is believed that routine assessment of sleep quality of the BD patient accompanying the clinical state, including exaggeration of somatic independent of the phase of the disease in order to make the appropriate sensations, high anxiety sensitivity and alexithymia. Our study psychosocial interventions and pharmacotherapy will help improve the demonstrates the importance of consultations and contact between quality of sleep and the quality of life. hospital clinics. Keywords: Bipolar disorder, functionality, sleep quality Keywords: Alexithymia, anxiety sensitivity, migraine type headache, References somatosensory amplification Harvey, A.G., Talbot, L.S., Gershon, A., 2009. Sleep Disturbance in References Bipolar Disorder Across the Lifespan. Clin Psychol 16, 256-277 Breslau N, Lipton RB, Stewart WF, Schultz LR, Welch KM. Harvey, A.G., Soehner, A.M., Kaplan, K.A., Hein, K., Lee, J., Kanady, Comorbidity of migraine and depression: investigation potential J., et al., 2015. Treating improves mood state, sleep, and etiology and prognosis. Neurology 2003; 60:1308-1312. functioning in bipolar disorder: a pilot randomized controlled trial. Matta AP, Moreira Filho PF. Depressive symptoms and anxiety in J Consult Clin Psychol 83, 564-577. patients with chronicand episodic tension-type headache Arq ORAL PRESENTATIONS Saunders, E.F., Novick, D.M., Fernandez-Mendoza, J., Kamali, M., neuropsiquiatr 2003; 61:991-994. Ryan, K.A., Langenecker, S.A., et al, 2013. Sleep quality during Karakurum B, Soylu O, Karatas M, Giray S, TanM, Arlier Z, et al. euthymia in bipolar disorder: the role of clinical features, personality Personality, depression, and anxiety as risk factors for chronic traits, and stressful life events. Int J Bipolar Disord 13, 1-16. migraine. Int JNeuroscience 2004; 114:1391-1399 Norton PJ, Asmundson GJG. Anxiety sensitivity, fear, and avoidance behavior in headache pain. Pain2004;111:218-23 OP-030 Wacogne C, Lacoste JP, Guillibert E, Hugues FC, Le Jeunne C. Stress, anxiety, depression and migraine. Cephalalgia 2003; 23: 451-455. Yong N, Hu H, Fan X, Li X, Ran L, Qu Y, Wang Y, Tan G, Chen ANXIETY SENSITIVITY, ALEXITHYMIA AND L, Zhou J. Prevalence and risk factors for depression and anxiety EXAGGERATION OF SOMATIC SENSATIONS IN among outpatient migraineurs in mainland China. J Headache PATIENTS WITH MIGRAINE TYPE OF HEADACHES Pain. 2012 Jun;13(4):303-10. Selim Polat1, Çiçek Hocaoğlu2, Ahmet Tüfekçi3 1Recep Tayyip Erdoğan Training and Research Hospital, Psychiatry Clinic, Rize. OP-031 2Recep Tayyip Erdoğan Üniversitesi, Medical School, Psychiatry Department, Rize. FACTORS RELATED TO DEPRESSION AND ANXIETY 3 Recep Tayyip Erdoğan Üniversitesi, Medical School, Neurology LEVELS OF ONCOLOGY INPATIENTS AT IZMIR Department, Rize. UNIVERSITY MEDICAL SCHOOL HOSPITAL AIM: Anxiety sensitivity (AS) has been described as an exaggerated Tarkan Amuk1, Hatice Çilem Binicier2, Gizem Çakmak3, fear against anxiety conditions and symptoms believed to have harmful 3 physical, physiological and social outcomes. Individuals with high Belfu Karakaplan 1 AS have the tendency to wrongly interpret the sudden, relatively Medicalpark Izmir Hospital Psychiatry Department-Izmir 2Medicalpark Izmir Hospital OncoloIy Division - izmir severe and inexplicable physical anxiety symptoms as dangerous, and 3 frequently exhibit avoidance behavior. This is prevalent in patients Izmir University Medical School Student -Izmir with psychosomatic disorders. Psychosomatic disorder with prominent AIM: Cancer is a disease that leads to important changes with physical, repetitive, chronic pain complaints, such as migraine, may also exhibit psychological and social dimensions in the patient. Next to its chronicity difficulties in coping abilities. This study has aimed at comparing and seriousness, and its uncertainties, aches and pains, it is a disease alexithymia, anxiety sensitivity and exaggeration of somatic sensations that reminds of death, guilt, forsakenness, panic and anxiety. High in migraine patients with healthy individuals. prevalence with a broad variance (9-60%) of psychiatric morbidities among cancer patients has been reported. Anxiety and depression in METHODS: This study included 100 patients of 18-65 years of age cancer adversely influence the psychological state and the attitudes to with migraine type headaches consecutively consulting Recep Tayyip acceptance, urge to fight against the condition, treatment compliance Erdoğan Training and Research Hospital, Neurology polyclinics and life quality of the patient between 1 January 2013 and 1 June 2013 and 100 healthy individuals meeting the inclusion criteria of the study. All participants completed METHODS: The study was carried out between December 2015 a sociodemographic questionnaire, the SCID-I, the Anxiety and February 2016 at Izmir University Hospital with 100 patients (60

55 females and 40 males) between the ages of 18 and 60 years. The patients by the day. We have aimed to evaluate the consultations requested from completed a sociodemographic questionnaire. Data acquired by the our clinic and their outcomes. study were statistically analyzed using the SPSS 22 program. METHODS: In this retrospective study the records of psychiatric RESULTS: Anxiety and depression were detected in, respectively, 21 consultations requested from various inpatient services between (21%) and 22 (%22) of the patients. Patients with anxiety included 16 February 2011 and June 2014 at Ondokuz Mayıs University Medical females and 5 males, and those with depression included 22 females School Hospital, Child and Adolescent Psychiatry Department have and 5 males. been scanned. Data acquired from file investigations consisted of the sociodemographic details of the patient, the department requesting DISCUSSION: In this study anxiety significantly correlated with the consultation, the diagnoses made and whether any treatment was advanced age, not having any hobbies, and having a history of implemented, and, the preference for the therapeutic agents prescribed psychiatric disorder; while depression was significantly correlated with if any treatment had been given. living in a crowded provincial environment, having used cigarettes for 23 years or over, having a family history of psychiatric disorder and the RESULTS: Among a total of 1500 patients for whom consultations factor of facing a new diagnosis of 0-1 month. were requested, majority were at or above the age of 12 years (n:1128, 75.2%), and consisted mostly of girls ((n:935, 62.3%). The patients Keywords: Anxiety, cancer, depression, psycho-oncology, generally came from the same province (n:1103, 73.5%). Consultations sociodemographic characteristics were preferably carried out at the clinics which the patient had been References admitted to (68.9%) and were mostly directed to those coming from Atmaca G, Durat G. Kanser Hastalarında İntihar Riski.(Suicide Risk in other provinces (OR:1,59). The mean time taken for the consultations, Cancer Patients) Sakarya Üniversitesi Sağlık Yüksekokulu Psikiyatri recorded in the automation systems as ‘’meeting’’ (the request), was 352,44 Hemşireliği ABD. Aralık 2015; 1(4):2 6). (± 596,70) minutes. The unit requesting most of the consultations was Aydın O, Deveci A, Danacı A. Kanser Tanısı İntihara Yol Açar Mı? Risk the child emergency service (47.2%), followed by child general service Algılama ve Azaltımı Nasıl Yapılabilir? Des Cancer Diagnosis Lead (15.5%), child hematology-oncology (13.5%). The first ranking reason to Suicide? How to Reduce Risk Detection and Reducing) Celal for requesting consultation was ‘’depressive symptoms’’ (n:328, 21.9%), Bayar Üniversitesi Tıp Fakültesi, Psikiyatri ABD, Manisa. Cilt 11, and the second ranking reason being ‘’suicidal attempt’’ n:237, 15.8%). Sayı 4, Aralık 2012, page:2 The most frequently made diagnosis was depression (n:335, %22.3), ORAL PRESENTATIONS Aydemir Ö, Köroğlu E. Psikiyatride Kullanılan Klinik Ölçekler. followed by behavioral disorders (2.8%). Incidence of diagnosing more Psikoloji ve Psikiyatri Dizisi. HYB Basım Yayın 226. Ankara 2009, than one psychiatric disorder at the first consultation was 11.4%; and page. 206-2011. 55.6% of the patients had been prescribed a psychotropic agent at Deniz,M. Ayaktan Kemoterapi Alan Hastalar ve Yakınlarında Sağlıkla the first consultation, with being the most prescribed agent İlgili Yaşam Kalitesi.Uzmanlık Tezi.(Consultancy Thesis: Life (23.9%), followed by risperidone (8.4%). Incidence of starting therapy Quality of Health in Outpatients on Chemotherapy and Their with multiple agents was 14.9%. Relations)Edirne:Trakya Üniversitesi Tıp Fakültesi Aile Hekimliği DISCUSSION: Prognoses of the physical illnesses and treatment of Anabilim Dalı, 2011:5-20. the comorbid psychiatric disorders can be improved by the psychiatric Güleç G, Büyükkınacı A. Kanser ve Psikiyatrik Bozukluklar (Cancer consultations (3,4). The need for consultation-liaison psychiatry and and Psychiatric Disorders) Osmangazi Üniversitesi Tıp Fakültesi successful multidisciplinary approaches is increasing. Psikiyatri ABD, Eskişehir. Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry 2011; 3(2):7-10. Keywords: Child and adolescent, consultation, liaison, inpatient, Işıkhan,V. Kanser ve Sosyal Destek. Hacettepe Üniversitesi İİBF treatment Sosyal Hizmet Bölümü. (Cancer and Social Support – Hacettepe Univeristy Economics and Management Department) Toplum ve References Sosyal Hizmet. Cilt 18, Sayı 1, Nisan 2007, Sayfa:2-4. Abalı, O., Tüzün, Ü., & Gürkan, K. (2006). Çocuk psikiyatrisi konsültasyonlarının değerlendirilmesi (Evaluation of child psychiatry consultations). Genel Tıp Dergisi, 16(3), 121-124. Baysal ZB, Pediatri-cocuk psikiyatrisi işbirliği: Konsültasyon liyezon OP-032 psikiyatrisi (Paediatrics- child psychiatry cooperation: consultation- liaison psychiatry). Katkı Pediatri Dergisi 1996; 17:925-31. EVALUATION OF THE CHILD PSYCHIATRY Emiroğlu, N., Aras, Ş., Yalın, Ş., Doğan, Ö., & Akay, A. (2009). Yatan CONSULTATIONS REQUESTED FOR INPATIENTS OF hastalar için istenen çocuk ve ergen psikiyatrisi konsültasyonlarının A UNIVERSITY HOSPITAL değerlendirilmesi (Evaluation of the consultative psychiatry requests for child and adolescent inpatients) Anadolu Psikiyatri Dergisi, 10, Emre Ürer1, Gökçe Nur Say2, Gamze Erzin3 217-225. 1Ankara University Medical School Hospital, Child and Adolescent Göker Z, Güney E, Dinç G, Üneri Ö. Evaluation of the Psychiatry Psychiatry Department, Ankara Consultations of Children and Adolescents Hospitalised in a 2Ondokuz Mayıs University Medical School Hospital, Child and Training and Research Hospital. Turkish J Pediatr Dis 2014; 8: 17- Adolescent Psychiatry Department, Samsun 24. 3Dışkapı Yıldırım Beyazıt Training and Research Hospital Psychiatry Clinic, Ankara AIM: Consultation-liaison psychiatry emphasizes that in the process of evaluating the patient, biological, psychological, environmental and sociocultural factors have to be taken into account. In children with physical illnesses, there are many psychiatric comorbidities and the treatment of the psychopathology is important. Hence, the psychiatric consultations requested for child and adolescent patients are increasing

56 OP-033 OP-034

PSYCHIATRIC EVALUATION OF PATIENTS WITH EVALUATION OF THE PSYCHIATRIC HEREDITARY ANGIOEDEMA CONSULTATIONS REQUESTED FOR INPATIENTS OF Özlem Kuman Tunçel1, Emine Nihal Mete Gökmen2, A UNIVERSITY HOSPITAL Nazlı Kahraman1, Şebnem Pırıldar1 Evnur Kahyacı Kılıç1, Rugül Köse Çınar2, Mehmet Bülent 1 Ege University Medical School, Mental Health and Disorders Sönmez2, Yasemin Görgülü2 Department, Izmir Ege 1Uzunköprü State Hospital, Edirne 2 Ege University Medical School, Internal Diseases Department, Allergyi 2Trakya University Medical School, Psychiatry Department, Edirne and Clinical Immunology Department, İzmir AIM: This study was carried out to determine the specifics of psychiatric AIM: Hereditary angioedema (HA) is a disease with serious prognosis of morbidity and mortality; and expectedly, living with a chronic condition consultations given in a hospital with respect to the clinics making the like HA affects the psychological state of the patient. This study has request, the reasons for the request, the diagnoses made, the treatments aimed at investigating the psychological state and the psychological given in relation to the diagnoses and the sociodemographic details of resilience of the HA patient. the patients. METHODS: In this descriptive and cross sectional study a total of 33 METHODS: This study involved the retrospective scanning of HA patients were diagnosed by a psychiatry consultant physician on the consultation forms completed for each psychiatric consultation the basis of the SCID-I for the DSM-IV axis I disorders, the Hamilton requested between 1 January 2011 and 31 December 2011 at Trakya anxiety rating scale (HAM-A), Hamilton depression rating scale University Medical School Hospital for inpatients at and above the (HAM-D) and the Resilience Scale for Adults (RSA). age of 18 years. The diagnoses were made on the basis of the DSM-IV criteria by the SCID-I interview. Statistical analyses of the data were RESULTS: Mean age of the 33 HA patients was 38.8 (±10.9 years, with 57% being females. Using the SCID-I), 9 were diagnosed with carried out with the SPSS 20 package program and the results were active depressive disorder or anxiety disorder (excepting specific expressed in percentage values. phobia). These patients and those not diagnosed with active psychiatric RESULTS: Psychiatric consultations were made for a total of 775 ORAL PRESENTATIONS disorder did not differ significantly on the basis of gender, age, level inpatients outside the psychiatry clinic, 422 (54.5%) being males and of education, age at onset of disease, family history of HA and death, 353 (45.5%) being females, with the mean age of the total group being HA diagnosis in first degree relatives, delayed diagnosis of HA, wrong 50.4 (±15.5) years. The clinics frequently requesting consultations diagnosis, the delay in diagnosing HA, time since diagnosis of HA, were ranked as the internal diseases (35.2%), physical therapy and mean attack counts, time since last attack, having experienced laryngeal rehabilitation (15.2%) and the general surgery (9.7%). The reasons for oedema, C1 inhibitor functional level, C1 inhibitor, C4, C1q and the requesting consultation were ranked as depressive complaints (24.5%), RSA scores (p>0.05). Mean score of HA patients on the HAM-D and requests made without giving any reasons (24.3%), agitation (13.4%) HAM-A were, respectively, 3.48 (±4,23) and 4.03 (±5.52). There were no correlations between the HAM-D and the HAM-A scores and age, and previous psychiatric diagnosis and /or treatment history (10.1%). age at HA onset, duration of HA, time of delay in diagnosis, mean Diagnoses made after the consultations were ranked as adjustment attack duration, time since last attack, C1 inhibitor functional level, disorders (19%), delirium (18.1%) and Depression (17.4%). In C1 inhibitor, C4 and C1qlevels (p>0,05). However, correlations were 23.7% of the patients there were no psychiatric disorders meeting determined between the mean RSA score (=27) and the mean attack the diagnostic criteria. Pharmacotherapy consisted of antidepressants duration (p=0.006; r=0.512), and the mean HAM-D score (p=0.033; (35.2%), antipsychotics (22.6%), benzodiazepines (9%) and mood r=-0,410) and the mean HAM-A score (p=0.041; r=-0.397). The RSA stabilising agents (1.2%). The remaining 32% of the patients were score (135.48±16.95) obtained in this study is significantly higher followed without drug therapy. than that (125.24±19.20) obtained in a study with 437 student nurses DISCUSSION: The results of our study place an emphasis on (p=0.004; t=3.139). the importance of consultation liaison psychiatry in hospitals. The DISCUSSION: Comorbid psychiatric disorders were diagnosed in cooperation established between all services will enable the assessment a minority group of the HA patients investigated in this study. The of the mental state of patients admitted to all clinics and provide a psychological resilience score exceeded that obtained in a previous study holistic approach to the treatment of the patients. with normal individuals indicating that unpredictable attacks met since early childhood have resulted in a psychological resilience in the patient Keywords: Inpatient, psychiatric consultation, psychiatric disorder, which has prevented the presentation of psychiatric disorders at the university hospital syndromic level. References Keywords: Angioedema, anxiety, Depression, hereditary, psychological Carr VJ, Lewin TJ, Walton JM et al., (1997) Consultatioliaison resilience psychiatry in general practice. Aust N Z J Psychiatry, 31: 85-94. References Rothenhäusler HB (2006) Mental disorders in general hospital patients. Gülbahar, O. Herediter Anjiyoödem (Hereditary angioedema)( 2015). Psychiatr Danub, 18: 183-192. Anjiyoödem, Ed: Mete Gökmen, N.Türkiye Klinikleri, 1. Baskı Sarandöl A, Akkaya C, Eker S et al., (2007) Uludağ Üniversitesi Ankara. Tıp Fakültesi Psikiyatri Anabilim Dalı Konsültasyon Liyezon Güngörmüş K, Okanlı A, Kocabeyoğlu T. Hemşirelik Öğrencilerinin Psikiyatrisi polikliniğinin ilk bir yılında istenen konsültasyonların Psikolojik Dayanıklılıkları ve Etkileyen Faktörler (Psychological değerlendirilmesi (Evaluation of the consultations requested for Resilience of Nursing Students and the Related Factors). Psikiyatri 2071 cases from the Consultation Liasison Psychiatry polyclinics of Hemşireliği Dergisi - Journal of Psychiatric Nursing 2015;6(1):9- Uludağ University Medical School Psychiatry Department During 14. the First Year of Its Opening) Türkiye’de Psikiyatri, 9: 26-3

57 OP-035 OP-037

REVIEW OF THE SCORING ON THE SUBSCALES PREVALENCE OF POST-PARTUM DEPRESSION AND OF THE SF-36 SURVEY AND THE PSYCHIATRIC THE RELATED FACTORS COMORBIDITIES IN EPILEPSY PATIENTS Ayça Asena Sayın1, Bilge Burçak Annagür1, Ali Annagür2 1 Şenay Kılınçel1, Oğuzhan Kılınçel2, Cengiz Akkaya3 Selçuk University Medical School, Psychiatry Department, Konya 2 1Uludağ University Child and Adolescent Mental Health Department, Selçuk University Medical School, Paediatrics Department, Konya Bursa AIM: The aim of the study was to assess the prevalence of post-partum 2Bursa Training and Research Hospital, Psychiatry Clinic, Bursa depression by the technique of clinical interviewing and to analyses the 3 Uludağ University Mental Health and Diseases Department, Bursa related factors. AIM: The level of balance and agreement between life expectations and METHODS: Women (n=206) in the postpartum 6th week arriving the physical, psychological and social limitations determine the quality consecutively at Selçuk University Medical School Child Health and of life for epilepsy patients. Biopsychosocial problems associated with Diseases polyclinics between December 2015 and June 2016 for epilepsy can be related to the age of the patient, the underlying aetiology routine health check of the new born infants were included in this of the illness, duration of epilepsy, frequency, severity and the type of study after obtaining a signed informed consent form. The participants the seizures, the EEG activity, antiepileptic medications (AEM) and the were conducted through the SCID-I and were asked to complete a sociodemographic questionnaire. Subsequently, they were also asked comorbid psychiatric disorders. to complete the Edinburgh Postnatal Depression Scale (EPDS), the METHODS: The study enrolled 117 epilepsy patients without a Multidimensional Scale of Perceived Social Support (MSPSS), Maternal history of psychiatric disorders. Absence of a history of psychiatric Postnatal Attachment Scale (MPAS) and the Beck Anxiety Inventory disorder and of drug therapy for psychiatric reasons were confirmed (BAI). The data were evaluated on the SPSS 15 program. Variables were by detailed history taking, psychiatric examination, and EEG recording expressed in terms of the mean ±standard deviation. All parameters and neuropscyhometric tests. In order to determine their physical were tested for normal distribution by the Kolmogorov–Smirnov test. ORAL PRESENTATIONS functions, pain, general health, vitality, social function, mental health Categorical data were compared by the Chi-square and the Fisher the patients completed the 36-item short form survey (SF-36) and the Exact test. Parametric data were compared by the t-test and the Mann- Hospital Anxiety and Depression Scale (HAS-HDS). Whitney U test. RESULTS: (PPD) was determined in 6.8% RESULTS: SF-36 scores of the female patients on the subscales (n=14) of the participating women. Sociodemographically, women of general health perception, fatigue and emotional role limitation with and without PPD differed significantly only on economical status; were significantly low. Fatigue and emotional role limitation subscale those with PPD having a lower economical level, and the social support scores were significantly low in females with partial, simple partial, received during pregnancy was also less as compared to the women and secondary general epilepsy (p <0.01). While both the HDS and without PPD. Also, in the group of women with PPD, the incidences the HAS scores of the females with complex partial, and secondary of a history of depression during pregnancy, history of major depressive generalized epilepsy were significantly elevated, only the depression disorder outside the period of pregnancy and comorbid psychiatric level of the females with primary generalized epilepsy were elevated (p disorders were higher. The EPDS and the BAI scores of the PPD group <0.01). Whereas the incidence of anxiety was higher among the females, were significantly higher and their scores on the MPAS and the MSPSS the incidence of depression was higher in the male patients as compared scores were significantly lower as compared to the group without PPD. to the females. DISCUSSION: PPD has many adverse consequences for both the DISCUSSION: Epilepsy is not only one of the widely spread mother and the new born infant. Women with high risk for PPD should neurological disorders but also the target of distorted public attitudes, be detected early as prevention or treatment of PPD is very important. mistaken notions and social discriminations against the epilepsy patients. Keywords: Depression, pregnancy, prevalence, postpartum Fear of being labelled, embarrassment about seizures and the resultant abstention from getting married or being in public adversely affect the References: lives of patients. (3). Overlooking the psychiatric comorbidities and the Akman C, Uguz F, Kaya N. 2007. Postpartum-onset major depression social disorders in epilepsy reduces the success of treatment. is associated with personality disorders. Comprehensive psychiatry 48;343-7. Keywords: Epilepsy, psychiatric comorbidity, quality of life, SF-36 Norhayati MN, Hazlina NH, Asrenee AR, Emilin WM. 2015. Magnitude and risk factors for postpartum symptoms: a literature References review. J Affect Disord 175;34-52 Fenwick P. Psychiatric Disorder and Epilepsy. Epilepsy. 2nd edn. Edited Uguz F, Akman C, Kaya N, Cilli AS. 2007. Postpartum-onset obsessive- by Anthony Hopkins, Simon Shorvon and Gregory Cascino. compulsive disorder: incidence, clinical features, and related factors. Published in 1995 by Chapman& Hall The Journal of clinical psychiatry 68;132-8. Fowler K, Sperling M, Liporace J, et al. The effect of seizure severity on Uguz F, Gezginc K, Kayhan F, Sarı S, Büyüköz D. 2010. Is pregnancy quality of life in epilepsy. Epilepsy Behav 2007; 11:208-11. associated with mood and anxiety disorders? A cross-sectional study. Temporal Lob Epilepsisinde Cerrahi Tedavi Öncesi ve Sonrası General hospital psychiatry 32;213-5. Depresyon, Anksiyete ve Yaşam Kalitesinin Değerlendirilmesi Yim IS, Tanner Stapleton LR, Guardino CM, Hahn-Holbrook J, (Evaluation of the Pre- and Post- surgery Depression, Anxiety and Dunkel Schetter C. 2015. Biological and psychosocial predictors of Quality of Life in Epilepsy) İrem Yıldırım Çapraz,Erhan Bilir, postpartum depression: systematic review and call for integration. Epilepsi 2011;17(3):77-84 Annu Rev Clin Psychol 11;99-137.

58 OP-038 Keywords: Help seeking, HIV infection, psychological complaints References INVESTIGATION ON A CLINICAL BASIS THE Gallego L, Barreiro P, Lopéz-Ibor JJ. Diagnosis and clinical features TREATMENT SEEKING BEHAVIOR OF HIV PATIENTS of major neuropsychiatric disorders in HIV infection. AIDS Rev. FOR THEIR PSYCHOLOGICAL COMPLAINTS 2011;13(3):171-9. Ezgi İnce1, Fatma Sargın3, Alper Gündüz4, Hayat Mahajan AP, Sayles JN, Patel VA, Remien RH, Ortiz D, Szekeres G, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and Kumbasar5, Bilgül Mete2, Özlem Altuntaş Aydın5, 4 7 6 recommendations for the way forward. AIDS (London, England). Dilek Yıldız , Bilgenur Bilge , Mustafa Yıldırım , 2008;22 (Suppl 2): S67. Serap Oflaz1, İlyas Dökmetaş4, Fehmi Tabak2 1Istanbul University Medical School, Mental Health and Diseases Department, Istanbul 2Istanbul University Cerrahpaşa Medical School, Infectıous Diseases Department, Istanbul OP-039 3Medeniyet University Göztepe Training and Research Hospital Infectıous Diseases Department, Istanbul HYPEREMESIS GRAVIDARUM AND 4Şişli Hamidiye Etfal Training and Research Hospital Infectıous Diseases PSYCHOLOGICAL SYMPTOMS: CHILDHOOD Clinic, Istanbul TRAUMAS, DEPRESSION, ANXIETY AND PHYSICAL 5 Bakırköy Dr. Sadi Konuk Training and Research Hospital, Infectıous CONDITION Diseases Clinic, Istanbul 6Haseki Training and Research Hospital, Infectıous Diseases Clinic, Yüksel Kıvrak1, İbrahim Yağcı2, Hacer Paşaoğlu Yağcı3 Istanbul 1Kafkas University Medical School, Psychiatry Department, Kars 7HIVEND-HIV Infectıon Association, Istanbul 2Kars Harakani State Hospital, Psychiatry Clinic, Kars 3Kafkas University Medical School, Women’s Diseases and Antenatal AIM : Incidences of psychiatric disorders are frequently observed in Department,Kars the course of human immunodeficiency virus (HIV) infection and the clinical characteristics are different as compared to the general AIM: Hyperemesis gravidarum (HG) is a clinical condition with a population (1). Given the stresses of social stigmas after HIV/AIDS course of severe nausea-vomiting and makes up one of the most common ORAL PRESENTATIONS diagnosis, attempts by these patients to seek psychological help are only reasons for hospitalization during the first months of pregnancy. HG, few (2). This study has aimed at investigating the psychiatric complaints apart from its adverse effects on the life quality of women, has a and treatment seeking by the HIV patients under follow up at infectious significant effect on the health economy. Hence, individual and public diseases polyclinics. costs. HG aetiology has not been clarified. We have aimed here to investigate the relationships of HG with depression, anxiety, childhood METHODS: Individuals over the age of 18 years, diagnosed to be traumas and exaggeration of somatic sensations. HIV positive and consulting five different infectious diseases clinics in Istanbul for their routine follow up controls have been included in this METHODS: The study enrolled 45 gravid women with HG, but study which is currently going on. Patients with opportunistic infections without any psychiatric disorders and 45 healthy gravid women of the CNS, malignancies or dementia were excluded. The participants without Hg or psychiatric disorders to make up the control group. All have completed a specially prepared sociodemographic questionnaire participants completed a sociodemographic questionnaire, the Beck including items on psychiatric complaints and treatment seeking Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI), approaches, as well as completing the Beck Depression Inventory (BDI) the Somatosensory Amplification Scale (SAS), the Childhood Traumas and the Beck Anxiety Inventory (BAI). Those who expressed psychiatric Questionnaire (CTQ) and the Pregnancy-Unique Quantification of complaints have been referred to consultant psychiatrists. The clinical Emesis and Nausea (PUQE). data have been obtained from the patient files. RESULTS: The two groups did not differ significantly on RESULTS: In this ongoing study, 172 patients have been included sociodemographical grounds except for the data on economical up to September 2106. Before diagnosis of HIV, incidence of status, which was lower in the HG group. Comparing the scores of psychological complaints were 24.6%, and increased to 70.8% after the HG group and the control group on the psychometric test, the the positive diagnosis; and 41.3% of these complaints had not been results were, respectively, 12.38±1.319 vs 5.02±1.738,(p<0.01) on shared with infectious diseases physicians; and 79.3% of the patients PUQE; 17.13±8.628 vs 7.64±4.44, (p<0.01) on BDI; 43.26±7.402 had not consulted a psychiatrist. In 28% of the patients the BDI vs 43.4±5.16, (p>0.05) on STAI-‘state’ ; 45.4±5.162 vs 41.73±4.95, score was above the cutoff point and 20% of these patients were put (p<0.05) on STAI-‘trait’; 34.57±7.67 vs 30.31±6.35 (p=0.05) on SAS; on psychiatric pharmacotherapy. The mean BDI score of the patients and 41.82±10.77 vs 34.86±4.01, (p<0,001) on CTQ. The results of with psychological complaints was 15.24 (±12.0) and the mean BAI the correlation analyses on the data from the HG group showed a score was 14.76(±12.9), both scores being significantly higher than the relationship between the PUQE score and the CTQ, BDI, SAS and corresponding mean scores of the HIV patients without psychological STAI-’state’ scores but not with the STAI ‘state’ score. complaints (p<0.001). Opportunistic infection, hospitalization for DISCUSSION: The results of our study suggest that childhood traumas HIV, antiretroviral resistance positivity were found to be related to (CT), amplification of somatic sensations (ASS) and state of anxiety psychological complaints (p<0.05). (STA) may underlie HG. Severity of HG may be associated not only with DISCUSSION: It can be difficult to recognize the psychiatric CT, ASS and STA, but also with depression. These results are expected symptoms of HIV patients due to the complicated biological, social to be useful in two respects. Firstly, they can be of use to physicians and psychological factors involved. Furthermore, the expression of these in family medicine, clinicians in maternity and psychiatry fields. They symptoms by the patients are limited. Hence, in conclusion, treatment can increase the clinician’s awareness of the psychiatric aspect of HG, of the psychological complaints of HIV patients is currently below what and thereby provide the basis for a multidisciplinary approach to the is expected. treatment of HG. Secondly, these results would be useful in the public

59 arena, by way of contributions to formation and implementation of the RESULTS: Treatment compliance of the patients on depot PP was programs for studies to prevent childhood traumas, on educating family significantly higher than compliance of the patients on OAP agents; and members and to shape public knowledge and awareness on the subject. the adverse side effects of PP on the daily performance of the patients were significantly lower as compared to the OAP agents. Our study has not established a definitive ‘cause-effect’ relationship for HG, and also it is not known if the observations made are tenable DISCUSSION: This study has demonstrated the higher efficiency of in different regions and cultures. Hence, further prospective studies on treatment of schizophrenia with depot PP with respect to compliance, HG in different regions and cultures would contribute positively to the side effects and quality of life as compared to the second generation aetiology of HG. OAP agents. There is, however, need for wider scale and more specific studies on the subject of this study. Keywords: Childhood traumas, hyperemesis gravidarum, pregnancy, Psychiatry Keywords: Antipsychotics, Paliperidon palmitate, quality of life, side effect, treatment compliance References Adams MM, Harlass FE, Sarno AP, Read JA, Rawlings JS. Antenatal References hospitalization amongen listed service women 1987–1990. Emsley R, Chiliza B, Asmal L (2013) The evidence for illness progression ObstetGynecol 1994; 84(1): 35–9. after relapse in schizophrenia. Schizophr Res 148 (1–3), 117–121. Fairweather DV. Nauseaandvomiting in pregnancy. Am J ObstetGynecol Hargarter L, Cherubin P, Bergmans P, Keim S, Rancans E, Bez Y et al. 1968;102(1):135-75. Intramuscular long-acting paliperidone palmitate in acute patients Gazmararian JA, Petersen R, Jamieson DJ, Schild L, Adams MM, with schizophrenia unsuccessfully treated with oral antipsychotics. Deshpande AD, Franks AL. Hospitalizations during pregnancy Prog Neuro Psychopharmacol Biol Psychiatry 58 (2015) 1–7. among managed careen rollees. ObstetGynecol 2002; 100(1): 94– Leucht S, Tardy M, Komossa K ve ark. (2012) Antipsychotic drugs 100. versus placebo for relapse prevention in schizophrenia: a systematic Kugahara T, Ohashi K. Characteristics of nauseaandvomiting in review and meta-analysis. Lancet 379:2063–2071. pregnant Japanese women. Nurs Health Sci 2006;8(3):179–84. Schreiner A, Aadamsoo K, Altamura AC, Franco M, Gorwood Kıvrak Y, Gey N, Kıvrak HA, Kokaçya MH, Çöpoğlu ÜS, Arı M. P, Neznanov et al., (2015) Paliperidone palmitate versus oral Kadına yönelik eş şiddeti, çocukluk travmaları, depresyon ve yaşam antipsychotics in recently diagnosed schizophrenia. Schizophr Res ORAL PRESENTATIONS kalitesi: Toplum temelli çalışma (Spouse violence against women, 169: 393–399. childhood traumas, depression and quality of life: A population based study) Anadolu Psikiyatri Dergisi 2015;16(5):314-22. Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. OP-041 Hyperemesisgravidarum, a literaturereview. Human Reproduction Update 2005; 11(5): 527–539. PROLACTIN LEVELS OF PATIENTS USING PALIPERIDONE PALMITATE Ali Baran Tanrıkulu, Memduha Aydın, Bilge Çetin İlhan, OP-040 Seda Kırcı Ercan, Deniz Altunova, İbrahim Eren Konya Training and Research Hospital, Beyhekim Psychiatry Clinic, COMPARISON OF DEPOT PALIPERIDON Konya PALMITATE AND SECOND GENERATION ORAL AIM: Paliperidone palmitate (PP), an agent, is ANTIPSYCHOTIC DRUGS WITH RESPECT TO used in the acute and maintenance treatment of schizophrenia. Side TREATMENT COMPLIANCE, SIDE EFFECTS AND effects include galactorrhea and amenorrhea, which are secondary QUALITY OF LIFE IN SCHIZOPHRENIA outcomes of hyperprolactinemia, and have often been reported in studies on PP therapy. Our study has aimed at evaluating the changes Demet Sağlam Aykut, Filiz Civil Arslan in serum prolactin levels of schizophrenia patients during the course of Karadeniz Technical University Medical School, Psychiatry Department treatment with PP treatment of at least 6 months. AIM: Despite there being effective treatment for schizophrenia, METHODS: This study has retrospectively scanned the data in the incidences of flare ups and repeated attacks are observed quite hospital files of schizophrenia patients who consulted Konya Training frequently. Treatment with antipsychotic agents reduces the incidence and Research Hospital, Psychiatry Clinic between Julya 2014 and July of repeat attacks, but incompliance with oral drug therapy given to 42% 2016. The patients had received PP monotherapy for a minimum of of the diagnosed patients endangers the rate of effectiveness. This study 6 months. Data consisted of sociodemographic information, clinical has aimed to compare the treatment compliance, side effects, patients’ characteristics, scoring on the Positive and Negative Symptoms Scale life quality during therapy with depot paliperidone palmitate (PP) and (PANSS), serum prolactin levels, TSH and other metabolic parameters. the second generation oral antipsychotic (OAP) agents. RESULTS: The study included 33 patients (15 females and 18 males). METHODS: This study included a total of 84 patients diagnosed Mean PANSS score of the patients was 48,2 (±15,8) all were in stable with schizophrenia, 33 of whom were under treatment with depot PP condition. Whereas there was not a statistically significant difference and 51 were treated with second generation OAP agents. All patients between the serum prolactin levels of female and male patients before completed the Positive and Negative Symptoms Scale (PANSS), the starting the PP therapy(p>0.05); after giving depot PP therapy for one Clinical Global Impressions Scale (CGS), the Extrapyramidal Symptom month, serum prolactin in females was 195,06±34,05 ng/ml as compared Rating Scale (ESRS), the UKU (Udvalg for Kliniske Undersøgelser) to 30,73±18,83 ng/ml in males, the difference being statistically significant Side Effects Rating Scale, the Short Form Health Survey- (SF-36), (p<0.001). After one year of regular therapy with PP monotherapy, the Morisky Medication Adherence Scale-MMAS-4) and the Three serum prolactin of the female group was 68,51±35,23 ng/ml which was Components of Insight (SAI) Scale. significantly higher than that of the males (34,07±17,61 ng/ml; (p<0.05).

60 While hyperprolactinemia symptoms were not detected in the male RESULTS: Schizophrenia patients (n:59) and the control group (n:36) patients, symptoms of amenorrhea (n=4) and galactorrhea (n=2) were did not differ significantly on grounds of age and gender. The mean more frequently seen among the female patients. duration of schizophrenia was 10.33 years, the mean PANSS score was 75.18 and the mean CGI-S score was 3.88. A statistically significant DISCUSSION: Hyperprolactinaemia effect with its acute and chronic difference in the choroid thickness between the patients and the controls effects is an important side effect of antipsychotic. Prolactin levels of was not e determined. A negative correlation was determined between patients on antipsychotic therapy should be regularly controlled. PP levels the subfoveal choroid thickness and the duration of schizophrenia (r=- rise rapidly during the first months of the therapy with the dose given, 0.38, p=0.006). especially in female patients. Through the first year of the therapy prolactin levels vacillate. There is need for further information on follow up and DISCUSSION: Currently, investigations on neurodegeneration and treatment approaches in hyperprolactinemia resulting from PP therapy. neuroprotection in psychiatric disorders with a course of structural and functional changes in the brain such as seen in schizophrenia have Keywords: Hyperprolactinemia, paliperidone palmitate, schizophrenia gained momentum. In our study, a difference in the choroid thickness References of schizophrenia patients and the controls could not be shown, although Bai YM, Chen TT, Lin WK et al, (2007) Pharmacokinetics a moderate negative correlation was observed between the duration study for hyperprolactinemia among schizophrenics switched of the disease and the subfoveal choroid thickness. There is need for from risperidone to risperidone long-acting injection. J Clin experimentation with larger number of patients, differentiation of the Psychopharmacol, 27(3): 306-8. remission and attack episodes of the disease, standardization of drug Bishara D (2010) Once-monthly paliperidone injection for the therapy and use of new technology OCT equipment. It is thought that treatment of schizophrenia. Neuropsychiatr Dis Treat, 6: 561-72. definitive retinal and choroid anomalies could serve as biomarkers for De Hert, Detraux J, Peuskens J (2014) Second-generation and the detection and monitoring the progress of the disease. newly approved antipsychotics, serum prolactin levels and sexual Keywords: Choroid thickness, optical coherence tomography, retina, dysfunctions: a critical literature review. Expert Opin Drug Saf schizophrenia 13(5): 605-24. McEvoy JP, Byerly M, Hamer RM et al. (2014) Effectiveness of References paliperidone palmitate vs haloperidol decanoate for maintenance Bayhan HA, Bayhan SA, Celikbilek A et al., (2015) Evaluation of the treatment of schizophrenia: a randomized clinical trial. JAMA, chorioretinal thickness changes in Alzheimer’s disease using spectral- ORAL PRESENTATIONS 311(19): 1978-87. domain optical coherence tomography. Clinical and Experimental Nussbaum AM, Stroup TS (2012) Paliperidone Palmitate for Ophthalmology, 43:145-151. Schizophrenia. Schizophr. Bull, 38(6): 1124–27. Celik M, Kalenderoglu A, Karadag AS et al., (2016) Decreases in Perry BI, Goldring KJ, Menon SJ (2016) Prolactin monitoring in the ganglion cell layer and inner plexiform layer volumes correlate acute psychiatry setting. Psychiatry Res, 235: 104-9. better with disease severity in schizophrenia patients than retinal nerve fiber layer thickness: Findings from spectral optic coherence tomography. European Psychiatry 32: 9-15. Hosak L, Hakeem K, Raad M et al., (2015) Is microvascular abnormality OP-044 a new endophenotype in schizophrenia? Psychiatria Danubina 27: 225-229. EVALUATION OF THE CHOROID THICKNESS IN Madeline HM, Nathan AG, Narelle KH et al., (2015) Retinal SCHIZOPHRENIA PATIENTS BY SPECTRAL DOMAIN microvessels reflect familial vulnerability to psychotic symptoms: OPTICAL COHERENCE TOMOGRAPHY A comparison of twins discordant for psychotic symptoms and controls. Schizophrenia Research, 164: 47-52. Memduha Aydın, Pınar Topçu Yılmaz, Bilge Çetin İlhan Konya Training and Research Hospital, Beyhekim Psychiatry Clinic, Konya OP-045 AIM: Recent studies on retinal vessels in schizophrenia have shown that the retinal venules are wider suggesting a relationship to microvascular INCIDENCE OF MINOR PHYSICAL ANOMALIES disorder. This study has aimed to compare the choroid layer thickness AND ITS RELATION WITH THE CLINICAL COURSE in schizophrenia patients and healthy controls by using the spectral IN SCHIZOPHRENIA: PILOT STUDY domain optical coherence tomography (SD-OCT) technique. Ertuğ Berberoğlu1, Hüda Paslı1, Can Uğurpala1, Selin Akışık METHODS: The study enrolled 59 schizophrenia patients followed Genç1, Nuran Çağlar1, Damla İnhanlı1, Hüseyin Utku at Konya Training and Research Hospital, Psychiatry Clinic and 36 Özkan2, Vehbi Alp Üçok1 healthy individuals as the controls. All patients were evaluated by 1 psychiatric tests and physical examination Those with diabetes mellitus, Istanbul University, Medical School, Psychiatry Department, Istanbul 2Istanbul University, Medical School hypertension, cardiovascular diseases, mental retardation, cigarette smoking habit/history, and with and eye disease that would interfere AIM: Minor physical anomalies (MPA) are deviations that emerge with the measurements were excluded from the study. In all participants of morphogenesis and result in very limited or no complaints of functional the study, choroid thickness was imaged by high depth OCT on the or cosmetic nature. MPA have been considered as signs of liability to fovea, and at 500µ, 1000 µ and 1500 µ nasal and temporal to the fovea. schizophrenia. The theory that schizophrenia is a neurodevelopmental Measurements were compared between the two groups; and correlation disorder claims that the signs of schizophrenia can be traced back to between the choroid thickness and the scores on the Positive and prenatal period. Since brain and the skin are both of ectodermal origin, Negative Symptoms Scale (PANSS) and the Clinical Global Impression MPA may be external indicators of anomalies in brain development. – Severity scale (CGI-S) were analyzed by the Spearman correlation Studies on the subject have shown that the repetitive type of MPAs are coefficient. The p value of <0.05 was accepted as statistically significant. seen more frequently in schizophrenia patients and that some regions

61 are affected more frequently than others. Furthermore, the increased with different psychiatric diagnoses. It has been observed by standardized incidence of MPA has been found to be related to symptom severity, assessment tools in 7-15% of patients at admission to hospital. It was negative symptoms, treatment resistance and homicidal attitudes. The the aim of this study to investigate the clinical characteristics and aim of this study was to compare MPA incidence in schizophrenia the response to treatment in the inpatients with observed catatonic patients and normal controls and to determine the relationship between symptoms during hospital stay. the anomalies and the symptoms. METHODS: This ongoing study was carried out at Istanbul University METHODS: The study included 123 schizophrenia patients Medical School Psychiatry Services with 23 patients who arrived up diagnosed on the basis of DSM-5 criteria, and 50 healthy individuals to August 2016 and were determined to exhibit at least two catatonic as the controls. Patients and the controls completed a specially prepared symptoms at the stage of hospital admission or later at hospital. All sociodemographic questionnaire and the Modified Waldrop Minor patients were assessed by the Bush-Francis Catatonia Rating Scale Physical Anomaly Scale (MWMPA). The patients also completed the (BFCRS). Data on clinical progress and demographic details were Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impressions acquired from the patient files. Scale (CGS) and the Global Assessment of Functioning (GAF) Scale. RESULTS: This ongoing study has enrolled a total of 23 patients by RESULTS: A statistically significant difference (p=0,000) was August 2016. The patients were followed for diagnoses on schizophrenia determined between the MWMPA total score of the patients (mean: (n=11), bipolar disorder (n=5), major depressive disorder (n=4). Two 4,82) and the controls (mean: 2,68). When the patients and the of the patients did not have any known diagnoses and were diagnosed controls were grouped on the basis of gender in order to detect the to have various neurological changes. Five patients had a history of discriminatory anomalies of the patients, anomalies of the face catatonic period with a mean duration of 19.6 (±11.4) days. The most (p=0,001), face and ear (p=0,005) and the mouth regions (p=0,041) frequent catatonic symptoms observed was immobility/stupor (95.7%), were prominent in the female patients as compared to the control; and, fixed stare (95.7%) and mutism (89.5%). Treatment with lorazepam anomalies of ear (p=0,028), eye (p=0,025), mouth (p=0,000) and hand was the first preference of 85.7% of the patients. However, 23% of these regions (p=0,038) were more prominent in the male patients. Regarding patients were given ECT as lorazepam was not effective at the expected the clinical course of the disease, the MWMPA total score correlated level. with the total score (p=0,001) and the ‘psychotic symptoms’ sub scale score (p=0,007) on the BPRS. The ‘depressive symptoms’ subscale score DISCUSSION: Catatonia is a syndrome that is seen with various ORAL PRESENTATIONS of BPRS was found to be correlated with anomalies of the facial region psychiatric and medical disorders. Definitive recognition of the (p=0,041), and the foot region (p=0,046). symptoms and other related data are important for understanding the underlying pathology. DISCUSSION: The preliminary results of our study have shown that MPA are discriminatory indicants between schizophrenia patients and Keywords: Catatonia, ECT, lorazepam healthy controls and it is thought that MPA can provide predictive References information on the clinical course of the disease. American Psychiatric Association. (2013). Diagnostic and statistical Keywords: Minor physical anomaly, neurodevelopment, schizophrenia manual of mental disorders (DSM-5). American Psychiatric Pub, p. 119. References Fink, M., Taylor, M. A. (2009). The catatonia syndrome: forgotten but Jones KL. Smith’s Recognizable Patterns of Human Malformation. not gone. Archives of General Psychiatry, 66(11), 1173-1177. : W.B. Saunders Company; 1997. Marenco S, Weinberger DR. The neurodevelopmental hypothesis of schizophrenia: following a trail of evidence from the cradle to grave. Dev. Psychopathol. 2000;12(3):501–527. OP-047 Tényi T, Halmai T, Antal A, Benke B, Jeges S, Tényi D, Tóth ÁL, Csábi G. Minor physical anomalies are more common in schizophrenia EVALUATION OF THE CORRELATION BETWEEN patients with the history of homicide. Psychiatry Res. 2015 Feb SERUM PGE2, 15D-PGJ, PPAR GAMMA LEVELS AND 28;225(3):702-5. EEG PARAMETERS IN SCHIZOPHRENIA PATIENTS Xu T, Chan RC, Compton MT. Minor physical anomalies in patients with schizophrenia, unaffected first-degree relatives, and healthy Rabia Nazik Yüksel1, Ayşe Pınar Titiz1, Elif Tatlıdil Yaylacı1, controls: a meta-analysis. PLoS One. 2011;6(9):24129. Kübranur Ünal2, Makbule Çiğdem Aydemir1, Weinberg SM, Jenkins EA, Marazita ML, Maher BS. Minor physical Turan Turhan1, Gamze Erzin3, Cevdet Züngün4, Erol Göka1 anomalies in schizophrenia: a meta-analysis. Schizophr Res. 2007; 1Ankara Numune Training and Research Hospital 89:72–85. 2Polatlı State Hospital 3Dışkapı Yıldırım Beyazıt Training and Research Hospital 4Düzen Laboraties, Biochemistry Core Lab OP-046 AIM: A number of hypotheses on the inflammatory processes due to external and endogenous factors in relation to the development EVALUATION OF THE CATATONIA PATIENTS of schizophrenia and other psychoses have been proposed. There is FOLLOWED IN THE PSYCHIATRY SERVICE strong evidence for immunological dysfunctions in schizophreni. On the basis of the hypothesis on the inflammatory process, this study Ezgi İnce, Alp Üçok has investigated the serum anti-inflammatory prostaglandin 15d-PGJ Istanbul University Medical School, Mental Health and Diseases and its nuclear receptor PPAR gamma and the pro-inflammatory Department, Istanbul prostaglandin E2 (PGE2) levels and their correlation with the data on AIM: Catatonia is a syndrome characterized with impaired interaction electroencephalography (EEG), with the intent to contribute to the with the external world and psychomotor changes. It can be associated aetiology of schizophrenia.

62 METHODS: The study included 44 individuals diagnosed with OP-048 schizophrenia on the basis of the DSM-V criteria, and consulting the psychiatry clinic of Ankara Numune Training and Research Hospital for EVALUATION OF COMBINATION THERAPY WITH complaints of acute flare up, and 39 healthy volunteers as the control LONG ACTING ANTIPSYCHOTIC AGENTS AND group. Serum PGE2, 15d-PGJ, PPAR gamma levels of all participants THERAPEUTIC USE OF MULTIPLE MEDICATIONS were estimated. The patient group completed a sociodemographic Yasir Şafak, Süheyla Doğan Bulut, Akfer Kahiloğulları, questionnaire and the positive and negative symptoms scale (PANSS). Hasan Karadağ, Sibel Örsel RESULTS: The results of our study showed a statistically significant Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara decrease in the serum PGE2, 15d-PGJ, and PPAR gamma levels of the AIM: Schizophrenia is a chronic disease that leads to the deterioration patient group as compared to the control group. The levels of these of social and professional functionality. Treatment is given by oral inflammatory markers did not show statistically significant correlations antipsychotic agents (OA), long acting depot forms of antipsychotic with the amplitudes and the frequencies of alpha and beta waves agents (LAA) and the combination of both types of medications. Studies comparing the OA and the LAA have not clarified with certainty which recorded with digital EEG. The only variable that affected the levels of type of treatment is more effective. This study has aimed at comparing all three biomarkers was the duration of the disease. the treatment compliance of patients using the LAA and the OA after DISCUSSION: There are differences in the serum levels of pro and anti- schizophrenia diagnosis and the use of additional medication use on account of side effects. inflammatory prostaglandins in schizophrenia patients in comparison to healthy controls. Determining that these differences were only related METHODS: This retrospective study included 250 schizophrenia to disease duration suggests that an assumed inflammation affects the patients being followed up at the Public Mental Health Centre of chronic course of schizophrenia. It can be said that inflammatory Dışkapı Yıldırım Beyazıt Training and Research Hospital. Data on the variables and comparisons between the LAA and OA users have been markers are good candidates as predictors of either the prognosis of made by statistical analyses. schizophrenia after diagnosis, or for recognizing the disease before its overt onset. Studies on long term data on the acute flare up and RESULTS: Of the 250 participating patients 30 (12%) were on only ORAL PRESENTATIONS remission periods of the patients, and investigations on the first degree LAA; 110 (44%) were on LAA and OA; and 110 (44%) were on only OA. Those on LAA either used the drug ‘once/2 weeks’ (n=42, 30%) relations of patients as well as the high risk individuals will be useful for or used LAA ‘once/4 weeks’ (n=98, 70%). Incidence of additional understanding the role of inflammation in the aetiology and the disease medication use due to side effects was 23.6% (n=26) in OA users, 31% process of schizophrenia. Failure to observe any correlations between (n=13) in LAA ‘once/2 weeks’ users; and 43.9% (n=43) in LAA ‘once/4 the levels of the inflammatory markers and the changes in brain waves weeks’ users, there being statistically significant differences between the estimated by conventional EEG point to the necessity of repeating this groups (p=0.008). Treatment compliance incidence was 51.8% (n=57) study with advanced devices in order to shed a better light on these among the OA users, 59.5% (n=25) among LAA ‘once /2 weeks’ users phenomena. and 30.6% (n=30) among LAA ‘once/4 weeks’ users, with statistically significant differences determined between the groups (p=0.001). Keywords: EEG, inflammation, PPAR gamma, prostaglandin E, DISCUSSION: There are significant differences in the use of Schizophrenia additional medication due to side effects and in treatment compliance References between groups on OA only, or those using LAA once every 2 weeks or Das I, Khan N. Increased arachidonic acid induced platelet once every 4 weeks. chemiluminescence indicates cyclooxygenase overactivity in Keywords: Depot antipsychotic agent, polypharmacy, schizophrenia schizophrenic subjects. Prostaglandins, leukotrienes and essential fatty acids. 1998; 58:165-8. García-Bueno B, Bioque M, Mac-Dowell KS, Barcones MF, OP-049 Martínez-Cengotitabengoa M, Pina-Camacho L, et al. Pro-/ anti-inflammatory dysregulation in patients with first episode EVALUATION OF CLINICAL CHARACTERISTICS of psychosis: toward an integrative inflammatory hypothesis of AND TEMPERAMENT IN SUBSTANCE USE schizophrenia. Schizophrenia bulletin. 2014; 40:376-87. DISORDER WITH AND WITHOUT ADULT Kaiya H, Uematsu M, Ofuji M, Nishida A, Takeuchi K, Nozaki M, ATTENTION DEFICIT AND HYPERACTIVITY et al. Elevated plasma prostaglandin E2 levels in schizophrenia. DISORDER COMORBIDITY Journal of neural transmission. 1989; 77:39-46. Esin Erdoğan1, Dursun Hakan Delibaş1, Nabi Zorlu2, Kaplan H, Sadock B. Schizophrenia and other psychotic disorders. Emel Paşa Baskın1, Ümit Karabulut3 Synopsis of psychiatry, 8th ed Baltimore: Williams and Wilkins. 1Sağlık Bilimleri University, İzmir Bozyaka Training and Research 2002:456-500. Hospital, Psychiatry Clinic, İzmir Lucas SM, Rothwell NJ, Gibson RM. The role of inflammation in 2İzmir Katip Çelebi University, Atatürk Training and Research Hospital, CNS and disease. British journal of pharmacology. 2006; Psychiatry Department, İzmir., 147:S232-S40. 3Derince Training and Research Hospital, Psychiatry Clinic, Kocaeli Saetre P, Emilsson L, Axelsson E, Kreuger J, Lindholm E, Jazin E. AIM: Higher incidence of attention deficit hyperactivity disorder Inflammation-related genes up-regulated in schizophrenia brains. (ADHD) is seen in adults diagnosed with substance use disorder (SUD) Bmc Psychiatry. 2007;7:1. as compared to the general population. This comorbidity of ADHD has

63 negative effects on the prognosis of SUD patients. This study has aimed OP-051 at comparing the clinical details and the temperament of SUD patients with and without ADHD comorbidity. SEARCH FOR WAYS OF TREATMENT IN METHODS: The study has included 80 patients with SUD diagnosis, ALTERNATIVE MEDICINE BY PATIENTS 80 patients with SUD and ADHD diagnoses, and 80 healthy adults as CONSULTING THE PSYCHIATRY POLYCLINICS OF A the control group. The groups have been matched for age and gender. UNIVERSITY HOSPITAL All three groups of participants have completed a sociodemographic Sedef Şeyma Yılmaz, Fadime Dalboy, Adem Aydın questionnaire, the structured clinical interview SCID-I for DSM –IV Necmettin Erbakan University, Meram Medical School, Psychiatry axis-1 disorders- Turkish version., the Wender Utah Rating Scale-short Department, Konya form (WURS), the Adult ADHD Self-Report Scale (ASRS-v1.1) and the Temperament evaluation of Memphis, Pisa, Paris and San Diego AIM: Despite the widened consciousness and services of mental health (TEMPS-A) scale. over the last 50 years, seeking treatments with alternative medicine for psychiatric disorders is seen to persist. This study has evaluated RESULTS: In the SUD+ADHD group, the starting age, total duration, the search for treatment with alternative medicine among the patients the frequency and amount of substance use, and comorbidity incidence consulting Necmettin Erbakan University, Meram Medical School, were higher. Alcohol and cannabis use ranked higher in the SUD group general psychiatry polyclinics. and multiple substance use ranked higher in the SUD+ADHD group, the intergroup difference being statistically significant (p<0.01). Scores METHODS: A total of 200 individuals (130 females and 70 males) on the ASRS subscales ‘combined type (n=36, 45%), hyperactive- consecutively consulting the psychiatry polyclinics were included in the impulsive type (n=26, 32.5%) and the inattentive type (n=18, 22.5%) study. In the questionnaire prepared for the study, sociodemographic details and all search for treatments with alternative medicine were were identified. In 10 patients of the SUD group and in 34 patients queried. The psychiatric diagnoses of the patients on the basis of of the SUD+ADHD group at least one dominant temperament was DSM-V were placed in three groups depicted as the , mood determined. In the SUD+ADHD group, the scores on the cyclothymic, disorders, and the psychosis groups and the groups were compared. irritable and anxious temperaments were higher, and these temperament scores of the three groups differed significantly (p<0.001). SUD and RESULTS: Among the 200 participating patients 22.3% of the female ORAL PRESENTATIONS SUD+ADHD groups did not differ significantly on the scores for and 35% of the male patients had sought treatment with alternative depressive and hyperthymic temperaments. medicine. Taking the level of education as the basis of comparison, 5 of 8(62%) of the illiterate patients, 23 of 75(30%) of primary school DISCUSSION : In this study the SUD+ADHD group had a severer graduates, 5 of 21(23%) of middle school graduates, 13 of 49 (26.5%) clinical profile for substance use, and had a higher incidence of the of lycée graduates and 8 of 47(17%) of university graduates had sought affective temperament subtypes depicted as cyclothymic, irritable ways of treatment using alternative medicine. When evaluated according and anxious types. When planning a treatment for SUD patients, to location of homes, 9 of 33(27%) of villagers, 16 of 45(35%) of urban clinicians should not overlook the ADHD comorbidity. Determination district dwellers, and 29 of 122 (23%) of inner city dwellers had tried of the temperament types among the SUD patients with ADHD alternative medicine. Evaluation with respect to employment showed comorbidity will facilitate the understanding of ADHD clinically and that 29 of 123 (23.5%) of those who did not have a job and 25 of 77 phenomenologically. (32%) of patients who had a job had looked for ways of alternative Keywords: Attention deficit hyperactivity disorder, clinical medicine. Finally, when compared on the basis of psychiatric diagnosis, characteristics, substance use, temperament 15 of 93 (16.5%) of the neurosis group, 21 of 76 (27%) of the mood disorders group and 18 of 31 (58%) of the psychosis group admitted References seeking treatment with alternative medicine. Faraone SV, Biederman J, Spencer T ve ark. (2006) Diagnosing DISCUSSION: Illiterate patients consulting the psychiatry polyclinics adult attention deficit hyperactivity disorder: Are late onset and with dominant psychotic symptoms, the incidence of seeking ways of subthreshold diagnoses valid? American Journal of Psychiatry, treatment with alternative medicine was significantly high. 163:1720–29. Kessler RC, Adler LA, Barkley R, Biederman J, Conners CK, Faraone Keywords: Alternative medicine, psychiatry, psychosis SV, Green-hill LL, 5. Jaeger S, Secnik K, Spencer T, Ustün TB, References Zaslavsky AM, 2005. Patterns and predictors of attention-deficit/ Uğuz F.,Karababa F., Aşkın R. Obsesif kompulsif bozukluk için yardım hyperactivity disorder persistenceinto adulthood: results from the aramada ilk başvuru yerlerinin değerlendirilmesi, Genel Tıp Derg national comorbidity survey replication. Biol. Psychiatry 57, 1442– 2007;17(1) 1451. Ohlmeier MD, Peters K, Te Wild, BT, Zedler M, Ziegenbein M, Wiese B, Emrich HM, Schneider U (2008). Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder OP-052 (ADHD). Alcohol Alcohol. 43,300–304. Wilens, T.E., Fusillo, S., 2007. When ADHD and substance use THE EVENTS OF JULY 15TH AS A SOCIAL STRESSOR disorders inter-sect: relationship and treatment implications. Curr. FOR BIPOLAR DISORDER PATIENTS Psychiatry Rep. 9,408–414. Ezgi İnce, Mete Erciş, Abdullah Fenercioğlu, Sibel Çakır van Emmerik-van Oortmerssen K., van de Glind G, Koeter M W, 1Istanbul University, Istanbul Medical School, Mental Health and Allsop S, Auriacombe M, Barta C, Schoevers RA (2014) Psychiatric Diseases Department, Istanbul comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of AIM: The aim of this study has been to determine the psychiatric the IASP study. Addiction, 109(2), 262-272. effects of the events of 15 July 2016, which occupied the daily agenda

64 intensively, on euthymic bipolar disorder (BD) patients under follow RESULTS: The age range of the patients and the control groups were, up. respectively, 20-56 and 25-58 years; and the groups did not differ significantly on sociodemographic details. The score on VS of the patient METHODS: Our study enrolled 56 BD patients under follow up at the group, especially in the females, was significantly high (p=0.038); and mood disorders unit. The participating patients were asked to complete also, the BEQ subscale score on ‘impulse severity’ was significantly a questionnaire with 36 questions on demographic information, mood, higher than that of the females of the control group (p<0.001). Pearson sleep, and appetite, thoughts of death, functionality and perspective on correlation analysis between the groups on the subscale scores of VS the future. Also, the patients were evaluated on the basis of acute stress and BEQ did not give a positive or negative relationship. However, disorder (ASD), anxiety disorder (AD) and psychoticism. Interviews regarding the scoring on BEQ, significant positive correlations were were partly conducted face to face and partly on the telephone. determined between positive expressivity and emotional expressivity RESULTS: Among 35.7% of the participating patients, mood changes (p<0.001, r:0.625), negative expressivity and emotional expressivity had occurred after the July 15th events and 45% of these switches were (p<0.001, r:0.536) and between impulse severity and emotional subthreshold depression; while 36.4% had changed sleep, 23.6% had expressivity (p<0.001, r:0.650). changed appetite. Among those patients who consumed cigarette or DISCUSSION: Our study has demonstrated that feelings and emotional alcohol, cigarette consumption by 34% of the smokers and alcohol expressions of vengeance adversely affect marital relationships. consumption by 4% of alcohol users had gone up. Two of the patients had suicidal ideation while one had attempted suicide. It was seen Keywords: marital adjustment, emotional expressivity, vengeance that the events had negatively affected the future perspective of 42% of the patients; and also 30 (53.6%) had at least 1 incidence of ASD symptoms, 24 (42.9%) had at least 1 incidence of AD symptoms and 9 (16.1%) patients had at least 1 incidence of psychoticism. In the OP-054 group with at least 1 incidence of ASD symptoms, the mean number of symptoms per patient was 4.4, and 50% of these patients had mood COMPARISON OF THE SCORES ON ALEXITHYMIA change, and 61% had changed sleep. AND THEORY OF MIND SCALES OF MOTHERS WITH AUTISTIC AND NORMAL CHILDREN. DISCUSSION: According to the results of the study we have carried out, public events with this degree of violence cause mood changes and adverse Hüseyin Ünübol, Kübra Ay ORAL PRESENTATIONS effects on the daily activities of BD patients. In order to understand the Üsküdar University, Istanbul interrelationship of the events and the reactions of the patients, further studies are needed. It is thought that after these types of social stressors, AIM: The aims of this study are to compare the mothers of children establishing closer relationships with the patients would have beneficial with autism and mothers of normal children on the basis of their effects on the functionality of the patients and the course of the disease. scores on the psychometric tests evaluating the level of alexithymia and performance on theory of mind tasks; to determine the effects of Keywords: bipolar disorder, population events, social stressor the acquired sociodemographic data on these scores, and to publish the results in the literature so as to contribute to the knowledge of researchers and readers. OP-053 [Family-Couple Therapies] METHODS: The study has been carried out with 50 volunteering mothers of autistic children (some of whom being educated in Uskudar EFFECTS OF THE FEELING OF VENGEANCE ON district of Istanbul at a private education and rehabilitation center) and EMOTIONAL EXPRESSIVITY IN MARRIED COUPLES 50 volunteering mothers of healthy children. Data were acquired by

1 1 2 means of a sociodemographic questionnaire, the Reading the Mind in Selim Polat , Aysun Selimoğlu Özyılmaz , Çiçek Hocaoğlu the Eyes Test (RMET) and the Toronto Alexithymia Scale (TAS). The 1 Recep Tayyip Erdoğan (RTEU) Training and Research Hospital, data were coded by the researchers and analyzed on the SPSS 16.00 Psychiatry Clinic, Rize. 2 Windows package program using the methods suitable to the purposes Recep Tayyip Erdoğan University (RTEU), Medical School, Psychiatry of the study. Department, Rize. RESULTS: Total scores and the scores on all subscales of the TAS of AIM : Feeling of vengeance, describable as an individual’s desire to the two groups of mothers were compared with their performances revenge or exact punishment for a wrong done on her or himself, on the basis of the ‘’theory of mind’’. The mean score of the mothers has an important place in interpersonal relationships. In recent years with autistic children on RMET were higher as compared to the vengeance has become subject of research and psychometric scales corresponding score of the mothers with normal children (the controls) have been developed for assessment. Up to date, vengeance has been (t(93)=1,46, p>.05); and also, their mean score on the TAS subscales of investigated especially in the work environment but not in marriage. ‘difficulty identifying feelings’ (t(93)=3,166, p= 0.002), and ‘difficulty Our study has therefore aimed at investigating the effects of the feeling communicating feelings’(t(93)=0,122, p= 0.006) were significantly of vengeance on emotional expressivity in married couples consulting higher as compared to the controls. our psychiatry polyclinics. DISCUSSION: The study has determined that the ability of METHODS: This study enrolled 30 couples (30 females and 30 males) mothers of autistic children to identify and to communicate feelings consulting the RTEU Training and Research Hospital, Psychiatry was significantly reduced. Alexithymia has been known to be related polyclinics between 1.9.2015 and 31.12.2015. The control group to childhood traumas and genetic factors. Although it has not been consisted of 30 married couples without any diagnoses of psychiatric included in the autism spectrum, the results suggest a possible relation disorders, demographically matched with the patients and volunteering with autism. It is recommended that alexithymia should be investigated to participate. All participants completed a sociodemographic to find out whether it is a cause or an effect. questionnaire, the Vengeance Scale (VS) and the Berkeley Expressivity Questionnaire (BEQ). Keywords: Alexithymia, Mind reading, Autism

65 OP-055 Reissing ED, Binik YM, Khalife S et al. (2003) Etiological correlates of : Sexual and physical abuse, sexual knowledge, sexual EVALUATION OF SELF ESTEEM AND CHILDHOOD self-schema, and relationship adjustment. Journal of Sex & Marital TRAUMAS IN PATIENTS DIAGNOSED WITH SEXUAL Therapy 29: 47-59. DYSFUNCTION AND COMPARISON WITH HEALTHY Martin‐Morales A, Meijide F, García N et al., (2007) Efficacy of CONTROLS vardenafil and influence on self‐esteem and self‐confidence in patients with severe . The journal of sexual Gülşen Teksin Ünal, Özge Şahmelikoğlu Onur medicine 4: 440-447. Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological McCabe MP, Altho SE. (2014) A systematic review of the psychosocial Diseases and Research Hospital, Psychiatry Department, Istanbul outcomes associated with erectile dysfunction: Does the impact of erectile dysfunction extend beyond a man’s inability to have sex? AIM : Sexual function disorder SFD) describes the loss of enjoyment The journal of sexual medicine 11: 347-363. in the stages of sexual response due to anatomical, physiological and Simopoulos EF, Trinidad AC. (2013) Male erectile dysfunction: psychological causes (American Psychiatry Association, 2000). Self- integrating psychopharmacology and psychotherapy. General esteem is the condition of satisfaction from having confirmed a Hospital Psychiatry 1: 33-38. self-concept after self-evaluation (Yörükoğlu, 2004). Evaluation of Yörükoğlu, A. (2004) Gençlik Çağı Ruh Sağlığı Ve Ruhsal Sorunlar. childhood traumas (CT) in SFD would be beneficial for the course of İstanbul, Özgür Yayınları. SFD treatment; and, also, the level of self-esteem can be improved by Yetkin N, İncesu C (1997) Cinsel işlev bozukluklarında kullanılan the treatment given. In this study it has been aimed to compare patients terimlerin gözden geçirilmesi. Nöropsikiyatri Arşivi 214-218. diagnosed with SFD with healthy controls on grounds of CT and the level of self-esteem; and to investigate the relationship between self- esteem parameters in SFD and the parameters of CT assessment. OP-056 METHODS: The study enrolled 24 patients, consecutively consulting the Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases and Research Hospital, Sexual Relationship Unit polyclinics EFFECTS OF SHORT TERM HORMONE THERAPY ON THE QUALITY OF LIFE AMONG INDIVIDUALS ORAL PRESENTATIONS and 24 healthy controls. All participants complied with the inclusion and exclusion criteria of the study and were sked to complete a WITH . sociodemographic questionnaire, the Rosenberg Self-Esteem Scale Emre Mutlu, Gökhan Öz, Koray Başar (RSES) and the Childhood Traumas Questionnaire (CTQ-28). Hacettepe University Medical School, Mental Health and Disorders RESULTS: In SFD patients, the mean score of CTQ-28 and the Department, Ankara scores on the RSES subscales of criticism sensitivity, depressive mood, AIM: There are many cross-sectional and a few observational studies psychosomatic symptoms, feeling threat in interrelations, joining on hormone therapy and its effects on mental health and quality of discussions and relationship with the father were significantly higher life among individuals with gender dysphoria (GD) (gender identity than the corresponding scores of the controls (p<.05). SFD diagnoses disorder). This natural observational study on individuals identified of vaginismus and were related to the CTQ-28 with the female gender at birth but have developed GD, the effects of subscale score on physical abuse and the SFD diagnoses of premature hormone therapy on quality of life, depressive symptoms, and perceived ejaculation and ejaculatory anhedonia were related to the CTQ-28 discrimination and social support were investigated. subscale on emotional neglect, there being significant differences between SFD patients and the healthy controls (p<.05). METHODS: Female individuals consulting the psychiatry polyclinics from July 2011 onwards with the complaint of GD were twice tested DISCUSSION: There are studies in the literature on the relationship psychometrically, firstly at the start of the psychiatric follow up and of SFD and CT ((Reissing et al., 2003; Beitchman et al., 1992; Yetkin secondly when evaluated for transgender female to male surgery after and İncesu 1997). Our observation of high incidence of CT among a period of using male hormones. Quality of life was assessed with the SFD patients are in agreement with those in the literature. There are World Health Organization Quality of Life Questionnaire – Abbreviated/ also studies on the adverse effects of SFD on self-esteem (Chung E Turkish version (WHOQOL-BREF-TR); perceived discrimination was et al., 2015; McCabe MP et al., 2014; Martin‐Morales a et al. 2007; assessed by the Multidimensional Scale of Perceived Social Support Simopoulos EF et al., 2013). Our results have demonstrated reduced (MSPSS), and depressive symptoms were estimated on the Beck self-esteem in SFD patients. We believe that successful treatment of Depression Inventory (BDI). Demographic information and the details SFD will contribute positively to self-esteem by the patient; and, also, on the transgender surgery were recorded in a self-report questionnaire. that CT history of the patient with SFD, and especially a history of physical abuse and/or emotional neglect should be taken into account RESULTS: Mean age of the participants (n=20) at the first evaluation in the treatment of the SFD patient. was 27,45 (±3,8) years; and, 15 (70%) were working on jobs, 8 (40%) were university students. Psychiatric evaluation indicated that 8 (40%) Keywords: Childhood traumas, self-esteem, sexual malfunction had a history of psychiatric disorders, 2 (10%) had a history of suicidal disorders, childhood traumas attempt; and 3 (15%) had a history of self-harm disorder. Mean follow References up duration was 25 (±9,9) months, and the mean duration of hormone Amerikan Psikiyatri Birliği (2000) Mental Bozuklukların Tanısal ve therapy was 12,65 (± 2,37) months. After the hormone therapy, the Sayımsal El kitabı, Yeniden Gözden Geçirilmiş Dördüncü Baskı increases in psychological scores (t = -2,587, p=.019), and social (DSM-IV-TR) (Çev. ed.: E Köroğlu). Ankara, Hekimler Yayın scores t = -2,115, p=.049) and the decreases in the scores on perceived Birligi, 2000. discrimination against the individual (Z = -2,363, p =.018), and the Chung E, Gilbert B, Perera M, Roberts, MJ (2015) Premature scores on the BDI (Z = -2,533, p =.011) were significant. Similarly ejaculation: A clinical review for the general physician. Australian significant changes were not observed in the performance on other family physician 44: 737. subscales of the tests.

66 DISCUSSION: Hormone therapy, currently an important component of the clinical approach to individuals with gender dysphoria, improves the quality of life, alleviates the symptoms of depression, and also reduces the perceived discrimination against them. These results need to be supported with controlled studies of wider scale, including individuals of both genders. Keywords: gender dysphoria, hormone therapy, quality of life References Murad MH, Elamin MB, Garcia MZ et al., (2010) Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf). 72(2):214-31 Rosalia Costa, Marco Colizzi. (2016) The effect of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: a systematic review. Neuropsychiatr Dis Treat. 12:1953-66. ORAL PRESENTATIONS

67

POSTER PRESENTATIONS

POSTER PRESENTATIONS

PP-001 PP-002

VAGINAL HEMORRHAGE DUE TO : HAIR LOSS DUE TO USE: CASE CASE PRESENTATION PRESENTATION Nermin Gündüz Nermin Gündüz Erzurum District Training and Research Hospital Erzurum District Training and Research Hospital INTRODUCTION: Escitalopram, is a selective serotonin reuptake INTRODUCTION: Alopecia constitutes and important problem, inhibitor (SSRI), frequently used in the treatment of depression and especially for women, in affecting the physical appearance. This side anxiety disorders. While causing an increase in the serotonin level in the effect is often overlooked by physicians. It should be approached on central nervous system, it leads to reduction in serotonin concentration grounds of differential diagnosis as alopecia can lead to treatment in the thrombocytes. Hence, serotonin promotes thrombocyte noncompliance. Information is limited on alopecia due to serotonin– aggregation, and plays a role in the regulation of blood vessel tonus and norepinephrine reuptake inhibitors (SNRIs). We have aimed to present the blood clotting process. Inhibition of serotonin reuptake by SSRIs a case of complaint due to alopecia resulting with venlafaxine use. results in reduction of the serotonin stored in the thrombocytes, and CASE: FT, a 40-year old female patient, after marital problems with consequently decreased thrombocyte aggregation which can increase her husband, developed in 2009 symptoms of ruminative thinking, the risk of hemorrhage. We have aimed to present in this report a case of intolerance, tension, anhedonia, avolition, , excessive daytime vaginal hemorrhage observed after escitalopram dose increase. sleepiness, difficulty going to sleep, weakness and impaired functionality. CASE: The 31-year old female consulted our polyclinics in January She was diagnosed with adjustment disorder mixed type and had 2016 with complaints of attacks of weeping, avolution, anhedonia, been under follow up, with a treatment history on variety of agents thoughts of insufficiency, appetite loss and weight loss, starting with the such as escitalopram, reboxetine, , modafinil, imipramine 4th month post-partum. It was learned that there were also problems and bupropion. In January, 2016 she consulted our polyclinics with with her marriage and place of work and lack of social support. With complaints of avolition, feelings of insufficiency, and daily frequent the preliminary diagnosis of major depressive disorder, she was started attacks of weeping, attention problems, depression and excessive day on escitalopram (10 mg/day). Since definite regression in her symptoms time sleepiness. She was diagnosed with manic depressive disorder and was not seen in the follow ups, escitalopram dose was titrated to 15 started, in view of her pharmacotherapy history, on venlafaxine (37.5 mg/day. This resulted in continual vaginal hemorrhage for 10 days not mg/day titrated to 75 mg/day). In the third month of her therapy associated with her menstrual cycle. She was referred for laboratory tests she reported excessive hair loss. Her hepatic and renal function tests, including a hemogram, hepatic and renal function tests, bleeding and vitamin D, B12 and folic acid levels were within normal limits. Her clotting time and consultations were requested from maternity and examinations at internal diseases and dermatology services reported hematology units for the exclusion of additional medical reasons that as normal. Venlafaxine dose was gradually reduced and treatment was might have underlain her condition. Her prothrombin time, APT, INR, terminated, upon which the hair loss problem regressed. hepatic, renal and thyroid function tests and her examination were all

DISCUSSION: Only few studies on hair loss due to venlafaxine POSTER PRESENTATIONS reported to be normal. She did not use an anticoagulant agent at the use were seen in the literature, which is a very rarely seen side effect. time of the hemorrhage episode. Reducing the dose of escitalopram Individual susceptibility has been hypothesized. However, as it is an back to 10mg/day, resulted in reduction in the hemorrhage. Treatment important development for especially female patients, clinicians should was switched to sertraline (50 mg/day) subsidence. She currently under consider this outcome in all female patients. In the case presented follow up. here, elimination of any internal and dermatological pathologies in DISCUSSION: We have aimed at presenting a case of hemorrhage the hospital units consulted and observation of results within normal due to escitalopram in the absence of any bleeding disorder. Normal limits in the tests requested suggested the possibility of a side effect of coagulation parameters and cessation of hemorrhage with the dose venlafaxine. Regression of alopecia with the termination of venlafaxine adjustment of escitalopram suggest that the vaginal hemorrhage was treatment is believed to have confirmed this conclusion. due to SSRI use. Keywords: Alopecia, hair loss, venlafaxine Keywords: escitalopram, bleeding, menorrhagia, vaginal bleeding References References Demir EY, Venlafaxine Induced Hair Loss: A Case Report, Dusunen De Ballista C. Antidepressant agents. In basic and clinical pharmacology. Adam The Journal of Psychiatry and Neurological Sciences Katzung BG, Masters SB, Trevor AJ, eds. 11th ed. New Delhi: Tata 2016;29:163-166. McGraw Hill, 2009;509-30. Hedenmalm K, Sundström A, Spigset O. Alopecia associated with Halperin D, Reber G. Influence of antidepressants on hemostasis. treatment with selective serotonin reuptake inhibitors (SSRIs) Dialogues Clin Neurosci 2007;9:47–59 Pharmacoepidemiol Drug Saf.2006;15(10):719–725. [PubMed] Tseng YL, Chiang ML, Lane HY, Su KP, Lai YC Selective serotonin Mermi O, Atmaca M, Kılıç F, Fluoksetin Kullanımına Bağlı Saç reuptake inhibitors reduce P2Y12 receptor-mediated amplification Dökülmesi: Bir Olgu Sunumu (Hair loss due to Fluoxetine Use: of platelet aggregation, Thromb Res. 2013 Apr;131(4):325-32. doi: Case Presentation), Düşünen Adam The Journal of Psychiatry and 10.1016/j.thromres.2013.02.007. Neurological Sciences 2014;27:266-269

71 Pereira CE, Goldman-Levine JD. Extended-release venlafaxine induced References alopecia. Ann Pharmacother 2007; 41:1084. Benazzi F: Risperidone-induced hepatotoxicity. Pharmacopsychiatry Uzun Ö, Cansever A, Özgen F. Sertralin kullanımına bağlı saç 1998; 31:241. dökülmesi: Bir olgu sunumu (Hair loss due to sertraline use: Case Cordeiro Q Jr, Elkis H., Pancreatitis and cholestatic hepatitis induced presentation). Klinik Psikofarmakoloji Bülteni 2003; 13:27-29. by risperidone, J Clin Psychopharmacol. 2001 Oct;21(5):529-30. Ereshefsky L: Pharmacokinetics and drug interactions: update for new antipsychotics. J Clin Psychiatry 1996; 11:12–25. Krebs S, Dormann H, Muth-Selbach U, Hahn EG, Brune K, Schneider PP-003 HT., Risperidone-induced cholestatic hepatitis. Eur J Gastroenterol Hepatol. 2001 Jan;13(1):67-9. TOXIC HEPATITIS DEVELOPMENT AFTER LOW Legaz Huidobro ML, González Carro P, Pérez Roldán F, Soto Fernández DOSE RISPERIDONE USE AND ITS TREATMENT: S, de Pedro Esteban A, Cuesta Domínguez R., Autoimmune hepatitis CASE PRESENTATION after risperidone-induced cholestatic hepatitis. Gastroenterol Hepatol. 2005 Mar;28(3):135-6. Nermin Gündüz1, Celaleddin Turgut2 1Erzurum District Training and Research Hospital, Psychiatry Department 2Göksun State Hospital, Psychiatry Clinic, Kahramanmaraş, PP-004 INTTRODUCTION: Risperidone is known to have has less hepatic DIAGNOSIS OF BIPOLAR DISORDER side effects in comparison to the phenothiazine groups of antipsychotic COMORBIDITY IN AUTISM AND THE TREATMENT agents. The hepatotoxicity mechanism due to risperidone has not been METHOD: CASE PRESENTATION understood. The active metabolite of risperidone (9-OH risperidone) 1 2 undergoes hepatic oxidative metabolism by CYP 2D6 enzyme of the Nermin Gündüz , Işık Karakaya 1 cytochrome P450 system, for elimination from the body. The serious Erzurum District Training and Research Hospital, Psychiatry Clinic 2Kocaeli University Medical School Hospital, Child and Adolescent pharmacokinetics of risperidone and 9-OH-risperidone may be Psychiatry Department, Kocaeli increasing the risk of hepatotoxicity in individuals classified as poor metabolizers. In this report, we present the case of elevated serum hepatic INTRODUCTION: Autism spectrum disorder, Asperger disorder, enzymes, diagnosed as hepatotoxicity, after 1-week use of risperidone. pervasive not otherwise specified (PDD-NOS) and disintegrative disorder have been grouped together in DSM-V, leaving CASE: The 21-year old female patient consulted our clinic in March out the Rett syndrome. The most frequently observed comorbidity with 2016 with complaints of reduced need for sleep, , autism is depression. However, there are reports of comorbidity with logorrhea and suspicious thoughts about family. It was learned that bipolar disorder (BD), too. We have aimed in this report to present a one week previously to this consultation she had been diagnosed at case of autism diagnosed with BD and the treatment procedure followed. another health care center with bipolar disorder manic phase psychotic CASE: The 16-year old male patient had been followed at the child type and had been started on risperidone (2mg/day). She had a rehabilitation service with autism diagnosis from the age of 4. It was history of heaving benefitted from risperidone. She was evaluated in learned that he had used fluoxetine, methylphenidate and risperidone. the emergency services for talking nonsense, disorganized behavior, Over the 4 years prior to his consultation the patient went through psychomotor agitation, impaired sleep quality and suspicions oriented a period starting with the spring months and extending to summer, to her family. Her hierogram was normal, but routine biochemical characterized with symptoms of reduced need for sleep, pugnaciousness, tests indicated raised levels of AST and ALT enzymes. Her abdominal hostility oriented to the family, psychomotor agitation, talking to USG and her cranial CT were reported as normal. She was admitted to himself, logorrhea, irritability, and destructive behavior such as POSTER PRESENTATIONS hospital and consultation was requested from the internal diseases unit. damaging the furniture. It was learned that he developed a platonic Hepatotoxicity of risperidone was considered. She was not started on relationship with a classmate and he showed verbal and physical abuse antipsychotics in the first week of her admission. Daily hepatic function to other friends due to excessive jealousy. He had persecutory tests were requested. She was given haloperidol im 1x2 and biperiden that classmates were planning to separate him from his girlfriend, and im 1x1 and followed. After terminating risperidone treatment, the daily erotomanic delusions that all other girls in the class were in love with follow ups showed dramatic improvement in AST and ALT levels. In him. He was evaluated in our polyclinics together with his parents and the second week of her admission treatment with amisulpride (200 mg/ was diagnosed with high functioning autism (HFA) and BD- psychotic/ manic episode. Treatment was started with risperidone /2 mg/day) and day) was started resulting in definitive improvement of her psychiatric valproic acid (400 mg/day). In his follow up controls, the patient talked symptoms. She is under follow up on an outpatient basis. less about his girlfriend, and his symptoms of irritability, hypermobility, DISCUSSION: The case we have presented did not have a history of increased libido and reduced sleep need subsided and turned for the liver disease. Observing significantly increased serum levels of hepatic better. His serum valproate level was 47.94. enzymes in the first week of risperidone treatment, which regressed upon DISCUSSION: In daily clinical practice, depressive symptoms are discontinuation of the drug suggested hepatotoxicity due to risperidone sometimes recognized but the manic and hypomanic symptoms are use. We have found only few reports in the literature on cases with frequently missed in patients diagnosed with HFA (4). The case of HFA hepatotoxicity due to risperidone use. By this case presentation we presented here was diagnosed with BD and was seen to benefit in the wanted to emphasize the importance of routine hepatic function test follow up controls from the risperidone and valproate treatment he had before and after starting therapy with antipsychotic agents. been started with. We wished to emphasize through this presentation the necessity of carefully querying the HFA patients for symptoms of Keywords: Hepatotoxicity, risperidone, toxic hepatitis mood disorders. Keywords: Autism, bipolar disorder, general developmental disorder, mania, valproate,

72 References DISCUSSION: Clinicians have to be careful about this side effect of Amerikan Psikiyatri Birliği, Ruhsal Bozuklukların Tanısal ve Sayımsal paliperidone even if rarely observed. El Kitabı, Beşinci Baskı (DSM-5), Tanı Ölçütleri Başvuru El Keywords: Atypical antipsychotic, extrapyramidal symptoms, Kitabı’ ndan, çev(American Psychiatric Associatıion Diagnostic paliperidone, paliperidone palmitate and Statistical Manual of Mental Disorders, fifth edition (DSM-5), Diagnostic Criteria Hand Book- translation). (Köroğlu E, Hekimler Yayın Birliği, Ankara, 2014. Ghaziuddin, M., Ghaziuddin, N., Greden, J., 2002. Depression in PP-006 persons with autism: implications for research and clinical care. J. Autism Dev. Disord. 32, 299–306. COMPLAINTS OF PSYCHOTIC FLARE UP Gutkovich, Z.A., Carlson, G.A., Carlson, H.E., Coffey, B., Wieland, N., FOLLOWING THE 15 JULY EVENTS IN TURKEY 2007. Asperger’s disorder and co-morbid bipolar disorder: diagnostic and treatment challenges. J. Child Adolesc. Psychopharmacol. 17, AND THE OBSERVED PSYCHOPATHOLOGIES: CASE 247–255 PRESENTATION Munesue T, Ono Y, Mutoh K, Shimoda K, Nakatani H, Kikuchi M, Nermin Gündüz1, Murat Cingöz2 High prevalence of bipolar disorder comorbidity in adolescents and 1Erzurum District Training and Research Hospital, Psychiatry Clinic, young adults with high-functioning autism spectrum disorder: A Consultant Dr preliminary study of 44 outpatients, Journal of Affective Disorders 2Erzurum District Training and Research Hospital, Psychiatry Clinic, 111 (2008) 170–175 Psychologist INTRODUCTION: The 15 July events in Turkey have resulted in PP-005 serious traumas in the population. It has been aimed in this report to discuss two cases of schizophrenia with flare up and delusional thoughts about the events. DEVELOPMENT OF OCULOGYRIC CRISIS DUE TO PALIPERIDONE USE: CASE PRESENTATION CASE 1: A 33-year old single male patient was evaluated at the emergency services as a legal case in the company of the police. History 1 2 Nermin Gündüz , Hacer Akgül Ceyhun taking revealed that the patient had a 7-year history of complaints on 1 Erzurum District Training and Research Hospital, Psychiatry difficulty going to sleep, persistent thinking about TV reports, hostile Department, Consultant Dr behavior, persecutory delusions of getting harmed and being followed. 2Atatürk University Medical School, Psychiatry Department, Erzurum, He reported that signal sounds were heard as the TV channels were Asst. Dr. changed, indicating control of his movements, enacted by the organizers AIM: Dystonia is observed less in the use of atypical antipsychotic of the events of 15 July, instigating him to contact the state directory of agents as compared to the typical antipsychotics. Oculogyric crisis is the fight against terror. He had been accompanied by the police on account dystonic reaction generally induced by the use of typical antipsychotic of stoning a school suspected to belong to the terrorist organization agents and is characterized by the involuntary upward deviation of the behind 15 July events. eyes accompanied with the feeling of being disturbed. Paliperidone is the 9-hydroxy metabolite of risperidone. While, akathisia and other CASE 2: The 45-year old male patient under follow up for 9 years extrapyramidal symptoms are reported as the side effects of paliperidone, after diagnosis of schizophrenia was admitted to inpatient services on the same side effects and vertigo and sedation have also been reported account of treatment incompliance. Detailed examination showed that for paliperidone palmitate. We have aimed at presenting here two cases the patient complained of being sent coded messages on the scroll bar of oculogyric crises due to paliperidone use and the mode of treatment at the bottom of the TV screen, which he attributed to the organization POSTER PRESENTATIONS given. behind the 15 July events. He had delusions about being followed by these terrorists by means of a grey substance they put in his tea, with CASE 1 : The 34-year old male patient with a 15-year history of psychotic the intention of harming him. He suspected that the state prosecutors disorder was admitted to our inpatient services with complaints of were collaborators and therefore his written complaints to their office homicidal behavior. Treatment was begun with paliperidone (9mg/day) and the national intelligence office (MIT) had been overlooked. While and olanzapine (10mg/day). On the 6th day of the therapy the patient in the ward, he frequently made attempts to call the director of the presented with involuntary bilateral contractions of the eye muscles MIT and the president of Turkey with resultant psychomotor excitation and consultation was requested from the ophthalmology and neurology when impeded. units. The reports given were both normal. Therapy was switched to 15 mg/day olanzapine and paliperidone was discontinued. The patient’s DISCUSSION: Psychosocial factors play a role in the appearance oculogyric crisis subsided. of psychotic disorders with prolonged symptoms and the subject has CASE 2: The 25-year old male patient under 3-year follow up for been a focus of interest in the recent years (1). The cases presented here schizophrenia had been initially put on depot paliperidone palmitate display the psychotic flare up after a typical psychological upheaval in (150 mg im) and olanzapine (20 mg/day). During the polyclinic controls, the general population. It is believed that clinicians should be prepared weight gain by the patient was observed and olanzapine was switched to for these flare ups following events that have traumatizing effects on (10mg/day). Within the first year of the therapy, bilateral the public. involuntary contractions in his eye muscles necessitated neurological Keywords: Psychological trauma, psychotic flare up, schizophrenia, and ocular examinations, resulting in diagnosis of oculogyric crisis. traumatic events in the population, traumatized public Biperiden (6 mg/day) was added to the treatment and aripiprazole was discontinued. As the dystonic reaction persisted, the depot paliperidone References palmitate treatment was also discontinued and (600 mg/day) Longden E1, Read J., Social Adversity in the Etiology of Psychosis: A was started, when the patient’s complaints regressed. Review of the Evidence. Am J Psychother. 2016;70(1):5-33.

73 PP-007 PP-008

REFLECTIONS ON PSYCHOPATHOLOGY OF THE 15 MOOD DISORDER AND MEGA CISTERNA MAGNA JULY EVENTS: TWO CASES OF TRIGGERED MANIA COMORBIDITY-CASE PRESENTATION Nermin Gündüz Özge Şahmelikoğlu Onur, Merve Çukurova, Sena Aksoy, Çağatay Karşıdağ Erzurum District Training and Research Hospital, Psychiatry Clinic, Bakırköy Mental Health and Neurological Diseases and Research Hospital, Consultant Dr Psychiatry Department, İstanbul INTRODUCTION : Acute stressor experiences because the appearance AIM: Mega cisterna magna, is morphologically a developmental and persistence of attacks in patients diagnosed with bipolar disorder. variation of the posterior fossa, characterized with widened cisterna Here we have aimed at showing examples on the psychopathological magna, intact cerebellar hemispheres and vermis. It is evaluated within effects of major public upheavals on individuals by presenting two cases the “Dandy-Walker complex’’. There are case reports proposing that of manic attack triggered by the events of 15 July. cerebellar dysfunction due to mega cisterna magna can result in affective symptoms. Her we present a case of mega cisterna magna and mood CASE 1 : It was learned that the 29-year old male patient under follow disorder comorbidity. up since 2009 with the diagnosis of bipolar disorder, including 5 manic attack episodes which had not repeated in the previous 3 years when CASE: The 24-yar old female patient consulted with complaints of he enjoyed good functionality. The patient as accompanied by a friend reduced need for sleep, excessive and fast speaking, increased mobility, increased preoccupation with religion, and suspiciousness. Her when examined at our polyclinics on 25 July 2016. He had not used examination showed elevated affect and mood, increased association, his medication for one week, and had symptoms of reduced need for mystical delusions and auditory hallucinations. She was on follow up sleep, explosions of anger, logorrhea, over emphasized and repetitive with bipolar disorder (BD) psychotic type manic episode. Cranial MRI religious statements and psychomotor agitation, which had started after and EEG examinations suggested mega cisterna magna at the occipital the events of 15 July. He had refused medication as they caused sedation region. Her psychiatric symptoms were treated with olanzapine (10 which he feared would prevent his attempts to defend his country. He mg/day) and lithium (900 mg/day). After complete clinical recovery, had at the time joined the night watch for 1 week and had not slept at she was discharged with the recommendation of neurological and all. Also, upon hearing the sustained loudspeaker calls from the minarets psychiatric follow up. to prayer after 15 July had caused increased preoccupation with religion. DISCUSSION: Cerebellum has connections with the dorsolateral He frequently had prayer beads and prayer books in hand. He was prefrontal cortex, medial frontal cortex, anterior cingulate cortex admitted to as inpatient to our services in this clinical condition. and posterior hypothalamus which are involved in the regulation of cognition and behavior. It is known to have involvement in the CASE 2: The 57-year old male village guard was examined at the motor, sensory, emotional, judgement and linguistic functions through emergency services on 06.08.2016. He had a single manic attack 20 the connections with the limbic regions and the cortical association years previously. He had been talking nonsense for the two weeks prior to regions. It has been proposed that the symptoms of BD are caused by this consultation. He had psychomotor agitation, suspicions of a repeat dysregulation of the cortico-subcortical and cerebellar regions. There of the 15 July events which caused spending sleepless nights keeping are case reports in the literature on the comorbidity of mega cisterna guard in the village, attributed to manic attack. He was admitted to our magna and psychosis-mood disorders. Although the case presented services for the regulation of his treatment. here supports the arguments for a role of cerebellar dysfunction in the development of BD, but there is need for studies on this relationship. DISCUSSION: Reports of studies have shown that seriously adverse POSTER PRESENTATIONS events of life have negative effects on the course of bipolar disorder and Keywords: Bipolar disorder, etiology, mega cisterna magna can lead to increased risk of relapse. Evets of 15 July in the general of References Turkey resulted in a traumatic experience of wide span. In the cases Güngör FC, Görgülü Y, Özer Ü. Duygudurum Bozukluğu ile Darier presented here, manic attack was triggered requiring hospitalization for Hastalığı ve Mega Sisterna Magna Varyantı Birlikteliği: Olgu treatment. Sunumu. Literatür Sempozyum 2014;1(3):25-30. Monkul et al. MRI Study of the Cerebellum in Young Bipolar Patients Keywords: Bipolar disorder, manic attack, public traumatization, Prog Neuropsychopharmacol Biol Psychiatry 2008;32:613–619. psychological trauma Turan T, Beşirli A, Asdemir A et al. Manic episode associated with mega References cisterna magna. Psychiatry Investig 2010; 7:305-307. Gershon A, Johnson SL, Miller I, Chronic stressors and trauma: prospective influences on the course of bipolar disorder, Psychol Med. 2013 December; 43(12) Johnson SL, Roberts JE. Life events and bipolar disorder: implications from biological theories.Psychological Bulletin. 1995; 117:434–449 Hammen C, Gitlin M. Stress reactivity in bipolar patients and its relation to prior history of disorder. American Journal of Psychiatry. 1997; 154:856–857. Neria Y, Olfson M, Gameroff MJ, Wickramaratne P, Trauma exposure and posttraumatic stress disorder amongprimary care patients with bipolar spectrum disorder, Bipolar Disord. 2008 June; 10(4): 503– 510

74 PP-009 Bryant RA, Harvey AG (1995) Acute stress response: A comparison of head injured and non-head injured patients. Psychol Med; 25: INVESTIGATION OF THE PRIMARY AND 869-874. SECONDARY CAPACITIES IN POST-TRAUMATIC Davison GC, Neale J.M. (2004) Anormal Psikoloji. (Çev. Ed. İhsan STRESS DISORDER (PTSD) PATIENTS Dağ). Ankara: Türk Psikologlar Derneği Yayınları. Dınvar PE (2011) Travma sonrası stres, dünyaya ilişkin varsayımlar Ebru Sinici ve Tanrı algısı arasındaki ilişki. Yayınlanmamış yüksek lisans tezi. GATA Nursing Professional School, Psychological Consultancy and Ankara. 2011. Guidance Centre, Ankara Eryılmaz A. (2011) Yetişkin Öznel İyi Oluşu ile Pozitif Psikoterapi Bağlamında Birincil ve İkincil Yetenekler Arasındaki İlişkilerin AIM: The aim of this study has aimed at demonstrating in patients İncelenmesi. Klinik Psikiyatri 2011;14:17-28. 10)First M.B., Spitzer diagnosed with posttraumatic stress disorder (PTSD) the relationships R.L., Gibbon M., M.S.W. and Williams J.B.W. (1997) Structured between the primary capacities (patience, time, relating, reliance, hope, Clinical Interview for DSM-IV Axis I Disorders (SCID-I) Clinical mildness/sexuality, affection, belief) and the secondary capacities Version American Psychiatric Press, Inc., Washington D.C. and (regularity, honesty, cleanliness, alertness, courtesy, openness, London, England. impulsiveness, success, reliability, thriftiness, compliance, justness, loyalty) described in the Wiesbaden Positive Psychotherapy and Family Therapy Inventory. PP-010 METHODS: The participants of this study included 50 PTSD patients followed up at the Gulhane Military Medical School, Mental VARIABLES AFFECTING BURNOUT IN SURGEONS Health and Diseases Clinic on an inpatient or outpatient basis, and AND PHYSICIANS AND THE RELATIONSHIP 50 healthy individuals without a diagnosis of psychiatric disorder as the control group. The patients were diagnosed with PTSD firstly by OF BURNOUT WITH JOB INVOLVEMENT AND clinical examination and interview, followed by the SCID-I interview COMMITMENT TO THE ORGANIZATION for DSM-IV, the Clinician-Administered-PTSD-scale (CAPS), and Reyhan Algül1, Doğan Yılmaz2, Ürün Özer1 the Posttraumatic Stress Diagnostic Scale (PSDS). Subsequently, 1Acıbadem University Atakent Hospital the participants were asked to complete the Wiesbaden Positive 2 Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Psychotherapy and Family Therapy Inventory (WPPFTI) and the Diseases and Research Hospital Impact of Event Scale-Revised (IES-R). AIM: Burnout is described as the effects on the individual of physical and RESULTS: Results of the analyses carried out showed that scores of the emotional exhaustion created by work stress, distancing the individual PTSD patients on depression correlated negatively with the primary from his profession, causing fostering of negative emotions towards capacity scores on patience, time, relating, reliance, hope, sensuality, work, colleagues and even to the individual’s own self. It has been affection and belief; and negatively with the secondary capacity scores emphasized that burnout can lead to serious outcomes on institutions on courtesy, honesty, success, obedience and justness. The IES-R scores and their staff and customers. Next to the effects like quitting a job, of the PTSD patients were found to correlate negatively with only the not attending work, loss of morale, productivity and efficiency, it can primary capacity scores on time, relation, reliance, hope, affection and also result in physical exhaustion, fatigue, psychosomatic disorders, belief. depression, anxiety, sleeplessness, problems with spouse and family DISCUSSION: It has been seen that the primary capacities were less and alcohol and psychoactive substance use. It has been emphasized developed in the PTSD patients as compared to the secondary capacities. that burnout is frequently seen in members of professions ‘’working POSTER PRESENTATIONS with other people’’, medical profession being among those with the CONCLUSION: It is thought the observed less development of the highest risk of burnout. It has been aimed in this study to investigate primary capacities, mainly associated with the emotional aspect of an and to compare the factors affecting the level of burnout in surgeons individual, result in the increase in depressive scores and the IES-R and physicians at internal branches of medicine and to determine the scores. relationship between burnout and job involvement and commitment to Keywords: PTSD, primary capacities, positive psychotherapy, the organization. secondary capacities, METHODS: This cross-sectional study was carried out with 82 References physicians working at the hospital of a private university. The participants Aker AT, Özeren M, Başoğlu M, Kaptanoğlu C, Erol A, Buran B: completed a sociodemographic and professional questionnaire, the Klinisyen Tarafından Uygulanan Travma Sonrası Stres Bozukluğu Maslach Burnout Inventory (MBI), Organizational Commitment Scale Ölçeği (TSSB-Ö) geçerlik ve güvenirlik çalışması. Türk Psikiyatri (OCT) and the Job Involvement Scale (JIS). dergisi 1999; 10: 286-293. RESULTS: Three participants who had not completed the forms Argyle M (2001) The psychology of happiness. East Sussex, Routledge. were excluded from the study and the data on 79 participants were S. 45. evaluated. Significant differences between the surgeons (n=39,49.4%) Amerikan Psikiyatri Birliği. Mental Bozuklukların Tanısal ve Sayımsal El and physicians (n=40, 50.6%) were not detected on grounds of Kitabı 4.Baskı (DSM-IV) (Çev.Ed.:E.Köroğlu) Ankara. Hekimler demographic details and on the scores of the psychometric tests used. Yayın Birliği. The sociodemographic characteristics that affected the scores on gender Beck A.T. (1961) An Inventory for measuring depression. Arch Gen and having children, were among the professional characteristics that Psychiatry 4:561-571. 5)Blake DD, Weathers FW, Nagy LM et al.: affected the scores on level of income, status and duration of work. The development of a clinician administered PTSD scale. J Truma Correlation analyses revealed positive and negative correlations between Stress 1995; 8:75-90. the three scales used.

75 CONCLUSION: Results of this study indicated that the two groups of used in the treatment of eating disorders with good effects, the eating medical professionals did not differ significantly with respect to burnout, disorders presenting with the use of venlafaxine are not the expected and that gender, having children, level of income and duration of working at side effects. The case presentation in this report points to the many a profession affected the severity of burnout. Organizational commitment complications that develop with venlafaxine treatment in order to and job commitment were also among factors affecting burnout. draw attention to the unexpected side effects that may develop with Therefore, studies to be carried out on these two important areas with multireceptor- active antidepressants. respect to improvement would decrease the level of burnout among Keywords: Eating disorder, hypomania, venlafaxine medical professionals. Keywords: Burnout, commitment to the organization, job involvement, physicians, surgeons PP-012 References Allen N, Meyer JP (1990) the measurement and antecedents of affective, THE RELATIONSHIP BETWEEN ATTENTION continuance, and normative commitment to the organization. DEFICIT HYPERACTIVITY DISORDER IN AIRPORT Journal of Occupational Psychology, 63:1-8. WORKERS AND THE RISK OF VEHICLE ACCIDENTS Algül R (2014) Bugün İşe Gitmesem İş Yaşamında Tükenmişlik Sendromu. ( What if I don’t Go to Work Today –Burnout Syndrome AT THE WORK PLACE at Work) Birinci Baskı, İstanbul, Mitra Yayınları. Özlem Çapan Özeren1, Haluk Gülmez2, Gökben Hızlı Maslach C, Jackson SE (1981) The measurement of experienced Sayar2 burnout. J Occup Behav, 2:99-113 1Maltepe University, Civil Air Transportation Management, İstanbul 2Üsküdar University, Feneryolu Health Research and Application Centre, İstanbul PP-011 AIM: Attention deficit hyperactivity disorder (ADHD), a chronic condition that leads to disability, is characterized with common EATING DISORDER AND HYPOMANIA DUE TO symptoms of lack of attention and impulsiveness. Adults with ADHD VENLAFAXINE USE: CASE PRESENTATION are liable to lose work and performance. For example, they have been shown to have difficulty with vehicle driving capacity. Given that Hatice Melek Başar, Hüseyin Bulut 138 vehicle accident were made between 2012 and 2014 among the Büyükçekmece State Hospital, İstanbul workers of the airport services company Havas, it was hypothesized that AIM: Venlafaxine is, next to being a structurally new antidepressant, airport workers who have made vehicle accidents should score higher also the first of the inhibitors of serotonin and norepinephrine reuptake. on scales for ADHD assessment than the workers who have not made Use of antidepressants like venlafaxine with effects on more than one any accidents. receptor type, carry the risk of triggering manic attacks, especially METHODS: The study was carried out with 110 volunteers among in bipolar disorder, despite their strong effectiveness. Also, effects of airport personnel who had made accidents, and age and gender matched venlafaxine on binge eating disorder associated with obesity and atypical 111 airport personnel who had not made any accidents, who made anorectic patients have been reported. However, there are not any up the control group. A sociodemographic questionnaire and Adult reports on eating disorder triggered by venlafaxine. We have presented ADHD Self-Report Scale (ASRS-v1.1) and ADD/ADHD Diagnostic in this report a case of bulimia and mania triggered by venlafaxine. and Evaluation Inventory were completed by the participants who were CASE: We discuss here the case of a 30-year old female patient who evaluated on demographic characteristics, and on the basis of their

POSTER PRESENTATIONS had consulted the neurology polyclinics with complaints of headaches scores on accidents made, performance and work attendance. and anhedonia when she was started on venlafaxine (75 mg/day). Three RESULTS: Among those who had made accidents only one months after the start of this therapy, she was referred to the psychiatry individual was diagnosed with ADHD. However, the scoring on the polyclinics with complaints of decreased sleep and eating, psychomotor ASRS hyperactivity subscale by those who had made accidents was agitation, logorrhea, spending money, vomiting and losing weight. significantly higher as compared to those who had not made accidents. Routine and neurological tests did not reveal any organic pathology. The experimental and the control groups did not differ on the basis of Her psychiatric examination showed increases in her self-care, pace of scores on other subscales. Hence, the experimental group had higher speaking, psychomotor activity and increased rate of association. She mean scores as compared to the controls on frequently changing works, did not describe any psychotic symptoms. She mentioned getting an difficulty in timing, alcohol use, forgetfulness in daily activities, restless unstoppable urge to eat excessively a few times a week followed by hand and feet, akathisia, difficulty waiting in a que, preoccupation with provoked vomiting. She had a history of diagnosis with anxiety disorder multiple jobs/projects simultaneously and having difficulty following and irregular treatment compliance, and a history of anxiety disorder these and similar subscales but they did not score lower in any subscales and MS in her mother. She was given appropriate information and as compared to the controls. her treatment was switched from venlafaxine to olanzapine (5 mg/ day) before being put on follow up. One week later she had partial DISCUSSION: The results have suggested that, although airport improvement in her symptoms. Her relations were informed and the workers who had and had not made accidents did not differ on grounds olanzapine dose was titrated to 10 mg/day. Her symptoms subsided in of ADHD diagnosis, those who had made accidents had significantly 10 days and clinical problems were not observed in her ensuing follow higher symptoms of hyperactivity. Informing the working staff and up controls. managers on the symptoms of ADHD, and its effects and out comes, and scanning the individuals to be assigned to jobs requiring attention DISCUSSION: Many clinical trials have shown the effectiveness for ADHD symptoms should reduce the incidence of work place of venlafaxine as an antidepressant. Although with its dual effects accidents. venlafaxine is beneficial in treating depression, it carries the risk of hypomanic switch in bipolar disorder patients. Hence, despite being Keywords: Attention deficit, hyperactivity, impulsiveness, job accidents

76 References should be checked and diagnosed by health professionals. Next to the Barkley, R.A., Murphy, K.R., DuPaul, G.J., & Bush, T. (2002). Driving biological therapy given, structured support therapy programs should in young adults with attention-deficit/ hyperactivity disorder: be developed for implementation at each trimester. knowledge, performance, adverse outcomes, and the role of executive Keywords functioning. Journal of the International Neuropsychological : Distress, pregnancy, mental health of women Society, 8, 655-672. References Fried, R., Petty, C.R., Surman, C.B., Reimer, B., Aleardi, M., Martin, Dülgerler, S., Engin, E. ve Ertem, G., 2005, “Gebelerin Ruhsal Belirti J.M., et al. (2006). Characterizing impaired driving in adults with Dagılımlarının İncelenmesi” (Investigation of the Distribution attention-deficit/ hyperactivity disorder: a controlled study. Journal of Mental Symptoms of Pregnant Women). Ege Üniversitesi of Clinical Psychiatry, 67, 567-574. Hemsirelik Yüksek Okulu Dergisi, 115-126. Knouse, L.E., Bagwell, C.L., Barkley, B.A., & Murphy, K.R. (2005). Kaplan, S., Bahar, A. ve Sertbas, G., 2007, “Gebelerde Dogum Öncesi Accuracy of self evaluation in adults with ADHD: evidence from a ve Dogum Sonrası Dönemlerde Durumluluk Kaygı Düzeylerinin driving study. Journal of Attention Disorders, 8(4), 221-234. İncelenmesi,(Investigation of the Pre- and Postnatal Anxiety State of Pregnant Women) Atatürk Üniversitesi Hemsirelik Yüksekokulu Dergisi, 2007, 13-121. PP-013 Nelson, A., 2003, “Transition to motherhood. Journal of Obstetric and Gynecologic Nursing”, 465-477. DETERMINATION AND COMPARISON OF THE PSYCHOSOCIAL STRESSORS IN THE THREE TRIMESTERS OF PREGNANCY USING THE PP-014 PRENATAL DISTRESS SCALE HEMATOLOGICAL CHANGES IN ANOREXIA Zeynep Alpugan1, Haluk Gülmez2, Gökben Hızlı Sayar2 1Üsküdar University, Social Sciences Institute, İstanbul NERVOSA: CASE PRESENTATION 2Üsküdar University, Feneryolu Health Research and Application Centre, Aynur Görmez1, Ayşe Kurtulmuş2 İstanbul 1İstanbul Medeniyet University, Psychiatry Department, İstanbul 2 AIM: On grounds of psychology, pregnancy is a risky period even for Bezmialem Vakif University, Psychiatry Department, İstanbul healthy as it harbors the interaction of many biological, psychological AIM: Anorexia Nervosa (AN) is an eating disorder characterized with low and environmental variables. Just as the mental condition and life body weight below the minimum for age and length, fear of weight gain experiences of women affect the course of pregnancy, so does pregnancy and distinct body image disorder. Mortality is high with an incidence of affect women in these aspects Aims of this study have been to determine 5-6%. Many medical complications are observed during the course of the psychosocial factors affecting prenatal stress in all trimesters of AN. There is not much data in the literature on hematological changes pregnancy, as well as to determine the level of prenatal stress at all the in AN. This report presents the hematological changes in a case of AN, trimesters. the course of these changes during treatment and the discussion of the METHODS: The study was carried out with 30 healthy pregnant mechanisms underlying the pathophysiology of AN. women between January and April 2016, at a private obstetrics- CASE: The 23-year old patient diagnosed with restricting type AN (at gynecology and antenatal clinic in İstanbul. At each trimester of extreme level) on the DSM-V criteria, was admitted as inpatient to our pregnancy 10 women were chosen randomly to provide the intended services. Hemogram results at admission were: Hb:10.6 g/dL, Hct:30.1 data by completing a pregnancy questionnaire and the prenatal distress questionnaire (PDQ). %, MCV:97.4 fL, MCH:34.3 pg, PLT:214 10*3/uL, WBC:7.31 POSTER PRESENTATIONS 10*3/uL, Iron:158 ug/dL, Iron binding capacity:<40 ug/dl, Ferritin: RESULTS: The following observations were made through this study: 885.29 ng/ml. After dietary regulation with stepwise increases of daily - Throughout the pregnancy, basic psychosocial factors causing anxiety/ calorie intake, the hemogram results on the 7th day of admission were: worry/unhappiness; feelings of low energy/fatigue, anxiety on giving Hb:6.31 g/dL, Htc:17.7 %, MCV:100 fL, MCH:35.7 pg, PLT:230 premature birth, physical complaints (vomiting, back ache, swollen 10*3/uL, WBC:3.06 10*3/uL. Hematology consultation was requested; feet), worry about the health of the fetus at birth; atypical cells were not detected in the peripheral spread and the direct Coomb’s test was negative. Detailed investigations did not indicate any - In the first trimester of pregnancy, additional psychosocial factors hemorrhage. Routine tests results indicated blood phosphorous level of causing anxiety/worry/unhappiness, health problems associated with <0.7 mg/dl (2.3-4.7 mg/dl). The patient was begun with Phosphate and the pregnancy ( blood pressure, blood sugar, anemia), worries about multivitamin supplementation when a rapid improvement of anemia pain at birth; weight gain and physical changes due to pregnancy; was observed: On the 11th day of admission, Blood analyses indicated: - In the second trimester of pregnancy, additional psychosocial factors Phospahte:4.7 mg/dl, Hb:8.81 g/dL, Htc:25.8%, WBC:3.95 10*3/uL. causing anxiety/worry/unhappiness, anxiety about attending work and And the ferritin level receded to the normal range (244,66 ng/ml). At coping with looking after the family; the end of one moth, hemogram was completely normal. - In the third trimester of pregnancy, additional psychosocial factors DISCUSSION: In approximately 33% of ANpatients; anemia, causing anxiety/worry/unhappiness, worries about the costs of the leucopoenia and thrombocytopenia are observed. These changes and clothing, nourishment and health care of the newborn, daily caring for the other medical complications generally return to normality with the baby, other care taking problems and anxieties about the people appropriate dietary regimen, especially after phosphate replacement. giving support. These changes, and their causes should be known by clinicians in order to avoid unnecessary and invasive treatment. CONCLUSION: Results of the research have shown that, it is necessary that the stress factors associated with the different stages of pregnancy Keywords: Anemia, anorexia nervosa, iron metabolism, phosphorous,

77 References Large M, Babidge N, Andrews D, Storey P, Nielssen O. Major Self- Hutter, G., Ganepola, S., Hofmann, W.K., 2009. The hematology mutilation in the First Episode of Psychosis. Schizophr Bull 2009; of anorexia nervosa. The International journal of eating disorders 35: 1012-1021. 42(4), 293-300. Rosling, A.M., Sparén, P., Norring, C., von Knorring, A.L., 2011. Mortality of eating disorders: A follow‐up study of treatment in PP-016 a specialist unit 1974–2000. International Journal of Eating Disorders 44(4), 304-10. Sabel, A.L., Gaudiani, J.L., Statland, B., Mehler, P.S., 2013. IS “HOMESICKNESS” A FORM OF GRIEF?: CASE Haematological abnormalities in severe anorexia nervosa. Ann PRESENTATION Hematol 92, 605-613. Ürün Özer, Reyhan Algül Acıbadem University Atakent Hospital AIM: Homesickness is description of the reactions to separation PP-015 from places accustomed to and people loved. It is attributed to the predominating feelings and thoughts of loss, to missing the accustomed FIRST ATTACK PSYCHOSIS WITH MAJOR SELF- environment and persons, and feelings of insecurity. Mourning the MUTILATION: CASE PRESENTATION death of a beloved person also consists of intense missing and feelings of grief, preoccupation with thoughts about the lost person, feelings Özge Yahmelikoğlu Onur, Cihad Çıtak, Çağatay Karsıdağ, of loneliness and alienation. Therefore, home sickness can be said Sema Ulukaya to resemble mourning and grief reactions. It has been described as a Bakırköy Mental Health and Neurological Diseases and Research Hospital, phenomenon of separation, a ‘mini-grief’. Psychiatry Department, İstanbul CASE: The 23-year old pregnant Russian wife, living in Turkey over 1 AIM: Self- mutilation/injury behavior, frequently associated with serious year after her marriage, consulted with complaints of unhappiness and psychiatric disorders, has been reported to have observed prevalence of somatic discomforts. She stressed feelings about missing her homeland 4% in general population and 21% in the psychiatric subpopulation. for the 6 previous months, wanting to go back and thoughts associated Self-mutilation has irregular and nonrepetitive styles, with non-suicidal with her life in her country. She had felt comfortable when in Russia, but very severely mutilating forms and can result in the permanent loss where her parents live, for holiday with her husband and her complaints of an organ or function. This report presents the case of a first attack had regressed. Her homesickness affected adversely her relationship with psychosis patients who had torn away part of his tongue. her husband. Having no problems economically or with her husband’s family, she could not describe a stressful living. Her condition was CASE: The 27-year old female Russian citizen resident of Moscow, was attributed to ‘’ homesickness’’ in the first instance. brought by the police to our services. Her physical examination showed a hematoma in the front one third of her tongue. She had arrived one DISCUSSION: Although considered as a reaction to separation, week earlier with her husband for holiday and had been lost for one homesickness can be intense and prolonged, leading to physical-mental week, then discovered in the airport making incomprehensible gestures problems and impairment of functionality. It had been shown to be and shouting at passersby. She had first bitten and then severed front related to anxiety, depression and social isolation. There are reports on one third of her tongue with a wire obtained from her underwear. She flare ups of previously present mood and anxiety disorders, as well as cases was conscious, with hostile aspect, negative attitude, irritable affect, not of triggered sleep impairment, memory problems, appetite change and revealing thought contents probably harboring auditory hallucinations. somatic diseases. Psychotherapeutic-psychiatric approaches have been She was admitted as an inpatient to our hospital to prevent probable indicated for severe homesickness. The therapy given to such patients POSTER PRESENTATIONS homicidal or suicidal attempts. Her treatment with was organized in the should follow the example of those reported to be effective in mixed context of the ENT consultation taken. Urinary toxicology, brain MRI grief reaction, and consist of cognitive behavioral therapy, interpersonal and routine blood tests did not reveal any underlying pathology. On the relationships therapy and complicated grief therapy. Currently, as mass third day of her treatment with haloperidol (20mg/day), chlorpromazine migratory events have been increasing, it should be taken into account (100 mg/day) and biperiden (10 mg/day im), she admitted to hearing that next to the problems of post migration adjustment to alien cultures, sounds instructing her to harm herself, and that she did not have a homesickness would be another factor contributing to the mental previous psychiatric consultation. Her complaints regressed in 15 health problems of the people concerned. It is believed that under these days and she was discharged on maintenance therapy with haloperidol circumstances treatment of home sickness should benefit from the (20mg/day), biperiden (4 mg/dya) and chlorpromazine (100 mg/day) therapeutic approaches which have been successful in the treatment of ‘mini grief’. DISCUSSION: In cases of psychosis, especially in the periods with active psychotic symptoms, the potential for self-mutilative attempts Keywords: Grief, homesickness, woman may increase. As physicians, we have to evaluate the potential for References damaging acts and the self-mutilative behavior of psychosis patients. Fisher S. Homesickness and health. The Psychologist 1988; 9:351-352. Keywords: First attack, psychosis, self-mutilation Fisher S, Murray K, Fraser N. Homesickness, health and efficiency in first year students. J Environ Psychol 1985; 5:181-195. References Shear MK. Clinical practice. Complicated grief. N Engl J Med 2015; Briere J, Gill E. Self-mutilation in clinical and general population 372:153-160. samples: prevalence, correlates and functions. Am J Orthopsychiatry 1998; 68:609-620. Hutter, G., Ganepola, S., Hofmann, W.K., 2009. The hematology of anorexia nervosa. The International journal of eating disorders 42(4), 293-300.

78 PP-017 AIM: The aim of this study has been to determine the incidence of admission to hospital as inpatients and the subsequent treatment of DIAGNOSIS OF PARKINSON’S DISEASE ASSOCIATED the individuals using synthetic cannabinoids (SC) after consulting the MILD NEUROCOGNITIVE IMPAIRMENT AFTER Bakırköy Prof Dr. Mazhar Osman Mental Health and Neurological HOSPITALIZATION FOR MAJOR DEPRESSION Diseases and Research Hospital psychiatric emergency services. Elçin Ataseven, Derya İpekçioğlu, Haluk Yeşilkaya, METHODS: The descriptive study was carried out with 158 SC using individuals who consulted our emergency services between 06.04.2016 Mehmet Cem İlnem, Tuba Gürbüz and 06.05.2016. Data on the participating patients were acquired from Bakırköy Prof Dr. Mazhar Osman Mental Health and Neurological the information management system of the hospital Diseases and Research Hospital, Psychiatry Clinic (No.7), İstanbul RESULTS: After evaluation at the emergency psychiatric service INTRODUCTION: Lewy body neurocognitive disorder (LBCD) and and receiving symptomatic treatment as necessary, 120 (76%) of the cognitive disorders associated with Parkinson’s disease (PD) resemble patients were referred to the polyclinics of Alcohol Substance Research, each other in clinical and neuropathological respects. In both disorders Treatment and Education Centre (AMATEM) İstanbul. The remaining α-synuclein deposits, called Lewy bodies, are found in the brain stem 38 (24%) patients were admitted as inpatients to our hospital. and the cerebral cortex. These protein aggregates adversely affect the Preliminary assessments on these patients consisted of behavior disorder neuronal metabolism and interconnections and neurotransmission thus due to (2, 0.12%), psychosis due to substance resulting in motor and cognitive dysfunction. LBCD and PD can be use (32, 20%) and delirium due to SC (3, 0.18%). Mean duration of clinically differentiated by the timing of the cognitive symptoms and hospital stay was 8.9 days. Two of the patients with deteriorated general motor symptoms. This report presents the process of differentiation of medical condition and pathological indications on EEG, were referred the two disorders in the case of a patient, with the aim of contributing to the emergency services of a multidisciplinary hospital, and one to the literature. patient who reported having swallowed a sharp item was referred to the CASE: S. K. The 47-year old male patient was admitted to our clinic general surgery department another hospital. after suicidal attempt with a knife. He had a 2-month psychiatric CONCLUSION: SC users have increased in our country in parallel to history with complaints of sleeplessness and hallucinations. When the rest of the world. Given the intoxication and psychotic symptoms examined, he was conscious, cooperative, oriented, looked older than caused by SC use, the danger of homicidal and self-mutilative attempts his age, with restricted affect, dysphoric mood, normal associations, may necessitate treatment in hospital on an inpatient basis. This short and visual hallucinations. His father had died of Alzheimer’s disease. term study not only informs us of the seriousness of the situation, but Results of the laboratory tests carried out to eliminate any pathologies it is also points to the importance of further follow up studies in other related to his general medical condition were within normal limits. His centers and of drawing the attention of the public and the clinicians treatment was started with aripiprazole and . As the tremor, observed before his admission, increased with development of akathisia, Keywords: Intoxication, psychosis, synthetic cannabinoid treatment was switched to amisulpride. Diffuse atrophy of cerebral and cerebellar hemispheres was seen in cranial imaging. Consultations with the neurology unit, neuropsychological tests, sensitivity to antipsychotic PP-019 agents and the timing of his symptoms and the observation of the prominence of his motor symptoms in comparison to the cognitive symptoms lead to the diagnosis of mild neurocognitive disorder ACUTE STRESS SYMPTOMS AFTER THE ATTACK ON associated with Parkinson’s disease. His treatment was designed by ATATÜRK AIRPORT: PRESENTATION OF 3 CASES the neurology physicians. He was discharged when his extrapyramidal Ürün Özer1, Münevver Yıldırım2, Reyhan Algül1,

symptoms and suicidal ideation regressed. POSTER PRESENTATIONS Ejder Yıldırım2 DISCUSSION: Dementia is seen more frequently in the elderly 1Acıbadem University Atakent Hospital population. Early diagnosis can slow down the progress of the disorder 2Bakırköy Prof Dr. Mazhar Osman Mental Health and Neurological and reduced the severity of symptoms. Although Alzheimer’s disease is Diseases and Research Hospital, İstanbul the leading cause of neurocognitive deterioration, LBCD due to PD also AIM very frequently seen. Patients show variance on age of onset, cognitive : The main symptoms of (ASD) appear in 3 symptoms, impairment of motor functions, and response to treatment to 30 days after the distressing event and consist of troubling memories and increased sensitivity to antipsychotic agents. It is important that and dreams, dissociation, avoidance and being over stimulated. these patients are diagnosed at early stage to receive the correct therapy, Traumatic events encompass war, physical or sexual , threat and these being vitally important for the patients and their relations. the natural or man-made calamities but are not limited by these. It has been predicted that ASD incidence may reach 50% after mass violence. Keywords: Depression, diagnosis, neurocognitive disorders, treatment Many people were killed or maimed after the bomb attack on İstanbul Atatürk Airport on 28 June, 2016. Those wounded were treated in İstanbul hospitals and many of the cases had required psychiatric PP-018 consultation. In this report, the cases of 3 individuals, treated after the airport attack in the hospital of a private university, are presented. A CROSS-SECTIONAL VIEW OF THE DANGER OF CASES: Two of the patients were females and one was a male, all being SYNTHETIC CANNABINOIDS airport workers. They reported exposure to bullets, bomb explosion and shrapnel. The patients were interviewed after recovery from orthopedic Hasibe Rengin Güvenç, Duru Saygın Gülbahar, surgery. Hence the structured psychiatric interviews were carried out Mehmet Cem İlnem in the first week of the event and were repeated after 3 days in all three Bakırköy Prof Dr. Mazhar Osman Mental Health and Neurological patients who were also asked to complete the Impact of Events Scale Diseases and Research Hospital, İstanbul (IES) and the Trauma Symptom Checklist-40 (TSC40).

79 RESULTS: All three patients were diagnosed with acute stress disorder hypotension, and increased prolactin levels. Sialorrhea, which is (ASD). disturbing to patients, is a very rarely seen side effect resulting from the antagonistic effect on the adrenergic and histaminergic receptors. It is DISCUSSION: Individuals with ASD have been reported to have concluded that although rare, sialorrhea should be questioned among impairment of social, interpersonal and professional functionality. ASD the drug side effects by clinicians. determined after a traumatic event has been proposed to be a powerful predictor of the post-traumatic stress disorder (PTSD). Considering the Keywords: atypical, antipsychotic, , risperidone, increasing traumatic events in the country, the number of individuals sialorrhea to consult psychiatric services for ADS should be expected to increase. Hence, the evaluation of patients in the acute stage of exposure to traumatizing public events and immediate intervention followed with PP-021 long term controls for PTSD should be useful in terms of the outcomes. There is also need for up-to-date and comprehensive studies on the subject. EPILEPTIC SEIZURE DUE TO QUETIAPINE USE: CASE PRESENTATION Keywords: Acute stress disorder, terror attack, trauma Hülya Çeçen1, İsmet Üstün2, Sevgi Gül Ertürk1 References 1Tatvan State Hospital, Psychiatry Department, Bitlis Amerikan Psikiyatri Birliği. Ruhsal Bozuklukların Tanısal ve Sayımsal El 2Tatvan State Hospital, Neurology Department, Bitlis Kitabı, Beşinci Baskı (DSM-5). Köroğlu E (çev ed.) Ankara, HYB, 2014, s. 371-380. AIM: One of the rare side effects of antipsychotic agents is to lower the Brewin CR, Andrews B, Rose S, Kirk M. Acute stress disorder and epileptic seizure threshold. Currently, atypical antipsychotic agents, with posttraumatic stress disorder in victims of violent crime. Am J less side effects on the extrapyramidal system, are used more frequently Psychiatry 1999; 156:360-366. than the typical agents. There are only few studies on the antipsychotic Classen C, Koopman C, Hales R, Spiegel D. Acute stress disorder as a agent effects on EEG. In the few reported studies comparing the typical predictor of postraumatic stress symptoms. Am J Psychiatry 1998; and the atypical antipsychotics, quetiapine has been shown to have 155:620-624. distinctly less effect leading to EEG anomalies. There are, however, studies reporting newly onset epileptic seizures under quetiapine treatment. This report discusses the case of a patient, without a history of epileptic seizures, presenting with a seizure 2 days after 200 mg/day PP-020 quetiapine addition to his treatment.

SIALORRHEA DUE TO RISPERIDONE: CASE CASE: The 35-year old single female patient with slight mental retardation had been on risperidone (2mg/day) treatment for PRESENTATION approximately 4 months due to complaints of behavioral problems Hülya Çeçen, Sevgi Gül Ertürk, Onur Okan Demirci associated with mental retardation. Quetiapine (200 mg/day) was added Tatvan State Hospital to her treatment to alleviate and episodic nervous tension. On the second day of quetiapine use, she had a 30 to 40-second loss of AIM: Risperidone, is an atypical antipsychotic agent with different consciousness, tonic-clonic contraction all over the body, fixed focusing chemical classification than typical psychotic agents and clozapine. In of the eyes and locked up jaw. For the evaluation of the described clinical the literature, there are not any case reports on sialorrhea due to drugs condition, she was referred to the neurology unit. In order to determine other than clozapine. This report has aimed to present the case of a the etiology, electrolyte levels and other biochemical parameters were patient who developed sialorrhea after depot form clozapine injections. estimated, and cerebral MRI and EEF were carried out. Her EEG report POSTER PRESENTATIONS CASE: The 44-year old married male patient, with a 5 to 6-month was givenNOT as mild-moderate PRESENTED organization disorder which was interpreted history of psychiatric consultation necessitated by legal reasons, and as the effect of the epileptic seizure seen afar the addition of quetiapine diagnosis of delusional disorder (persecutory sub type) treated with to her treatment, which therefore was discontinued gradually. She has depot risperidone (50 mg), consulted our polyclinics with complaint not experience any seizures thereafter. of sialorrhea. Interview with his relations as well as investigation of DISCUSSION: Quetiapine causes less EEG anomalies as compared to his hospital records revealed that his complaints had started in his the other atypical antipsychotic agents. Despite this advantage, atypical home village by accusing a relative of his of attempting to kill him by antipsychotics should be used, especially in the patient with mental putting poison in his food. He could not be persuaded by his wife and retardation, at the minimal dose, and dose increases should be very slow children to consult a hospital. At a stage when his symptom severity and the potential for seizures should be kept in mind. increased, he had threatened his relative by holding a gun at him when Keywords: legal proceedings had been started. His family history was not eventful. Electroencephalography, epileptic activity, quetiapine When examined his self-care was good, affect was slightly restricted, his References mood was dysphoric. His speech was normal, associations were correct. Gülpek D, Tokatlıoğlu B, Erol A (2006) Ketiyapin kullanımının yol His thought contents, although mildened by treatment, did reflect açtığı epileptik nöbet: Olgu sunumu.(Epiletpic seizure caused by persecutory delusions about his relative. He had partial insight, normal quetipaine Anadolu Psikiyatri Dergisi. 7(4):240-243. perceptions and his abstract thinking and intelligence were normal. He did not have an apparent impairment of functionality. Excess salivation was observed during the examination procedure. DISCUSSION: The difference of risperidone from the other antipsychotics is its antagonism of both the serotonin and the dopamine receptors. Most frequently seen side effect is sedation, weight gain, and at high doses, appearance of extrapyramidal symptoms, orthostatic

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A CASE OF MISOPHONIA PSYCHOTHERAPY OF DISSOCIATIVE IDENTITY DISORDER WITH INABILITY TO RECOGNIZE THE Pınar Kızılay Çankaya1, İlkay Kelex Altun2 1Fatih State Hospital, Psychiatry Clinic, Trabzon HUSBAND: CASE PRESENTATION 2Kanuni Training and Research Hospital, Psychiatry Clinic, Trabzon Mehmet Asoğlu, Ülker Fedai, Mahmut Kati, Özlem AIM: Misophonia, also described as selective sound sensitivity, is Beginoğlu, Öznur Akil, Meltem Göbelek, İsmail Karka, the intense negative psychological and emotional reaction to certain Faruk Pirinçcioğlu sounds, probably associated with the limbic system and its functional Harran University, Mental Health and Disorders Department, Sanliurfa connections with the auditory cortex and the autonomous nervous INTRODUCTION: The prevalence of dissociative identity disorder system. I can be comorbid with hyperacusis but it can be differentiated (DID) in the psychiatric subpopulation is reported to be in the 12-13% from hyperacusis on ground of sensitivity to particular but not all range. In this report, we present the case of a child, sexually assaulted sounds. at the age of 13 years, who developed dissociative identity disorder CASE: The 18-year old female patient consulted the polyclinics with triggered with marital conflicts. complaints of anhedonia, lack of morale, avolition, introversion and CASE: The 16-year old, married female middle school graduate, not nervous tension. She had used sertraline (50mg/day) for two months working, consulted with the complaints of not being able to recognize without benefit. She lived with her family and was disturbed especially her husband when she woke up in the night, forgetting what she had with the slurping sounds of her mother and sister while eating, which been told, answering the questions asked in her mind, speaking to caused excessive tension, and weeping such that she had to leave their herself, forgetting what she had done, visual hallucinations, simple presence and could no longer sit at the table with them. These sounds talking for her age, talking nonsense and depressive mood. Her were audible in her dream causing her to wake up disturbed. Also, as complaints had started at 13 when she was traumatized sexually by she heard sounds of eating, chewing and slurping when she went out her cousin, and increased after her marriage. Epilepsy was eliminated. and therefore started to avoid being in the company of people, and Her marriage conflicts were discussed, her score on the Dissociative put on ear phones when she had to go out. She lived confined to her Experiences Scale (DES) was 70%. An alter person was determined room, could not focus her attention and could not do her school work. in the therapy. The first step of the therapy was symptom stabilization During her psychiatric assessment, her self-care was good, she seemed agreement, the second step was handling the traumatic experiences. her own age, she was cooperative, and made eye contact; her affect was Attempts were made to alleviate the effects of the trauma on the alter anxious, mood dysphoric and mildly depressive. Her speech was clear person and the patient. In the last step of the therapy, the alter person and understandable and she did not have pathological perception. Her did not want integration. The alter person expressed the fear about thought process was normal, associations were correct, her thought the therapist being a male, and that she could own up the body in the content was related to her condition. Her cognitive ability was strong, presence of a female therapist. When invited to dominate the alter body her evaluation of reality and judgment capacity were normal. Her in the presence of the female therapist, the patient said ‘my head is extraverted behavior displayed uneasiness. Her sertraline dose was completely empty, there is nothing. There has been a complete unison, titrated up to 100mg/day and risperidone (0.5mg/day) was added. Her I am completely well’. The patient’s complaints related to DID were no symptoms had distantly regressed at her follow up control. longer present and her depressive symptoms had regressed. DISCUSSION: Misophonia is not included in the current psychiatric DISCUSSION: The etiology of multiple identity disorder is related to examination schedule, and although without clear diagnostic criteria, childhood traumas and has the character of a chronic posttraumatic it is a clinical condition associated with anxiety, depression, obsessive- stress disorder. The trauma, however, can sometimes be determined at

compulsive symptoms and explosive anger. Its classification as a separate POSTER PRESENTATIONS adult age. It can only be treated with psychotherapy and the prognosis psychiatric disorder with specific diagnostic criteria would help the NOT PRESENTED is good with the appropriate therapy. DID is a frequently observed recognition of the disorder and encourage further research. condition, but it is confused with other disorders and diagnosis can Keywords: Anxiety, depression, diagnostic criteria, misophonia, be delayed. Attention is drawn to the delays and its adverse outcomes obsessive-compulsive in the case discussed here and also to the success of the psychotherapy provided. References Schröder A, Vulink N, Denys D (2013) Misophonia: Diagnostic Keywords: Amnesia, dissociative identity disorder, inability to recognize Criteria for a New Psychiatric Disorder. PLoS ONE; 8(1). one’s husband Wu MS, Lewin AB, Murphy TK, Storch, EA (2014) Misophonia: References Incidence, Phenomenology, and Clinical Correlates in an AmericanPsychiatricPress, Washington, s.63-77. Undergraduate Student Sample. J Clin Psychol, 70: 994–1007 Şar V, Tutkun H, Alyanak B et al. (2000) Frequency of dissociative disorders among psychiatric outpatients in Turkey. ComprPsychiatry, 41:216-222.

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EVALUATION OF SATISFACTION WITH LIFE, SELF- INVESTIGATION OF IN ESTEEM AND BODY PERCEPTION IN MORBID MORBIDLY OBESE WOMEN OBESITY PATIENTS Mustafa Özlü1, Lale Gönenir Erbay1, İbrahim Şahin2, Mahmut Akyüz1, Lale Gönenir Erbay1, İbrahim Şahin2, Rıfat Karlıdağ1 Rıfat Karlıdağ1 1İnönü University Medical School Psychiatry Department. Malatya, 1İnönü University Medical School Psychiatry Department. Malatya, Turkey Turkey 2İnönü University Medical School Endocrinology Science Department 2İnönü University Medical School Endocrinology Science Department. Malatya, Turkey Malatya, Turkey AIM: The adverse effects of obesity on sexual functions have been AIM: There are studies on the direct relationship between obesity and known. This has been proven in males but the facts on how obesity lowered self-esteem. In studies on body perception by the obese, body effects sexual function in females is still unclear. The conflicting mass index (BMI) is seen to have significant effect on dissatisfaction reported results may be due to use of different approaches and materials with the body. There is an ongoing argument on whether the lowered in the evaluation of female sexual function and lack of control on factors self-esteem and negative body image in the obese are causes or effects. In that may have influenced the results. Factors of anxiety and depression this study, it has been aimed to investigate in the obese the correlation known to have negative influence on sexual functions were controlled between self-esteem and body perception and BMI and satisfaction with in this study and their effects were compared in morbidly obese women life. and healthy women with normal body weight. METHODS: This study included 136 morbid obese patients with METHOD: The study enrolled 72 morbidly obese women with body BMI at least 40 and above, arriving at İnönü University Medical School mass index (BMI) of 40 or over, arriving at İnönü University Medical Endocrinology Science Department and 69 healthy individuals as School Endocrinology Science Department and age matched 28 healthy the controls with BMI of <30. The participants were interviewed on women with BMI < 30 as the control group. The participants were the basis of the DSM-V by a psychiatrist and those with a psychiatric interviewed on the basis of the DSM-V by a psychiatrist and those with disorder were excluded from the study. The patient and the control a psychiatric disorder were excluded from the study. The patient and group completed a sociodemographic questionnaire, the Coopersmith the control group completed a sociodemographic questionnaire, the Self-Esteem Inventory (CSEI), the Body Satisfaction Scale (BSS), the Arizona Sexual Experiences Scale (ASES), the Beck Anxiety Inventory Satisfaction with Life Scale (SLS), the Beck Anxiety Inventory (BAI) (BAI) and the Beck Depression Inventory (BDI). and the Beck Depression Inventory (BDI). RESULTS: The results of the statistical analyses demonstrated that RESULTS: Results of the statistical analyses showed that the scores of the ASES score of the morbidly obese group were significantly higher the morbidly obese patients were significantly higher than those of the compared to the control group (p=0.007). Scores on the subscales on control group on the BDI (p=0.001), the BAI (p=0.001) and the CSEI sexual impulse (p=0.001), physiological stimulation (p=0.015) and (p=0.001); whereas the control scores were significantly higher than orgasm capacity (p=0.006) were all, except the scores on the subscale those of the morbidly obese patients on the BSS (p=0.001) and the SLS satisfaction (p=0.110), indicative of significant impairment of sexual (p=0.002). function in the morbidly obese women. DISCUSSION: The results of our study show that morbidly obese DISCUSSION: In this study it has been shown that all areas of patients have high scores on depression and anxiety and low scores on sexual functions, except satisfaction, were impaired in the morbidly life satisfaction and body perception. However, the self-esteem scores obese women as compared to the controls. In the studies carried out POSTER PRESENTATIONS were higher as compared to the controls. Results reported by other by others overweight and obesity were shown to be a risk factor for in studies showed lowered self-esteem in the obese. In the western countries sexual dysfunction in the male and similar investigations with women concept of being slim is preferred and the obese are marginalized and were recommended. The conflicting results of limited number of subjected to various types of labelling. Considering that self-esteem is investigations with women were attributed to the lack of strict control affected by interpersonal relationships and the meaning ascribed by the of the variables. In this study controlling variables of anxiety, depression individual to these interrelationships, negative feedback from the social and chronic physical illness with likely effects on sexual function was environment is expected to lower self-esteem. The contrasting result of important for the correct interpretation of the results. Results of this our study can be explained by the social structure and the variation in study indicate the importance of querying sexual functions in morbidly the number of patients. obese women patients. Keywords: Body perception, morbid obesity, satisfaction with life, self- Keywords: Arizona Sexual Experiences Scale, morbid obesity, sexual esteem functions References References Caldwell MB, Brownell KD, Wilfley DE (1997) Relationship of weight, Esposito K, Giugliano F, Ciotola M, De Sio M, D’Armiento M, body dissatisfaction and self-esteem in African American and white Giugliano D. (2008) Obesity and sexual dysfunction, male and female dieters. International Journal of Eating Disorders, 22;127- female. Int J Impot Res 20: 358–65. 130. Esposito K, Ciotola M, Giugliano F, et al. (2007) Association of body Telch CF, Agras WS. (1994) Obesity, binge eating and psychopathology: weight with sexual function in women. Int J Imp Res 19:353–7. Are they related? Int J Eat Disord. 5: 53-61.

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SCHIZOAFFECTIVE DISORDER PATIENT WITH PRENATAL OBSERVATION OF A PREGNANT PSYCHOTIC ATTACK DEVELOPING MANIA WOMAN WITH MIXED SUBSTANCE USE AFTER PALIPERIDONE PALMITATE USE: CASE Zeliha Dönmez1, Burcu Yüce1, Nazlı Ateş1, Emin Erhan PRESENTATION Dönmez2 Hasan Mervan Aytaç, Pınar Çetinay Aydın, Nazan Aydın 1Erenköy Mental and Neurological Diseases Training and Research Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Hospital Diseases and Research Hospital 2Haydarpaşa Numune Training and Research Hospital AIM: Paliperidone, an atypic antipsychotic agent, is the active metabolite AIM: Substance use is an increasing problem worldwide. Until recently of risperidone and is obtained from 9-hydroxy-risperidone. Dopamine this problem was predominantly associated with males but latest D2 has a high affinity for 5HT-2A receptors, but has antagonistic effect studies indicate that differences of substance use between males and on the α1, α2 and H1 receptors. In this report, we have presented the females have progressively decreased. Also, substance use is seen to have case of a 45-year old female patient with a 15-year history of psychiatric more deleterious effects on females as compared to the males. Given disorder, presenting with mania after paliperidone palmitate treatment. the female characteristics of fertility and mothering, the damaging CASE: The patient who had been hospitalized in the past for effects of substances on intrauterine growth and the outcomes of schizoaffective disorder had started 1 month before the consultation to neurodevelopmental problems of childhood and afterwards cannot be have complaints of auditory hallucinations giving her orders, delusions overlooked. We have aimed in this article to review the literature for about her husband adulterating with her daughter and fears of harming problems of substance use during pregnancy, and to emphasize that herself. Although she did not have comorbid mood disorder symptoms substance use would affect the entire population by adverse effects on as in her previous hospital admission, she was diagnosed again with the health of the mother and the offspring. schizoaffective disorder. As she did not comply with her preventive CASE: The 30-year old pregnant patient with self-mutilative behavior therapy, she was started on paliperidone palmitate (150 mg/day first was put in restricted ward with the preliminary diagnoses of substance th day; 100 mg/day 8 day im) and lorazepam (2 mg/day) was added to use and psychosis due to substance use. The patient had a 4-year history the therapy. Two weeks subsequently, while on antipsychotic treatment of substance use, and had become aware of her pregnancy in the 20th she presented with euphoric mania symptoms such as increased amount week having continued to use substance in during these weeks. After of speech, decreased need for sleep, increased libido and self-confidence, observation for 18 days without substance use symptoms of psychosis euphoria. Her score on the Young Mania Rating Scale was 27. Despite subsided and despite being at the 28th week of pregnancy absence of having missed the last dose of treatment by 2 weeks, persistence of the any major fetal anomaly was ascertained. The patient was discharge th manic symptoms necessitated skipping the dose on the 38 day and to be followed on outpatient basis. However, as she did not come for adding lithium (1200 mg/day) to the therapy. The patient had displayed controls, and did not attend the AMATEM instructive seminars, it was sleeplessness and irritability in her previous mood episodes, but after assumed that she continued using drugs and it was planned to isolate paliperidone palmitate she had become euphoric. Using the Naranjo her at the AMATEM service until the advent of birth. Her obstetric Adverse Drug Reaction Probability Scale her score was 10 confirming examinations indicated normal fetal development. She was followed that the effect was due to paliperidone palmitate. Occurrence of the without use of medication and at the stage when birth was imminent, affective elevation under an effective antipsychotic therapy strengthened she was transferred to a hospital with obstetrics, newborn intensive our hypothesis. She was put on oral haloperidol (5 mg/day) instead care and psychiatry clinics where normal spontaneous birth took place of paliperidone palmitate. As the manic symptoms subsided she was without complications. discharged from the hospital. POSTER PRESENTATIONS DISCUSSION: It is concluded that when facing substance use in DISCUSSION: Mani and hypomania induced by treatment pregnancy, the case should be evaluated with a multidisciplinary with atypical antipsychotic agents has been attributed to frontal- approach. Substance using pregnant women can be said to have very dopamine discharge cause by 5HT-2A receptor antagonism. Potential little social support. Therefore, policies have to be made for increasing antidepressant action by the serotonin discharge through α-2 antagonist the social support and the education of women throughout the effects, they are believed to have triggered the mania. Considering that pregnancy. As seen with the case presented here, in certain circumstances her previous mood episode was irritable in type in contrast to the hospitalization and stopping contact with substance can become euphoric mood after paliperidone palmitate treatment suggested that this last affective episode may have been due to reasons independent necessary. of her existing disorder. The fact that this was observed under strong Keywords: Pregnancy, psychosis, substance antipsychotic treatment combined with benzodiazepine strengthened our thesis. Keywords: Mania, paliperidone, paliperidone palmitate, schizoaffective disorder, schizophrenia

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ACUTE DYSTONIA DUE TO ARIPIPRAZOLE USE EVALUATION OF THE PSYCHIATRY CONSULTATIONS REQUESTED WITHIN ONE Mustafa Kurt, Vesile Altınyazar, Elif Özlem Canazlar YEAR BY OTHER DEPARTMENTS IN A UNIVERSITY Adnan Menderes University Medical School, Psychiatry Department, HOSPITAL Aydın Mustafa Kurt, Çağdaş Öykü Memix, Levent Sevinçok AIM: Acute dystonic reaction (ADR) is an extrapyramidal side effect of Adnan Menderes University Medical School, Psychiatry Department, medication that appears with involuntary contractions of the muscles of Aydin the neck, chin, face and tongue. Studies made with atypical antipsychotic agents have concluded that the risk of developing dystonia was much AIM: The aim of this research has been to determine the details of lower than with typical antipsychotics. Here the case of a patient with the psychiatry consultations given by the Psychiatry Department of , who developed acute dystonia after aripiprazole Adnan Menderes University Medical School Hospital with respect to the requesting department, the physical diagnoses on the concerned treatment, is presented. patients, and the reasons for making the request and the interventions CASE: The 19-year old single male patient had been treated with and treatments undertaken on the report of the consultations. quetiapine and duloxetine at a health center after developing symptoms METHODS: Psychiatric assessments on the consultation reports of discontent, anhedonia, and avolition and sleep disorder persisting for requested between 01/05/2015 and 30/04/2016 by different 1 month. He had stopped using the drugs as his complaints increased. departments of Adnan Menderes University Medical School Hospital He consulted us with further complaints of being followed by others, for inpatients and the emergency unit outpatients, at and above the age being talked about by others, fear of being harmed by people, thoughts of 18 years, were scanned retrospectively and the data were transferred of harming his environment and himself, auditory hallucinations, to structured forms to be analyzed statistically. nervous tension and uneasiness. He had a history of using fluoxetine for RESULTS: Within the cited one year psychiatric consultation was depression when he was 15 and his mother’s brother had been diagnosed requested for 618 patients at and above the age of 18 years, with a with psychotic disorder. When examined, he was conscious, cooperative, mean age of 47,6 (±2.1) years and consisting of 301(48,7%) females with slightly reduced self-care, dysphoric mood, predominant feelings and 317(51.3%) males. More than one consultations were made for of discontent, thought contents of persecutory and referential delusions, 14.7% of these patients. The departments making the requests, in and associations with auditory hallucinations. Routine laboratory tests the order of request frequency, were the medical units (45.6%), the results were within normal limits. He was diagnosed with transient general emergency service (35%) and the surgical units (19.4%). psychotic disorder on the basis of DSM-V criteria and was started on The highest demand was received from the internal diseases unit aripiprazole (15mg/day) and was discharged from the hospital on the among the medical units, and from plastic and reconstructive surgery 9th day with partial remission. On the 12th day of the therapy he came unit among the surgical units. The reasons for consultancy requests back with complaints of involuntary contractions of the muscles in the ranked as suicidal ideations and attempts (28%), depressive symptoms right neck causing difficulty of neck movement. As the onset of the (15.7%), agitation (12.9%), anxiety symptoms (6.5%) and sleep complaint was sudden, acute dystonia due to aripiprazole was deemed disorders (5.8%). The three foremost medical assessments on the responsible and he was given biperiden (im). The dystonia regressed in request cases were oncological diseases (21.5%), cardio-pulmonary half an hour, and biperiden (2 mg/day) was added to the treatment for diseases (14.7%) and muscular/skeletal system diseases (14.4%). The psychiatric of the patients given consultative examination included 1 week with reduction in aripiprazole dose (10 mg/day). He is currently mental disorders (19.4%) and suicidal attempts (14.6%). The most being followed up in remission. POSTER PRESENTATIONS frequently made psychiatric diagnoses during consultation were mood DISCUSSION: Aripiprazole mechanism of action is different from the disorders (48.3%). After the psychiatric consultation, appropriate other atypical antipsychotics in being partially agonistic on Dopamine treatments were planned for 46.8% of the cases, 20.7% were placed D2 and Serotonin 5-HT1A receptors and antagonistic on 5-HT2A and under polyclinic control, 16.7% did not have any psychopathology to 5-HT2C receptors. Clinical trials have shown that during aripiprazole be treated, 11.7% were admitted to the psychiatric wards, and 4.7% treatment the incidence of extrapyramidal symptoms is 9%, reminiscent were referred to different departments. Among the cases prescribed a treatment, 31.4% were started on a single drug, 15.4% on multiple of placebo treatment. Potkin et. al. (2003) showed that when 20-30mg/ drugs. The three most frequently prescribed drugs were antidepressants day aripiprazole therapy was compared with placebo, incidence of acute (19.9%), antipsychotics (11%) and anxiolytics (5.8%). dystonia was 0-1%. Our results and the increasing examples of case reports show that acute dystonia due to aripiprazole is not a rare event. DISCUSSION: In our hospital, psychiatric consultations requested by the internal medicine and emergency units exceeded those from Keywords: Acute dystonia, aripiprazole, psychotic disorder the surgical units. The most frequently made diagnoses were on References mood disorders and the most frequently prescribed drugs were the Desarkar P, Thakur A, Sinha VK (2006) Aripiprazole-induced antidepressants. acutedystonia. Am J Psychiatry 163(6): 1112-3. Keywords: Consultation, inpatient, psychiatry Potkin SG1, Saha AR, Kujawa MJ, Carson WH, Ali M, Stock E, References Stringfellow J, Ingenito G, Marder SR. (2003) Aripiprazole, an Aslan S, Candansayar S, Coşar B, Işık E (2003) Bir üniversite antipsychotic with a novel mechanism of action, and risperidone vs hastanesinde bir yıl süresince gerçekleştirilen psikiyatri placebo in patients with schizophrenia and schizoaffective disorder. konsültasyon hizmetlerinin değerlendirilmesi (Evaluation of the Arch Gen Psychiatry. Jul;60(7):681-90. psychiatric consultation service given within one year in a university Tandon R. (2002) Safety and tolerability: how do newer generation hospital),Yeni Symposium 41: 31-38 “atypical” antipsychotis compare? Psychiatr Q 73(4): 297-311.

84 Canan F, Koçer E, İçmeli C, Özçetin A, Ataoğlu A (2008) Bir PP-031 Üniversite Hastanesinde Yatan Hastalar için İstenen Psikiyatri Konsültasyonlarının Değerlendirilmesi (Evaluation of the ATYPICAL CLINICAL COURSE OF BIPOLAR psychiatry consultations requested for inpatients of a university DISORDER WITH CATATONIC EPISODES: CASE hospital), Düzce Tıp fakültesi dergisi 1:22-27 PRESENTATION Merve Sertdemir1, Mehmet Ak2 1 PP-030 Necmettin Erbakan University Meram Medical School, Child and Adolescent Mental Health and Diseases Department 2 SCHIZO-OBSESSIVE DISORDER: CASE Necmettin Erbakan University, University Meram Medical School, PRESENTATION Mental Health and Diseases Department AIM Ceren Enüstün Hürmeydan, Özlem Zekiye Çetinkaya : Although catatonia has been classified as a sub-type of schizophrenia in the DSM-V, it can be observed with other psychiatric, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases and Research Hospital, Psychiatry Clinic, İstanbul neurological and medical disorders. It is frequently comorbid with mood disorders. Bipolar disorder with catatonia comorbidity has AIM: Incidence of obsessive-compulsive disorder (OCD) among the different symptomatological and clinical course, with different age of patients diagnosed with psychotic disorders (PD) is higher as compared onset, comorbidity and response to therapy. A case is presented here to the general population. Indicator of ‘poor insight’ brings a dimensional with the aim to emphasize these differences. approach to obsessions, and proposes a continuum between obsessions and delusions such that this spectrum, starting with obsessions, can vary CASE: The 56-year old female patient with frozen up movements as far as overvalued thoughts and typical delusions. In this report a very and anomalous behavior was brought to the polyclinics. Psychiatric rare schizo-obsessive disorder case is presented. examination indicated reduced self-care, unwillingness to cooperate with limited communication, and blunt affect. Her delayed behavior CASE: The 26-year old male patient living with his parents and was generally negativistic. She walked sideways and took posture. It with a history of schizo-obsessive diagnosis was evaluated. His OCD has learned that when catatonic episodes were over, she indulged in symptoms were recognized after returning from the obligatory military prayer and related activities. Her sleep requirement was reduced and service, when he started to empty and clean the refrigerator shelves. He repetitively checked if the plug had been pulled off and frequently she refused to eat. The results of her routine blood tests, cranial MRI washed his hands, thus spending much time in the bathroom. He and EEG were normal, and her scores on the Bush-Francis Catatonia ordered for 2 years the same meal from an outside source believing that Rating Scale (BFCRS) and the Young Mania Rating Scale (YMRS) meals prepared at home were not clean. He bought drinking water in were, respectively, was 21 and 27. Her symptoms of 2-year duration had pet bottles by the case and refused to use the glasses at home. He had started with excessive cleaning, increased religious activities, reduced a personal kitchen cuPPoard which he did not allow to be used by the sleep and introversion, reduced speech, staring at fixed points, taking members of the family. He believed that the steam generated while posture and refusing to eat and to get dressed, all typical of catatonia. the family members showered polluted the detergents and therefore She had been admitted as inpatient with the diagnosis of bipolar disorder the laundry washed by these would be contaminated and unclean. He –catatonic episode and started on lorazepam (5 mg/day), risperidone (4 wore the clothes he bought continually believing that they did not get mg/day), valproic acid (1000 mg/day). She came back nearly a year later soiled as he spent his time in his bedroom, and threw them in the with the complaint of a new episode of catatonia. She was admitted to bin after 2 months. He complained that having to live in a dirty home our servicesNOT and started on PRESENTEDolanzapine (10 mg/day), lorazepam (2mg/ POSTER PRESENTATIONS with dirty meals tortured him, making him weaken and ill. He did day) and lithium (900 mg/day). On the first day of the treatment the not have insight. He was put on , regarded as the golden extent of her spontaneous speech increased, and the bluntness of affect standard for treating OCD, in gradually increased dosage. Since the and posture taking behavior also regressed. However, the catatonic symptoms persisted, amisulpride (titrated to 800mg/day), an atypical symptoms repeated in the subsequent days and the lorazepam dose was antipsychotic, was added to the therapy. increased to 6mg/day. On the 11th day of the therapy her scores on the DISCUSSION: Regarding the high incidence of schizophrenia and BFCRS and YMRS were, respectively, 0 and 4. OCD comorbidity, schizophrenia patients with obsessive symptoms are DISCUSSION: Detailed history taking in catatonia patients for mood believed to make up a significant group such that the term ‘’schizo- disorders has importance. The underlying bipolar disorder can alter the obsessive’’ has been coined for some time. It is obvious that studies have symptoms and the clinical course. The case discussed here demonstrates to be made to distinguish the schizo-obsessive subtypes, to determine that bipolar patients with catatonic episodes display atypical onset and the diagnostic criteria and the treatment regimes. course, with the need for a treatment to control the attacks and to Keywords: Obsessive-compulsive disorder,’schizo-obsessive disorder, prevent the mood disorder symptoms and may also show resistance to schizophrenia. treatment. References Keywords: Bipolar disorder, catatonia, therapy Buckley PF, Miller BJ, Lehrer DS,Castle DJ (2009) Psychiatric Comorbidities and Schizophrenia.Schizophrenia Bulletin References 35(2);383-402. Abrams R, Taylor MA, Stolurow KAC (1979) Catatonia and mania: Insel TR, Akiskal HS (1986) Obsessive-compulsive disorder with patterns of cerebral dysfunction. Biol Psychiatry 14:111-117 psychotic features: a phenomenologic analysis.Am J Psychiatry Braunig P, Kruger S, Shugar G (1998) Prevalence and clinical significance 143:1527-1533 of catatonic symptoms in mania. Comprehensive Psychiatry

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REVERSIBLE DYSKINESIA DUE TO COMPARISON OF MUSIC PREFERENCES OF USE: CASE PRESENTATION INDIVIDUALS WITH A HISTORY OF ALCOHOL- SUBSTANCE USESAND HEALTHY CONTROLS Safiye Bahar Ölmez, Adnan Özçetin, Ahmet Ataoğlu Düzce University Medical School, Mental Health and Disorders Ayşe Ender Altıntoprak1, Hande Çelikay1, Sözdar Ektiren2, Department, Duzce Süleyman Berk Yıldırımlar3, Canberk Gelir4, Umut Bozacı4 1 AIM: Selective serotonin reuptake inhibitor (SSRI) type of agents Ege University Substance Dependency, Toxicology and Drug Sciences are frequently used in treating psychiatric disorders. Although Institute, Substance Dependence Consultancy, İzmir 2 extrapyramidal symptoms (EPS) secondary to antipsychotics agent Yıldırım Beyazıt University, Psychology Department, Ankara 3 use are frequently observed, movement disorders secondary to SSRI Yaşar University Psychology Department, İzmir 4 therapy have also been reported. In the literature, reports on dyskinesia İzmir Ekonomi University Psychology Department, İzmir due to paroxetine therapy are very rare, the cases so far presented being AIM: People usually chose the music that will satisfy them with dyskinesia of the facial region. In this report a case of involuntary and conscious intent and change their moods listening to music with choreiform dyskinesia in the extremities is presented. This case is the emotional associations. Despite choosing music reflecting their anger or first of its kind in the literature. grief, they still feel better. Previous studies have shown that rap music is CASE: The 32-year old female patient consulted with depressive a more popular choice among those individuals with alcohol and illegal symptoms, anhedonia, avolition and insomnia. She had been using substance use habit. This study has been aimed to compare the music duloxetine (30mg/day) for 2 months. She was diagnosed with major preferences of individuals with a history of alcohol and substance use depressive disorder according to DSM-V criteria and her treatment and healthy individuals without a similar history. was started as duloxetine (60 mg/day) and diazepam (5 mg/day). With METHODS: The study enrolled a total of 2014 individuals of whom the persistence of the depression symptoms, treatment was switched to the experimental subjects consisted of 102 individuals under treatment th paroxetine (20 mg/day). On the 4 day of the therapy the patient had for alcohol and substance use at Ege University Substance Dependency, involuntary and repetitive choreiform dyskinesia at her two elbows and Toxicology and Drug Sciences Institute, Substance Dependence Clinic knees. Her physical examination, routine hematological and biochemical and Ege University Medical School, Mental Health and Disorders laboratory test did not reveal an underlying pathology. In the cranial Department, dependency ward. The control group consisted of 102 MRI, basal ganglia appeared normal. With the discontinuation of her healthy individuals, without a history of alcohol or substance use, therapeutic drugs the dyskinesia regressed and completely stopped in 2 and matched with the experimental group on age, gender, who they days. She was restarted on duloxetine (30 mg/day) with dose titration to live with and the frequency of listening to music while working. All 60 mg/day. Her depression symptoms regressed and she was discharged. participants completed a sociodemographic questionnaire and a special DISCUSSION: The 5 cases of dyskinesia due to paroxetine use reported questionnaire for preferences of music. in the literature are related to involuntary tongue, mouth, and ear RESULTS: The participants consisted of 68 (33.3%) females and movements. The increased effectiveness of serotonin in the nigrostriatal 136(66.7%) males; 25 (12.3%) being alcohol users, 71(34.8) substance pathways induced by SSRI treatment may cause reduced dopaminergic users; with a mean age of 29.72 (±10.99) years and mean income of 2346 effectivity with resulting EPS. Although SSRIs as compared to most (±1907) TL; 165(80.9%) living with their families; 84 (41.2%) senior antidepressants are expected to have less extrapyramidal system side high school graduates; 110 (53.9%) employed. Mean age of starting effects, the case presented here shows that, even if reversible, EPS can alcohol-substance use was 16.8 (±3.91) years; 135 (66.2%) used every

POSTER PRESENTATIONS arise with SSRI agents adversely affecting patients’ quality of life and day; 64 (31.4%) always listened to music while working. The alcohol- may result in the unwanted treatment incompliance. substance users preferred listening to arabesque, rap, techno music, Keywords: Dyskinesia, extrapyramidal system, paroxetine, side effect whereas the controls significantly preferred rock, classics, jazz, reggae and blues (respectively, F(1,202)=43.924, p=0.000; F(1,201)=30.741, References p=0.000; F(1,201)=22.626, p=0.000; F(1,201)=4.469, p=0.036; Arnone D, Hansen L, Kerr JS. (2002) Acute Dystonic Reaction in An F(1,164)=11.093, p=0.001; F(1,184)=11.437, p=0.001). When asked Elderly Patient with Mood Disorder After Titration of Paroxetine: to score the feelings and thoughts evoked by the song they liked most, Possible Mechanisms and Implications for Clinical Care. Journal of the alcohol-substance users expressed significantly more emotions of Psychopharmacology 16(4):395-397. anger, grief, tension, rebellion, hopelessness, loneliness (all p estimations Lee MS & Nam JW (2000) A Case of Paroxetine Induced Dyskinetic were <0.05). Movements. Journal of Clinical Psychopharmacology 20(6):712- 713 DISCUSSION: Music therapy is included in the effective treatments for alcohol and substance dependents. Further controlled studies should help developing methods for mood regulatory abilities, and the formation of methods to prevent recurrence. Keywords: Alcohol, choice of music, substance References Herd, D (2014) Changes in the prevalence of alcohol in rap music lyrics 1979-2009. Substance Use & Misuse. 49:333-342 Loxton, N. J., Mitchell, R., Dingle, G.A., Sharman, L. (2016) How to tame your BAS: Reward sensitivity and music involvement, Personality and İndividual Differences. 97:35-39

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GLOBUS HYSTERICUS PRESENTING AFTER SEXUAL MISINFORMATION IN NATIONAL NEWSPAPERS TRAUMA: CASE PRESENTATION ABOUT ATTENTION DEFICIT AND HYPERACTIVITY DISORDER Nermin Gündüz1, İrem Damla Manga Çimen2 1Erzurum District Training and Research Hospital, Psychiatry Clinic, Miraç Barış Usta, Yusuf Yasin Gümüş 2Kocaeli Darica Farabi State Hospital Child and Adolescent Psychiatry Ondokuz Mayıs University, Child and Adolescent Mental Health and Clinic Diseases Department, Samsun AIM: Globus refers to the continually or intermittently feeling the AIM: Misinformation about mental diseases and patients in the media presence of a round plug or strange substance in the throat. It is generally promote the development of negative judgements and concepts that a clinical symptom with tendency to repeat and difficult to treat. lead to discriminatory labelling against these disorders and patients. Although it often surfaces with eating it does not result in . This type of labelling is made against attention deficit and hyperactivity Next to many organic pathologies that can explain globus, there are disorder (ADHD) and has the risk of upsetting treatment compliance of also many factors of stressful living that can cause this symptom. The the patients and changing the course of the disease for worse. This study case reported here is about the development of globus hystericus after has aimed at investigating the misinforming items on ADHD appearing childhood trauma of sexual abuse. in the national newspapers with accessible archives and a high turnover. CASE: The 19 year-old male patient was referred to psychiatry services METHODS: On the basis of 2015 data recorded by Turkey Statistics by the ear-nose-throat unit with the preliminary diagnosis of globus Institution, 7 national newspapers with the highest daily numbers issued hystericus. When interviewed, the patient explained that he had been were selected. The issues of these papers published between January feeling over 7 months the presence of an obstruction and a mass in his 2008 and 31 December 2015 were scanned for any of the combinations throat. He had a history of sexual abuse at the age of 12, an experience of the words in ‘attention deficit and hyperactivity disorder (ADHD)’. he could not understand, and preferred to conceal, and complained of The data collected were subdivided as ‘scientifically informing’, intermittent difficulties of speaking, and speaking with a weak voice. It ‘misinforming’ and ‘labelling’. was learned that after the traumatic event he had become introverted RESULTS: Altogether 105 new items were collected from the archives with fallen school performance and bad relationships with his school of the newspapers selected. Of these 62 were ‘news’, 58 were ‘specialist mates and had developed nervous tension and somatic complaints. views’ and 17 were ‘articles’. The ‘specialists’ concerned were psychiatrist He personally complained of introversion, anhedonia, lowered self- physicians (16), consultant psychologists (24), and psychologists (18). esteem and problems of attention and concentration. He was started In 10 (9.5%) of the items statements encouraging labelling were found. on fluoxetine (20 mg/day) on account of his depressive symptoms. The News on the treatment of ADHD (19) and misinformation about sexual assault event was detailed in the interviews. Social activities were pharmacological treatment of ADHD (5) were determined. recommended whereupon the patient decided to join computer, English and diction courses. In his last interview, the feeling of obstruction in DISCUSSION: Labelling has been described as making references to his throat had decreased by 90%. And the symptoms of depression had individuals with characteristics considered to be outside the norms of also regressed significantly. the local culture or the society and thereby reducing their respectability and their social acceptance. In 9.5% of the items scanned, the DISCUSSION: In individuals with a history of sexual abuse, symptoms ‘’impulsiveness’’ component of ADHD has been found to be associated of dissociation, anxiety, sexual dysfunction, lowered self-esteem, with objectionable subjects such as ‘problems of discipline’, ‘theft’, suicidality, complaints of posttraumatic stress disorder and somatization. ‘substance use’, and ‘disloyalty’. Statements about pharmacotherapy The individual whose case was presented here had experienced a feeling of ADHD (38%) were unscientific. Given these data, measures of obstruction in his throat for long years after childhood sexual abuse. should be taken to prevent labelling of ADHD and especially of the POSTER PRESENTATIONS As the investigations for an organic pathology were negative, he had been pharmacotherapy of ADHD in Turkey. given a successful psychiatric therapy. We have wanted to emphasize Keywords: here that childhood traumas should be queried when an organic basis ADHD, labelling, newspaper, stigmatization cannot be determined for long term somatization complaints. References Karabekiroğlu, K, Cakin-Memik N, Ozcan-Ozel O, Toros F, Öztop Keywords: Globus hystericus, sexual trauma, trauma D, Özbaran B, Aydın, C (2009). DEHB ve Otizm ile İlgili Bilgi References Düzeyleri ve Damgalama: Sınıf Öğretmenleri ve Anababalarla Çok Harris MB, Deary IJ, Wilson JA (1996) Life events and difficulties in Merkezli Bir Çalışma (The Level of Knowledge on ADHD and relation to the onset of globus pharyngis. J Psychosom Res. 40:603– Autism and Labelling: A Multicentered Study with School Teachers 615. and Parents)Klinik Psikiyatri, 12;79-89 Thompson WG, Heaton KW (1982) Heartburn and globus in Kellison I, Bussing R, Bell L, Garvan C (2010) Assessment of apparently healthy people. Can Med Assoc J. 126:46–48. stigma associated with attention-deficit hyperactivity disorder: Psychometric evaluation of the ADHD Stigma Questionnaire. Psychiatry research, 178(2), 363-369

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RELIABILITY AND VALIDITY OF THE TURKISH DOES APPLICATION OF THE PROBATION LAW VERSION OF DSM-5 DISSOCIATIVE SYMPTOM HAVE ADEQUATE EFFECTIVITY ON TREATMENT SEVERITY SCALE FOR DEPENDENCE? Ahmet Herdem1, Ecenur Aydın Aşık1, Kadir Aşçıbaşı1, Hakan Coşkunol1, Hande Çelikay1, Sözdar Ektiren2, Orkun Aydın2, Kuzeymen Balıkçı4, Deniz Alçı1, Talat Süleyman Berk Yıldırımlar3, Canberk Gelir4, Umut Bozacı4 Sarıkavak5, Emine Özge Çoldur1, Fikret Poyraz Çökmüş1, 1 Ege University Substance Dependency, Toxicology and Drug Sciences Serra Yüzeren1, Fatma Akdeniz6, Siğnem Öztekin1, Didem Institute, Substance Dependence Consultancy, İzmir 2 Suculluoğlu Dikici14, Ertuğrul Köroğlu3, Ömer Aydemir1 Yıldırım Beyazıt University,Psychology Department, Ankara 3 1Celal Bayar University Medical School, Psychiatry Department, Manisa Yasar University,Psychology Department, İzmir 4 2Abant İzzet Baysal University Mental Health and Neurological Diseases, İzmir Economy University Psychology Department, İzmir Training and Research Hospital, Bolu AIM: The legal basis of the Probation Law was prepared in 2005 and 3 Boylam Psychiatry Institute, Ankara amendment were made in the following years. In the Penal Code of 4 Manisa Mental Health and Neurological Diseases Hospital, Manisa Turkey –Law No 5237, clause 191 states that individuals ‘’buying, 5 Ege University Medical School Psychiatry Department, İzmir accepting or keeping narcotics ‘’ can be put under probation. In this 6 Bolvadin State Hospital, Bolvadin, Afyon study, it has been aimed to investigate whether substance dependents AIM: This study aims to demonstrate the reliability and validity of the have benefitted from freedom under probation. Turkish version of the Dissociative Symptoms Severity Scale (DSSS) METHODS: This study has been carried out with individuals minimally developed on the criteria of the DSM-V in order to assess the symptoms 1 year maximally 5 years after their treatment for substance dependence and severity of under probation. Sociodemographic details, history of substance use, METHODS: The study has been conducted with 50 inpatients and criminal involvement, and suicidal ideation, their evolution of the outpatients diagnosed with dissociative disorder on the criteria of probation process, their lives after the probation period and the pattern DSM-V at Celal Bayar University Medical School, Psychiatry Clinic. of social support have been investigated. The participants were 41 individuals with substance use disorder who had been at least once RESULTS: Post traumatic stress disorder was diagnosed in 32 of the referred to Ege University Substance Dependency, Toxicology and Drug participants, and acute stress disorder was diagnosed in 15 participants; Sciences Institute, Substance Dependence polyclinics for treatment while 150 healthy individuals without any mental or physical illnesses under probation. Although attempts were made to contact by telephone made up the control group. Mean age of the participants was 32.1 392 individuals under the same category, as 223 had changed their (±12.0) years; 57.7% (116) were females; 31.3% were educated at telephone numbers, 27 had refused to participate, 101 had not answer university level; 29.9% were lycee graduates. Disease duration in the the phone call, the number of participants had dropped to 41. group diagnosed on trauma related disorders was 4.08 (±4.57). The Cronbach alpha internal consistency of the DSSS was 0.91 and the RESULTS: All participant who came to the interview carried out in item-total score correlation coefficient was between 0.58 and0.80 August 2016 were male, with a mean age 33.6 (±8.98) years, being (p<0.0001). In the exploratory factor analysis of DSSS, the Kaiser- married and 19 (46.3%) single; with 33 (80.5%) educated at least Meyer-Olkin (KMO) coefficient and the Bartlett coefficient for up to middle school; 28 (70%) having an income of 0-2000TL; 29 sampling sufficiency were determined to be, respectively, 0.92 and 988 (70.7) still working.; and 15 (36.6%) finding their income inadequate. (p<0.0001). A single factor, with an Eigen value of 5.04, accounted for Mean duration of substance use was 9.33 (±8.05) years, and 7 (17.1) 63% of the variance. were still using substance. As the score on DSM-V diagnostic scores POSTER PRESENTATIONS increased, incidences of switch to cannabis and heroin, continuing to DISCUSSION: These results have shown the reliability and validity of use substance, joining physical fights, getting arrested, wasting physical the Turkish version of the Dissociative symptoms severity scale. health, getting abused also increased. (respectively, F(1,37)=4.971, Keywords: Dissociative symptoms severity scale, reliability, validity p=0.032; F(1,37)=7.873, p=0.008; F(1,35)=10.544, p=0.003; F(3,34)=3.476, p=0.026; F(4,34)=3.980, p=0.009, F(3,35)=3.223, References p=0.034; F(1,36)=7.639, p=0.009). Amerikan Psikiyatri Birliği (2011), Ruhsal Bozuklukların Tanısal DISCUSSION ve Sayımsal Elkitabı, Beşinci Baskı (DSM-5). Tanı Ölçütleri : In this study only 10% of the intended experimental Başvuru Elkitabı (The Diagnostic and Statistical Manual of population had been reached. The psychosocial treatment given by the Mental Disorders, Fifth Edition (DSM-5) The Diagnostic Criteria treatment centers is very critical until communication with the cases Handbook) (American Psychiatric Association (Çev. Köroğlu E) reaches the adequate level. Since criminal acts and alcohol-substance Hekimler Yayın Birliği, Ankara, 2013. dependence are strongly related, measures taken by legal psychiatry in Aydemir Ö, Köroğlu E (2012) Psikiyatride Kullanılan Klinik Ölçekler this respect are very important. (Clinical Scales Used in Psychiatry) Ankara, HYB Basım Yayın Keywords: Adult, probation, substance use s.226

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IS THERE A RELATIONSHIP BETWEEN EVALUATION OF THE CAPACITY TO MAKE A MALTREATMENT IN CHILDHOOD AND DECISION ON THE TERMINATION OF PREGNANCY: SCHIZOPHRENIA? COMPARISON OF CASE PRESENTATION SCHIZOPHRENIA PATIENTS WITH HEALTHY Ali Ercan Altınöz, Didem Yiğit, Altan Eşsizoğlu SIBLINGS Eskişehir Osmangazi University Medical School, Psychiatry Department, Zeynep Yıldız Akbey1, Mustafa Yıldız2, Nermin Gündüz3, Eskisehir Hatice Turan4 AIM: Mental disorders prevalent in the perinatal period are serious 1Adapazarı Hendek State Hospital, Psychiatry Clinic causes of morbidity and mortality for both the mother and the fetus. 2Kocaeli University Medical School, Psychiatry Department, Kocaeli Starting with the psychotic disorders, many mental disorders affect the 3Erzurum District Training and Research Hospital, Psychiatry Clinic decision making capacity of the individual. Individuals with mental 4Private Moodist Psychiatry and Neurology Hospital Psychiatry Clinic, disorders during pregnancy are difficult cases on both medico-legal and İstanbul ethical grounds. On the one hand clinicians are obliged by ethics to respect the autonomy of the individual, and on the other hand, they AIM: Genetic liability is a determinant of the development of the have to evaluate, within the framework of legal psychiatry, the process disorder. Since 100% risk of schizophrenia diagnosis has not been of decision making by the individual. While the literature on the mental observed in identical twins, environmental factors are also effective in disorders during pregnancy is enriched by the day, there is only limited the disease development. Incidence of childhood abuse or neglect range information on the medico-legal and ethical aspects of the subject. between 30 and 75 % in patients diagnosed with psychotic disorders. The aim of this study has been to investigate the effect of childhood CASE: The 28-year old female patient with a 10-year history of mild abuse on the development of schizophrenia. level of mental retardation and bipolar mood disorder was using regularly lithium and valproic acid. When it was realized 19 weeks after her last METHODS: The study was carried out with 100 schizophrenia patients menstruation that she was pregnant, she consulted for the termination with a score of 5 or lower on the Clinical Global Impressions Scale of the pregnancy. Her previous pregnancy had been terminated on (CGIS) or not in the active phase of psychosis attack and their healthy grounds of her existing psychiatric disorders. A multidisciplinary siblings who have grown up in the same environment with the patients. medical decision was made on not terminating her pregnancy. Schizophrenia patients completed a sociodemographic questionnaire, DISCUSSION: Psychiatric disorders can at times be grounds for the SCID-I on the DSM-IV, The Brief Negative Symptom Scale (BNSS), terminating pregnancy. Especially mental retardation, psychotic Scale for assessment of positive symptoms (SAPS), the Dissociative disorders and substance use disorder can constitute the reasons for Experiences Scale (DES), the Clinical Global Impressions Scale (CGIS), terminating a pregnancy beyond the legally permitted limit of 10 the Global Assessment of Functioning (GAF) Scale and the Childhood weeks. In the case presented here the decision making capacity from Experience of Care and Abuse Questionnaire (CECA.Q). The control both the mental retardation and the course of the bipolar disorder will group completed a sociodemographic questionnaire, the Dissociative be considered and discussed again. Experiences Scale (DES), the Childhood Experience of Care and Abuse questionnaire (CECA.Q). Keywords: Decision making capacity, legal psychiatry, pregnancy termination RESULTS: When the two groups were compared, the mean total score on the DES and the scores on the physical abuse, emotional abuse and sexual abuse subscales aware found significantly higher in the patient group. A moderate correlation was determined between the total and the PP-040 POSTER PRESENTATIONS subscale scores of DES and CECA.Q. A moderate negative correlation determined was between the CECA.Q total score and the age of the GENDER IDENTITY DISORDER WITH patient and with the age of onset of the disease. A positive correlation ADOLESCENCE ONSET: CASE PRESENTATION between the CECA.Q and DES scores and the CGIS score, and a İrem Damla Manga Çimen1, Nermin Gündüz2 negative correlation between CECA.Q and DES scores and the GAF 1Darıca Farabi State Hospital Child and Adolescent Psychiatry Clinic, score were determined. Whereas there were no correlations between the Kocaeli, Consultant Dr. total scores of CECA.Q and BNSS or the SAPS total score, when the 2Erzurum District Training and Research Hospital, Psychiatry symptom levels were considered, significant relationships were observed Department, Consultant Dr between some subscales and items. A significant positive correlation was determined between the mean total scores of DES and BNSS. AIM: Gender dysphoria or gender identity disorder (GID) is the condition of complaining of one’s own gender and desiring intensely to DISCUSSION: It can be said that childhood abuse plays a role on have the opposite gender, or insisting to be of the opposite gender. It has the early onset of schizophrenia, and may have effects not only on been aimed to present in this report the case of an individual who was the formation of the positive and the negative symptoms, but also on of the female gender until the start of adolescence when gender identity functionality and the clinical severity of the disease. disorder developed. Keywords: Childhood abuse, dissociation, schizophrenia CASE: The 17-year-old female patient had worn skirts and long hair th References until the 6 grade at school, but started to play football, wearing Sullivan PF (2005) The genetics of schizophrenia. PLoS Med. 2:e212. trousers at school and outside, and cut her hair short like boys. She had a history of suicidal attempt when separated from her girlfriend. It was Cardno AG, Marshall EJ, Coid B, et al. (1999) Heritability estimates learned that when her breasts developed, she wore corsets, she felt like for psychotic disorders: the Maudsley twin psychosis series. Arch a male, wanted to have transgender surgery, followed the web pages of Gen Psychiatry. 56:162–168.

89 people like herself on the internet, resented being referred to as a lesbian, 8 cases, combined with antipsychotics (risperidone, aripiprazole) in 2 always desired to be a police officer, and had tried to protect her mother cases, or with benzodiazepines (alprazolam, diazepam) in 4 cases, and since childhood. Her mother was upset and wanted her to be treated. with lithium in1 case. The time taken for getting treatment ranged from Interviews with the mother revealed that she had been divorced from 1 to 18 years, in which time span 3 patients had attempted suicide; her first husband when pregnant, and had remarried when the patient while 4 still had suicidal ideation, and 3 had dissociative symptoms. The was 8 years old, that she had another daughter from her second marriage patients were given 2-4 sessions of IRRT during interviews. Significant that the sisters got along well but that the patient had problems with improvement was recorded in scoring on the Beck Depression the step-father. It was also learned that the mother kept her marriage Inventory, and the PTSD scaling, and in the risk of suicidal attempt. for economic reasons as she had inadequate social support.The patient Trauma related symptoms had regressed and functionality, academic had contacted her natural father 5 years previously, and had met him performance and family relations had improved. for a total of 5 times, and they talked on the phone once a month. She had addressed her maternal uncle and grandfather as ‘father’ until she DISCUSSION: After traumatizing experiences, the mental integrity, was at the second grade of school. A total of 5 interviews were made life quality and social functionality of the individual is adversely with the patients with 3 to 4-week intervals. These were supportive affected. Adaptation of the above cited model of therapy and its use interviews and concentrated on self-esteem. Changes in the patient’s in the treatment of psychopathologies related to trauma will be useful feelings and perceptions were not noted. At the last interview treatment for the patients and the practice. Although there have been reports on with sertraline (25mg/day) was started for her symptoms of depression IRRT, there is need for further work in Turkey in this field. and the dose was titrated to 50 mg/day a week later. Keywords: Imagery (simulacrum), re-experiencing, therapy, trauma DISCUSSION: It has been observed that the patient who did not have References problems with gender identity at childhood, developed the disorder in Grunert BK, Smucker MR, Weis JM et al., (2003) When prolonged adolescence. It should be emphasized that gender identity development exposure fails: Adding an imagery-based cognitive restructuring next to genetic and biological factors may also be affected by experiences component in the treatment of industrial accident victims suffering of intrafamilial conflicts. from PTSD. Cognitive and Behavioral Practice 10: 333-46. Keywords: Adolescence, female gender, gender identity disorder Grunert BK, Weis JM, Smucker MR et al., (2007) Imagery rescripting and reprocessing therapy after failed prolonged exposure for post- traumatic stressdisorder following industrial injury. J Behav Ther Exp Psychiatry, 38(4):317-28. PP-041 Holmes EA, Arntz A, Smucker MR (2007) Imagery rescripting in cognitive behaviour therapy: images, treatment techniques and “IMAGERY RESCRIPTING AND REPROCESSING outcomes. J Behav Ther Exp Psychiatry. Dec;38(4):297-305. THERAPY”: EVALUATION OF EIGHT CASES Deniz Altunova, Memduha Aydın, Bilge Çetin İlhan, Ali Baran Tanrıkulu, İbrahim Eren PP-042 Konya Training and Research Hospital, Beyhekim Psychiatry Clinic, Konya RECURRENT PRIAPISM DUE TO SINGLE AIM:Research has shown the effectiveness on trauma of cognitive DOSE PALIPERIDONE PALMITATE USE: CASE behavioral therapies (CBT) widely used in psychotherapy. The ‘Imagery PRESENTATION Rescripting and Reprocessing Therapy’ (IRRT) designed to alleviate Derya Büyüköz1, Esra Kabadayı2, Zeynep Tatlı3, Mustafa PTSD symptoms, is the imagery-based method of implementing CBT POSTER PRESENTATIONS Uğurlu1, Görkem Karakaş Uğurlu2 in changing the mental simulations, beliefs and schemas related to 1 trauma, and has three stages: Ankara Atatürk Training and Research Hospital, Psychiatry Clinic, Ankara 1. Making the traumatized individual recall and re-experience the 2Ankara Yıldırım Beyazıt University, Psychiatry Department, Ankara traumatic imagery and simultaneously express verbally the associated 3Ankara University, Psychiatry Department, Ankara thoughts and sensations in detail; AIM: Priapism is the prolonged and painful penile erection in the 2. Replacement of the ‘victim child’ image with the ‘competent adult’ absence of both physical and psychological stimulation. Although image that confronts the traumatizing event and rescues the child from there are many reported etiological factors, it is frequently attributed the scene; to drug use. Here, the development of priapism after a single dose of 3. Making the traumatized individual visualize himself/herself as an paliperidone palmitate is reported in the case of a patient. adult calming down and soothing the ‘traumatized child’. In this report CASE: The 55-year old male schizophrenia patient had consulted a cases of PTSD treated with IRRT will be presented. mental health care center with the complaint of flare up, and had been METHODS: After diagnosis of PTSD at Konya Training and Research put on olanzapine therapy. Since his treatment compliance had been Hospital, Beyhekim Psychiatry Clinic, 8 patients were conducted irregular, and given his history of risperidone treatment without side through IRRT. Subsequently, the clinical data on the 8 patients and the effects, therapy was switched to depot antipsychotics with paliperidone results of IRRT given were evaluated. palmitate (150 mg im). On the third day of his therapy the patient consulted our hospital with complaint of painful and prolonged RESULTS: All 8 patients were females in the 16 to34-year age range penile erection. Examination and urological tests did not result in any with 7 having a history of sexual traumatization and 1 ‘another’ pathology that explain the etiology of priapism, which therefore was type of trauma. Before IRRT, all 8 had been on pharmacotherapy attributed to paliperidone palmitate use. Since the priapism episodes with appropriate dosage and duration. Treatment had consisted of repeated three times during his follow up, therapeutic aspiration of the antidepressants (paroxetine, venlafaxine, citalopram or fluoxetine) in corpora cavernosa and intracavernosal adrenalin injection was carried

90 out. Paliperidone palmitate treatment was switched to quetiapine (200 DISCUSSION: Aripiprazole addition to PP therapy is a generally mg/day). In the following 3-month controls, the patient did not have well tolerated approach to reducing serum hyperprolactinemia, also repeat any episode of priapism. with beneficial effects on the negative symptoms of schizophrenia. The results of the study are in agreement with those in the literature. DISCUSSION: Priapism occurs as a result of the blockage of venous drainage of the corpora cavernosa. The role of the antipsychotic agents Keywords: Aripiprazole, hyperprolactinemia, paliperidone palmitate, in priapism probably involves α-1 adrenergic antagonism resulting in schizophrenia penile vascular dysregulation. To the best of our knowledge, this report References is the first on priapism due to paliperidone palmitate action, which is Peuskens J, Pani L, Detraux J et al., (2014) The effects of novel and newly strongly evinced by the repetition of the episodes until the effect of the approved antipsychotics on serum prolactin levels: a comprehensive long acting drug expired. review. CNS Drugs 28(5):421-53. Wahl R, Ostroff R. (2005) Reversal of symptomatic hyperprolactinemia Keywords: Paliperidone palmitate, priapism, schizophrenia by aripiprazole. Am J Psychiatry. 162(8):1542 References Brichart N, Delavierre D, Peneau M et al. (2008) Priapism associated with antipsychotic medications: a series of four patients. Prog Urol, PP-044 18:669-73 Wearne D. (2014) “A case of priapism associated with paliperidone.” DUAL-ACTION ANTIDEPRESSANT SIDE EFFECTS- Australian and New Zealand Journal of Psychiatry 48.10: 962 HYPERPROLACTINEMIA AND GALACTORRHEA: CASE PRESENTATION

PP-043 Bilal Tanrıtanır1, Meltem Gündoğan2 1Yozgat State Hospital, Yozgat 2 HYPERPROLACTINEMIA DUE TO PALIPERIDONE Eskişehir State Hospital, Eskisehir PALMITATE USE REVERSED BY ARIPIPRAZOLE AIM: Venlafaxine is an antidepressant agent that shows in a dose- ADDITION TO THERAPY dependent manner inhibitory effects on serotonin, noradrenaline (NE) and dopamine reuptake inhibition. Rare side effects of Deniz Altunova, Memduha Aydın, Ali Baran Tanrıkulu, hyperprolactinemia and galactorrhea have been reported. It has been İbrahim Ere aimed in this report to discuss the dose-effect relationship of venlafaxine Konya Training and Research Hospital, Beyhekim Psychiatry Clinic, in a case of major depression presenting with hyperprolactinemia and Konya galactorrhea after its use. AIM: Hyperprolactinemia is a frequently observed serious side effect CASE: The 40-year old married female patients had used venlafaxine of antipsychotic agents, and especially of risperidone, paliperidone and (75mg/day) after the diagnosis of major depression. She developed amisulpride. Hyperprolactinemia can be asymptomatic or may present symptoms of avolition, anhedonia and weakness. Her treatment dose with effects such as gynecomastia, galactorrhea, amenorrhea, hirsutism, was titrated to 150 mg/day. On her control, it was seen that she was infertility, and reduced bone mineral density. These symptoms can lactating. Except weakness, her complaints remained the same. Her upset patient compliance with therapy. Combination therapy with serum prolactin (PRL) level was estimated to be 40.69 ng/ml versus the laboratory normal range of 4.79-23.3 ng/ml. This and the estimated aripiprazole leads to lowering of the circulating prolactin levels and galactorrhea were attributed to venlafaxine dose and it was reduced to hence its symptomatic effects, thereby facilitating the maintenance of 75mg/day. After two under polyclinic control her serum PRL level was POSTER PRESENTATIONS the treatment. This report aims to demonstrate the discussed clinical reduced to 17.89 ng/ml. phenomena in patients. DISCUSSION:There is evidence that selective serotonin reuptake METHODS NOT PRESENTED : This study gathered data by scanning the hospital records inhibitors (SSRI) bring about hyperprolactinemia by direct action on of the symptomatic complaints of female schizophrenia inpatients of the hypothalamic post synaptic 5-HT receptors or indirectly over the Konya Training and Research Hospital, Beyhekim Psychiatry Clinic, tuberoinfundibular dopaminergic neurons. Case reports showing that placed under monotherapy with paliperidone palmitate (PP). The 5 increasing venlafaxine dose from 75 mg/day to 150 mg/day results patients benefitting from PP therapy and showing improvement in the in hyperprolactinemia with ensuing galactorrhea and gynecomastia, symptoms of hyperprolactinemia by combined therapy with aripiprazole indicate that 150 mg/day is the threshold dose for these side effects. were further investigated. Abdelmawla et al reported that venlafaxine at a dose of 75 mg did not produce constriction via the NE receptors on the dorsal vein of human RESULTS: Scanned patient data showed a mean age of 39.8 (±9.6) hand but constriction occurred with 150 mg dose, indicating that above years, using PP for a mean period of 15.8 (±8.4; 6-24) months, on a the 150 mg dose, NE reuptake inhibition is added to serotonin reuptake mean dosage of 100.0 (±30.5; 75-150) mg. Mean total PANSS score of inhibition. the patients before and after the PP therapy were, respectively, 89.2 and 49.6. Mean serum prolactin levels assessed before the PP therapy, and Keywords: Galactorrhea, hyperprolactinemia, venlafaxine 38 days and 3 months after starting the PP therapy were, respectively, 48.0 (±26,2; 14.0-84,7) ng/ml ; 173.8 (±54.4; 125.5-263.0) ng/ml and 133.7 (±64.8; 54.6-203.1) ng/ml. Before the addition of aripiprazole (2.5-15mg/day) to the therapy, the mean serum prolactin level was 122.1 (±56.1; 55.2-205.4) ng/ml, and the mean serum level of prolactin, assessed 7 to 60 days after aripiprazole use, was significantly reduced to 32.0 (±23.1; 5.9-58.7) ng/ml (p<0.05).

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MIND THEORY AND EXECUTIVE FUNCTIONS IN EFFECTS OF SOCIODEMOGRAPHIC AND CLINICAL BIPOLAR DISORDER PATIENTS AND FIRST DEGREE FACTORS ON THE DURATIONS OF BIPOLAR RELATIONS DISORDER MOOD SWING EPISODES 1 2 Taçlan Duman, Figen Çulha Ateşçi, İbrahim Sendur Cem Gündüz , Cengiz Akkaya 1 Pamukkale University Hospital, Psychiatry Department, Denizli Muammer Agim Gemlik State Hospital, Bursa 2Uludag University Medical School, Psychiatry Department, Bursa AIM: It has been aimed in this study to determine the mind theory AIM: It has been aimed in this study to determine the major factors functions in bipolar disorder (BPD) patients and their first degree affecting the total duration of the manic, depressive, mixed type and relatives, to compare these functions between the patients and healthy euthymic episodes in bipolar disorder (BPD). (control) individuals and to investigate the effects of mind theory executive function disorder. METHODS: Hospital files of 151 patients diagnosed with BPD on the criteria of DSM-V at Uludag University Medical School, METHODS: The study has enrolled 30 BPD patients in the 18 to 60- Psychiatry Department, and Mood polyclinic have been retrospectively year age range, diagnosed on the basis of the DSM_IV criteria, 30 first investigated. degree relatives of these patients and 30 healthy individuals, matched for age, gender and level of education with the other groups, as the control RESULTS: Mean age of the selected 151 patients was 41.5 (± 12.9; group. Participants completed a sociodemographic questionnaire, the 19–83) years; and the group consisted of 86 females (57%) and 65 (43%) males. The patients passed 86.3% of the time under follow up SCID-I for DSM-IV, the Hamilton Depression Rating Scale (HAM-A) in euthymic period, while the durations of the manic and depressive and the Young Mania Rating Scale (YMRS), the Wechsler Adult episodes were very close to each other. The married patients as compared Intelligence Scale-revised (WAIS-R), and the cognitive tests including to the singles, and the employed patients compared to the unemployed the Wisconsin Card Sorting Test (WCST), the Stroop test, the Trail patients had significantly longer euthymic periods (respectively, Making Test (TMT) A and B, the Digit Span Test (DST), the Reading (p=0.016) and (p=0.018). The retired patients had longer depression the Mind in the Eyes Test (RMET), the Hinting Task and the Faux Pas episodes as compared to the employed ((p=0.016) and the unemployed Test. (p=0.006) patients. RESULTS: Significant intergroup differences were not determined in DISCUSSION: BPD dos not represent a homogenous patient scoring on executive functions and attention tests except in the TMT-A population. The differences in the course of the disease necessitate and the Back Counting in the DST where the BPD patients performed treatment strategies specific to each patient. worse as compared to the controls. Comparing the BPD patients with Keywords: Bipolar disorder, Episode duration, sociodemographic and without psychotic symptoms, there were not significant intergroup factors defenses on the WAIS-R, and only the scores on TMT-A and B among the executive function and attention tests gave a significant difference References between these groups. Significant negative correlations were observed Altshuler LL, Kupka RW, Hellemann G et al. (2010) Gender and between the falling performance on the RMET and the increases in depressive symptoms in 711 patients with bipolar disorder evaluated disease onset age in BPD, the duration of BPD and the number of the prospectively in the Stanley Foundation bipolar treatment outcome manic/hypomanic attacks. Also significant correlations existed between network. Am J Psychiatry 167(6):708-15. Goodwin FK, Jamison KR (2007) Manic Depressive Illness. 2nd ed. the scoring on executive functions and values of the duration of BPD, POSTER PRESENTATIONS New York, Oxford University Press. number of manic/hypomanic attacks, total number of attacks and the age at BPD onset, and also between the scores on psychomotor speed and attention and the values of BPD duration and the age at BPD onset. PP-047 DSICUSSION: It is seen that in the BPD patients, deficits exist in attention and psychomotor speed and in the verbal memory functions. MEAN PLATELET VOLUME AND THE NEUTROPHIL/ Within the scope of the mind theory functions significant differences LYMPHOCYTE RATIO RESPONSE TO TREATMENT were not found between BPD patients, their first-degree relatives and OF DEPRESSION the controls. There is need for work with larger patient and control groups to produce evidence whether WAIS-R tests on intelligence are Ali Barlas Mırcık, Ahmet Öztürk, Erdem Deveci, Onur continually predictive and could specify endophenotype for BPD. Yılmaz, İsmet Kırpına Bezmialem Vakif University, Psychiatry Department, İstanbul Keywords: Bipolar disorder, executive functions, mind theory AIM: There are increasing reports on raised blood levels of inflammation References indicators parameters in patients with major depression disorder. Bora E, Yücel M, Pantelis C (2009) Cognitive endophenotypes of Neutrophil/lymphocyte ratio (NLR) and the man platelet volume bipolar disorder:A meta-analysis of neuropsychologial deficits in (MPV), easily estimated by routine laboratory techniques, are proposed euthymic patients and their first-degree relatives. J Affect Disord to be indicators of the inflammatory processes. It has been reported 113(1-2):1-20 that NLR and MPV are increased in bipolar disorder, schizophrenia and Kulkarni S, Jain S, Janardhan Reddy YC, Kumar KJ, Kandavel T (2010) major depressive disorder (MDD) and the elevation in MPV is reversed Impairment of verbal learningand memory and executive function by escitalopram treatment in MDD. In this study the blood levels of in unaffected sibling of probands with bipolar disorder. Bipolar NLR and MPV before and after therapy have been compared in the Disord 12(6):647-56 inpatients diagnosed with MDD.

92 METHODS: Hospital files of 48 inpatients diagnosed with MDD (TAS-20), the Beck Depression Inventory (BDI) and the Beck Anxiety on the criteria of DSM-IV and treated at Bezmialem Vakif University, Inventory (BAI). Medical School Psychiatry Services Department between 2014 and RESULT: There were not any significant demographic differences 2106 were retrospectively scanned. The patients did not have any other between the patient and the control groups. Mean age of the IGP group chronic disorder or acute infections. Patients’ scores on the Hamilton was 37.60 (±12.75) years and that of the control group was 35.33 Depression Rating Scale (HAM-A) and the Clinical Global Impressions (±10.75) years. Females made up 86.7% (n=26) of the IGP group and Scale (CGIS) together with the blood platelet count, MPV, lymphocyte 76.7% (23) of the control group. In the IGP group, total TAS-20 score and neutrophil counts and the erythrocyte sedimentation rate (ESR) and the scores on the subscales ‘difficulty identifying feelings’ (IDE) before admission to hospital and at discharge were compared. and ‘externally oriented thinking’ (EOT) were significantly higher RESULTS: When compared the clinical assessment scale scores were than those of the controls. In the IGP group, positive correlations were significantly lowered at discharge from hospital (p<0.001), and similar determined between the BDI score and the scores on total TAS-20 and reductions were observed in the MPV (p<0.05), NLR (p<0.05) values. its subscale ‘difficulty identifying feelings’ (IDE); and between BAI However, a significant rise in the lymphocyte counts were determined score and the scores on total TAS-20, and its subscales IDE, EOT and (p<0.05). There were not any significant differences in ESR, and the ‘difficulty communicating feelings’ (COM). Also in the IGP group level platelet and neutrophil counts of education and employment status were found correlated with the Alexithymia score. DISCUSSION: These findings may reflect a possible role of the inflammatory processes, indicated by the levels of MPV and NLR, DISCUSSION: In so far as we know, this study is the first to investigate in the complicated pathophysiology of MDD. Since elevated MPV alexithymia, anxiety and depression in IGP patients. We believe that increases the risk of cardiovascular diseases, it can be said that treatment even if IGP patients may not have psychological complaints, their of inflaming in MDD would decrees morbidity and mortality. Platelets condition with respect to alexithymia and its relation with the anxiety re known depots of serotonin which has a role in the etiology of and depression levels should be investigated. We also believe that further depression. Changes in MPV may have been affected by the changes studies are necessary on the subject. in the level of serotonin due to the therapy or other pathophysiological Keywords: Alexithymia, anxiety, depression, idiopathic generalized factors. There is a need for further investigations to clarify the relation pruritus of MPV and NLR to the etiology of depression. References Keywords: Depressive disorder, mean platelet volume, neutrophil/ Poot F, Sampogna F, Onnis L (2007) Basic knowledge in lymphocyte ratio psychodermatology. J Eur Acad Dermatol Venereol. Feb;21(2):227- References 34. Ataoglu, A, Canan F (2009) Mean platelet volume in patients with Sifneos PE (1973) The prevalence of ‘alexithymic’ characteristics in major depression: effect of escitalopram treatment. Journal of psychosomatic patients. Psychother Psychosom. 22(2):255-62. clinical psychopharmacology, 29;4:368-371. Canan F, et al., (2012) Association of mean platelet volume with DSM- IV major depression in a large community-based population: the PP-049 MELEN study. Journal of psychiatric research, 46;3:298-302. THE SOCIODEMOGRAPHIC AND CLINICAL DETAILS SPECIFIED IN THE REQUESTS OF PP-048 EMERGENCY SERVICE FOR PSYCHIATRY

CONSULTATION ON SUICIDAL ATTEMPT CASES POSTER PRESENTATIONS ALEXITHYMIA, ANXIETY AND DEPRESSION IN IN Fatih Baz, Erdoğdu Akça, Zeynep Senkal, Mehmet Kemal IDIOPATHIC GENERALIZED PRURITUS Kuşçu Medine Gıynas Ayhan1, Zübeyde Tekin Kurku2, Marmara University, Psychiatry Department 3 1 Fatih Kayhan , İbrahim Eren AIM: It was decided to investigate the sociodemographic and clinical 1 Konya Training and Research Hospital, Psychiatry Clinic, Konya details specified on the request forms for ‘suicide attempt’ cases received 2 Konya Beyhekim State Hospital, Dermatology Clinic at the psychiatry department from the emergency service of the Marmara 3Selçuk University Medical Scool, Psychiatry Clinic University Pendik Training and Research Hospital. AIM: Alexithymia, described as the difficulty of recognizing and METHODS: The psychiatry consultation requests received from expressing emotions and feelings, has been associated with various the emergency service between 01/01/2015 and 01/01/2016 were dermatological disorders. Idiopathic generalized pruritus (IGP) is a retrospectively scanned from hospital information system. Among the condition characterized by persistent itching of the skin without any 965 requests received for psychiatry consultation, 343 were for suicidal visible skin changes or inflammatory conditions. This study has aimed attempt cases and these were evaluated within the scope of the study. to determine the incidence of alexithymia in cases of IGP and the RESULTS relationship of alexithymia with anxiety and depression, and to compare : Of the suicidal attempt cases investigated, 35.3% were males and 64.7% were females; with 56.9% being married, 33.2% the results of IGP patients with those on healthy controls. single, 2.3% widowed and 7.6% divorced. The most frequently made METHODS: The study included 30 individuals diagnosed with diagnosis was major depression (52.8%) followed by psychotic disorder IGP when consecutively consulting the polyclinic, and ascertained to (3.4%) while 37.9% could not be ascribed to any psychiatric cause. The have no other mental or physical illnesses, and 30 healthy individuals most frequent mode of attempt was overdosing with drugs (64.4%), from the general population. Participants were asked to complete followed by piercing-cutting tools (9%) and jumping from heights a sociodemographic questionnaire, the Toronto Alexithymia Scale (5.8%). In the entire group, 71.6% of the females and 51.2% of the

93 males used the approach. The attempts were planned in partial response to the treatment, dose increase in accordance with the the case of 38.8% of the females and 19.4% of the males. Regard to literature, as against changing the agent, is preferred as use of different repeated attempts, 36.4% of the females and 32% of the males had a drugs may be risky. history of suicidal attempt, and suicidal ideation continued in 27.9% of the females and 47.1% of the males. There were not correlations Keywords: Angioedema, anxious, bipolar disorder, olanzapine between the attempts and the seasons and the months of the year. References However, males appeared to have attempted more frequently at late Citrome L, Kantrowitz JT (2009) Olanzapine dosing above the licensed hours of the day and on week days, while females had attempted in the range is more efficacious than lower doses: fact or fiction. Expert evening and at weekends. Rev Neurother 9(7):1045-58. DISCUSSION: Among the psychiatry consultation requests made from the emergency service, the most frequently given explanation is suicidal attempt (35.5%). In agreement with the literature, incidences PP-051 of suicidal attempts were more associated with the female gender and the choice was frequently overdosing with drugs. Evaluation of people who have made suicidal attempts or have suicidal ideation requires a NORMOPROLACTINEMIC GALACTORRHEA DUE careful approach. The clinicians must take a very detailed history in TO SULPIRIDE USE: CASE PRESENTATION order to prevent the repetition of the suicidal attempt. Nermin Gündüz Keywords: Consultation emergency, suicide Erzurum District Training and Research Hospital, Psychiatry Clinic- Consultant Dr AIM: Sulpiride is a benzamide group antipsychotic agent which acts by PP-050 selective blockage of the presynaptic D4 and postsynaptic D2 receptors. This mechanism of action can lead to hyperprolactinemia, which in turn HIGH DOSE OLANZAPINE USE IN BIPOLAR has serious outcomes as gynecomastia, amenorrhea, and galactorrhea. DISORDER ANXIETY EPISODE: A CASE WITH It has been aimed here to present a case of normoprolactinaemia with ANGIOEDEMA HISTORY galactorrhea. Feride Keskinler, Eren Yıldızhan, Nesrin Buket Tomruk, CASE: M.A. a 40-year old married female patient with primary Armağan Özdemir school education, had been on follow up since 2010 with complaints Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological of difficulty falling asleep, anhedonia, avolition, and attention Diseases and Research Hospital İstanbul problems that had started with marital problems. Her symptoms got further complicated with headaches, general joint aches, indigestion, AIM: In this report a case of angioedema history due to use of different gastrointestinal problems of vacillating diarrhea and constipation, and agents such as cefuroxime axetil, nitrofurantoin, lacidipin, and paroxetine her treatment in the intervening years included sertraline, trazodone, will be presented with the difficulties of treatment experienced. venlafaxine and quetiapine XR, when she also consulted the physical CASE: The 60-year old female patient with a history of psychotic therapy and rehabilitation and the gastroenterology services with normal depression 12 years previously, had been admitted as an inpatient to results to her general medical examination. Upon discontinuation of the internal diseases service for angioedema ascribed to cefuroxime sulpiride, galactorrhea regressed. axetil use. The angioedema regressed after pheniramine maleate and DISCUSSION . : Sulpiride at the dose of 50mg/day can be used to treat

POSTER PRESENTATIONS dexamethasone But at the same time, she was given alprazolam (1 mg/ day), and mirtazapine (15 mg/day) for insomnia. Later she was also psychosomatic disorders. Considering that the case discussed here was given quetiapine (100 mg/day) and sertraline (100mg/day) to treat her complicated with fibromyalgia syndrome and irritable bowel syndrome, fear of using medicines, fear of people, and continual negativity in her sulpiride was added to duloxetine. Since galactorrhea appeared after thought content. She consulted our services with increasing severity sulpiride and ceased dramatically with discontinuation of the drug, of insomnia, severe anxiety, psychomotor agitation, and erotomanic there is good reason in attributing the observed galactorrhea to sulpiride. delusions. She was diagnosed with bipolar disorder anxiety episode Hyperprolactinemia and its serious outcomes are side effects that are and admitted as an inpatient to psychiatry service. It was learned that seen more often with sulpiride and risperidone as compared to the other she had planned to join many teaching courses, marriage and dowry antipsychotic agents. There are reports of galactorrhea in presence of preparations. Sertraline was discontinued and she was started on normoprolactinaemia with antidepressant use, but we have not come quetiapine (up to 400mg/day) and diazepam. Propranolol was added across any report on a case of galactorrhea with normoprolactinaemia to the therapy on account of tachycardia and tremor and levothyroxine due to sulpiride. was added for hypothyroidism. Severe tachycardia and unchanged Keywords: clinical complaints lead to reduction of the quetiapine dose and switch Galactorrhea, normoprolactinemic galactorrhea, prolactin, to olanzapine (20mg/day) which she had benefited from in the past. sulpiride Valproic acid (500mg/day) was added for mood stabilization. Partial References improvement of symptoms was seen but the erotomanic delusions Mong-Liang L, Shen WW, Chun-Hsin C (2008) Time course of the persisted such that diazepam was discontinued and olanzapine dose was changes in antipsychotic-induced hyperprolactinemia following the increased to 30g/day. Clinical remission was achieved and the patient switch to aripiprazole. Progress in Neuro-Psychopharmacolo and was discharged. When admitted to the hospital her Young mania rating Biologic Psychiatry. 2(8):1978-81. scale score was 29, but at discharge it was lowered to 3. Pane MR, Howie PW, McNeilly AS, Cooper W, Marine M, Kidd DISCUSSION: Selecting therapeutic agents which a patient had L (1985) Sulpiride and the potentiation of progestogen only previously benefited from is an appropriate approach. In case of contraception. Br Med J (Clin Res Ed) 291:559-61.

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REVERSIBLE PARKINSONISM DUE TO LONG TERM APPROACHING DELIRIUM WITH CENTRAL USE OF VALPROIC ACID IN AN ELDERLY PATIENT NERVOUS SYSTEM TUBERCULOSIS ETIOLOGY: WITH MANIC ATTACK: CASE PRESENTATION CASE PRESENTATION Demet Sağlam Aykut, Ahmet Tiryaki, Gizem Aral İbrahim Öner, Ayten Öztürkmen, Güray Koç, Evren Yaşar Karadeniz Technical University Medical School, Psychiatry Department, Bilkent Physical Therapy and Rehabilitation Training and Research Trabzon Hospital, Consultation Liaison Psychiatry Divison, Ankara AIM: Valproic acid (VPA) has been used since 1966 as a mood AIM: Delirium is a mental disorder with organic causes, manifesting stabilizer. It has wide scale side effects on the central nervous system, the impairment of different cognitive functions. The underlying etiology most frequently met side effect being tremor. Although Parkinsonism is is very variable and knowledge on the treatment and prognosis is very a less frequently seen side effect, in recent publications VPA has been limited. This report has aimed to summarize the approach to a case of shown as one of the important causes of Parkinsonism. There are few delirium related to central nervous system (CNS) tuberculosis. references to reversible Parkinsonism due to VPA. Also, a dose-response CASE: The 80-year old male patient was on follow up by the Brain relationship between VPA and severity of Parkinsonism is not clear. Damage Rehabilitation Clinic with the diagnosis of CNS tuberculosis. In the case presented here, the reversible Parkinsonism observed was Psychiatric consultation was requested for sleep irregularities and thought to be due to long term use of VPA at a high dose and it was behavioral pathologies. As communication with the patient was aimed to draw attention to this reversible side effect. unsatisfactory, his history was taken from his bed side companion and the health care personnel attending him. His circadian rhythm CASE: The 72-year old, married, male patient had been followed up was impaired over the previous 2 weeks, his consciousness vacillated for 30 years with bipolar disorder had been using VPA (2500 mg/day) during the day, his time and person orientation was especially impaired, and lithium carbonate (900 mg/day) for 15 years. In the 10 years after and he showed aggressive behavioral pathology with verbal attack on starting VPA treatment, his speech, gait, movements in general and those attending him. He had hallucinatory behavior secondary to visual balance were impaired with increasing rate. In the 15 days before his hallucinations and the symptoms increased in the afternoons. He had consultation, he had difficulty getting out of bed, fell down frequently been on clonazepam oral solution (0.75 mg/day), and mirtazapine and had difficulty swallowing. However, further complaints were (15mg/day). Delirium was diagnosed and the therapy switched to added to these symptoms within the 10 days before his consultation haloperidol oral solution (1 mg/day), and the course was followed such that he talked more, had nervous tension, increased energy and on the delirium evaluation scale. When symptoms did not improve, decreased need for sleep. His examination showed excessive talking, haloperidol dose was increased to 2 mg/day. When the symptoms still unfocused, tangential and, circumstantial; his affect was anxious, mood did not regress at the end of 1 week, haloperidol was terminated and increased towards euphoria, thought contents had worries about loss of therapy switched to risperidone (1 mg/day – 2x oral solution) which functionality. He had lost his appetite, He was diagnosed with bipolar was preferred so as to prevent drug interaction since the patient was on disorder, manic episode, secondary Parkinsonism, and was admitted as anti-tuberculosis rifampicin and isoniazid. In the second week controls, an inpatient. VPA was gradually decreased and 4 days after termination behavioral pathology and the visual hallucinations had disappeared of VPA his posture improved, swallowing difficulty regressed and he while the sleep disorder, attention-concentration, orientation and could walk by himself without support. memory pathologiesNOT were regressing.PRESENTED The delirium symptoms of the patient have continued in the 4th month of his admission to hospital. DISCUSSION: Relationship between VPA treatment and Parkinsonism is very heterogeneous, and the cases in the literature have been reported DISCUSSION: In the literature, the first choice of treatment for on a wide spectrum of latency, symptom severity, and disease onset delirium, excepting delirium due to alcohol use, is haloperidol. When POSTER PRESENTATIONS time. In the case presented here, Parkinsonism was observed with long the treatment is unsuccessful, or if there are adverse side effects, there term treatment on high dose VPA, and the symptoms disappeared with is no consensus on the choice of the effective alternative agent. In discontinuation of VPA. the case discussed here, risperidone was selected in view of the other effective agents in use. Our results may be related to another underlying Keywords: Bipolar disorder, parkinsonism, Valproic acid pathology. References Keywords: CNS tuberculosis, delirium, risperidone Brugger F, Bhatia K, Besag FM (2016) Valproate-Associated Parkinsonism: A Critical Review of the Literature.CNS Drugs. References Jun;30(6):527-40. Khan Babar A, et al. (2012) Delirium in hospitalized patients: Zadikoff C, Munhoz R P, Asante A N, Politzer N (2007) Movement implications of current evidence on clinical practice and future disorders in patients taking anticonvulsants.J Neurol Neurosurg avenues for research—a systematic evidence review. Journal of Psychiatry. Feb; 78(2): 147–151. hospital medicine 7.7 580-589. Parellada E, Baeza I, de Pablo J, Martínez G. (2004). Risperidone in the treatment of patients with delirium. The Journal of clinical psychiatry, 65(3), 348-353.

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SCHIZOPHRENIA WITH STEWART-MOREL HSV AND EBV ENCEPHALITIS WITH MOOD SYNDROME: CASE PRESENTATION (AFFECTIVE) DISORDER: CASE PRESENTATION Şenol Bayram1, Şeyma Selen Sevinç1, Gamze Erzin2, İbrahim Öner, Ayten Öztürkmen, Güray Koç, Evren Yasar Sema Göka1, Makbule Çiğdem Aydemir1, Erol Göka1 Bilkent Physical Therapy and Rehabilitation Training and Research 1Ankara Numune Training and Research Hospital Psychiatry Clinic, Hospital, Consultation Liaison Psychiatry Divison, Ankara Ankara AIM: Herpes simplex virus encephalitis (HSVE) is the encephalitis 2DışkapıYıldırım Beyazıt Training and Research Hospital Psychiatry with the highest risk of mortality, and, unless treated, progresses on a Clinic, Ankara course involving 70% incidence of mortality. In this report, a case of AIM: Hyperostosis Frontalis Interna (HFI) is a condition of excessive mood (affective) disorder presenting after HSVE and Epstein-Barr virus bone development on the endocranial surface of the frontal region encephalitis (EBVE) comorbidity, with cognitive pathologies in the that had been recognized in the 18th century. There are reports in the foreground, is to be discussed. literature linking HFI to the neuropsychiatric Stewart-Morel syndrome CASE: The 49-year old married male patient had a history of being and obesity. Here we have aimed to present a rare case of schizophrenia followed at the Brain Damage Rehabilitation Service. After the with Stewart-Morel syndrome. requested consultative report, he was reported to have clinically limitless CASE: The 39-year old female patient developed symptoms of behaviors. As stated by his family and on the reports in hand, he had introversion, preoccupation with religious practices and auditory been admitted to communicable/infectious diseases unit with suspicion hallucinations 14 years previously to her admission to our psychiatry of encephalitis based on complaints of fever, head ache and talking nonsense. His cranial MRI had indicated hyperintensity at T2A-Flair ward with psychotic symptoms persisting over a month despite sections on the left temporal lobe anteromedial areas; frontal lobe treatment with appropriate drug dosage over an appropriate period. posterobasal divisions – (more distinctly on the left) and the insular She had previously given partial response to typical and atypical regions on the cingulate gyri- anterior areas (more distinctly on the antipsychotic agents, except olanzapine, and had received ECT. right). EEG had revealed frontotemporal slow (theta-delta) waves; and With her treatment resistance in mind, it was decided to start her on lumbar puncture CSF sample was positive for HSV and EBV with PCR clozapine. Her blood test results and EEG were within normal limits techniques. Treatment had been started with ceftriaxone, acyclovir and but her cranial MRI report stated that cerebellar hemispheric lateral vancomycin. Antiviral therapy had been stopped on the 43rd day. During sulci and the hemispheric cortical sulci at bilateral frontal region are the 2 weeks prior to his psychiatry consultation, risperidone (1 mg/ markedly distinct with secondary eutrophication, with disorganized day) had been added to his therapy to meet the complaints of amnesia, tabular space at the bilateral frontal cortex. The cortical sulci at the increased self-esteem, excessive talking. In his psychiatric examination, hemispheric vertex are also markedly district (hyperostosis-frontalis- he had euphoric mood, increased speed and volume of speech, increased interna). Physical examination showed short philtrum, high forehead, self-esteem, NOTtargeted behavior, PRESENTED and noteworthy memory problems. His hirsutism and abdominal obesity. Combining the results of the patient’s score on the Young mania rating scale (YMRS) was 24. Addenbrooke’s cranial MRI and physical examination results with psychosis suggested cognitive examination (ACE-R) was used to assess his cognitive the diagnosis of Stewart – Morel syndrome. Under therapy her pathology. The results showed impairment of encoding memory, short referential delusions regressed, auditory hallucinations disappeared and term memory and retrieval capabilities (9/26). Treatment was switched her insight was partially restored. She was discharged under clozapine from risperidone to valproic acid (1000 mg/day). At the end of the first (600 mg/day) maintenance therapy. She attended her controls regularly month control at the polyclinic, although his memory functions were and remained in remission. still impaired, his mood symptoms had regressed with YMRS score at POSTER PRESENTATIONS 16. He is currently in the third month of follow up under treatment. DISCUSSION: We have prepared this case presentation to emphasize and draw attention to the importance of cranial MRI in psychotic DISCUSSION: In HSVE, the typical localization is the temporal lobe. disorders and the rarely seen neuropsychiatric syndromes. In the case reported here the observed difference was the comorbidity with bilateral localization. Apart from pathology related to memory Keywords: Neuropsychiatric syndromes, schizophrenia, Stewart -Morel functions, mood disorder had occurred. Syndrome Keywords: EBV, HSV, mood disorder, viral encephalitis References Hershkovitz I, Greenwald C, Rothschild BM, et al (1999) Hyperostosis frontalis interna: an anthropological perspective. Am J Phys Anthropol. 109: 303–325. Rowlands IP, Das BC (1967) Stewart-Morel syndrome. British Medical Journal. 3(5564):559-560.

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DEVELOPMENT OF AND THREE-YEAR FOLLOW UP IN AUTISM SPECTRUM: HOMICIDAL–SUICIDAL IDEATION AFTER FACTORS PREDICTING THE PROGNOSIS NALMEFENE ADDITION TO LONG ACTING Koray Karabekiroğlu, Berkan Şahin, Muazzez Aydın, METHYLPHENIDATE THERAPY FOR ALCOHOL Mahmut Müjdeci, Barış Usta, Abdullah Bozkurt, Tolga USE DISORDER COMORBID WITH ATTENTION Karaosman, Armağan Aral, Cansu Çobanoğlu, Ayşegül DEFICIT HYPERACTIVITY DISORDER: CASE Kurt, Neriman Kesim, Emre Ürer, İrem Şahin PRESENTATION Ondokuz Mayıs University Arda Karagöl, Güler Özkula, Vahap Ozan Kotan, Nurhak AIM: Young children (n:433) diagnosed with autism spectrum disorder Çağatay Birer, Selvi Ceran Kayıpmaz, Özgün Karaer (ASD) were followed up for 3 years and the data were evaluated to Karapıçak, Burcu Akın Sarı, Hande Ayraler Taner discriminate the factors affecting the prognosis of the disease. Baskent University Medical School, Ankara METHODS: Young children with a mean age of 72.3 (±45.9; 16-212) AIM: In treatment planning it is always necessary to consider the risks months; consisting of 89 girls and 344 boys; and in the diagnostic of increased side effects and to decide correctly on which disorder to classification of autism (AT) (n=183), atypical general developmental give priority in the treatment of multiple psychiatric disorder cases. This autism (AGDA) + those with not otherwise described AGDA (n=210) report discusses the case of a patient with diagnoses of attention deficit and Asperger’s syndrome (AS) (n=40) have been included in this study. hyperactivity disorder (ADHD) comorbid with alcohol use disorder, Prognostically, improvement to the stage of not being diagnosed in who developed panic attack and homicidal and suicidal ideation the AGDA and the AS groups (indicated by a score <3 on the Clinical after the addition of nalmefene to the treatment with long acting Global Impressions Scale) and achieving the AGDA status or better in methylphenidate. the AT group were considered as remission or the cured state. CASE: The 38-year old married male patient, with a history of RESULTS: Those considered ‘cured’ were 39% of 265 cases followed consuming 5 bottles of beer per day over the previous 5 years, had been up for 4-12 months; 60.7% of 219 followed up for 12-24 months; and, using long acting methylphenidate (54 mg/day) over the previous 2 77.8% of 185 followed up for 24-39 months. Differences on gender years. He was given, in addition, nalmefene treatment after consulting basis were not discerned in follow up periods longer than 2 years, but the polyclinics for alcohol use problem. He developed the side effects of the AT group showed significantly lower incidence of improvement as panic attack and homicidal and suicidal ideation. compared to the other groups: in 24to39-month follow up, the ‘cured’ incidences were 58.8% in AT, 88.5% in AGDA and 92.3% in AS. The DISCUSSION: In vitro research has shown that nalmefene is an incidences of improvement among those with obsessive-compulsive opioid receptor ligand with antagonistic action on the μ and δ-opioid disorder (OCD) or bipolar disorder (BD) comorbidities, were receptors and partial agonistic action on the κ receptors. The inhibitory significantly lower than those without comorbidities: in 24to39-month control by the medial prefrontal cortex on the anxiogenic output of the follow up, the ‘cured’ incidences were: 68,4% in with vs 82% without amygdala is modulated by dopamine which, therefore, has an important OCD (p:0.03); and 23.1% with vs 82% without BD (p<0.001). Within role to play in anxiety. And dopaminergic deficit can be involved in the first year of follow up, improvement rate was higher in the 3-6 year- the development of anxiety. The described mechanism of action by age group (49%), with the rates being 41% in <3-year age; 27.1% in nalmefene may cause decreased levels of dopamine resulting in anxiety. 6-12-year age and 29.6% in >12-year age groups (p:0.02). However, Methylphenidate may raise the blood level of nalmefene through an this age dependent improvement rate disappeared in 1-2 and >2-year undescribed mechanism and contribute to the observed psychotic follow ups. The factors best predicting improvement were determined attack. The observed panic attack was not attributed to alcohol craving by regression analyses. The predictors of bad prognosis in the 4-12- POSTER PRESENTATIONS since the patient had not experienced any problems in the past when month follow up were: ‘low level of maternal education’; being younger giving up alcohol voluntarily for periods of 1 week to one month (as than 3 and older than 6 years of age; being diagnosed with AT (the for example, for the Muslim religious practice of fasting in the month worst) and having OCD comorbidity. of Ramadhan). The homicidal and suicidal ideation may have resulted from an interaction of methylphenidate and nalmefene. There are not DISCUSSION: In the combined evaluation of the total data, any references in the literature to these side effects of this combination improvement for autism depended on starting education at an early of drugs. From this stance, this case is the first reported with these age and maintaining it with regularity; and giving stronger support in side effects. ADHD shows a high incidence of comorbidity with other the case of children with parents of low education, with OCD or BD psychiatric disorders. Hence, if the comorbidity, and with clinically severe level of ASD. Patient does not go to remission after treatment of the comorbid Keywords: Autism, general developmental autism, prognosis psychiatric disorders, ADHD should be taken into serious clinical investigation. Keywords: Methylphenidate, drug interaction, nalmefene drug interaction, nalmefene psychiatric side effect

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FACTORS AFFECTING DEPRESSION AND ANXIETY LEVEL AND PREVALENCE OF ALEXITHYMIA A IN THE CAREGIVERS OF BED-CONFINED POPULATION OF PHYSICIANS IN ANKARA, AND TERMINAL STAGE CANCER PATIENTS: EFFECTS OF THE AFFECTING FACTORS COGNITIVE FLEXIBILITY Arda Karagöl, Güler Özkula, Nurhak Çağatay Birer, Aytül Karabekiroğlu1, Esra Yancar Demir2, Servet Aker3, Selvi Ceran Kayıpmaz, Vahap Ozan Kotan, Özgün Karaer Birsen Kocamanoğlu4, Gamze Sırmalı Karabulut4 Karapıçak, Hande Ayraler Taner, Burcu Akın Sarı 1Ondokuz Mayıs University, Psychiatry Department, Samsun Baskent University Medical School, Ankara 2Ordu University Training and Research Hospital Psychiatry Department, AIM: Alexithymia is a type of thinking focused on external stimuli Ordu rather than the internal emotional experiences, and is characterized by 3Samsun Canik Public Health Center, Samsun externally oriented thinking (EOT). It is related to various psychiatric 4Samsun Training and Research Hospital Psychiatry Clinic, Samsun disorders and depression. Although its importance is seldom emphasized AIM: Cancer is regarded as a chronic disease necessitating long term clinically, it is a factor directly affecting mental health. Physicianship caregiving to the patient. Some studies on the subject have reported that is among the professions with high risk for psychiatric disorders. there is a higher prevalence of psychological problems and reduction Alexithymia and EOT can contribute to these mental disorders. The in quality of life among caregivers as compared to cancer patients. aim of this study is to determine the level and prevalence of alexithymia Caregivers have a higher level of depression and anxiety as compared among physicians in Ankara, and to investigate the factors influencing to the general population. There is need for studies to determine the these. causative factors behind the depression and anxiety symptoms in primary caregivers. Cognitive flexibility (CF) has regulatory significance METHODS: Participants of the study consisted of 83 physicians in the adaptation of humans to new living conditions; and, lower level working in 5 different hospitals in Ankara. All were asked to complete of CF may underlie the severity of the depression and anxiety in primary a sociodemographic questionnaire and the Toronto alexithymia scale caregivers of terminal cancer patients. It has been aimed in our study (TAS-20). to evaluate the factors affecting the depression and anxiety levels of RESULTS: Participants’ mean total score on TAS-20 was 44.1 (± 6.3), primary caregivers of terminally ill cancer patients. and 13.25% were alexithymic on this basis. The participants with METHODS: The study included terminally ill cancer patients of 18 psychiatric disorder diagnosed in a family member had significantly years of age and over, being followed at hospital with stage 4 cancer greater difficulty in expressing feelings. EOT, female gender, advancing diagnosis on an inpatients basis. The primary caregivers of the patients age, increased years in the profession, being married, having been born were evaluated with a structured sociodemographic questionnaire, and in the Western half of Turkey and having lived in the Western half of were asked to complete the Beck depression inventory (BDI), the Beck Turkey for a long period of time were factors positively correlated with anxiety inventory (BAI), the Zarit Caregiver Burden Interview (ZBI) alexithymia. and the Cognitive Flexibility Scale (CFS). DISCUSSION: EOT may be associated with depression, cultural norms RESULTS: Mean BDI and BAI total scores of the participants were, and labelling. In order to maintain their mental health, physicians must respectively, 17,95 (±1,53) and 18,42 (±1,88’). BAI scores of those caring be aware of their EOT in therapeutic environments and psychiatric for female and for male patients were, respectively, 13,54 (±2,20) and interviews and be able to discuss these. 21,02 (±2,57). BAI scores of those caregivers with additional health problems as compared to those without health problems were, respectively, Keywords: Affective symptoms, alexithymia, behavioral symptoms,

POSTER PRESENTATIONS 23,62 (±3,20) vs 15,29 (±2,21). BAI scores of those caregivers sharing the psychotherapy same home with the patient as compared to those who did not, were, References respectively 20,45 (±2,38) vs 12,66 (±2,07). The estimated differences Douglas A. Mata, Marco A. Ramos, MPhil, Narinder Bansal, Rida were statistically significant with respect to the gender of the patient Khan, Constance Guille, Emanuele Di Angelantonio, Srijan Sen. (t=2,20, p=0,03), with respect to health problems (t=2,26, p=0,03); (2015) Prevalence of Depression and Depressive Symptoms Among and on sharing the home (t=2,46, p=0,01). Effects of the independent Resident Physicians: A Systematic Review and Meta-analysis. variables on the BDI and BAI scores were determined by multivariate JAMA 314(22):2373-2383. regression analysis. The level of cognitive flexibility on the CFS, the level Goldman ML, Shah RN, Bernstein CA. (2015) Depression and Suicide of burden in the ZBI and the lack of support for the caregiver explained Among Physician Trainees Recommendations for a National 41% of the variance in depression and anxiety in caregivers. Response. JAMA Psychiatry.72(5):411-412 DISCUSSION: The results indicate the necessity of evaluating the cognitive capacity of coping in the caregivers of cancer patients, as well as the importance of increasing the support given to these caregivers. PP-060 Keywords: Cancer, caregiver, cognitive flexibility References HOT WATER EPILEPSY WITH DISSOCIATIVE McCorkle R, Siefert ML, Dowd MF et al (2007) Effects of advanced SYMPTOMS: CASE PRESENTATION practice nursing on patient and spouse depressive symptoms, sexual Hatice Kaya, Mert Sudabatmaz, Erhan Ertekin function, and marital interaction after radical prostatectomy. Urol İstanbul Medical School Nurs 27:65–77. Hodges LJ, Humphris GM, MacFarlane G:(2005) A meta-analytic AIM: Psychiatric and neurological disorders can at times appear with investigation of the relationship between the psychological distress similar symptoms at the clinic. Comorbidity of many neurological of cancer patients and their carers. Soc Sci Med 60:1–12 disorders with psychiatric disorders complicate the process of diagnosis.

98 In cases with an atypical course and not easily placed in any category of of abuse and dependence. In this report two cases of oxybutynin abuse classification, differential diagnosis for neurological disorders should be are presented. kept in mind. This report presents such a case. CASES: The cases are 22 and 19-year old males, both doing term in CASE: The 21-year old male university student consulted our clinic with prison, referred to psychiatry services for assessment of substance use the complaints of going through a roughly 10-minute phase of amnesia from the urology unit where they were being followed up for nocturnal after a hot bath when he failed to recognize where he was and experienced . The cases had a history of substance use but no comorbidity of a ‘mixed up mind’. He did not describe fainting, losing consciousness or other diseases, and were using oxybutynin as an easily accessible agent myoclonus. He had been referred to psychiatry services after assessment since they had difficulty getting other substances of preference while in of his health by MRI, EEG, routine biochemical and hematological tests prison. Having started with 1 tablet per day, they had gradually increased which were found to be within normal limits. His complaint had started the numbers to sustain the euphoric mood. After discontinuation of at the age of 10, and happened once a month with increasing incidence oxybutynin use, withdrawal symptoms of insomnia, nervous tension, at stressful times. He had lost his mother after lung cancer at the age of and difficulties of orientation were experienced which regressed in 8; and his father helped him bathe when the patient remembered him about 3 weeks. singing sad prayers. He did not have previous psychiatric consultations. DISCUSSION: The cases presented here were in prison and using He was conscious, cooperative with complete orientation, limited eye oxybutynin, instead of the usual cannabis and heroin, on account of easy contact. His mood was euthymic, affect restricted, and he did not access and cheapness, similarly to the cases reported in the literature; describe delusions or hallucinations; did not have homicidal or suicidal thoughts. He did not describe depersonalization or derealization. On and had displayed the same tolerance and withdrawal symptoms as seen the Rorschach test, characteristics of need for support, psychological after the use of harder substances. Availability on white prescription, inhibition, defensive attitude, affective traumatizing and depressiveness and cheapness facilitates its openness to abuse. were determined. Upon the advice of Dr. Mert Sudabatmaz at internal Keywords: , dependence, oxybutynin, substance diseases unit, diagnosis for dissociative disorder was abandoned and hot water epilepsy was taken in hand. His EEG was repeated at the neurology unit. He was started on carbamazepine (400 mg/day) with the preliminary diagnosis of hot water epilepsy. He was informed on his PP-062 condition and was advised to avoid direct contact with hot water. RETROSPECTIVE INVESTIGATION OF THE DISCUSSION: Hot water epilepsy (HWE) is a type of reflex epilepsy REPORTS ON LEGAL CASES REFERRED TO triggered by the direct contact of the head with water at 40-50°C. PAMUKKALE UNIVERSITY PSYCHIATRY HOSPITAL Seizures generally start at childhood. HWE incidence in the general population varies in the range of 255-883/100.000 and it constitutes Osman Zülkif Topak1, Sahabettin Çetin1, Osman İsmail 6.9% of the total epilepsy types. After the photosensitive epilepsy it is Özdel1, Ramazan Reha Erken2 the most frequently observed reflex epilepsy. Interictal EEG is frequently 1Pamukkale University, Psychiatry Department, Denizli normal. 2Pamukkale University Public Health Department, Denizli Keywords: Dissociative disorder, hot water epilepsy, neuropsychiatry AIM: This study has aimed at investigating the reports on the legal References cases issued at Pamukkale University, Psychiatry Hospital in order to Bebek N, Gürses C, Gokyigit A, et al. (2001) Hot water epilepsy: clinical determine the relationships between the data on the legal context with and electrophysiologic findings based on 21 cases. Epilepsia.42: the data on psychiatric problems and sociodemographic details. 1180–1184. METHODS: The legal psychiatry reports issued on the case of Zeki G, Ilker IH, Hidir UU, Zeki O (2010) Hot water epilepsy: seizure 363 individuals between May 2015 and May 2016 by Pamukkale POSTER PRESENTATIONS type, water temperature, EEG findings and treatment. Neurologist University Psychiatry Hospital were investigated retrospectively. The 16:109–12 reports were classified in relevance to the penal law and the civil law, and the sociodemographic details of the individuals, their requests, diagnoses, presence of mental retardation, past psychiatry consultations, PP-061 and alcohol and substance use, and the decision on the reports were statistically evaluated. OXYBUTYNIN ABUSE: PRESENTATION OF TWO RESULTS: Of the 363 cases evaluated, 65.8% (n=239) concerned CASES males and 34.2% (n=124) concerned females, the mean age of all applicants was 42,27(±17,8); and 54% (n=198) cases came under the Ali Ercan Altınöz, Harun Olcay Sonkurt penal code and 45.5% (n=165) came under the civil law. Psychosis was Eskişehir Osmangazi University Mental Health and Disorders the most frequently given psychiatric diagnosis on reports under penal Department, Eskişehir code (22,2%) and under the civil law (22,4%). In 17.9% (n=65) of the AIM: Anticholinergic agents, being used for nearly 60 years for the reports the applicant did not have any psychopathology. Psychometric treatment of Parkinson’s disease, spasmodic diseases and the side effects test was requested for 53.4% (n=194) of the cases and the most used of antipsychotic agents, are liable to abuse on account of their euphoric was WAIS-R (12%; n=78) and 71.9% (n=261) of the applicants had side effects. Reports in the literature on anticholinergic agent abuse is previous psychiatry consultations. A history of previous criminal acts mainly about biperiden with very limited reporting on the others which was determined in 49.5% (n=98) of reports under the penal code, have the same potential to induce euphoric mood. Despite the use of although 21.2% (n=43) applicants had concealed this initially. On the anticholinergic agent oxybutynin for the treatment of excessively 47.9% (n=174) of all the reports, applicant’s level of education was not active urinary bladder since the 1970s, there are only 5 case reports in given; and where the detail was available, 90.4% of indicated education the literature on its abuse. Easy access to these agents increases the risks was at senior high school level or below. The most frequently given

99 reasons for report request was criminal responsibility (47.1%; n=171), olanzapine. Olanzapine may have acted by alpha1 receptor blockage, and on appointment of guardian (38.3%; n=139). or muscarinic type 1, histaminergic type 1 and serotoninergic type 2 receptor activation and -3phosphate and diacylglycerol increase DISCUSSION: This study has indicated in accordance with other may have given rise to vasodilatation and hence, edema. This case is similar studies that the most frequently expressed diagnosis in legal important for drawing the attention of physicians to the possibility of psychiatry reports is psychosis, that the incidence of repeated crime in peripheral edema development with olanzapine use. reports under the penal code was high, and that the level of applicant education was low. However, the incidence of crime in the absence of Keywords: Peripheral edema, olanzapine, side effect any active psychiatric diagnosis was also high. Given that when expertise is requested, previous requests have to be taken into account, and as requests for legal psychiatry reports are increasing, it can be seen that the PP-064 cases have to be studied comprehensibly and that legal psychiatry units as distinct from clinical psychiatry units have to be established. PARKINSONISM DUE TO ARIPIPRAZOLE USE: CASE Keywords: Legal psychiatry, penal code, report organization PRESENTATION References Meltem Pusuroğlu, Gözde Salihoğlu, Bülent Bahçeci, Kalenderoğlu A, Yumru M, Selek S, Savaş HA (2007) Gaziantep Çiçek Hocaoğlu Üniversitesi Tıp Fakültesi Adli Psikiyatri birimine gönderilen Recep Tayyip Erdogan University, Psychiatry Department, Rize olguların incelenmesi(Investigation of the cases referred to the Gaziantep University Medical School, Legal PsychiatryUnit) Adli AIM: It has been aimed in this case presentation to draw the attention Psikiyatr. Nöropsikiyatri Arşivi, 44: 86-90. of physicians to the subject by discussing the diagnostic and treatment Niyazi Uygur (2014) Adli Psikiyatri Uygulama Kılavuzu.(Guidebook principles in the current literature in these types of patients. of Practicing Leal Psychiatry)Türk Psikiyatri Derneği Yayınları CASE: The 38-year old female patient had been on aripiprazole for 3 Çalışma Birimleri Dizisi 18 Güncellenmiş 2. Basım, s. 38-70. months after diagnosis of psychotic disorder. In the two weeks prior to consultation she developed tremor and rigidity that prevented moving about on her own. She consulted our psychiatry polyclinics with PP-063 complaints of EPS symptoms. With the termination of aripiprazole therapy her symptoms regressed. BILATERAL LOWER EXTREMITY EDEMA RELATED DISCUSSION: Aripiprazole, is an antipsychotic agent with partial TO OLANZAPINE USE: CASE PRESENTATION agonistic action on D2 and 5-HT1A receptors, and antagonistic action Celaleddin Turgut on 5-HT2A receptors. On grounds of its differing pharmacological Kahramanmaraş Dr. Sureyya Adanali Goksun State Hospital, Psychiatry effects, it is considered to have reliably less side effects than other Clinic antipsychotic agents. Unlike aripiprazole, atypical antipsychotic agents such as olanzapine, clozapine and risperidone have side effects such INTRODUCTION: Olanzapine is a frequently preferred atypical as weight gain, prolactinemia and other metabolic outcomes which antipsychotic agent for treatment of psychiatric disorders. The restrict their use. Another serious side effect of antipsychotic agents is well-known side effects are weight gain, sleepiness, dizziness, dry extrapyramidal system (EPS) symptoms, which have been shown by mouth and constipation. Peripheral edema is a rarely met side effect studies to be among the factors adversely affecting treatment compliance. that upset treatment compliance. Bilateral pedal edema is usually In studies carried out with aripiprazole, EPS symptoms, especially during associated with congestive heart failure, nephrotic syndrome, Graves’ the first weeks of therapy, are reported to be very close to that seen with POSTER PRESENTATIONS disease, hyponatremia, hepatic cirrhosis, and lymphedema and drug placebo. Also, it has been reported that when treatment is switched to interactions. I this report we have aimed at presenting a case of bilateral aripiprazole after EPS symptoms caused by other antipsychotic agents, pedal edema after olanzapine addition to pharmacotherapy and its it is effective in correcting EPS symptoms, including tardive dyskinesia. regression by change of the drug. On the other hand, there are studies and case reports in the recent years on incidences of EPS symptoms after aripiprazole use. EPS symptoms CASE: The 45-year old female patient had been on paroxetine (40mg/ present in different forms and interfere with the management of daily day) during the previous 3 months for general anxiety disorder. The living by patients, and disrupt the treatment compliance and hence patient had nausea when paroxetine dose was titrated to 60 mg/day. the antipsychotic effectiveness. Parkinsonism, an acute EPS symptom In her previous psychiatric consultation, she had not benefited from resulting from drug therapy, usually surfaces within the first month mirtazapine, mianserin, trazadone and quetiapine. For her recent of therapy. Factors including advanced age, female gender, and mood complaints of loss of appetite, uneasiness and difficulty falling asleep, disorder diagnosis, having a history of parkinsonian symptoms, or a olanzapine (2.5mg/day) was added to her treatment and titrated to brain pathology and having been on antipsychotics for a long period 5mg/day. But, 15 days after rearrangement of the therapy, edema in facilitate the development of Parkinsonism. the legs and feet was observed without hyperemia, other color change or ulceration. She was evaluated by the nephrology, dermatology, and Keywords: Aripiprazole, atypical antipsychotic agent, Parkinsonism cardiovascular surgery units. Radiological and laboratory investigations References did not detect any pathology. As development of edema could not Akpınar ÇK, Aygün D, Doğru H, Bolat N (2015) Aripiprazol’a be associated with any systemic pathology olanzapine was switched Bağlı Parkinsonizm: İki Olgu Sunumu ( Parkinsonism Due to to risperidone (1 mg/day); and 15 days later her edema disappeared Aripiprazole: Presentation of Two Cases). Meandros Medical completely. Journal 16:124-7. DISCUSSION: As there was not edema before olanzapine use and İnanı İ, Çalışan AM, Kürkçü A, Eren İ (2015) Aripiprazole bağlı observed after addition of olanzapine to the therapy, and was lost ağır parkinsonizm: Olgu sunumu. (Severe parkinsonism due to after the discontinuation of olanzapine the edema was attributed to aripiprazole: case presentation) Yeni Symposium 53 (2): 50-52.

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EATING DISORDERS AND FAMILY RELATIONSHIPS: DIFFERENTIAL DIAGNOSIS OF FRONTOTEMPORAL CASE PRESENTATION DEMENTIA AND PSYCHOTIC DEPRESSION: CASE PRESENTATION Burcu Başusta1, Çiçek Hocaoğlu2 1Fatih Sultan Mehmet Vakıf University, Literary Studies Department, Emine Yağmur Atay1, Fatma Kaya2, Nazmiye Güçlü1, Psychology Division, İstanbul Rahşan Karacı2, Gülay Kenangil2 2 Recep Tayyip Erdogan University, Medical School, Psychiatry 1Erenköy Mental and Neurological Diseases Hospital, Mental Health Department, Rize. Department, İstanbul 2 AIM: Eating disorders (ED) are characterized by the impairment Erenköy Mental and Neurological Diseases Hospital,Neurology of eating behavior due to biological, psychological, familial and Department,İstanbul sociocultural factors. In western populations prevalence of ED is 1% AIM: Depression and dementia are frequently observed psychiatric for anorexia nervosa (AN), 2-4% for bulimia and about 3-4% for binge syndromes. In differential diagnosis of , which eating disorder. Reasons for the increases in ED have been proposed to causes distinct impairments of personality and behavior, one of the include cultural change, increased westernization and industrialization, psychiatric disorders that have to be evaluated is psychotic depression. weakening of family relationships and reduction of social support. ED Cognitive functions are lost in both conditions, making differential prevalence is increasing in developing countries including our country diagnosis difficult. Cognitive functions losses due to depression are and draws academic interest. AN is the ED that has been recognized for reversible, but not in dementia which is a progressive disorder. a very long time and can be described as the refusal to eat in order to lose weight despite the threat against one’s physical integrity, and mostly CASE: B.S, a 54-year old married, female, primary school graduate affects young women. The difficulties experienced in the diagnosis and patient living with her family. Her complaints of discontent, treatment of AN should orient clinicians to understand this disorder introversion, loss of interest that presented after her father’s demise 3 better. Many factors of the psychodynamic, biological social and familial years back, were treated with venlafaxine (225 mg/day) and aripiprazole nature are known to have a role in the development of AN. Not only (10 mg/day) after the preliminary diagnosis of major depression. Her by its presentation but also through it treatment process AN affects the complaints did not improve and others such as increased appetite, family as well as the patient. A case of AN is discussed here with her amnesia and suspiciousness appeared. demographic and clinical history in reference to the dynamic theories It was learned that the patient had abandoned her antidepressant of psychiatry. treatment. Her family history had Alzheimer’s disease diagnosis in her CASE: The 21-year old female university student developed anxiety father. During her psychiatric examination, she was conscious, with about gaining weight for the five years following her parents’ divorce. reduced self-care, without time orientation, unwilling to cooperate. She insisted on losing weight believing to be overweight, and kept Her mood was depressive, affect was apathetic, speech spontaneity exercising. In the 2 years prior to her psychiatric consultation she had was diminished, reaction time was increased. There were perspective attacks of binge eating and forcing herself to vomit afterwards. She has delusions in thought contents. Her impulse control had decreased, been under follow up for AN and binge eating/vomiting type with a judgementNOT was inadequate PRESENTED and she did not have insight. At the first body mass index of 16. evaluations after admission as an inpatient to psychiatry services, her neurocognitive test battery scores were 7 on the Beck depression DISCUSSION: The case of AN, which is one of the most serious inventory, 9/30 on the Mini Mental Test, 7 on the Frontal Assessment mental disorders with high risk of mortality, has been presented in order Battery (FAB) test and 4/31 on the Benton Facial Recognition Test. to draw the attention of clinicians to this eating disorder. The results were evaluated as primary dementia. Cranial MRI showed POSTER PRESENTATIONS Keywords: Anorexia nervosa, eating disorders, family relationships distinct cortical atrophy on the left hemisphere. Sertraline (50mg/day) was started for treatment. References DISCUSSION Oyekçin DG, Sahin ME (2011) Yeme bozukluklarına yaklaşım. : It has been reported in the literature that dementia Approach to eating disorders) Türk Aile Hek Derg 15(1):29-35. and depression can be comorbid. The common characteristic of both Ünlü G, Aras Ş, Güvenir T, Büyükgebiz B, Bekem Ö (2006) Yeme is the loss of cognitive functions. Impairment of planning, organization reddi olan çocukların annelerinde kişilik bozuklukları, depresyon ve and executive functions and symptoms of apathy have been related to anksiyete belirtileri ve aile işlevleri. (Personality disorders, depression frontal type of frontotemporal dementia. Given the age of onset and a and anxiety symptoms and family functions of the mothers of family history of dementia combined with the observation of distinct behavioral changes with cognitive losses were seen to meet the criteria children refusing to eat) Türk Psikiyatri Dergisi 17(1): 23-25. of diagnosis for frontotemporal dementia, also supported with the neurological imaging. Keywords: Dementia, depression, frontotemporal dementia, neuropsychiatry References Erden-Aki O (2010) Yaşlı bireylerde demans ve depresyonun ayırıcı tanısı.(Dementia in the elderly individual and its diagnosis) Turkish journal of geriatrics. Supp.3:37-42 Uysal Tan F, Akbostancı CM (2001) Demanslarda klinik ayırıcı tanı. (Clinical differential diagnosis of ) Demans dergisi. 1:15- 25

101 PP-067 functional. The aim of this study has been to establish the validity and the reliability of the Turkish version of the NSSS-S. EVALUATING ANXIETY IN METHODS: The study was carried out with 100 volunteers (50 Nazile Arpacı1, Elif Subaşı1, Melek Taşsöker2, Sevgi Özcan2, females and 50 males) between the ages of 17 and 40 years and with Mehmet Ak1 different sexual orientations, selected with the snow ball system. The 1Necmettin Erbakan University Meram Medical School, Psychiatry participants were asked to complete a sociodemographic questionnaire Department, Konya and the Golombok- Rust Inventory of Sexual Satisfaction (GRISS). For 2Necmettin Erbakan University School of Dental Medicine, Oral and the purposes of assessing the ‘test-retest’ reliability of the NSSS-S, the Maxillofacial Radiology Department, Konya participants were asked to complete it twice, 3 week apart. RESULTS AIM: Bruxism is tooth grinding accompanied by clenching of the jaw, : To determine the criteria validity the GRISS has been used and is observed mainly in stage 2 and REM sleep. It has been classified and the correlation coefficient has been determined to be =0.660. The in the subgroup of in the DSM-V. It is observed with a 5% internal consistency Cronbach alpha coefficient was 0.912. The item incidence in children and 10% incidence in adults. It can cause serious analysis yielded the item-total correlation coefficient range as 0.422- damage on teeth. The etiology includes local and systemic factors and 0.744. The test-retest positive correlation results range was 0.53-0.82 psychiatric disorders and use of psychiatric medication. The aims of (p<0.05). Structural validity was assessed by factor analysis and a single factor structure was found. this study were to assess in Bruxism, through the use of psychometric test scales, how individuals felt under the conditions they were in, and DISCUSSION: Results of the analyses made have indicated that the when independent of these conditions; and to determine the capacities Turkish version of NSSS-S has adequate validity and reliability to be of understanding and expressing personal emotions and coping with used on the Turkish population samples. anxiety. Keywords: New Sexual Satisfaction Scale (NSSS), reliability, validity METHODS: During the first consultation at the oral and maxillofacial References radiology clinic, individuals were diagnosed with Bruxism on the criteria of the American Academy of Sleep Medicine (AASM) 2014 Bancroft J, Loftus J, Long JS (2003) Distress about sex: A national survey of women in heterosexual relationships. Archives of Sexual guidelines. Individuals with and without Bruxism were asked to Behavior, 32:193–208. complete the COPE-.the Coping Strategies Inventory, the State-Trait Butzer B, CamPPell L (2008) Adult attachment, sexual satisfaction, Anxiety Inventory (STAI) and the Toronto Alexithymia Scale (TAS). and relationship satisfaction: A study of married couples. Personal Data were analyzed on the SPSS-16 statistics program. Intergroup Relationships, 15:141 comparison of numerical variables with normal distribution was carried out with the Student t-test, and the Mann Whitney U-test was used for the numerical values not complying with normal distribution. PP-069 RESULTS: IndividualsNOT with PRESENTED Bruxism diagnosis had significantly higher scores as compared to individuals without Bruxism diagnosis on the COPE-coping strategies subscales no.7 (coping with religion) and TREATMENT RESISTANCE OF UNIPOLAR MANIA no.15 (use of alcohol-substance), but there were not similarly significant IN PREGNANCY, AND REMISSION WITH LITHIUM differences on the other subscales. Also, significant intergroup differences AND RISPERIDONE: CASE PRESENTATION were not determined on the STAI and the TAS scores. Eren Yildizhan, Armağan Özdemir, Hafize Miray Aytaç, DISCUSSION: It was observed that the individuals diagnosed with Nesrin Buket Tomruk

POSTER PRESENTATIONS Bruxism coped with anxiety predominantly through either religious Bakırköy Mazhar Osman Mental Health and Neurological Diseases and faith or use of alcohol and substance. Research Hospital Keywords: Anxiety, Bruxism, Scale AIM: The case of a patient, whose treatment medication dose was References reduced while in remission for planning pregnancy, is discussed with Davies SJ, Underhill HC (2016) Individual Oral Symptoms İn Burning the aim to draw attention to the concept of treatment resistance Mouth Syndrome May Be Associated Differentially with Depression in pregnancy, as experienced by the patient through repeated and And Anxiety, Acta Odontol Scand. 74(2):155-60 prolonged manic attacks during pregnancy which were brought under control with great difficulty. CASE: The 30-year old patient had a 15-year history of bipolar disorder PP-068 with only manic attacks, and twice hospitalization for treatment with risperidone (8 mg/day), valproic acid and lithium combination which ensured an 8-year attack free life. She planned pregnancy and therefore THE NEW SEXUAL SATISFACTION SCALE- SHORT her treatment was gradually reduced and discontinued. She was FORM: VALIDITY AND RELIABILITY OF THE followed without medication for 4 months when, with the pregnancy, TURKISH VERSION she developed a manic attack and was admitted to the hospital. Burak Okci, İbrahim Ömer Saatcioğlu, Feryal Cam Çelikel Improvement was not achieved with quetiapine (400 mg/day) or with risperidone, which had been beneficial previously. She had to be given 7 FMV Işık Univeristy, Clinical Psychology, İstanbul sessions of ECT when at the 17th week of pregnancy. She was discharged AIM: The New Sexual Satisfaction Scale (NSSS) has been developed as with partial remission, but 3 days later the attack repeated and she was a research project by Štulhofer et al., to assess the effect of pornography readmitted as inpatient. Quetiapine dose was titrated to 600 mg/day, on the sexually socializing of young individuals. The short form and a further 7 sessions of ECT was carried out. Risperidone (6 mg/ (NSSS-S) was a later development and has been proposed to be more day) and lithium (900 mg/day) were added to the treatment and she was

102 discharged with partial remission. On the 21st week of pregnancy manic DISCUSSION: This study is the first to investigate suPAR levels in SA attack of psychotic type repeated, and hospitalization was required. She and AD. Lack of significant differences may be due to inflammatory was put on haloperidol (20 mg/day), dose adjustments were made with dysfunctions occurring in the course of the disease. Also, lack of a quetiapine (800 mg/day) and lithium (1200 mg/day) and with a blood change in the suPAR level in early stage progress to the disease may level of lithium of 0.54 mmol/L, the dose was titrated to 1500 mg/ indicate a lack of role in the pathophysiology of AD. There is need for day. At this stage a lasting remission was achieved. She gave birth in wide scale prospective studies to determine the role of suPAR in the the 7th month of pregnancy to an underweight but otherwise healthy pathogenesis of AD. baby. Postpartum, the last lithium dose reached toxic blood levels and Keywords: Alzheimer’s disease, subjective amnesia, suPAR it was discontinued. She was on risperidone (6 mg/day) which was supplemented with valproic acid and the euthymia was maintained. References DISCUSSION: The first line treatment for bipolar disorder during Brosseron F, Krauthausen M, Kummer M et al., (2014) Body Fluid pregnancy is the use of antipsychotic agents. But some patients attain Cytokine Levels in Mild Cognitive Impairment and Alzheimer’s remission with mood stabilizatorr, lithium. Disease: a Comparative Overview. Mol Neurobiol. 50(2):534-544. Eugen-Olsen J, Andersen O, Linneberg A et al., (2010) Circulating Keywords: Bipolar, electroconvulsive therapy, lithium, peripartum, soluble urokinase plasminogen activator receptor predicts cancer, risperidone, unipolar treatment cardiovascular disease, diabetes and mortality in the general population. J Intern Med. 268:296–308. Haupt TH, Kallemose T, Ladelund S et al, (2014) Risk factors associated PP-070 with serum levels of the inflammatory biomarker soluble urokinase plasminogen activator receptor in a general population. Biomark Insights. 9: 91–100. COMPARISON OF PLASMA SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR (SUPAR) BETWEEN INDIVIDUALS WITH SUBJECTIVE AMNESIA AND EARLY STAGE ALZHEIMER’S PP-071 DISEASE RELATIONSHIP OF BEHAVIORAL PROBLEMS TO Gizem Çetiner1, Gözde Gültekin1, Mehmet Yürüyen2, Hakan LEVETIRACETAM USE IN EPILEPTIC CHILDREN Yavuzer2, Funda Engin Akcan1, Murat Emul1, 1 2 1 Neşe Kocabaşoğlu1 Mahmut Müjdeci , Emine Tekin , Mirac Barış Usta , 3 1 1 İstanbul University Cerrahpasa Medical School Psychiatry Department İbrahim Erkan , Koray Karabekiroğlu 1 2 İstanbul University Cerrahpasa Medical School Internal Disease Ondokuz Mayıs University, Child and Adolescent Mental Health And Department, Geriatrics Clinic Diseases Department Samsun AIM: Inflammatory mechanisms play an important role in the 2Ondokuz Mayıs University, Child Neurology Department, Samsun pathogenesis of Alzheimer’s disease (AD). Soluble urokinase 3Ondokuz Mayıs University, Biostatistics Department, Samsun plasminogen activator receptor (suPAR) is a protein measurable in the plasma and is a biomarker for systemic inflammatory activity, with high AIM: Relationship between behavioral problems and epilepsy has levels being reported to be related to cardiovascular pathologies, cancer, been demonstrated in children. Also, use of some of the antiepileptic infectious diseases, mortality and cigarette smoking. The main aim of drugs adversely affect the behavioral and social functions. Although this study is to determine the plasma suPAR levels in early stage AD it has been argued that the relatively new antiepileptic agents such as patients who have not yet received any treatment and in individuals levetiracetam, oxcarbazepine and lamotrigine have less side effects, POSTER PRESENTATIONS with subjective amnesia (SA) and thereby investigate the role of suPAR levatiracetam has been shown to have side effects including emotional levels in the pathophysiology, early diagnosis and progression of AD. instability, irritability, hyperactivity and aggressive behavior. This study has aimed at determining the behavioral changes in 6 patients under METHODS: The study included 32 individuals with (SA) and levatiracetam therapy. 29 early stage AD patients. The participants were firstly scanned on the mini mental test(MMT), clinical dementia rating (CDR) scale, METHODS: This ongoing study included, with informed consent of geriatric depression scale (GDS) and the Hachinski ischemic score the parents, 6 children consulting the Child Neurology Polyclinics of (HIS). Afterwards they went through the evaluation of verbal memory our hospital between 01.01.2016 and 01.06.2016, who did not have a processing, digit span test, verbal fluency, logical memory, the Stroop history of antiepileptic agent use and were put on levetiracetam therapy test and clock drawing test. Plasma suPAR levels were estimated by after diagnosis of epilepsy. The parents of the children were asked to ELISA kit. complete the Child Behavior Checklist/4-18 (CBCL) before and one month after the levatiracetam therapy was begun on their children. RESULTS : Age in the AD group was significantly higher in comparison The data on these psychometric tests will be discussed. The scores on to the SA group (76.90±6.12 vs 71.35±4.84; p=0.002). The groups did subscales have been analyzed by the Wilcoxon test on the SPSS 21 not differ significantly with respect to gender (χ2=1.018, p=0.313) and program, and a p <.05 value was accepted as statistical significance. marital status (χ2=3075, p=0.215). Level of education was significantly higher in the SA group as compared to the AD group (χ2=15.610, RESULTS: Half (n=3) of the patients were girls. The group mean p=0.04). Intergroup differences of significance were not observed age was 11. The mean dose of levatiracetam given was 20 mg/kg/day. with respect to cigarette smoking (χ2=0.219, p=0.640), cardiovascular The scores on the CBCL subscales on depression, attention problems, diseases (χ2=1.164, p=0.281), diabetes (χ2=0.013, p=0.908), Hepatic opposing regulations and aggressive behavior were revaluated. The T pathologies (χ2=1.935, p=0.164), malignancy (χ2=0.002, p=0.962). and the Z scores were calculated on the basis of the study by Neşe Erol Plasma level of suPAR in SA 6.06±3.15 ng/ml and in AD was 5.54±3.18 e.t al. (2005). Statistically significant differences were not determined in ng/ml, did not differ significantly (p=0.386). the two sets of CBCL scores analyzed. However, observed behaviors of

103 2 children on ‘opposing regulations’ after levetiracetam treatment had PP-073 reached clinical significance. DISCUSSION: In a study with 288 patients using levetiracetam, THE RELATIONSHIP BETWEEN INTERNET 59% had developed behavioral changes due to the drug treatment. DEPENDENCE AND SOCIAL MEDIA USE AND Also, a group of children and adolescents on levetiracetam therapy INSOMNIA SEVERITY AND SLEEP QUALITY and evaluated on the basis of CBCL, showed increase scores on the Yavuz Selvi1, Hanife Albayrak2, Çiğdem Bal2, Büşra Nur aggressive behavior subscale as compared to the placebo group. In this Coşgun2, Burak Ekici2, Hasan Hüseyin Eser2, Tuba Hınıs2, study a significant change in the CBCL scores one month after starting 2 2 2 levetiracetam treatment was not observed. As the study is ongoing, the Emine Kanmaz , İmadeddin Malla , Fatih Sevgi , 2 2 results will be revised with the expansion of the investigated population Batuhan Yeşil , Şeyma Nur Zeki of children. 1Selçuk University Medical School, Psychiatry Department, Konya 2Selçuk University Medical School, Konya Keywords: CBCL, child epilepsy, levetiracetam AIM: Internet dependence and the prolonged usage of the games and References the social media result in physical and mental problems as well as sleep Nese Erol et al., (2005) Behavioral and Emotional Problems Among disorders. Limited sleep per se can be a primary problem, and can arise Turkish Children at Ages 2 to 3 Years. J Am Acad Child Adolesc with causes of general medical condition and the internet dependence Psychiatry. 2005 Jan; 44(1): 80–87. preented to the individual by modern living and technological advances. It has been shown quite openly that sleep limitation results in liability to day time sleepiness, lack of attention (carelessness), depression and PP-072 anxiety and work and family related problems. This study has aimed at investigating the relationship between sleep quality and internet SENSITIVITY TO DISGUST ON HEALTH ANXIETY dependence which is highly prevalent among the youthful population. SYMPTOMS AND EFFECTS OF THE DIFFICULTIES METHODS: The study enrolled 300 healthy volunteering university OF EMOTION REGULATION students. With the aim, the participants were asked to complete a sociodemographic questionnaire, Internet Addiction Test (IAT) to Melike Büşra Hacıoğlu, Cansu Omrak, Irmak Gültekin, determine the scale of internet dependence, the Insomnia Severity Gizem Cesur Index (IS) to assess the level of sleep hygiene. The sociodemographic İstanbul Commerce University, Psychology Department, İstanbul data were statistically analysed by the Chi-square test, and the groups were compared using the T-test. The value of p<0.05 was accepted as AIM: The aim of the study is to investigate the predictive power of statistically significant. sensitivity to disgust and the difficulties of emotion regulation on adult health anxiety symptoms. RESULTS: In the 260 evalutions made on 146 /57.16%) females and 114 (43.84%) males with a total group mean age of 20.26 (±1.81) years, METHODS: The study enrolled a total of 456 participants between the with 47.3% displaying internet dependence; 35.7% having clinically ages of 18 and 54 (mean26.80, ±7.84) and consisting of 276 females and insignificant sleep limitation, 47.7% having threshold level of sleep 180 males. The participants were asked to complete a sociodemographic limitation and 16.6% showing sleep limitation at the clinical level. questionnaire, the Health Anxiety Inventory (HAI), the Difficulties in Mean sleep hygiene score was 28,59 (±6,75); mean social media account Emotion Regulation Scale. (DERS) and the Disgust Scale-R (DS) number was 2,76 (±1,71) and a statistically significant correlation was RESULTS: Hierarchical regression analyses have shown that, firstly, the determined between the severity of sleep limitation and the severity of DS subscale contamination-based disgust (β =.11, t = 2.10, p <.05) and internet dependence (p<0.01). POSTER PRESENTATIONS the DERS subscale strategies (β =.19, t = 2.61, p <.05) have significant DISCUSSION: According to the results of the study, a positive predictive power on the HAI subscale ’excessive sensitivity to somatic correlation exists between internet dependence and the number of social symptoms (R2 =.11, F(8, 447) = 7.13, p <.01). Secondly, the DS subscale media accounts and impairment of sleep hygiene, severity of insomnia death/disintegration (β =.19, t = 3.53, p <.01) and the DERS subscale and quality of sleep, indicating that internet dependents. This study is a strategies (β =.41, t = 6.02, p <.01) have significant predictive power on preliminary study for for futher work on the relationship between mood the HAI subscale anxiety on somatic disease (R2 =.24, F(8,447) = 15.23, symptoms internet dependence. p <.01). Keywords: Internet dependence, insomnia, sleep quality DISCUSSION: Limited number of studies in the literature have focused on the psychological symptoms associated with the feeling of References aversion. To the best of our knowledge, this is the first study on the Arısoy O. (2009). İnternet bağımlılığı ve tedavisi., (Internet dependence effects of the difficulties of emotion regulation on health anxiety, which and its treatment). Psikiyatride Güncel Yaklaşımlar 1(1), 55-67. has been discussed on the basis of the information available in the Kraut R, Patterson M, Lundmark V, Kiesler S, Mukhophadhyay T, literature. Scherlis W (1998). Internet paradox: A social technology that reduces social involvement and psychological well-being?. American Keywords: Difficulties of emotion regulation, health anxiety, disgust psychologist, 53(9), 1017-1031. References Lund HG, Reider BD, Whiting AB, Prichard JR. (2010). Sleep patterns Olatunji, B. O., & Sawchuk, C. N. (2005). Disgust: Characteristic and predictors of disturbed sleep in a large population of college features, social manifestations, and clinical implications. Journal of students. Journal of adolescent health, 46(2), 124-132. Social and Clinical Psychology, 24(7), 932-962.

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NEGATIVE HALLUCINATION, SOMATIZATION AND TOPIRAMATE USE IN TREATING BORDERLINE PSYCHOTIC DISORDER: CASE PRESENTATION PERSONALITY DISORDER: CASE PRESENTATION Didem Beşikçi Keleş, İshak Saygılı, Mehmet Fatih Gizem Dönmezler, Özge Onur Şahmelikoğlu, Üstündağ, Hüseyin Güleç, Mustafa Güneş Çağatay Karsıdağ Erenköy Mental and Neurological Diseases Training and Research Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Hospital, Psychiatry Clinic, İstanbul Diseases and Research Hospital, Psychiatry Department, İstanbul AIM: Negative hallucination is the active deletion of perceptions, AIM: Borderline personality disorder (BPD) is a serious and frequently formation of a vacuum in the reality or the vague observation of observed psychiatric disorder, characterized by inconsistency in affect the unreal. Freud has proposed that negative hallucination is related regulation, impulse control, interpersonal relationships and self-image. to repression of perceptions (not thoughts). In this report, we have It is observed with 6% frequency in first step healthcare units, and with discussed negative hallucination and somatization in relation to the case 15-20% frequency in psychiatry hospitals and outpatient polyclinics of a patient under follow up for psychotic disorder who believes in being due to increased psychiatric health service. Although nearly 80% of blind despite the absence of any underlying pathology, and refuses to the patients are on regular medication, use of pharmacotherapy in talk for fear of becoming completely blind upon speaking. BPD is subject of controversy. The best effects have been observed with topiramate, lamotrigine, valproate and atypical antipsychotics CASE: The 21-yaer old male patient who was admitted as an inpatient olanzapine and aripiprazole. The case presented here, who had with the increase over 5 months of his psychiatric complaints. His frequently abandoned treatment for BPD on account of the side effects history revealed that he had been using substance for 7 years, had of a variety of agents prescribed, has been followed on topiramate. diminished eyesight for the previous 1 year, and believed in not talking lest he became completely blind. He had not left home for the previous CASE: The 27-year old married patient, lycee graduate and mother of 4 months and believed that people read his thoughts. He had been one was given her first psychiatric treatment in a child and adult mental treated 2 times in the previous 1 year as an inpatient, and was not on health hospital at the age of 14 after a suicidal attempt. She had a history any treatment for the previous 8 months. He made contact through jests of repeated suicidal and self-harm attempts and bad interpersonal and mimics or answered questions by silent movement of his lips. He relationships. Her psychotic symptoms surfaced from time to time and did not describe delusions but he had negative hallucination on losing her last hospital treatment was for depression 3 years previously. Her eyesight and somatization. As previously eye clinic exams reported the pharmacotherapy consisted of antidepressants, anticonvulsants, typical lack of any ocular pathology, he was examined by MRI and consultation and atypical antipsychotics. She had refused to use her medication was requested from the neurology unit. Although he had mild cerebral mainly on account of side effects of sedation and weight gain. Her atrophy, this was not enough to explain his symptoms. As his symptoms treatment was switched from anticonvulsant and atypical antipsychotic partly regressed while in hospital, he has discharged and placed under combination to topiramate with gradual increase in dosage. follow up. DISCUSSION: There is not an agent specifically approved with DISCUSSION: The term ‘negative halluciantion’2 was coined by adequate evidence for use in treating BPD, which has resulted in the use Bernheim in 1884 and was used by Freud, but later it was converted of agents not proven to be useful in studies or by practice and, hence, to ‘’denial’’ which Freud used the word in the general sense as the in the use of multiple agents. Topiramate is an anticonvulsant reported equivalent of negative hallucination. At the same time, he used the in the literature to be a mood stabilizer with the effect of weight term in the sense of doubting whether to give or not give a place to loss. Effective doses for BPD treatment have been shown to improve traumatic perceptions. The term ‘somatization’ has been used by Pichon irritability, anger, anxiety, bad interpersonal relationships and quality of and Laforgue as an equivalent of negative hallucination, referring to life. Use of topiramate for treatment of BPD can be expected in anger POSTER PRESENTATIONS it as the mental or intellectual blind spot, in the sense to dimmish control and weight loss especially in the female patient. the psychological significance of anything by attempts to deny what Keywords: Borderline, personality disorder, topiramate conflicts with self. There have been arguments between Freud and Laforgue on the use of the term. Evaluating the term as a defensive References mechanism is important since it has developed in the case discussed here Lieb K, Völlm B, Rücker G, Timmer A, Stoffers JM (2010) on a psychological base and has emerged as the main symptom in the Pharmacotherapy for borderline personality disorder: Cochrane clinical state of the patient. systematic review of randomized trials. The British Journal of Psychiatry, 196(1), 4-12. Keywords: Negative hallucination, psychotic disorder, somatization Nose M, Cipriani A, Biancosino B, Grassi L, Barbui C (2006) References Efficacy of pharmacotherapy against core traits of borderline Bourguignon A, Manus A (1980) Negative hallucination, denial of reality personality disorder: meta-analysis of randomized controlled trials. and scotomization. Ann Med Psychol (Paris). Feb;138(2):129-53. International clinical psychopharmacology, 21(6), 345-353. Laforgue, R (1927). Scotomization in Schizophrenia. The International Journal of Psycho-Analysis Jan: 473.

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SOCIODEMOGRAPHIC AND CLINICAL HOW COMPLIANT IS THE TREATMENT OF MANIC CHARACTERISTICS OF GEROPSYCHIATRIC EPISODE WITH THE GUIDELINES? PATIENTS WITH RISK OF SUICIDAL ATTEMPT Emrah Yıldızoğlu, Çiler Acar, Kürşat Altınbaş 1 1 1 Gizem Dönmezler , Nurhan Fıstıkçı , Ender Cesur , Canakkale Onsekiz Mart University, Medical School, Psychiatry 1 2 Elif Çarpar , Güntuğ Güngör Department, Canakkale 1Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases and Research Hospital, Psychiatry Department, İstanbul2İstanbul AIM: In this study we have aimed to evaluate the agreement of the Kanuni Sultan Suleyman Training and Research Hospital, Internal treatment given to bipolar disorder (BPD) manic episode patients, Diseases Unit,, İstanbul followed at the Canakkale Onsekiz Mart University, Medical School AIM: Human life span has increased with the improvement of living Hospital psychiatry ward, with the Psychiatric Association of Turkey standards, but given the decrease in the rate of birth, the elderly (PAT) Treatment guidelines for Bipolar Disorder. population is gradually on the increase. It is expected that by 2025 METHODS: The retrospective study has been carried on the 28 disease nearly 1.2 million people will be over the age of 60; and in parallel to phases of 27 BPD manic episode patients followed up at our clinic the expectancy all over the world, 21st century may be the century of the between January 2015 and July 2916. Medical records, evaluation tools elderly in Turkey. Studies predict increases in the incidences of suicidal attempts in the coming years. This study has aimed to investigate the and scales have been scanned in patients’ files. sociodemographic details and the clinical data of geriatric patients RESULTS: Majority of the 26 patients were males, the mean group treated on an inpatient basis on account of risk of suicidal attempt. age was 40.5 (±14.3; 18-65) years; with 16 (57%) married, 15 (53%) METHODS: This cross-sectional study was carried out with 250 primary school educated and 17 (61%) unemployed. All 26 patients patients over the age of 65 admitted to Bakırköy Mental Health and had been admitted with the diagnosis of BPD manic phase; 7 had Neurological Diseases and Research Hospital, psychiatry services not been previously treated; 21 (75%) were on various treatments; between June 2011 and March 2013. The criteria of exclusion consisted mean duration of BPD was 12.6 (±11.2; min.1- max.39) years; and of dementia, delirium and psychotic disorders with organic pathology mean hospital stay was 20.6 (±11.5; min.3-max.46) days. Patients since the study was about disorders of substance and medication use or with first degree relatives diagnosed with psychopathologies included other health conditions. 3 (10.7%) with alcohol dependence, 2 (7%) with major depression, RESULTS: Among the 250 patients investigated, there were 48 2(7%) undiagnosed anxiety disorder, 1 (3%) with BPD. The severity of patients, 28 females and 20 males, who had been admitted with the risk manic attack of the moment was mild in 2 (7%), moderate in 18 (64%) of committing suicide. Mean age of the patients was 68 years; 79.2% and severe in 8 (28%); and all of those with mild attack, 83% of those (n=38) had an education of primary school or less; 47.9% were married, with moderate attack severity and 87% of those with severe attacks; 41.7% widowed, 6.3% divorced and 4.2% were single; and 79.2% lived and considering all mania patients irrespective of severity of attach 85% with family, 4.2% in care homes and 14.6% alone. While the family had been treated in agreement with the PAT guidelines. Response to support of 54.2% was complete, 31.3% had insufficient family support and 14.6% had no family support. Clinically, 77.1% had a physical treatment at discharge from hospital was 1 (3%) nonresponse; 2 (7%) disease, 37.5% used cigarettes, and 10.4% had a history of alcohol use. partial response, 2 (7%) open response, 4/14%) near recovery, 19(68%) While 58.3% (n=28) had a history of suicidal attempt, 79.2% (n=38) full recovery. Among those who recovered, the time taken to recovery were diagnosed with mood disorders, and 76.3% of this group of was 21.8 ((min.10, max.46) days.

POSTER PRESENTATIONS patients had depression. DISCUSSION: It has been determined that 85% of the BPD manic DISCUSSION: On the basis of age, suicidal attempt incidence is the episode patients were treated according to the guidelines of PAT. This highest worldwide in the age group of 70 years or over. Mental disorders outcome is below 30% in depressive episodes without psychosis. The make up a strong risk factor for suicide at old age. Psychological autopsy finding in this study as well as in others that there is more compliance studies have reported that in geriatric suicide cases 71-97% had mental with treatment guidelines in manic episode treatment may be due to the disorders and the most frequently made diagnosis was depression. greater emphasis in the guidelines on the manic episode. The relative Keywords: Elderly, geropsychiatry, suicide ease of treatment of manic attacks as compared to depression may be References explained by there being more effective treatment choices for manic Beğer T, Yavuzer H (2012) Yaşlılık ve Yaşlılık Epidemiyolojisi.(Old Age attacks. It can be concluded that the PAT guidelines for manic episode and Old Age Epidemiology) Klinik Gelişim Dergisi, 25(3), 1-3. treatment are in agreement with clinical practice. Ciulla L, Nogueira EL, Silva Filho IG, Tres G, Engroff P, Ciulla V, Neto Keywords: Bipolar disorder, manic episode, treatment guidelines AC (2014) Suicide risk in the elderly: data from Brazilian public health care program. Journal of affective disorders, 152, 513-516. References Altınbaş K, Smith D, Oral TE (2011) Adherence to turkish psychiatric association guideline for bipolar depression treatment in a specialized mood disorders outpatient unit. Psychiatria Danubina, Vol. 23, No. 2, pp 189–193 Baek JH et al (2014) Pattern of Pharmacotherapy by Episode Types for Patients with Bipolar Disorders and Its Concordance With Treatment Guidelines.Journal of Clinical Psychopharmacology Psychopharmacology 34: 577-587

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PHENOMENOLOGICAL COMPARISON OF DEVELOPMENT OF ACUTE PSYCHOSIS AFTER DEPRESSION OF OLD AGE AND OF ADULTHOOD PREGABALIN USE: CASE PRESENTATION Ceren Bingolo1, Gülfizar Sözeri Varma2, Yasar Enli3, Gamze Özçiçek, Sadiye Visal Buturak, Hatice Özdemir Özge Karaca2 Rezaki, Orhan Murat Koçak, Ayşe Gül Yılmaz Özpolat 1Sirnak State Hospital, Sirnak Kırıkkale University Medical School, Psychiatry Department, Kırıkkale 2 Pamukkale University, Medical School, Psychiatry Department, Denizli AIM: Pregabalin is a lipophilic GABA analogue used in the treatment of 3 Pamukkale University, Medical School, Biochemistry Department, epilepsy, neuropathic pain, anxiety and sleep disorders and has also been Denizli recommended for the treatment of anxiety in schizophrenia. In this AIM: Characteristics specific to old age make diagnosis and treatment report a case of acute psychosis development after the use of pregabalin of depression difficult. The phenomenological differences observed in for neuropathic pain will be discussed the depression of old age increase the difficulty of diagnosing old age CASE: The 42-year old male, primary school graduate patient married depression. This study has aimed at comparing the characteristics of old with 2 children, was brought to the emergency services by his wife with age depression with depression at adulthood. the complaints of irritability, talking to himself and visual hallucination. METHODS: The study included 40 patients diagnosed with major He was on follow up at the orthopedics and the physical therapy and depressive disorder (MDD) between the ages of 18 and 60 years, and 40 rehabilitation units for a work accident that took place 5 months previously. He had been started on pregabalin (600 mg/day) 48 hours MDD patients above the age of 60 years. All patients were evaluated on before the psychiatry consultation. He or his family did not have a the basis of the SCID-I, Hamilton depression rating scale (HAM-D), history of psychiatric disorders. His psychiatric examination showed the Hamilton anxiety rating scale (HAM-A), the Montgomery–Asberg that he was conscious, cooperative, oriented, with anxious mood, and Depression Rating Scale (MADRS), Brief Psychiatric Rating Scale had visual hallucinations, his attention had diminished. Cranial CT at (BPRS) and the Standardized Mini Mental Test (SMMT). the emergency service and the subsequent neurological examination, RESULTS: Both the old age group (OAG) and the adult group and blood tests were reported to be normal. He was admitted as an (ADG) had MDD of moderate severity uncomplicated with psychosis. inpatient and pregabalin therapy was discontinued. On account of There were not significant intergroup differences on the HAM-D and visual hallucinations and the risk of harming his environment, he was HAM-A total scores. The MADRS and BPRS scores of the OAG were started on haloperidol (10 mg im). All of his complaints reversed in 24 higher than those of the ADG. In the OAG, the HAM-D subscale hours and he was followed without medication and discharged on the scores on falling asleep, waking in the middle of the night, waking early 5th day of admission to hospital. in the morning and hypochondriasis were higher than in the ADG but DISCUSSION: This report has described the psychotic symptoms the suicidal ideation subscale score was lower than that of the ADG. developed by a patient after pregabalin treatment. There are only The OAG scores on the MADRS subscales of internal tension and 2 case reports in the literature on similar cases, the common feature maintaining attention were higher than in the ADG, and the suicidal of all 3 cases being that 3 days after the increase in pregabalin dose ideation subscale score was lower than that of the ADG. The incidence they developed agitation, irritability, and visual hallucinations which of the first depressive episode was 40% in the OAG and 52.5% in the completely disappeared upon discontinuation of the drug. It must ADG. A history of depression in the first-degree relatives of the OAG be kept in mind that psychosis may develop in patients treated with were lower than that in the ADG. In the OAG patients in the first pregabalin MDD attack, score on the HAM-D subscale on feeling guilty was lower

Keywords: Hallucination, pregabalin, psychosis POSTER PRESENTATIONS as compared to that of OAG patients who had experienced multiple attacks, but the scores on the HAM-D subscales waking up in the References middle of the night and waking up early in the morning were higher. Olaizola I, Ellger T, Young P, et al (2006) Pregabalin-associated acute psychosis and epileptiform EEG-changes. Seizure, 15(3):208-10. DISCUSSION: It has been argued that hypochondriasis, psychomotor Pedroso JL, Nakama GY, Carneiro Filho M et al (2012) Delirium, retardation, psychomotor agitation and psychotic symptoms are more psychosis, and visual hallucinations induced by pregabalin. Arq frequently observed in the old age depression, as compared to the Neuropsiquiatr 70(12):960 adults. The results of a meta-analysis has shown that in old age MDD patients, frequency of familial mood disorders was low, frequency of somatic symptoms were higher, and feelings of guilt and loss of sexual functionality were seen less as compared to the adult MDD patients. PP-080 This study has demonstrated that in old age MDD, sleep disorders, attention related problems and hypochondriac concerns were more PSORIASIS DEVELOPMENT DUE TO LITHIUM: CASE frequent, while suicidal ideation was less frequent as compared to adult PRESENTATION MDD patients. Also, the results suggest that the rating of guilt feeling can be a clue to having had previous episodes of depression. İsa Kumlu, Erguvan Tuğba Özel Kızıl Ankara University Medical School, Mental Health and Diseases Keywords: Depression, old age, phenomenology Department, Ankara References AIM: Lithium is used as an effective agent for the treatment of bipolar Sozeri-Varma G. Depression in the elderly (2012) Clinical features and disorder. It has side effects on many systems, the dermatological side risk factors. Aging and Disease, 3(6), 465-471 effects, including acne, pityriasis versicolor, folliculitis, alopecia and Thomas AJ, O’Brien JT (2009) Mood disorders in the elderly. Psychiatry psoriasis being the most frequently seen. Psoriasis is an inflammatory 8: 56-60. condition with T-lymphocyte mediated excessive keratinocyte

107 proliferation. Lithium effects on the immune system are thought to Personality Questionnaire (EPQ), the COPE-Coping strategies cause the development and flare up of psoriasis. This report discusses inventory (CSI) and the Minnesota Multiphasic Personality Inventory the case of psoriasis development after lithium treatment. (MMPI). Data analyses were done on the SPSS-17 package program. CASE: The 34-year old female patient was being followed with bipolar RESULTS: A positive correlation between the EPQ subscale score disorder type II diagnosis. Her history included multiple depressive and on and job satisfaction. Positive correlations were three hypomanic episodes, and treatment with antipsychotic agents as found between job satisfaction and the CSI subscales on Positive quetiapine and olanzapine. In March, 2016 she was in depressive episode reinterpretation and growth, active coping and planning; and negative with psychotic symptoms, and on treatment with lamotrigine (250mg/ correlations were found between job satisfaction and CSI subscales on dy) and aripiprazole (20mg/day), when aripiprazole was discontinued Mental disengagement and substance use(p<0.05). and risperidone depot 50mg/ 2 weeks was added. In May, 2016 her DISCUSSION: When the literature is scanned alpha type personalities depressive symptoms continued and she was started on lithium (600mg/ are seen to have reduced job satisfaction, but there are not any studies day) with plans to increase the dose gradually. By July 2016 she was on on the subscales of EPQ developed by Eysenck. The results of our study 900 mg/day lithium with the blood level of lithium being 0,59 mEq/L. on the negative correlation between neuroticism and job satisfaction Her depressive symptoms and suicidal ideation had regressed. However, points to diminished job satisfaction by uneasy, anxious and angry on the extensor surfaces of her extremities and on her abdominal surface physicians. To the best of our knowledge, there is not a study in the squamous, iridescent, plaque type lesions were observed. She was literature investigating the effects of coping strategies on job satisfaction. referred to the dermatology physician with the preliminary diagnosis of Our study has shown that mental and behavioral disengagement, and psoriasis which as confirmed and she was started on topical treatment focusing on and venting of emotions and alcohol and substance use with betamethasone +calcipotriol, with remarkable regression in her are associated with reduced job satisfaction, whereas active coping, lesions. As she had benefited from lithium it was decided to continue planning and reinterpreting positively indicate job satisfaction among with lithium together with her dermatological treatment. the physicians. It is indicated that measures should be taken for DISCUSSION: Relation of lithium to psoriasis was first shown by intraprofessional training on stress coping strategies for physicians who Carter in 1972 and subsequently reports were published on the subject. bear the extra stress of avoiding errors and of the making responsible Incidence of psoriasis development or flare ups were reported to be in decisions in unclear unresolved situations. the 3.4-45% range and the flare up cases were seen more frequently, Keywords: coping with stress strategies, job satisfaction, personality, when 20 weeks of use have been mentioned. The underlying mechanism physician is not known, but cAMP reduction and hence the reduction in cAMP dependent processes have been implicated. Inhibition of intercellular References calcium release by lithium has been shown to increase the proliferation Batıgun AD, Şahin HD (2006) İş stresi ve sağlık psikolojisi araştırmaları and differentiation of keratocytes. Studies on cytokines have suggested için iki ölçek: A-tipi kişilik ve iş doyumu.( Two scales for studies that psoriasis due to lithium and idiopathic psoriasis depend on different on work stress and health psychology; A type personality and job physiopathological mechanisms. In the case presented here, psoriasis has satisfaction= Turk Psikiyatri Derg 17: 32-45 appeared in a patient who did not have a known dermatological disease. Golbası Z, Kelleci M, Doğan S (2008) Relationships between coping This case presentation is an example showing that patients should be strategies, individual characteristics and job satisfaction in a sample queried for dermatological symptoms and followed on these at the start of hospital nurses: Cross-sectional questionnaire survey. Int J Nurs and maintenance stages of lithium treatment. Stud 45: 1800–1806 Keywords: Lithium, psoriasis

PP-082 POSTER PRESENTATIONS PP-081 FIRST MANIC ATTACK AFTER WITHDRAWAL OF DULOXETINE TREATMENT RELATION OF JOB SATISFACTION TO PERSONALITY AND STRESS COPING STRATEGIES Çiler Açar, Emrah Yıldızoğlu, Yağmur Duva, Kürşat Altınbaş OF PHYSICIANS Canakkale Onsekiz Mart University, Medical School, Psychiatry Department, Canakkale Güler Özkula, Arda Karagol, Nurhak Birer, Özgün Karapıçak AIM: The risk of hypomanic switch in antidepressant (AD) using mood Başkent University, Department of Psychiatry, Ankara disorder patients is being rated as 20-40%. There are reports in the literature on cases of hypomanic/manic switch after AD dose reduction AIM: In recent years, there has been concentration on the subject of or discontinuation of AD treatment. In this report a case of manic job satisfaction, conceptualized as the individual’s affect related to the switch after discontinuation of duloxetine used for major depression undertaken job or different aspects of it. Although there are many has been presented in order to draw attention to a possible outcome of studies converging from different angles on job satisfaction, particularly AD withdrawal. on factors related to the place of work and the work itself, there are CASE: The 46-year old house wife married with two children was limited investigations concerning the individual. This study has aimed brought to the polyclinics after the development of excessive talking, to investigate the relationship between job satisfactions of physicians signs of increased self-confidence, and sleep limitation to 2-3 hours, on the one hand and personality and strategies of coping with stress on excessive money spending and increased psychomotor activity. In the the other. 4 days prior to the consultation the patient had started dressing in a METHODS: The study was carried out between January and April new style and looking for new areas of preoccupation. She had been of 2106, with 258 physicians employed at the hospital of a private under duloxetine (60 mg/day) therapy for a year for major depression; university. The participants were as ked to complete the Eysenck and after remission, the AD dose had been gradually decreased and

108 discontinued. The patients’ symptoms had started 4 days after stopping phase advance, and bright light therapy. Total sleep deprivation was duloxetine. She did not have a history of previous manic or psychotic implemented from 09:00 in the morning until 18:00 hours the next attack and had comorbidity of diabetes type II. Her sister had a day. Bright light therapy consisted of 30-minute exposure to 10,000 history of repetitive depression. It was observed during her psychiatric lux light. This was repeated for a total of 15 times. Sleep phase advance examination that her psychomotor activity had increased, mood was was started the day after total sleep deprivation. His sleep-waking hours euphoric, affect was euphoric, her speech had increased in pace and were 18:00-02.00 on the first day, 20:00-04.00 on the second day and volume; associations were fast; self-confidence was elevated and thought 22:00-06:00 on the third day. One day after the end of the therapy contents had grandiose delusions. Her score on the Young mania rating his HAM-D score had fallen to 8. And in his follow up the scores scale was 25. She was diagnosed as being in the manic episode. She regressed to 6, 4 and 3. After the chronotherapy treatment was started was started on risperidone (2 mg/day) as an outpatient to be followed with lamotrigine (25mg/day) and it was titrated to 200 mg/day. He was at the polyclinics. On the basis of her clinical symptoms, the dose was discharged in state of wellbeing. increased to 4 mg/day, achieving complete remission in 4 weeks. DISCUSSION: After triple chronotherapy, the depressive symptoms of DISCUSSION: There are several hypotheses proposed on the the patient had regressed in 48 hours. Triple chronotherapy may be an mechanisms underlying manic switch after discontinuation of alternative combination therapy in cases requiring fast recovery without antidepressant therapy, and the most discussed proposals include the side effects. noradrenergic hyperactivity model, the cholinergic-monoaminergic Keywords: Bipolar disorder, chronotherapy, depression, sleep interactivity model, the hyperserotonergic mania model and the deprivation REM sleep reversal and hyperdopaminergic model. As clinician, we should remember the risks of manic/hypomanic switch at the end as References well as at the start of AD therapy. As the development of these attacks Plante DT, Winkelman JW (2008) Sleep disturbance in bipolar independently of AD treatment remains to be a matter of interest, the disorder: therapeutic implications. Am.J.Psychiatry, 165: 830–43. observed event of switch should always be evaluated. Wu JC, Kelsoe JR, Schachat C, et al (2009) Rapid and sustained antidepressant response with sleep deprivation and chronotherapy Keywords: Duloxetine, hypomania, mania in bipolar disorder. Biol Psychiatry, 66: 298–301. References Wirz-Justice A, Benedetti F, Berger M, et al (2005) Chronotherapeutics Goldberg JF, Truman CJ (2003) Antidepressant-induced mania: an (light and wake therapy) in affective disorders. Psychol Med, 35: overview of current controversies. Bipolar Disord. 5:407-20. 939 –44. Kora K, Kaplan P (2008) Antidepresan İlaç Kesimi İle Tetiklenen Hipomanik/Manik Kayma. (Hypomanic/Manic Switch triggered by drug discontinuation.)Türk Psikiyatri Dergisi 19:329-33 PP-084 Narayan V, Haddad PM (2011) Antidepressant discontinuation manic states: a critical review of the literature and suggested diagnostic criteria. J Psychopharmacol 25:306-313. RETROSPECTIVE EVALUATION OF 30.000 PATIENTS CONSULTING THE PSYCHIATRY POLYCLINICS OF A STATE HOSPITAL PP-083 Ülker Fedai, Mehmet Asoğlu, Mahmut Kati, Özlem Beginoğlu, Öznur Akıl, Meltem Göbelek, İsmail Karka, TRIPLE CHRONOTHERAPY FOR BIPOLAR Faruk Pirinççioğlu DEPRESSION: CASE PRESENTATION Harran University, Mental Health and Disorders Department, Sanliurfa

Evnur Kahyacı Kılıc1, Okan Çalıyurt2 AIM: There is need for epidemiological studies to get clues about the POSTER PRESENTATIONS 1Uzunkopru State Hospital, Edirne etiology and pathogenesis of psychiatric disorders and to determine 2Trakya University Medical School, Psychiatry Department, Edirne the risk groups. Our study has aimed at investigating the prevalence of mental disorders on the basis of gender and age and the interrelationships AIM: There is need for fast, effective and reliable methods of treatment between these factors. for bipolar depression, which is difficult to meet with the standard methods of treatment. We have aimed here to discuss the importance METHODS: The study targeted 30000 patients who consulted the of fast and maintained remission in bipolar depression by presenting a Sanliurfa Balıklıgol State Hospital Psychiatry polyclinics between 2008 case of treatment with triple chronometry in addition to standard mode and 2012; and included 17757 patients after eliminating those without of treatment. a diagnosis and/or below the age of 18 years. CASE: The 58-year old male patient consulted with the complaints RESULTS: Gender distribution was 65.2% for females and 34.8% of lack of morale, avolition, anhedonia and sleep impairment that for males. Incidence of psychiatric diagnoses was highest for anxiety had persisted for the previous 3 months. He was under follow up with disorders (52.8%) followed with mood disorders (30.1%), dissociative escitalopram (10 mg/day), valproate (1500 mg/day) and quetiapine disorders (7.3%), schizophrenia and other psychotic disorders (4.4%) (200 mg/day) treatment with partial benefit. He had experienced 3 and adjustment disorders at very low rates. Among anxiety disorders, depression episodes and 1 manic episode previously. He was admitted ‘the otherwise not described anxiety’ diagnoses lead the others (41.2%); to Trakya University Medical School, Psychiatry Clinic. His psychiatric while depressive disorder diagnoses (25.2%) were leading among the examination showed reduced self-care, reduced psychomotor activity, mood disorders. On the basis of gender, adjustment disorders were reduced pace and volume of speech, with irregular sleep and restricted distributed equally between females and males, but there was a higher affect. His thought contents included guilt and suicidal ideation. prevalence of schizophrenia and psychotic, sexual, behavioral and On the admission, his score on the Hamilton depression rating scale alcohol-substance use disorders among the males. Also, anxiety disorders (HAM-D) was 18. It was planned to give the patient adjunctive triple were more prevalent among females (71.4% vs 28.6% in the males). chronotherapy consisting of combined total sleep deprivation, sleep Mood disorders were seen in 62.2% of the females 37.8% of the males.

109 Mean age of the general psychiatric diagnosis cases was 37.9 (±14.3), DISCUSSION: ECT has been shown to be an effective treatment for and varied as 39.3 for anxiety disorders, as 37.8 for schizophrenia and psychotic depression of old age, and for patients with suicidal ideation psychotic disorders and as 37.2 for mood disorders. and catatonic symptoms. It has also been safely used in pregnancy. In our clinic, the highest risk of suicidal attempt was in the old age group DISCUSSION: The majority of the patients consulting the polyclinics with psychotic depression and ECT ensured nearly complete recovery. were female which can be attributed to the female attitude of seeking The indications for ECT were in agreement with the guidelines of the help for psychiatric help. As the lifestyle of women in this region is Psychiatric Association of Turkey for ECT and also the current literature. restricted, and the places they can go to without restriction includes the hospital, the greater number of consultations may have a demographic Keywords: Complication, ECT, indication, response to treatment basis. This descriptive study will be useful for comparison reasons References with the results of similar studies in other regions. The study also has importance in being the first to analyze the Urfa population and in Sayar GH, Özten E, Eryılmaz G, Göğcegöz I, Ceylan ME (2014) identifying the risk groups. Elektrokonvulzif terapi üzerine güncel bir gözden geçirme. (Cuurent review on electroconvulsive therapy)Psikiyatride Güncel Keywords: Descriptive study, epidemiological study, psychiatric Yaklaşımlar. 6:107-125. disorders Tomruk NB, Kutlar MT, Mengeş MO, Canbek Ö, Soysal H (2007) Reference EKT Klinik Uygulama El Kitabı. (Handbook of clinical ECT Goldman HH. (1988) Psychiatric epidemiology and mental health performance)Güncel Klinik Uygulamalar ve Endikasyonlar. services research. Review of General Psychiatry, second ed., San Ankara, TPD yayınları 2007:4-8. Mateo, CA, Appleton&Lange, p.143-156. Karadağ F, Oğuzhanoğlu NK, Özdel O, Ateşci FÇ. (2000) Psikiyatri polikliniğine başvuran hastaların ilk yakınmaları ve tanılara göre PP-086 dağılımı. (First complaints of psychiatric inpatients and their distribution on a diagnostic basis) NöropsikiyatriArşivi 37:221-226. EFFECTIVENESS OF REHABILITATION PROGRAM ON THE SCHIZOPHRENIA PATIENT: CASE PRESENTATION PP-085 Tülay Yılmaz, Mustafa Akkuş, Özlem Arıkan, Filiz ELECTROCONVULSIVE THERAPY PERFORMED Demiroğlu, Serkan Erkan, Cenk Varlık IN ÇANAKKALE 18 MART UNIVERSITY, MEDICAL Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological SCHOOL HOSPITAL PSYCHIATRY SERVICES IN TEN Diseases and Research Hospital, Bakırköy Public Mental Health Center, İstanbul MONTHS AIM: Schizophrenia is a chronic and severe illness with a course of Çiler Açar, Emrah Yıldızoğlu, Neslihan Kılıç, Halil İbrahim progressive loss of capabilities considerably diminishing the social Tas, Kürşat Altınbaş and professional functionality of the patient. Despite the positive Çanakkale Onsekiz Mart University, Medical School, Psychiatry developments achieved though treatment, pharmacotherapy has limited Department, Canakkale effect on functionality. It has been aimed in this report to draw attention AIM: In this report we have aimed at determining the sociodemographic to the improvements achieved in social functionality and reduction in and clinical data on the inpatients treated at our psychiatry clinic with the number of hospital admissions by rehabilitation methods, despite electroconvulsive therapy (ECT) within the span of approximately one treatment resistance in the case presented here. POSTER PRESENTATIONS year. CASE: K.N., a 52-year old single male patient, first admitted to METHODS: Hospital records of inpatients treated with ECT between Cerrahpasa Medical School Psychiatry clinic at the age of 17 with August 2015 and June 2016 at Canakkale Onsekiz Mart University, schizoaffective disorder, had thereafter been admitted to hospital Medical School Hospital psychiatry wards were evaluated retrospectively. 20 times until the age of 46 and despite treatment with various antipsychotic agents his auditory hallucinations had persisted. He had RESULTS: Within a period of 10 months 10 patients (4 females and not attended his controls regularly, and did not have insight. He did 6 males) with a mean age of 59.9 (±17.8; min. 21, max. 76) have not join social organizations and his contact with other persons was been treated with ECT. One patient was pregnant and not under very limited. Previous psychometric assessments indicated that his pharmacotherapy; and 60% of the patients were in the geriatric age score was 149 on the Positive and Negative Symptoms Scale (PANSS), group. Psychiatric diagnoses included psychotic depression (n=6, 60%), and 97 on the Social Functioning Scale (SFS). He started consulting bipolar disorder (BPD) depressive episode (n=1,10%), bipolar disorder Bakırköy Mental Health and Neurological Diseases and Public Mental manic episode (n=2, 20%) and catatonic depression (n=1, 10%). The Health Center and benefited significantly from the multidirectional major indication for ECT was suicidal risk (n=7, 70%), followed by rehabilitation programs. After starting these programs until the middle not responding to drug therapy (n=2, 20%) and pregnancy preclusion of 2016, his treatment compliance improved and despite the persistence of drug therapy for BPD manic episode (n=1,10%). In 30% of the of his auditory hallucinations he was able to perform his activities by patients ECT had been used in previous hospital stays; and 60% (n=6) himself and live alone in his house, attend regularly the public mental were under antidepressant treatment. Mean ECT sessions counts were health center and join social organizations of theatre, dinners and 5.8 (±0.4), started on the 6.4th (±4.3; 3- 14) day of hospital treatment, similar activities. At the end of the rehabilitation program his PANSS with mean seizure time of 28.1 (±6.9; min: 6-max.75) seconds. In score was 672 and SFS score was 144. 9 (90%) cases propofol and rocuronium were used for anesthesia; 2 (20%) geriatric patients had cardiac complications and 1 (10%) had DISCUSSION: In treating schizophrenia, the aim is not only to remove retrograde amnesia. Mean time of hospital stay was 27.1 (±7.1; min.19- all symptoms but also to ensure the improvement of the mental and max.38) days social functionality, the quality of life and wellbeing of the patient. This

110 aim shows itself in real life as taking seriously the improvement focused References approach in therapy. We have aimed here to show the effectiveness and Abbott C, Bustillo J (2006) What have we learned from proton the importance of the rehabilitation programs implemented next to magnetic resonance spectroscopy about schizophrenia? A critical given drug therapy. Adding rehabilitation programs to pharmacotherapy update. Current opinion in psychiatry, 19(2), 135-139. will be helpful in the clinical practice. Addington J, Penn D, Woods SW, Addington D, Perkins DO (2008). Facial affect recognition in individuals at clinical high risk for Key Word: Functionality, rehabilitation, schizophrenia psychosis. The British Journal of Psychiatry, 192(1), 67-68. References Arslan M, Kurt E,Eryıldız D (2014) Effects of a psychosocial rehabilitation program in addition to medication in schizophrenic patients: PP-088 a controlled study. Bulletın Of Clınıcal Psychopharmacology 24:4;360-7. Ulusoy S, Delice MA (2015). The Role of Individual Assessment on BY MATERNAL Increasing the Functionality of a Person with Schizophrenia. INVOLVEMENT: CASE PRESENTATION Dusunen Adam, 28(2), 162. Turan Ayidaga1, Halise Devrimci Özgüven1, Seda Topçu2, Zeynep Işıklar2, Betül Ulukol2 1Ankara University Medical School, Mental Health and Diseases PP-087 Department, Ankara 2Ankara University Medical School Hospital Childrens’ Health and EVALUATION OF THE CORTICAL ACTIVITY OF Diseases Department, Ankara SCHIZOPHRENIA PATIENTS WHILE PERCEIVING AIM: Factitious disorder (FD) of the caregivers is characterized with FACIAL EXPRESSIONS DETERMINED BY NEAR the triad of simulation of disease, pathological lying and going around INFRARED SPECTROSCOPY hospitals for someone under their care with the primary motive of gaining Emrah Abdullayev1, Bora Başkak1, Işıl Karaboğa1, attention or sympathy from others. FD is a rarely observed and hard to Yasemin Hoşgören Alıcı1, Nilay Sedes1, Zeynel Baran2, diagnose exploitative behavior, and can be lethal. The predicted annual incidence of FD for the under 16s is 0.4/100.000; and for the infants Halise Devrimci Özgüven1 under 1, it is 2/100.000, with maternal involvement in 94-99% of the 1Ankara University Medical School, Mental Health and Diseases cases; and the outcomes of mortality being 6-9% and lasting damage Department, Ankara being 7.3%. Diagnosis is possible by a suspicious and multidisciplinary 2Hacettepe University, Psychology Division, Ankara approach to every case. The aim of this case presentation is to report a AIM: The aim of this study has been to compare the activity of the rarely met case together with the difficulties involved in the diagnostic prefrontal cortex (PFC) during a task of recognizing facial emotion process, and the belief that it will be an example to remember for the between 24 schizophrenia patients in remission and 24 healthy controls. sake of future cases. METHODS: The task of recognizing facial emotion expression was CASE: The 37-year old primary school graduate patient, married and prepared by using a standard battery of tests proven to measure the task mother of a 4.5-year old boy who had been hospitalized with repeating effectively and the prefrontal cortical activity was measured and recorded hypoglycemic attacks and had stayed three times in hospital for a total at 24 points by functional near infrared spectroscopy (FNIRS) method. of 69 days without improvement. In the last admission to hospital, the Facial expressions not expressing emotion have been controlled. The child had been taken away from the mother to the intensive care unit relationship of the brain PFC activity with the symptom levels were when the hypoglycemic attacks ceased immediately. The laboratory test POSTER PRESENTATIONS assessed by the Positive and Negative Symptoms Scale (PANSS = PSS showed low C-peptide levels indicating the insulin in his circulation and NSS), and its effects on mind theory by the Implicit-Association was not due to endogenous hyperinsulinemia but to exogenous insulin. Test (IAT), the Faux pas test (FT) and on functionality by Personal and Investigation of the mother’s medical records showed acquisition of Social Performance Scale (PSP) scale. reports and prescriptions in 2009, 2012 and 2013 for Diabetes Mellitus RESULTS: Under non- affective conditions and conditions not (DM) and for insulin. Laboratory tests and examination of the mother related to recognizing basic feelings, the patient group (PG) showed did not confirm a diagnosis of DM. After detailed interviews the a higher PFC activity in comparison to the control group (CG). The mother admitted to having injected her son with insulin in all episodes PFC activity difference in affective and non-affective conditions in of hospital stay, thus confirming the diagnosis of FD. the CG was not observed in the PG. This finding suggests that during DISCUSSION: The mother’s history included having been abandoned the determination of affective or non-affective facial changes either by her father before her birth; having endured childhood traumas the PG need more PFC resource than the CG, or the CG can shut of physical abuse and neglect, hospital consultations with somatic down the PFC activity during recognizing facial emotion which the PG complaints and having lost newborns 6 times due to premature birth have problems in doing the same. Also, the right-front PFC activity before the birth of her son. She was diagnosed with passive aggressive related to negative affect was found related to the PSS subscale delusion; personality disorder and Munchausen syndrome by proxy. the right-rear PFC activity was found related to the PSS subscale odd behavior, and the left front PFC activity was found related to the NSS Keywords: Child abuse, factitious disorder, Munchausen by proxy subscale avolition total scores. The left rear PFC activity was related to References the ability to understand faux pas. Therefore, the increased PFC activity Fulton DR (2000) Early recognition of Munchausen Syndrome by in evaluating facial expressions in schizophrenia may be playing a role in Proxy. Crti Care Nurs Q 23:35-42. the positive symptoms and social cognitive impairment. Meadow R (1977) Munchausen syndrome by proxy: The hinterland of Keywords: Near infrared, schizophrenic disorders, spectroscopy child abuse. The Lancet 2:243-5.

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THE SOCIOMETRIC STRUCTURE OF THE QUALITY OF LIFE IN PATIENTS WITH FAMILIAL PARENTAL REFLECTIVE FUNCTIONING MEDITERRANEAN FEVER AND THEIR CLOSE QUESTIONNAIRE IN EARLY CHILDHOOD IN RELATIVES. TURKISH POPULATION Semra Ulusoy Kaymak1, Mustafa Uğurlu1, Görkem Karakaş Deniz Hazal Karabulut, Ali Oğulcan İlhan, Asiye Kumru, Uğurlu2, Serdar Süleyman Can2, Murat İlhan Atagün2, Gizem Arıkan Ali Çayköylü2 Özyeğin University, Psychology Division, İstanbul 1Atatürk Training and Research Hospital, Psychiatry Clinic, Ankara, Ankara AIM: Parental reflective functioning is described as the capacity of 2Yıldırım Beyazıt University Medical School Psychiatry Department, parents to think about their own and their children’s psychological Ankara condition. In early childhood, the reflective functioning of the mother and the mothering behavior affects the regulation of the stress involved AIM: Familial Mediterranean Fever (FMF), observed in certain in childcare. The aim of this study is to test the validity and reliability populations, is a hereditary disease with a course involving periodic of the Parental Reflective Functioning Questionnaire (PRFQ) in the fever, abdominal and chest pains and vomiting. Attacks can last 24-48 Turkish population within the scope of the TÜBİTAK 3501 Career hours and can be very severe. As compared to the healthy population, Project (Project No: 114K813). lower quality of life of FMF patients has been known. It has been METHOD: The study was carried out with 251 mothers of low aimed here to compare the life quality of the patients with that of their socio-economic status. The participants, with a mean age of 31 (± relations who share the same environment and the difficulties of severe 5.05) years were asked to complete psychometric tests to assess their attacks with them. mothering capacity. The factor structure of the PRFQ was analyzed by METHODS: The study included 20 FMF patients who needed the the principal component analysis and the confirmatory factor analysis help of their relatives on account of the symptoms of the attacks and on the STATA data analysis and statistical software (Stata Corporation, the persons who gave care to them during the attacks. The participants 2015). The models, model fit indices (CFI, RMSEA, SRMR) and the were conducted on the SCID, and completed a sociodemographic statistically significant differences of the models from one another were questionnaire, the Short Form Health Survey- (SF-36) and the Life analyzed by the likelihood-ratio test using the Chi-square distribution. Events Inventory (LEI.) For reliability, the Cronbach alpha coefficients were investigated. RESULTS: Mean age of the patients was 34,67 (± 13.55) years, most RESULTS: In the first application, a 3-factor structure with an Eigen were married women. Mean age of the relations of the patients was value above 1, and explaining 37% of the variance was found. On the 49.88 (± 10.90) years. The mean score on the LEI was 8 (± 5,96) for the Scree plot 3 elbows were observed. Pre-mentalizing, nonmentalising, patient group and 5.43 (± 5.65) (p: 0.338) for the patients’ relations. malevolent attributions, certainty about the child’s mental states, interest and curiosity in child’s mental states were loaded on the DISCUSSION: While the scores of the patient group on the primarily original scale. Only the 27th item was different from the original FMF related SF-36 subscales on physical functioning, bodily pain, scale. It was observed that the results of the first analysis made (Model general health perceptions, vitality and physical summary showed lower 1-measurement model) needed to be improved (χ2(321) = 838.30, CFI quality of life than their relations, the relations, although not afflicted =.75, RMSEA =.08, SRMR =.10). The values of the modification index with FMF, reflected a low quality of life similarly to the patients as were investigated and 3 models were tested. When analyzed with the indicated from their scoring on the physical role functioning, social 2 likelihood ratio (LRχ (1) = 29.50, p<.001), Model 3 was seen to be role functioning, emotional role functioning, mental health and mental better than Model 2. (χ2 (319) = 770.29, CFI =.77, RMSEA =.07,

POSTER PRESENTATIONS summary, which also were low in comparison to the general Turkish SRMR =.09). The Cronbach alpha coefficient for pre-mentalizing, population (Table 1). nonmentalising, malevolent attributions was = 0.76; for certainty about the child’s mental states (CMS was=0.86 and for Interest and curiosity Keywords: Caregiver, Mediterranean fever, quality of life in child’s mental states was =0.75. Comparison of the parameters of quality of life in FMF patients DISCUSSION: The scale with similarity to the original consisted of 3 and their relations subscales and it was able to estimate in Turkish mothers with 12to36- month old babies the maternal capacity for thinking on their own and Patients Relation of the Patients their offspring’s psychological conditions. Only the 27th item loaded was different from the original, 12 low level items were removed. mean sd mean sd p Keywords: Early childhood, low socioeconomic status, parental Physical function 62,7778 27,625 100,00 27,6259 0.089 reflective functioning, scale Physical Role functioning 33,3333 39,5284 100,00 39,5284 0.317

References Bodily pain 37,7500 23,0201 100,00 23,0201 0.045

Kelly K, Slade A, Grienenberger, JF (2005). Maternal reflective General Health perceptions 26,2500 14,5773 100,00 14,5773 0.001 functioning, mother–infant affective communication, and infant Vitality 0.031 attachment: Exploring the link between mental states and observed 25,0000 19,0862 70,00 19,0862 caregiving behavior in the intergenerational transmission of Social role functioning 47,2222 32,3420 100,00 32,3420 0.238

attachment. Attachment & Human Development, 7(3), 299-311. Emotional role functioning 37,0333 48,4325 100,00 48,4325 0.096 Rutherford HJ, Goldberg B, Luyten P, Bridgett DJ, Mayes, LC Mental health 0.323 (2013). Parental reflective functioning is associated with tolerance 36,5000 15,0333 88,00 15,0333 of infant distress but not general distress: Evidence for a specific Physical summary score 36,4500 7,49037 55,20 7,49037 0.002 relationship using a simulated baby paradigm. Infant Behavior and Mental summary score 32,4375 12,7186 57,50 12,7186 0.105 Development, 36(4), 635-641.

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COGNITIVE FUNCTIONS AND VASCULAR RISK SOCIOMETRIC CHARACTERISTICS ON TURKISH FACTORS IN OLD AGE DEPRESSION POPULATION SAMPLE OF THE EARLY CHILDHOOD CHILD INTENTIONALITY SCALE Ceren Bingolo1, Gülfizar Sözeri Varma2, Yaşar Enli3, Özge Karaca2 Deniz Hazal Karabulut, Ali Oğulcan İlhan, Asiye Kumru, 1Sirnak State Hospital, Sirnak Gizem Arıkan 2Pamukkale University, Psychiatry Department, Denizli Özyegin University, Psychology Department, İstanbul 3Pamukkale University Medical School Biochemistry Deparment, Denizli AIM: Maternal characteristic of interpreting the behavior of the child, AIM: First onset depression at old age accompanied with impairment of termed as child intentionality (e.g.: my child does not eat because he executive functions, and somatic complaints, does not like me) play a role in mother-child interaction and affect not necessarily associated with familial depression, has been described factors such as maternal sensitivity. Maternal perceptions on child as ‘’vascular depression’’ (VD). It has been proposed that VD etiology intentionality change over the course of . The aim is related to vascular risk factors and the ischemic changes in the brain. of this study was to prepare the Turkish version of the Early childhood This study has aimed at investigating cognitive functions at old age and Child Intentionality Scale and to test its validity and reliability within their relation to vascular risk factors. the scope of the TÜBİTAK 3501 Career Project (Project No: 114K813. METHODS: The study was carried out with 40 patients over METHODS: The study was carried out with 251 mothers of low socio- the age of 60 years and diagnosed with major depression disorder economic status. The participants, with a mean age of 31 (± 5.05) years (MDD) and 40 healthy individuals as the control group (CG). Data were asked to complete psychometric tests to assess their mothering on all participants were gathered from the SCID-I, the Hamilton capacity. The factor structure was analyzed by the principal component Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale analysis and the confirmatory factor analysis on the STATA data analysis (HAM-A), Montgomery–Asberg Depression Rating Scale (MADRS), and statistical software (Stata Corporation, 2015). The models, model the Standardized Mini Mental Test (SMMT), the Montreal Cognitive fit indices (CFI, RMSEA, and SRMR) and the statistically significant Assessment (MoCA), and the Apathy Rating Scale (LARS). General differences of the models from one another were analyzed by the Cardiovascular Risk Scoring (GCRS) was carried out and the blood likelihood-ratio test using the Chi-square distribution. For reliability, homocysteine, cholesterol, HDL, T3, T4, TSH, vitamin B12 and folic the Cronbach alpha coefficients were investigated. acid levels were estimated. RESULTS: Considering the results in the first application with Eigen RESULTS: In the MDD group, the HAM-D, HAM-A MADRS and value above 1, and the Scree plot elbows, 2 and 3-factor analyses LARS scores were found to be higher than those of the CG, whereas were carried out. Item distribution in the 2-factor model was found the SMMT and the MoCA scores were lower than in the CG. The to be in better agreement with theory and the original scale and the MD group displayed impairment especially in orientation, visio-spatial subsequent analyses were carried out with the 2-factor solution which functions, and memory and language areas. Inter group differences explained 42% of the variance. The factors were: as the caregiver child in the GCRS parameters and serum homocysteine levels were not and maternal helplessness, and mother-child fear. The tested Model observed. A relationship between the cardiovascular risk factors and 1 required improvement of the results (χ2 (134) = 353.32, CFI =.85, the cognitive functions could not also be found in the MDD group. RMSEA =.08, SRMR =.06). The values of the modification index were However, a negative correlation between the LARS score and the scores investigated and 4 models were tested. Model 4 was not statistically on SMMT and MoCA were determined. Also, a negative correlation superior to Model 3 (LRχ2(1) =2.36, p=.125), and Model 3 was accepted was observed between the serum homocysteine levels and the SMMT as the last model (χ2 (132) = 270.51, CFI =.90, RMSEA =.06, SRMR scoring in the CG. =.06). The Cronbach alpha coefficient was 0.62 for the subscale as the POSTER PRESENTATIONS DISCUSSION: In this study, diminished cognitive functions, care giver the child, and was 0.84 for the subscale maternal helplessness especially associated with orientation, visuospatial functions, memory and child-mother fear. and language use were determined in the old age depression patients, DISCUSSION: It has been determined that while child-mother was in agreement with the reports in the literature. But the results did not used as a separate factor in the original scale, mothers with 12 to36- support the proposals that a relationship existed between these losses month old babies in the population with low economical status in and the serum cardiovascular risk markers such as homocysteine. Turkey, this factor appeared to be part of the maternal helplessness Keywords: Depression, cognitive function scales, homocysteine, old factor. Only 2 factors have been excluded on grounds of loading. age, vascular depression Keywords: Early childhood, child intentionality, low socio-economic References status, scale Koenig AM et al. (2015) Neuropsychological functioning in the acute References and remitted states of late-life depression. J Alzheimers Dis. 45:175- Feldman R, Reznick, JS (1996). Maternal perception of infant 85. intentionality at 4 and 8 months. Infant Behavior and Development, Paranthaman R, Burns AS, Cruickshank JK, Jackson A, Scott ML, 19(4), 483-496. Baldwin RC (2012) Age at onset and vascular pathology in late-life Zeedyk MS (1997) Maternal interpretations of infant intentionality: depression. Am J Geriatr Psychiatry. 20:524-32. Changes over the course of infant development. British journal of developmental psychology, 15(4), 477-493.

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IS IT A LIMITED INTEREST PATTERN ON MEDICO-LEGAL PSYCHIATRIC ASSESSMENT OF A CHILDHOOD PORNOGRAPHY OR IS IT CASE OF EXHIBITIONISM– CASE PRESENTATION PEDOPHILIA?: CASE PRESENTATION Uğur Cıkırıkcılı1, Barış Sancak2, Emine Füsun Özdemir3, Armağan Aral, Gökçe Nur Say Ahmet Türkcan3 Ondokuz Mayıs University, Child and Adolescent Mental Health and 1İstanbul University, İstanbul Medical School, Psychiatry Department, Diseases Department, Samsun İstanbul 2Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological AIM: Autism spectrum disorder (ASD) describes a range of conditions Diseases and Research Hospital, İstanbul classified as neurodevelopmental disorders and encompasses the Asperger 3Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Syndrome (AS). Children with AS can display in public behaviors such Diseases and Research Hospital, Legal Psychiatry Unit, İstanbul as masturbation, inappropriate touching, obsessions with sexual stimuli, fetishism, kissing aliens, sexual violence and intense preoccupation with AIM: Exhibitionism is a rarely seen paraphilic disorder that can lead to pornography. Curiosity and obsession of children with AS cause them serious social and legal outcomes and needs to be carefully evaluated and to download and watch pornographic material and they can be affected treated. Often cases are held under police custody and legal psychiatry on account of being pedophilic and come face to face with the legal reports are requested for criminal responsibility. This report has aimed penal system. There are reports on the possible pedophilic inclinations on contributing to the literature by discussing a case of exhibitionism. of ASD diagnosed children. We wanted to draw attention to the subject CASE: The patient, known to have 2 previous legal files on him; by presenting the case discussed here. familial and social problems for a long time, had been referred by court CASE: The case was a 15-year old adolescent girl brought to our clinic to Bakırköy Mental Health and Neurological Diseases Hospital, Legal as a legal case for assessment if she was ‘non compos mentis’. She was Psychiatry Clinic to be assessed for ‘’criminal responsibility’’ on grounds using child pornography, keeping it in her computer and sharing it in of ‘’Indecent behavior and sexual abuse of 2 female children’’. the social media. According to the explanations of her history, she talked Psychiatric examination indicated that the patient’s thought contents on Facebook with someone she did not know personally about naked contained evocations of masturbation need from time to time. Projective people, photographs of naked children and especially about famous tests revealed increased sexual descriptions and mental preoccupation, children. When the other person had asked to see the photographs, she difficulty of impulse control, avoidance of emotional expressions, had downloaded them on her computer and sent them. She had been characteristics of passivity and shyness, with normal perception of previously followed up at our polyclinic with AS and major depression reality. diagnoses. It was learned she collected from the internet material about famous children and watched baby bathing videos. During her DISCUSSION: Although predominantly associated with males, interview, she stated that for a few months she had been looking up exhibitionism is also seen in females. It has been proposed that and searching in the internet material about famous children whose exhibitionistic behavior especially at childhood aims to attract parental luxurious life style and nakedness aroused curiosity, and that she did not attention. Exhibitionist are quite shy individuals with low self- feel sexually aroused when watching this material. After the interview, confidence. the report prepared stated that the activity of the patient was understood As the behavior is repetitive, social, psychiatric and legal involvements to be related to AS and her lack of realization and distinction of the are frequent. While 6 members of the health assessment committee had legal aspect and the results of the activity, and that she did not have the decided in favor of diminished legal responsibility, 2 had opposed this. capacity to regulate her behavior. Majority decision was given on the basis of the difficulty in impeding

POSTER PRESENTATIONS DISCUSSION: There are insufficient publications on pedophilia and the misbehavior despite the past legal cases and the continuation of in ASD. In the literature ASD and criminal behavior were impairment in interpersonal functionality. In these types of cases discussed in relation to limited areas of interest, the deficits of social decision making in legal psychiatry is often complicated and demands interaction and the inadequacies of the jurisdiction. Children with AS careful investigation of each case individually. do not have ability to judge the outcomes of their behavior and lack Keywords: Criminal responsibility, exhibitionism, legal psychiatry capacity for empathy. Child psychiatry experts have to evaluate very carefully the criminal responsibility of children with AS. When coming References to a decision on the subject, the sexual development of the child, the JP. Czerny, P. Briken, W. Berner (2002) Antihormonal treatment of motivation behind the observed behavior and the level of social-sexual paraphilic patients in German forensic psychiatric clinics, Eur knowledge and the limited areas of interest must be taken into account. Psychiatry 17: 104-6 Keywords: Autism, legal psychiatry, pedophilia References Chesterman P, Rutter SC (1993) Case report: Asperger’s syndrome and sexual offending. The Journal of Forensic Psychiatry, 4(3): p. 555- 562.

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SOCIODEMOGRAPHIC – CLINICAL INVESTIGATION OF THE INTERRELATIONSHIPS CHARACTERISTICS OF THE FIRST-TIME OF ANXIETY, DEPRESSION AND ANGER IN MIXED CONSULTING PATIENTS WITH ANXIETY AND ANXIETY-DEPRESSION DISORDER: A PRELIMINARY DEPRESSION SYMPTOMS AND THE FACTORS STUDY INFLUENCING THE INCIDENCE OF TREATMENT 1 NONCOMPLIANCE Mustafa Uğurlu , Görkem Karakaş Uğurlu, Semra Ulusoy Kaymak1, Ali Çayköylü2 Mustafa Uğurlu1, Görkem Karakaş Uğurlu, Semra Ulusoy 1Ankara Atatürk Training and Research Hospital, Psychiatry Clinic, Kaymak1, Ali Çayköylü2 Ankara 1Ankara Atatürk Training and Research Hospital, Psychiatry Clinic, 2Yıldırım Beyazıt University, Faculty of Medicine, Psychiatry Department, Ankara Ankara 2Yıldırım Beyazıt University, Faculty of Medicine, Psychiatry Department, AIM: Mixed anxiety-depression disorder (MADD) is a diagnostic Ankara category included in the International Classification of Disorders (ICD- AIM: Psychiatric disorders are generally progressive. Therefore, two of 10) under the heading of “Other Anxiety Disorders’’. The symptoms the most significant factors influencing the course and the outcome of of anxiety and depression in MADD are subthreshold for diagnosis, the disorders and, hence, treatment compliance, are correct diagnosis and it is a different clinical condition despite involving a liability to and appropriate therapeutic relationship formed with the patient at develop major depressive disorder and anxiety disorders. Significant first consultation. The aims of this study have been to investigate the relationships have been demonstrated between anger and symptoms of sociodemographic and clinical details of the first-time consulting patients mental disorders. This preliminary study has aimed at investigating the with anxiety and depression symptoms and the effects of these details on interrelationships of anxiety, depression and anger in (MADD). patient attendance to the scheduled first time follow up controls. METHODS: The study enrolled outpatients at the psychiatry METHODS: The patients participating in this study were asked polyclinics with subthreshold symptoms of depression or anxiety. to complete the Beck depression inventory (BDI), the Beck These patients were asked to complete the Beck depression inventory anxiety inventory (BAI) and the Quality of Life Assessment (QLA) (BDI) the Beck anxiety inventory (BAI) and the State Trait Anger Scale questionnaire. The patients coming for control 3 months after the date (STAS). of the first consultation were evaluated. METHODS: Mean age of the participants was 31.4 (±10.3) years, and RESULTS: Diagnoses made at the first consultation with the their BAI and BDI scores were, respectively, 26,3±14.2 and 24±11.9. participating patients consisted general anxiety disorder (36.8%), Upward BAI scores negatively correlated with the STAS subscale depression (21%) and adjustment disorders (17.2%); and treatment ‘controlled anger’ (β = -0.46, p < 0.05), and the upward BDI scores with selective serotonin or norepinephrine reuptake inhibitors (SSRI, positively correlated with the scores on STAS subscales Expressed Anger SNRI)) had been started on 61.6% of the patients of whom 47% came (β = 0.44, p < 0.05) and ‘the trait of anger’ (β = 0.49, p < 0.05). back for the first follow up control after a period of 31.1 ± 30.2 days. The BAI and BDI scores were, respectively, 26.5±14.7 and 26.4±12.2. DISCUSSION: The results of this study have shown that increased Comparisons of those who attended first control and those who did anxiety made it difficult to control anger, while increased depression was on the bases of marital status and the QLA scores gave statistically related to increased anger and facilitated the extraversion of anger. The significant differences (p < 0.05). Logistic regression analyses indicated difference between these observations can be likened to the difference that the factors significantly influencing attendance to follow up between urinary urgency incontinence (inability to hold back even the controls consisted of starting therapy with SSRI or SNRI (β = 4.525, p overflow incontinence

slightest anger when anxiety level is increased) and POSTER PRESENTATIONS = 0.013), the scores on the Physical Health (β = 0.939, p = 0.004) and (accumulation of anger during depression period and its overflow). In Independence (β = 1.065, p = 0.008) subscales of the QLA. 30-40% of patients with depression have anger attacks the severity of which are twice as high as the anger seen in patients with severe anxiety DISCUSSION: The results of this study are in agreement with those of Gulec et al.,2011), also carried out in Turkey. Starting treatment with disorder. SSRI or SNRI increased 4.5 fold of the incidence of attending follow Keywords: Anger, anxiety, depression up controls as compared to those cases followed without drug therapy and the others treated with antidepressants. While 1 unit increase in the References score on QLA subscale Independence showed a 6% increase in follow up Fava M, Rosenbaum JF (1999) Anger attacks in patients with depression. control attendance, 1 point increase on the QLA on ‘feeling physically The Journal of clinical psychiatry. 60(suppl 15):21-4. well’ lead to 6% decrease in the attendance which can be attributed to Kaya B, Ünal S (2001) Karma anksiyete ve depresyon bozukluğu. the thoughts of the patients about not needing to be followed up on (Mixed anxiety and depression disorder) Psikiyatri Dünyası. 5:80-8. account of feeling in good health. Keywords: Control, psychiatry polyclinics, treatment compliance References Strauss JS, Kokes RF, Ritzler BA, Harder DW, Van ORDA (1978) Patterns of disorder in first admission psychiatric patients. The Journal of nervous and mental disease. 166(9):611-23. Gulec G, Yenilmez C, Ay F (2011) Bir Anadolu Şehrinde Psikiyatri Kliniğine başvuran hastaların hastalık açıklama ve çare arama davranışları. (Disclosing details of illness and help seeking behaviour of patients consulting a psychiatry clinic in an Anatolian town). Klinik Psikiyatri Dergisi. 14(3):131-42.

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EVALUATION OF PATHOLOGICAL JEALOUSY WITH EFFECTS OF POLYPHARMACY, SLEEP AND THE A COURSE OF COMPULSIVE SEXUAL COUPLING PSYCHOPATHOLOGIES OF FAMILY MEMBERS WITHIN THE SPECTRUM OF OBSESSIVE- ON THE SYMPTOMS AND THE TREATMENT COMPULSIVE DISORDERS: CASE PRESENTATION OUTCOMES OF A CASE OF MENTAL RETARDATION WITH BEHAVIORAL DISORDERS. Görkem Karakaş Uğurlu1, Mustafa Uğurlu2, Semra Ulusoy 1 2 Kaymak2, Ali Çayköylü1 Mustafa Uğurlu , Görkem Karakaş Uğurlu , Semra Ulusoy 1 2 1 Yıldırım Beyazıt University, Faculty of Medicine, Psychiatry Kaymak , Ali Çayköylü 1 Department, Ankara Ankara Atatürk Training and Research Hospital, Psychiatry Clinic, 2Ankara Atatürk Training and Research Hospital, Psychiatry Clinic, Ankara 2 Ankara Yıldırım Beyazıt University, Faculty of Medicine, Psychiatry Department, Ankara AIM: Jealousy is a negative emotional attitude developed against an AIM: Consulting psychiatry polyclinics or services with complaints imagined rival, the real loss of a valued relationship or the threat of of mental retardation and various psychiatric symptomatology is very it. When it exceeds the accepted norms of a particular population or frequent events and there are a multitude of different influencing culture, it is identified as pathological jealousy (PJ). Given its intrusive factors, including medications, in the appearance and the continuity nature and the presence of extreme control and security seeking of the symptoms. In this report, it has been aimed to present a case behavior, it has been considered as being one of the ‘’, illustrating these factors and their appropriate treatment. and thus can be evaluated among the obsessive-compulsive spectrum disorders (OCSD). CASE: Mr.A., the 25-year old male patient, with previous diagnoses of cerebral palsy, mild-moderate mental retardation and epilepsy, CASE: Mr. A., the 46-year old male laborer, married for 17 years, was brought in wheel chair by his relations to our polyclinics with consulted the clinic with the complaint of extreme jealousy that he the complaints of unwillingness to attend physical rehabilitation had experienced for the previous 10 years. Severity of his complaints programs, refusal to attend previously joined activities, inability to increased with the development of marital problems. He had daylong make adjustment, loss of appetite, sudden anger explosions he could suspicions over the loyalty of his wife, complicated with concentrated not interpret and sleep irregularities. It was learned that he had had thoughts and images. In order to discard these preoccupations, he behavioral problems since the age of 15 and had been under a variety telephoned his wife frequently, went back home from work under of psychiatric treatments. At the time of this consultation he was on many pretenses and excuses, searched his wife’s telephone and personal paliperidone palmitate (100 mg/month), clomipramine (2 mg/day), belongings. He did realize the excessiveness of these behaviors with carbamazepine (300 mg/day), risperidone (5 mg/day), escitalopram feelings of remorse and guilt. However, over the previous 3 months, the (10 mg/day) and quetiapine (400 mg/day) which was reprogrammed controls he made at home were not adequate to satisfy him such that as paliperidone palmitate (100 mg/month), clomipramine (1 mg/day), carbamazepine (300 mg/day) and quetiapine (350 mg/day). His father practically every day he experienced forced sexual coupling with his wife Mr. Z. was interviewed and started on Sertraline (50 mg/day). Mr A. despite lack of an appropriate arousal. On days without this coupling responded significantly favorably to the cut down of drugs, the dose his worries were deepened causing extreme uneasiness. His measured and time adjustments of his new pharmacotherapy and provision of psychometric scores were 36 on the Beck anxiety inventory (BAI), 16 sleep hygiene. on the Beck depression inventory) and 37 on the Yale-Brown Obsessive- DISCUSSION: Patients with mental retardation are usually ‘over

POSTER PRESENTATIONS Compulsive Scale (YBOCS). He was treated with escitalopram (10 mg/ day) and conducted through cognitive behavioral therapy (CBT) as well treated’ and the drugs used generally violate the current guideline rules. as being referred to a family consultant. In his third follow up control at The holistic approach by reorganizing the appropriate dose and timing the end of 9 weeks, his BAI, BDI and YBOCS scores were, respectively, of drug therapy, sleep hygiene and attendance to the mental problems 21, 9 and 26. of the family members and the psychoeducation of his family results in good response from the patients and their families with improvement DISCUSSION: This case differs from similar PJ cases on account of the in the quality of life. symptoms of compulsive sexual coupling and is closer to the OCSD in Keywords: Family, polypharmacy, psychoeducation, sleep character. ‘’Compulsive sexual coupling’’ appears to be distinct from the impulse control disorders, sexual behavior disorders or dependence that come under ‘’impulsive-compulsive sexual behaviors’’ described in the literature. The positive response to escitalopram and CBT, is in favor of PP-099 the evaluation of this case under OCSD. COMORBIDITY OF ACROMEGALY AND Keywords: Compulsive sexual coupling, pathological jealousy, DISSOCIATIVE PERSONALITY DISORDER: CASE Obsessive compulsive spectrum PRESENTATION References DeSteno D, Valdesolo P, Bartlett MY (2006) Jealousy and the threatened Sevilay Künt, Pınar Çetinay Aydın, Ekin Dağıstan, Nalan self: getting to the heart of the green-eyed monster. J Pers Soc Öztürk, Nazan Aydın Psychol. 91(4):626-41. Bakırköy Prof Dr. Mazhar Osman Mental Health and Neurological Diseases and Research Hospital, İstanbul Marazziti D, Di Nasso E, Masala I, Baroni S, Abelli M, Mengali F, Mungai F, Rucci P (2003) Normal and obsessional jealousy: a study AIM: Dissociative personality disorder (DPD) is a psychiatric disorder of a population of young adults. Eur Psychiatry. 18(3):106-11.. characterized by the presence of more than one personality in the same

116 individual with short or long-term domination of the life of the afflicted incontinence. She did not have a previous psychiatric consultation. Her individual, with lack of knowledge of the existence and unawareness of history included complaints over the previous 5-6 months of grandiose the actions of one another by these personalities. The DPD patient does and persecutory delusions, and auditory and visual hallucinations. not complain to the physician directly on the basic personality or memory She had had a medical abortion at the 17th week of pregnancy due problems. Symptoms become apparent indirectly or secondarily to other to intrauterine death after which she had been referred to psychiatry syndromes, complications and comorbidities or acute crises resulting in services for her psychiatric symptoms. She was started on risperidone, psychiatric assessment of DPD. Hence the variety in the complaints but on the 3rd day of the treatment her general condition deteriorated, should emphasize the importance of remembering this disorder. This and she was admitted to the internal diseases service for supportive report presents the case of a patient with diagnosis of acromegaly, who therapy when she developed papillary edema and loss of visual acuity. consulted with dissociative symptoms and was diagnosed with DPD. During her 1-month hospital stay, a neurological basis of her complaints could not be determined. For a period of time she also had fever, CASE: The 37-year old female, primary school graduate patient, married leukocytosis and increased serum CK level. Upon request for psychiatric with 1 child had a 16-and year history of acromegaly diagnosis and was consultation she was examined, and was found to have stupor, mutism, on treatment with hydrocortisone (10mg/day) and levothyroxine (10 waxy flexibility, posture taking and dysphagia. She was diagnosed with mg/day). Her first psychiatric consultation was after losing consciousness post NMS catatonia and 12 sessions of electroconvulsive therapy (ECT) for a few minutes during the funeral of his uncle when she had been were carried out. Her response was good and she was discharged with brought to the emergency service. She did not remember the event, and clozapine (200mg/day) maintenance therapy. She has maintained her it as learned that she had amnesia on odd behaviors, 2-3 times a week wellbeing for 12 months without any motor or psychiatric symptoms. and lasting 3-4 minutes, including attempts to jump out of the window, to burn her clothing with cigarette butts or other source of fire, and to DISCUSSION: Catatonia is a rare condition that can develop with stab her relations with a knife. She was diagnosed with DPD. primary affective or psychotic disorders. It should be remembered that catatonia can develop with different medical conditions and with NMS DISCUSSION: There are case reports of acromegaly comorbid with as shown in the case reported here. psychotic disorder, depression and anxiety disorders in the literature. Although the psychiatric observations have not been etiologically related Keywords: Antipsychotics, catatonia, neuroleptic malign syndrome to acromegaly, its presence should be kept in mind given the risks of psychiatric flare ups due to hormone replacements, and the effects of social difficulties caused by acromegaly on the prognosis of the disease. PP-101 In the case discussed here, although the dissociative observations and the diagnosis of acromegaly did not take place at the same time, the traumatic experiences due to symptoms of acromegaly had importance. THIOL-DISULPHIDE HAEMOSTASIS AND THE PROBABILITY OF SUICIDAL ATTEMPT IN Keywords: Acromegaly, dissociation, trauma DEPRESSION: PRELIMINARY RESULTS References 1 2 Sar V et al. (1997) Dissosiyatif Kimlik Bozukluğu: Tanı ve Nozolojik Mustafa Uğurlu , Görkem Karakaş Uğurlu , Şükrü Alperen 2 2 2 Sorunlar. Dissosiyatif Yaşantılar Ölçeğinin (DES-II) geçerlik ve Korkmaz , Sümeyye İslamoğlu , Çağlar Soykan , güvenilirliği. (Dissociative personality disorder: Diagnosis and Semra Ulusoy Kaymak1, Tuncer Kılıç2, Mehmet Uğurlu2, nosological problems. Validity and reliability of the Dissociative Ali Çayköylü2 Experiences Scale -DES-II) 33. Ulusal Psikiyatri Kongresi Bildiri 1Ankara Atatürk Training and Research Hospital Psychiatry Clinic, Kitabı. s.55-64, Ankara. Ankara Sar, V (2004) Disosiyatif Kimlik Bozukluğu: Çocukluk Çağı Ruhsal 2Yıldırım Beyazıt University, Psychiatry Department, Ankara

Travmaları İle İlişkili Bir Psikopatoloji. İstanbul POSTER PRESENTATIONS AIM: One of the focal points of the studies on the aetiopathogenesis of psychiatric disorders is the subject of oxidative stress and the underlying mechanisms. Although studies on depression have demonstrated PP-100 the importance of the role of oxidative mechanisms, the relationship between suicidal attempt and oxidative mechanisms has not been CATATONIA DEVELOPMENT DUE TO understood. The aim of this study has been to find out the relationship NEUROLEPTIC MALIGN SYNDROME: CASE between the thiol-disulphide levels, the novel biomarker for oxidative PRESENTATION mechnisms, and the severity of depression, impulsiveness and suicidal attempts. Aynur Nabi1, Aynur Görmez2, İsmet Kırpınar2 METHODS: The patients included in this study were selected on the 1Bezmialem Vakif University, Mental Health and Neurological Diseases basis of consulting psychiatry for the first attack or relapse of depression, Department, İstanbul not having used any psychotropic agents in the previous 6 months 2Medeniyet University, Mental Health and Neurological Diseases and not having been diagnosed with any medical comorbidity. The Department, İstanbul patients completed a sociodemographic questionnaire, the Hamilton AIM: Neuroleptic malign syndrome (NMS) is a life threatening depression rating scale (HAM-D), Barratt impulsiveness scale (BIS), complication that can develop at any stage of treatment with and the Suicide Probability Scale (SPS). Blood samples were collected antipsychotics and rarely with non-neuroleptics, generally during the for analysis of the thiol parameters. second week of the therapy, although the patient might have used the RESULTS: Mean age of the patients was 33 (±11.1), their total same agents previously without any complications. In this report a case psychometric test scores being 22.4±6.2 on HAM-D, 82.8±13.5 on SPS of NMS with catatonia development is discussed. and 64.6±9.7 on BIS. Mean total thiol level was found to be 516 (±57.2). CASE: The 38-year old female patient, married and mother of 3 Whereas a significant correlation between the thiol parameters and the children consulted the emergency service with acute urinary and fecal SPS scores of the first attack patient group was not demonstrable, a

117 moderate negative correlation was determined between disulphide levels for long term experience of vaginismus without seeking therapy. The and the SPS scores of the relapsed depression group. prevalence of vaginismus is 0.06% in all births, and although natural birth is expected to help the treatment of women with vaginismus, it is DISCUSSION: In our study a statistically significant relationship was not recommended before the treatment of vaginismus. not oberved between the thiol-disulphide parameters and the total scores on the HAM-D and BIS in patients presenting with the first Keywords: Labelling, pregnancy, vaginismus attack or relapsed depression. However, a moderate negative correlation References was determined in the relapsed depression patients between the thiol- Drenth J (1988) Vaginismus and the desire for a child. Journal of disulphide parameters and the SPS total score, without a similar Psychosomatic Obstetrics & Gynecology, 9(2):125-37. observation in the first depressive attack patients. In a study on the Goldsmith, Tomer et al., (2009) Vaginismus as an independent suicide phenomenon and oxidative mechanisms, lowered levels of NOx risk factor for cesarean delivery. The Journal of Maternal-Fetal & (nitrites/ nitrates), lipid hydroxyperoxides as an aspect of oxidative Neonatal Medicine, 22(10): 863-866. damage, and the total plasma antioxidant capacity (TPAC). Observation Rosenbaum TY, Padoa A (2012) Managing pregnancy and delivery in of a moderate negative correlation between disulphide levels and the women with sexual pain disorders (CME). The journal of sexual scores on SPS in this preliminary study may reflect a dysfunction in the medicine. 9(7):1726-35. oxidative system. Keywords: Depression, oxidative stress, suicide, thiol Erel O, Neselioglu SA (2014) Novel and automated assay for thiol/ PP-103 disulphide homeostasis. Clin Biochem, 47(18):326-32. Vargas, Heber Odebrecht. et al., (2013) Oxidative stress and lowered total antioxidant status are associated with a history of suicide SOCIAL ANXIETY DISORDER AND PSYCHOSIS LIKE attempts. Journal of affective disorders, 150(3): 923-930. SYMPTOMS: CASE PRESENTATION Yager S, Forlenza MJ, Miller GE (2010). Depression and oxidative Mustafa Tatlı damage to lipids. Psychoneuroendocrinology, 35(9): 1356-1362. Psychiatry Resident, Medikar Hospital, Karabük AIM: Anxiety on personal position in social hierarchy and adverse expriences in interpersonal relationships can in time combine and PP-102 lead to pathological anxiety; and in the severe condition, there may be symptoms of persecutory fears. In this report it has been aimed to EFFECTS OF VAGINISMUS AND LABELLING, evaluate in detail the differential diagnosis of social anxiety disorder SEXUALITY, PREGNANCY AND GIVING BIRTH (SAD) within the context of psychotic disorders and the effects of this ON THE MOTIVATION FOR TREATMENT: CASE evaluation on the approach to the treatment choice by presenting the PRESENTATION case of a patient. Görkem Karakaş Uğurlu1, Mustafa Uğurlu2, Semra Ulusoy CASE: T.A., the 21-year old male patient consulted our psychiatry Kaymak2, Ali Çayköylü1 polyclinics with the complaints of not being able to look people on the 1Yıldırım Beyazıt University Medical School, Psychiatry Department, face, and having sensations of somatic contractions and tremor when in Ankara a social gathering. History taking revealed that he had a 5-year history 2Atatürk Training and Research Hospital, Psychiatry Clinic, Ankara of psychiatric disorder and had been under follow up for the previous 5 months with the diagnosis of atypic pscychotic disorder and had to AIM: Vaginismus is the clinical condition involving involuntary be hospitalised. After his clinical and psychometric assessments, he was

POSTER PRESENTATIONS contractions of the vaginal muscles resulting from fear or anxiety diagnosed with primary social anxiety disorder. Secondarily to the social associated with vaginal penetration. Patients with vaginismus can anxiety symptoms he had to cope with, he was diagnosed with depressive become pregnant by either the ejaculate being on the vaginall opening mood disorder, and as to his general medical condition, he was also and the movement of the sperms towards the ovaries, or after self diagnosed with intermittent exotropia. He was started on escitalopram insemination by the woman. with also a dose decrease of his risperidone treatment. In his first follow CASE: Mrs. A., the 30-year old female lycée graduate, married up control it was noticed that his affect was euthymic, and that he had patient, consulted for the first time our sexual dysfunction polyclinics started forming eye contact and did not display psychotic symptoms. with complaints of not being able to have sexual intercourse with her He had become able to join social activities with reduced feelings of husband. She had anticipations of pain and associated anxious thoughts. social anxiety. In all the attempts she had exprienced painful vaginal and leg muscle DISCUSSION: Individuals starting to isolate themselves from the contractions. She had a history of 2 pregnancies without completed society and intraverting on account of SAD may foster thought contents intercouse and had given birth by cesarean section 3.5 and 6 years of perceiving the society as a source of threat, such that the social fears previously. The couple were still trying to have a complete intercouse. of the individual my appear as experiences of psychotic symptoms. The She had decided to seek treatment so as to end her marital problems due psychosis like symptoms oberved in SAD benefit from antidepressants to vaginismus, on the advice of the family members. as against treatment with antipsychotic agents. DISCUSSION: Since some couples can have satisfaction through Keywords: Anxiety, pychosis, social phobia sexuality without intercourse, the motivation for seeking treatment may be primarily the desire to have children. In about 74% of the patients with vaginismus, the motivation to seek treatment has been the desire for pregnancy. In the case discussed here, continuation of sexuality without intercourse, having overcome the impediment to pregnancy and giving birth, and the fear of getting labeled may have been the reasons

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THE ROYAL PATH TO OBESITY IN FOOD THERAPEUTIC STRATEGIES FOR TREATMENT DEPENDENCE: CASE PRESENTATION RESISTANCE SCHIZOPHRENIA ON CASES FOLLOWED AT ANKARA UNIVERSITY MEDICAL Ali Kandeğer1, Hasan Bozkurt2 1Selçuk University Medical School, Psychiatry Department, Konya SCHOOL, PSYCHIATRY CLINIC 2Gaziosmanpaşa University, Child and Adolescent Psychiatry Department, Melike Ezerbolat Özateş, Kazım Cihan Can, Tolgahan Tokat Tuncal, Oğuzhan Herdi, Ali Kemal Göğüş AIM: Food addiction has drawn attention with the world wide increase Ankara University, Psychiatry Department, Ankara in the prevalence of obesity and diabetes and the role of processed foods AIM: Although the treatment of the resistant schizophrenia is currently in daily life in the 21st century. Experiments with animals and imaging the subject of debate, clozapine has been accepted as the gold standard studies on the human brain have demonstrated behavioural and for treating such cases, although someonly respond partially and some neurobiological similarities between substance and food dependence. do not respond at all. Despite the trials with adjunctive treatment Chocholate, classified with the ideal pleasure giving substances with using various antipsychotic agents, the level of evidence has not been high fat and sugar content, especially craved for by females in the satisfactory. This study has aimed at describing the treatment given to western world, have been accepted as foods consumption of which is resistant schizophrenia patients at our clinic. difficult to prevent. We have aimed to present the case of a patient who consulted with serious symptoms of chocolate dependence. METHODS: Hospital files archived over the previous 1 month have been retrospectively scanned to reach the data on 42 patients put on CASE: The 13-year old girl was brought to the polyclinics with clozapine at our clinic. Details on sociodemographic information, complaints of severe anger and irritability symptoms with the potential disease duration, clozapine treatment dosage and duration and the of damaging her environment. Her love of chocolate since the age of incidences of combined therapy with other antipsychotic agents with 8 had increased over the previous two years such that she had come to respective dosage and duration have been investigated. The acquired consume 8-10 portions of chocolate containing foods (cakes, pastes, data were analysed statistically. tablets and others) per day in order to get satisfaction. She wanted to start the day with chocolates. When without money, she borrowed RESULTS: Augmentation therapy with antipsychotic agents had been chocolates from the canteen at her school. When she could not reach used in 15 (36%) of the 42 patients, with the preference of agents chocolates, she became excessively irritable, insulting her family and ranked as zuclopenthixol(26.7%), aripiprazole (20%) and paliperidone damaging the surrounds by throwing articles about and was pscified (13.3%), risperidone (13.3%), quetiapine (6.7%), amisulpride (6.7%), by eating chocolate. Regularity of her daily diet had been impaired by sulpiride (6.7%), haloperidol (6.7%); and these treatments had begun skipping the regular meal times and acquiring almost all of her caloric after a mean time of 2.8 (±3.6) years following the start of clozapine need from chocolaty foods. She had intermittent feelings of remorse, treatment. The meanduration of clozapine treatment was 6.7 (±4,3) given her weight gain, and had made several fruitless attempts to years and the mean dosage was 450 (±198) mg. Statistically significant give up eating chocolates. She did not have any other past or present differences in the mean dosage of clozapine given to patients with behavioural problems. It was learned that she had been on treatment and without additional antipsychotic treatment; and also in clozapine with atomoxetine and risperidone with the diagnosis of attention deficit dosage with and without need for additional therapy on the basis of and hyperactivity disorder. Her own and family history were without gender were not observed (p>0,05). any significance and her laboratory test results were within normal DISCUSSION: In this study, the therapeutic strategies at our clinic limits, while her body mass index (BMI) was in the 85-95th percentile. on the cases of treatment resistant schizophrenia patients together with

DISCUSSION: The case reported here displays the diagnostic criteria the incidences of additional therapy have been reviewed. The important POSTER PRESENTATIONS specific for substance dependence with the symptoms of tolerance, results of this study are the demonstration of equality in the use of atypic withdrawal, craving and failed attempts to stop the habit. and typical antipsychotic agents for additional therapy, the difficulty of predicting the need for additional therapy, and the lack of significant Keywords: Attention deficit hyperactivity disorder, dependence, obesity changes in the dosage of clozapine therapy after the starting date. References Keywords: Augmentative therapy, clozapine, resistant, schizophrenia Carter A, Hendrikse J, Lee N et al., (2016) The Neurobiology of “Food Addiction” and Its Implications for Obesity Treatment and Policy. References Annu Rev Nutr, 36: 105-128. Ceylan D et al., (2014). Increase in Antipsychotic Polypharmacy Cocores JA, Gold MS (2009) The Salted Food Addiction Hypothesis Treatment in Patients with Schizophrenia Between 1994-2000 and may explain overeating and the obesity epidemic. Med Hypotheses, 2010. Current Psychopharmacology, 3(2): 108-112. 73:892-899. Paton, Carol et al.,(2003). Patterns of antipsychotic and anticholinergic Gearhardt AN, Davis C, Kuschner R (2011) The addiction potential of prescribing for hospital inpatients. Journal of Psychopharmacology, hyperpalatable foods. Curr Drug Abuse Rev, 4: 140-145. 17(2): 223-229.

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RELATIONSHIP OF THE NEUTROPHIL/ HISTORY OF CONTACT WITH CATS-DOGS LYMPHOCYTE RATIO WITH OXIDATIVE STRESS AND CONSUMING RISKY FOODSTUFFS IN AND PSYHCOPATHOLOGY IN SCHIZOPHRENIA SCHIZOPHRENIA Burak Kulaksızoğlu1, Sibel Kulaksızoğlu2 Hatice Kaya, Çağdaş Yokuşoğlu, Ertuğ Berberoğlu, Ezgi 1Antalya Training and Research Hospital Psychiatry Clinic, Antalya İnce, Merve Seçkin, Ahmet Soyata, Alp Üçok 2Antalya Training and Research Hospital Biochemistry, Antalya İstanbul University Medical School AIM: The aims of this study have been to investigate the relationship AIM: Although the relationship between schizophrenia and childhood between the serum neutrophil/lymphocyte ratio (NLR) and the total contact with cats-dogs has not been clarified, it remains as a focal point antioxidative status (TAS), total oxidative status (TOS), oxidative of interest. The possible relationship has been attributed to a variety stress index (OSI), paraoxinase (PON) and total thiols ( T.thl); and of factors such as parasitological infections due to toxoplasma and to determine the relationship between these parameters and the toxocara, to viral zoonoses and bacterial infections. In this study it has psychopathological symptoms in schizophrenia patients. been aimed to investigate the differences of childhood contact with cats- METHODS: The study included 64 volunteering schizophrenia patients dogs and consumption of risky foods between schizophrenia patients being followed at Antalya Training and Research Hospital Psychiatry and healthy individuals. Polyclinics and 61 healthy individuals as the controls. Haemogramic METHODS: The study enrolled 72 schizophrenia patients (20 females data were obtained on the automatic Beckman Coulter Counter and 52 males) between the ages of 18 and 40 years and 41 healthy (LH780). Serum TOS, TAS, PON and T.thl levels were measured using individuals (14 females and 27 males) as the control group. The patients the Erel method, a specific, fully automatic and colorimetric method. had been previously diagnosed on the basis of clinical interviews at A Sociodemographic questionnaire completed by all the participants. İstanbul University Medical School, Psychiatry Department and were The patients also completed the Positive and Negative Symptoms Scale selected among those who were literate. For ensuring the accuracy of (PANSS).. the data, patients in acute flare up periods were excluded from the study. RESULTS: In the schizophrenia patient group, neutrophil count, The control group were age and gender matched with the patient group NLR, TAS and TOS were significantly elevated and the lymphocyte and it was ascertained through clinical interviews that they did not have count, T.thl and the T.thl / OSI ratio were found to be significantly psychiatric disorders, had not consumed psychotropic agents, and did lowered as compared to the control group. A significant positive not have first and second degree relatives with a history of psychosis. correlation was determined between the PANSS positive scores and the Signed informed consent forms were obtained from all participants. In leucocyte counts, and a significant negative correlation was determined addition to the items on the standard sociodemographic quetionnaire, between the PANSS total score and the leucocyte counts and the T.thl additional items were included on whether having had cat-dog contact / OSI ratio. In the schizophrenia patient group, a significant negative at the ages of 0-15 years, whether having hunted, or consumed raw correlation was observed between the NLR and the T.thl / OSI ratio and meat, raw eggs, and unpasteurised milk. These additional dichotomic also a significant positive correlation was determined between NLR and parameters were statistically analysed by the Chi-square test, and the the TOS and OSI. cat-dog contact duration and the other numerical data were analysed by the Mann-Whitney U test. DISCUSSION: It is possible to obtain information on the oxidative RESULTS stress and the psychopathological symptoms of schizophrenia patients : Hunting was done by 4 patients and 1 control; raw meet by using the easily and cheaply measured NLR. Oxidative stress and was consumed by 11 patients and 6 controls; raw eggs were consumed inflammation are important factors in the pathogenesis of schizophrenia. by 6 patients and 4 controls; 20 patients and 14 controls had owned POSTER PRESENTATIONS cats-dogs and 15 patients and 15 controls had contact with cats-dogs. Keywords: NLR, oxidative stress, PANSS, schizophrenia Duration of keeping cats-dogs was 190 weeks for the patients and 260 weeks for the controls. Contact with cats-dogs was 222 weeks for the References patients and 300 weeks for the controls. Altamura AC, Buoli M, Pozzoli S (2014) Role of immunological factors in the pathophysiology and diagnosis of bipolar disorder: DISCUSSION: Statistical anlyses have not demonstrated significant Comparison with schizophrenia. Psychiatry Clin Neurosci, differences between the patients and the controls on hunting, raw meat 68(1):21–36. and egg and non-pasteurised milk consumption or on contact with cats- Erel O. A novel automated direct measurement method for total dogs during the age range of 0-15 years. Also the duration of keeping antioxidant capacity using. a new generation, more stable ABTS and contact with cats-dogs did not differ between the groups. radical cation. Clin biochem 2004;37:277-285. Keywords Fendri C et al., (2005) Oxidative stress involvement in schizophrenia :, Contact with cats-dogs, pasteurised milk, raw eggs, raw pathophysiology: a review.L’Encephale, 32.2 Pt 1: 244-252. meat, schizophrenia, toxoplasma Szkandera J, Absenger G, Liegl-Atzwanger B et al.,(2013) Elevated References preoperative. neutrophil/lymphocyte ratio is associated with Torrey EF, Simmons W, Yolken R (2015) Is childhood cat ownership a poor prognosis in soft-tissue sarcoma. patients. Br J Cancer, risk factor for schizophrenia later in life? Schizophrenia Research, 108(8):1677–1683. 165: 1-2. Torrey EF, Yoken R. (1995) Could Schizophrenia Be a Viral Zoonosis Transmitted From House Cats. Schizophrenia Bulletin, 21: 2

120 PP-108 AIM: It has been known that all chronic disorders have adverse and particularly disabling effects on mental health. This is important in POSTMENOPAUSAL UTERINE HAEMORRHAGE DUE patients on haemodialysis for chronic renal failure, which involves a TO VENLAFAXINE USE: CASE PRESENTATION higher prevalence of depression, anxiety and suicidal attempts than in the general population, as shown by studies on the subject. The aim Buğra Çetin1, Sermin Gül Kahya2 of this study has been to investigate the psychosocial factors affecting 1Dr.Münif İslamoğlu State Hospital, Kastamonu suicidal ideation by dialysis patients. 2Zile State Hospital, Tokat METHODS: The study included chronic renal failure patients on AIM: Venlafaxine is an agent with antidepressant effects based on haemodialysis. The patients were asked to complete in addition to mainly the inhibitory mechanism action on the reuptake of serotonin a sociodemographic questionnaire, the Multidimensional Scale of and noradrenaline, although it exhibits to a less extent inhibition of Perceived Social Support (MSPSS), Suicide Probability Scale (SPS), the reuptake of dopamine. Its most frequently seen side effects are the Quality of Life Assessment –short form (SF-36) and the Symptom nausea, perspiration and head ache. Although cases of haemorhage due Checklist-90-Revised (SCL-90-R). to venlafaxine use have been known in the literature, only one case of postmenopausal haemorrhage has been reported. It has been aimed RESULTS: Mean age of the patients was 48.7 (±1.3) years, and their here to present and discuss a case of postmenopausal haemorrhage after mean total score on the MSPSS was 65.8 (±16.1), with the mean increased dose of venlafaxine. scores on the subscales ‘family support’ and ‘support of freiends’ being, respectively, 24.3 (±5.4) and 20.4 (±7). The mean score on the SPS was CASE: The 49-year old female patient without any known medical 57.4 (±15.1) and on the SCL-90 it was 0.8 (±0.7). Statistical evaluation illness except peptic ulcers, had been on sertraline (up to 100 mg/day) of the data by regresion analysis indicated that the score on the SPS treatment for approximately 15 years. During the previous 2 years she β had been on 75 mg/day with regularity. Despite her compliance wih correlated significantly with the scores on ‘support of friends’ ( = β β the treatment, she had complaints of not being able to go to sleep, fears -0.407, p < 0.001), ‘family support’ ( = 0.197, p = 0.001), anxiety ( = β about her relations getting harmed, feeling weepy and restless. Her 0.175, p = 0.002), general well being ( = -0.162, p = 0.002) and vitality dose of venlafaxine was increased to 150 mg/day. One month later, at (β = 0.060, p = 0.047). her polyclinic control, she reported that although she had not had any DISCUSSION: Results of this preliminary study have been noteworthy menstrual haemorrhage over the previous 6 months, she developed a particularly on the observation of elevated probability of suicide with prolonged haemorhage after the velafaxine dose increase. There were increased family support. This result may indicate a problem in the not any pathological results after her examination at the gynaecology statistical approach or can be interpreted as the increased feeling of guilt and maternity unit and laboratory investigations. Venlafaxine dose was by the patient vis-a-vis the the efforts of the caregivers in the family. The reduced back to 75 mg/day. Her psychological complaints regressed other unexpected result, subject to debate, is the relationship between and she gained remission. She has not had any mentsrual haemorhage vitality scores and the increased probability of suicide. Increased level of during the 1.5 years of follow up. anxiety was another factor found to increase the probability of suicide. DISCUSSION: Incidences of menorrhagia, vaginal haemorhage On the other hand, support of friends and general well being have been and increased haemorhage have been reported with venlafaxine seen to be associated with decreased probability of suicide. use. It has been hypothesised that stimulation by noradrenaline of the gonadotrophin releasing hormone lead to vaginal haemorhage. Keywords: Dialysis, quality of life, socail support, suicide Venlafaxine at low therapeutic doses of 75-100mg/day is mainly a References serotonin reuptake inhibitor, but dose increase is argued to increase the Chen C-K, Tsai Y-C et al., (2010) Depression and suicide risk in noradrenergic effect. Observing vaginal haemorrhage after venlafaxine hemodialysis patients with chronic renal failure. Psychosomatics, dose increase to 150 mg/day, and the disappearence of the haemorrhage 51(6):528-. e6. after dose reduction to 75/mg/day supports this hypothesis. Kimmel PL, Thamer M, Richard CM et al., (1998)Psychiatric illness POSTER PRESENTATIONS Keywords: Drug side effect, post menopausal haemorrhage, venlafaxine in patients with end-stage renal disease. The American journal of medicine, 105(3):214-21. References Thompson MP, Kaslow NJ et al.,(2002) The mediating roles of Linnebur SA, Saseen JJ, Pace WD (2002) Venlafaxine Associated perceived social support and resources in the self-efficacy-suicide Vaginal Bleeding. Pharmacotherapy, 22 (5): 652-55. attempts relation among African American abused women. J Wyeth-Ayerst Laboratuarları. Effexor (Venlafaxine) Ürün Bilgisi. Consult Clin Psychol, 70(4):942. Philadelphia, PA; 2000.

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A REVIEW OF PSYCHIATRIC SYMPTOMS, QUALITY ACUTE LITHIUM INTOXICATION: EVALUATION OF OF LIFE AND SOCIAL SUPPORT AGAINST SUICIDAL THREE CASES ATTEMPTS OF DIALYSIS PATIENTS Evnur Kahyacı Kılıç1, Mehmet Bülent Sönmez2, 2 2 Mustafa Uğurlu1, Görkem Karakaş Uğurlu2, Suna Yasemin Görgülü , Rugül Köse Çınar 1Uzunköprü State Hospital, Edirne Sohtaoğlu3, Semra Ulusoy Kaymak1, Ali Çayköylü2 2Trakya University Medical School, Psychiatry Department, Edirne 1Ankara Atatürk Training and Research Hospital, Psychiatry Clinic, Ankara AIM: Lithium (Li) therapy is the gold standard for acute attack episodes 2Yıldırım Beyazıt University Medical School, Psychiatry Department, and the preventive treatment of bipolar disorder (BPD). Blood levels Ankara of Li have to be monitored after reaching an effective concentration as 3Şırnak State Hospital the therapeutic range is very narrow and intoxication can occur. In this

121 report we have aimed to present three cases arriving at the emergency METHODS: The 34 adult OCD patients enrolled in this study were services with Li intoxication. asked to complete the Childhood Traumas Questionnnaire (CTQ) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). CASE 1: The 58-year old female patient had a 30-year history of BPD. She had been euthymic on Li (1200 mg/day) for the last 25 years. She RESULTS: Statistically significant correlations were determined arrived at the emergency service with complaints of nausea, vomiting, between the scores on Y-BOCS subscales obsession and compulsion and insomnia and restlessness. It was learned that she had been put on ACE the CTQ subscales on emotional abuse, physical abuse, sexual abuse, inhibitor two weeks previously and had been using nonsteroidal anti- emotional neglect and physical neglect. inflammatory drugs (NSAIDs) daily for the previous week. Her serum DISCUSSION: Thre are few studies on the relationship of chidhood Li level was 1.24 mEq/L. Her neurological examination showed that she traumas and OCD with results not in complete agreement. There may was conscious, fully oriented, had slight tremor of the hands. She was be a very complicated relationship in question affected by many factors started with 0.9% NaCL infusion and forced alkaline diuresis when the which need to be ascertained by multidimensional studies on childhood Li level regressed to 0.7 mEq/L. traumas in OCD CASE 2: The 62-year old female was brought to the emergency Keywords: Childhood, obsessive-compulsive disorder, trauma service with loss of consciousness. It was learned that she had a 20- References year history of schizoaffective disorder and had been using Li. In the Carpenter L, Chung MC (2011) Childhood trauma in obsessive pevious week her speech had gradually become unitelligible. She was compulsive disorder: The roles of alexithymia and attachment. inclined to sleep, her motions had slowed down, had slight tremor of Psychology & Psychotherapy: Theory, Research & Practice, 84(4): the hands and diarrhea. Her serum Li level was estiamted to be 2.3 367-388. mEq/L. Nephrological consultation was requested for renal disorder, Mathews CA, Kaur N, Stein MB(2008) Childhood trauma and and she was put on dialysis for renail failure, when her serum Li level obsessive-compulsive symptoms. Depress Anxiety, 25(9):742-51. was reduced to 1.0 mEq/L. Visser HA, van Minnen A et al., (2014) The relationship between adverse childhood experiences and symptom severity, chronicity, CASE 3: The 64-year old male patient had been followed up for 25 years and comorbidity in patients with obsessive-compulsive disorder. J after bipolar disorder diagnosis. He was brought to the polyclinics with Clin Psychiatry, 75(10):1034-9. nausea, tremor and balance problems when walking. When examined, he was conscious, his speech was dysarthric, had rough tremor of the hands, rigidity in the arms and ataxic gait. Serum Li level was 1.9 mEq/L. He was referred to emergency units and was put on dialysis, PP-112 when the serum Li regressed to 0.8 mEq/L. BINSWANGER’S DISEASE AFTER DIFFERENTIAL DISCUSSION : Acute Li intoxication treatment should concentrate on DIAGNOSIS OF LATE ONSET PSYCHOTIC the symptoms rather than only the serum level of Li. Symptom severity DISORDER: CASE PRESENTATION should be evaluated on the basis of good history taking and the changes of the serum Li level in order to assess the aetiology of the condition. Meltem İzci Kasal, Aybala Sarıçiçek, Almıla Erol, Rapid diagnosis and fluid therapy and, if necessary, dialysis should be Gökhan Bahtiyar started to prevent the development of neurological sequels. Katip Çelebi University Mental Health And Diseases Department, İzmir Keywords: Acute intoxication, haemodialysis, lithium, side effect AIM: Binswanger’s disease or subcortical leukoencephalopathy, is a form of small vessel due to white matter damage. It References

POSTER PRESENTATIONS has been aimed in this report to present a case of Binswanger’s disease Ataoğlu A (2006) Lityuma bağlı nörotoksisite.(Neurotoxicity due to lithium) Türkiye Klinikleri J IntMed Sci, 2(29):52-9. CASE: The 60-year old primary school graduate, widowed female Eroğlu MZ, Özpoyraz N (2010)Bipolar bozuklukta koruyucu tedavi. patient consulted the neurology clinic with the complaints of retarded (Peventive therapy in bipolar disorder) Psikiyatride Güncel response to questions and suspicions of flea infestation. She was referred Yaklaşımlar, 2(2). to the psychiatry clinic with the preliminary diagnosis of psychotic Pandey S, Jain S, Chatterjee R (2008) Acute lithium toxicity: two cases disorder. It was learned that the patient had become subdued for the with different outcomes. Neural India, 56:484-85 previous 2 years, had become more suspicious, had been binge eating for the previous 4 months, and displayed improper behaviours such as lying down on the street. Her psychiatric examination revealed persecutory delusions and delusional parasitosis. She was admitted PP-111 as an inpatient. Her cranial MRI revealed ‘’High density signals of gliotic foci (?) at T2AG in the subcortical areas of the bilateral INVESTIGATION OF THE RELATIONSHIP BETWEEN frontoparietal regions, and signal changes due to gliosis in subtentorial THE CHILDHOOD TRAUMAS AND SYMPTOMS OF area’’. Her EEG was normal. Neurology unit was consulted for organic pathologies, but a degenerative dementia was not considered. Possible OBSESSIVE-COMPULSIVE DISORDER secondary pathologies had to be eliminated. She complained daily of Sinem Zeynep Metin, Sinem Özer fleas moving around her body, and could not cooperate fully to enable Üsküdar University Mental Health and Diseases Department, İstanbul complete interview. She was started on aripiprazole (5mg/day titrated to 30mg/day). As her clinical condition did not improve, treatment AIM: Childhood traumas are known to cause many psychiatric was switched to olanzapine (20mg/day). In a while she was observed disorders at adulthood. In this study the relationship between adult to perform her daily activites only when reminded and shown the way. obsessive-compuışsive disorder (OCD) and childhood traumas has been She mixed her visitors up and did not show any affective contribution. investigated. Neuropsychological tests could not be done as she did not cooperate.

122 Neurology was consulted with a preliminary diagnosis of dementia, developments in the condition of the patients to one another over the given the late onset psychotic symptoms and the atypic behaviours, whatsapp, during the periods when the clinicians and nurses were not and diffusion MRI and positron emission tomography (PET) were on duty, to decide on the alternative procedures to be applied to bring requested. Diffuion MRI did not show any pathology and the PET under control the excitation of the patient so as to reduce the need for could not be performed as the national health system did not meet restrainment. the costs. She was diagnosed with Binswanger’s disease and treatment RESULTS: “The Whatsapp Group of Physical Restraint’’ group and the with antipsychotic agents was discontinued. Although she was planned entire clinical team have met their goals by January 2016. The changes for discharge, being hypertensive with diabetes mellitus, she died of myocardial infarction on the 116th day of her admission. in the incidence of physical restraint use between 2013 and 2016 were given as 19,8% in the last 5 months of 2013; 36,2% in 2014; 20,3% in DISCUSSION: Binswanger’s disease usually rpesents between the 2015, and 3,4% in the first 8 months of 2016. ages of 50 and 60 years. Studies have shown that advanced age and DISCUSSION hypertension are associated with white matter lesions which together : The dramatic reduction in restraint application with subcortical atrophy increased the risk of dementia. The diagnostic has shown the effective work of the group and the achievement of criteria for the extent of subcortical white matter has not been the planned goal. When the adverse effects of physical restraint on established. The case idscussed here consulte with white matter lesions, the patient and the costs of physical restraint are considered, wide chronic hypertension and intellectual function losses due to advanced scale studies to establish effective measures to reduce restraint in the age, and a progressive cognitive deterioration was observed. Additional psychiatry wards should be started. investigations on old age patients arriving with psychotic symptoms is Keywords: psychiatry, restraint, whatsapp important for the differential diagnosis of these symptoms. References Keywords: Binswanger’s disease, hypertension, late onset, psychotic Bilici R., Sercan M., Tufan E. (2013) Psikiyatri Kliniklerinde Yalıtım ve disorder Bağlama uygulamaları.(Applications of Isolation and Restraint in References Psyhciatry Clinics). Düşünen Adam Dergisi, 26:80-88 Gold G, Kövari E, Herrman FR et al., (2005) Cognitive consequences of thalamic, basal ganglia, and deep white matter lacunes in brain aging and dementia. Stroke, 36(6):1184. PP-114 Lo RY, Jagust WJ (2012) Alzheimer’s Disease Neuroimaging Initiative. Vascular burden and Alzheimer disease pathologic progression, EPISTAXIS AFTER OLANZAPINE USE: CASE Neurology, 79(13):1349. Román GC, Sachdev P, Royall DR et al., (2004) Vascular cognitive PRESENTATION disorder: a new diagnostic category updating vascular cognitive Celaleddin Turgut1, Nermin Gündüz2 impairment and vascular dementia. J Neurol Sci, 226(1-2):81. 1Göksun State Hospital, Psychiatry Clinic, Kahramanmaraş, Consultant Dr 2Erzurum District Training and Research Hospital, Psychiatry PP-113 Department, Consultant Dr AIM: Olanzapine is a thienobenzodiazepine type of second generation USE OF WHATSAPP IN THE CONTROL OF antipsychotic agent with structural similarity to clozapine. The EXCITATION IN THE PSYCHIATRY WARD frequently seen side effects are sedation, orthostatic hypotension, constipation, impairment of hepatic functions, extrapyramidal system Nalan Öztürk, Suna Uysal Yalçın, Nazan Aydın

symptoms, metabolic effects and weight gain. It has been aimed in this POSTER PRESENTATIONS Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological report to present a case of epistaxis due to the use of olanzapine (10mg/ Diseases Research Hospital, Psychiatry Clinic No 15, İstanbul day) treatment. AIM: Isolation and restraining of inpatients of psychiatric clinics is CASE: The 23-year old male patient was followed for schizoaffective necessitated if alternative methods to control the behaviour of patients disorder, depressive episode under amisulpride (400 mg/day) and do not work. The aim is to prevent self harm, harming others and sertraline (50 mg/day) treatment. He consulted the polyclinics with the damage to the surroundings during excitation, as well as to prevent complaints of suspiciousness, difficulty in falling asleep, anhedonia and falling down in confusion and loss of orientation, interference with loss of appetite. Olanzapine (10mg/day) was added to his treatment the medical equipment and incompliance with the treatment given. and he was followed on an outpatient basis. One week after starting Restraining involves fixing the patient on the bed with tapes over the olanzapine, he started to experience 5 to 10-minute episodes of epistaxis chest and on both of the arms and legs to limit physical movements. The which could be stopped by nasal packing. Normal blood pressure was adverse physical and psychological effects on patients of restraining have observed during the epistaxis episode. His case was evaluated at the ear- been considered and in the recent years studies have been carried out nose-throat(ENT) unit, and the haemogram, hepatic and renal function, for measures to be taken to reduce the implementation of isolation and and coagulation test results were normal. Taking detailed history on his restrainment of patients in psychiatry wards. This report summarises previous hospital admissions indicated that olanzapine (10 mg/day) the prodecures started with this purpose at the No 15 Psychaitry Clinic addition his therapy with valproic acid +sodium valproate (500mg/ of Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological day), haloperidol (10mg/day), biperidene (4mg/day) had resulted in Diseases Research Hospital. epistaxis which diappeared with the discontinuation of olanzapine. As METHODS: The No.15 Psychiatry Clinic was formed in August 2013 he did not have a systemic comorbidity and the results of the physical and a group of caregivers, named as the ‘’The Whatsapp Group of examinations and laboratory tests were within normal limits, olanzapine Physical Restraint’’ was formed, to reduce the incidence of restrainment was suspected to be the cause of the observed epistaxis, and the therapy measures on psychiatry patients together with the cooperation of was switched to quetiapine (300mg/day). He did not report repeating the clinical team. The aim was to communicate immediately the episodes of epistaxis.

123 DISCUSSION: In the case reported here, the appearance of epistaxis PP-116 after starting olanzapine addition to the treatment, the patient’s history with a similar event, the dramatic stop in epistaxis incidences SCHIZOPHRENIA LIKE PSYCHOSIS DUE TO A after discontinuing olanzapine, and the absence of any underlying DIFFERENT MEDICAL CONDITION WITH VOLUME pathological cause have led to the decision of discontinuing olanzapine DEFICIT IN THE CAUDATE AND LENTIFORM as the probable cause. There are not any case report in the literature on NUCLEI: CASE PRESENTATION epistaxis due to olanzapine. Although it is extremely rare, it is important for the clinician to evaluate the cases with epistaxis by detailed history Celaleddin Turgut1, Nermin Gündüz2, Zeynep Yıldız Akbey3 taking, laboratory tests of hepatic and renal function, and coagulation 1Göksun State Hospital, Psychiatry Clinic, Kahramanmaraş, Consultant parameters together a with a haemogram. Dr 2Erzurum District Training and Research Hospital, Psychiatry Clinic, Keywords: Epistaxis, haemorrhage, nosebleed, olanzapine Consultant Dr Taylor D, Paton C, Kerwin R et al., (2007a). Schziophrenia, The 3Hereke State Hospital, Psychiatry Clinic, Adapazarı, Consultant Dr Maudsley, The South London and Maudsley NHS Trust & Oxleas NHS Trust Prescribing Guidelines, 9. baskı, London Informa AIM: Many diseases with a course of neurological deficits can present Healtthcare, p8-141 with psychotic or mood disorder symptoms. In the daily clinical practice, patients with psychotic symptoms may get diagnosed with psychiatric disorders without eliminating other causes related to general PP-115 medical condition. It has been aimed in this report to present a case that started with neurological symptoms and progressed rapidly with distinct deterioration due to volume decreases of the lentiform and LATE ONSET DELIBRATE SELF HARM IN caudate nuclei accompanied with psychotic symptoms. ADULTHOOD: CASE PRESENTATION CASE: The 37-year old female patient consulted our polyclinics with Gözde Salihoğlu, Tuğçe Taşkın Uyan, Çiçek Hocaoğlu complaints of suspiciousness and violent physical behaviour towards her Recep Tayyip Erdoğan University, Medical School, Psychiatry Department, father. The patient had a history of divorce at the age of 22 years due Rize to violent behaviour, and had experienced stillbirth while married. At AIM: Delibrate self harm (DSH) behaviour, described as an attempt 28 she lost her mother due to CVA. At 29 she started having difficulty against one’s own body without the intent or desire to die. Despite being walking which advanced within 1 year confining her to a wheelchair. At a very serious health concern world wide, the underlying causes, the risk the same period she had developed problems of inability to fall asleep, factors and its relation to psychiatric disorders and treatment approches irritability, unintelligible speech, inability to leave home with feelings are not completely understood. There is not psychiatric disorder specific of suspicion and fear and violent behaviour towards her father. She had to DSH behaviour. However, DSH behaviour can be observed in the been hospitalised and diagnosed with pscyhotic disorder and a court course of mood disorders, anxiety disorders, eating disorders and order had appointed her father as her guardian. She had been discharged especially of the borderline personality disorder. It has been reported with maintanance therapy on antipsychotics but had not complied with that it is frequently observed in females and adolescents. A study on the her treatment. Given her symptoms of tremor in the hands and the head subject has also reported that while the incidence of DSH behaviour is region, impaired physical mobility and falling down, , 1% in the general population, it can be as high as 12% in the adolescent sleep disorder, impaired functionality, decreased self care in addition and young adult population, there being a negative correlation between to her irritability and suspiciousness necesittated cranial MRI when the DSH behaviour and increasing age. volume decrease in bilateral lentiform and caudate nuclei was observed; consultation with the neurology unit thus resulted in favour of a CASE: The 46-year old female patient followed up in our clinic with metabolic disorder. The patient is still under follow up with treatment POSTER PRESENTATIONS repeated major depresive disorder attacks, with DSH behaviour dating on olanzapine (20mg/day). back 3 years and evinced by repeated, and closely inflicted pin holes, DISCUSSION scalpel lacerations, wounds due to peeling and snatching her skin were : It is necessary to eliminate disorders of the general present on both arms. Her case has been presented in the context of the medical condition before diagnosing schizophrenia and similar pscyhotic current literature on the subject. disorders. When a medical condition giving rise to psychosis is observed the diagnosis, on the basis of the DSM-5 criteria, becomes a ‘Psychotic DISCUSSION: Although studies are showing that the incidence of Disorder Due to Another Medical Condition’. The case reported here is DSH behaviour is increasing, the causes, the course of the disorder, risk important in drawing attention to the necessity of eliminating medical factors and therapeutic approcahes are shortcoming. Therefore, there conditions before arriving at the diagnosis of schzophrenia or similar is need for the better understanding of DSH behaviour. Our study has psychotic behaviour. importance in drawing attention to the possibility of late adulthood Keywords: onset of DSH behaviour. Impaired physical mobility, metabolic disease, organisity, Psychosis due to another medical condition, psychotic disorder Keywords: Aetiology, delibrate self harm behaviour, late onset References Cerutti R, Manca M et al., (2011) Prevalence and clinical correlates of deliberate self-harm among a community sample of Italian Keshevan MS, Kaneko Y (2013) Secondary psychoses: an update. adolescents. J Adolesc, 34: 337-47. World Psychiatry, 12:4–15. Hintikka J, Tolmunen T et al. (2009) Mental disorders in self-cutting adolescents. J Adolesc Health, 44: 464-67. Klonsky ED, Oltmanns TF, Turkheimer E (2003) Deliberate self-harm in a nonclinical population: Prevalence and psychological correlates. Am J Psychiatry, 160:1501-08.

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THE TECHNIQUE OF EXTERNAL LOOK AT PANIC DISORDER DUE TO ISOTRETINOIN USE: INSIGHT: PILOT STUDY WITH 3 CASES CASE PRESENTATION Alişan Burak Yaşar1, Elif Çarpar2, Dilara Usta3, Kadir Veysel Akansel1, Zeliha Cengiz1, Mehmet Diyaddin Özdel4, Meliha Zengin Eroğlu1, Önder Kavakçı5 Güleken2, Ömer Akil Özer1 1Haydarpaşa Numune Training and Research Hospital, Psychiatry Clinic 1Sağlık Bilimleri University, Şişli Hamidiye Etfal Training and Research 2Bakırköy Mental Health and Neurological Diseases and Research Hospital, Mental Health and Neurological Diseases Clinic, İstanbul Hospital, Psychiatry Clinic 2Sağlık Bilimleri University, Gazi Yaşargil Training and Research 3Üsküdar University Psychology Department Hospital, Mental Health and Neurological Diseases Division 4Dışkapı Yıldırım Beyazıt Training and Research Hospital, Psychiatry AIM: Although there are case reports on depression, psychosis, suicidal Clinic attempt and completed suicidal attempt after isotretinoin use, there is 5Sivas Cumhuriyet University, Psychiatry Department only one report on the development of panic disorder. In this report it AIM: Insight in psychiatric disorders is the capacity of the individual has been aimed to discuss another panic disorder case after isotretinoin to be aware of and to understand personal experiences. Poor insight has use. negative effects on the treatment process and the course of the disorder, CASE: The 25-year old male patient consulted our polyclinics with the and, therefore, improving the patient’s insight becomes an important complaints of repeatedly feeling ill at ease, fear of death, tachycardia target of the treatment. ‘’External Look at Insight Project’’ is a treatment and shortness of breath. He did not have a personal or family history technique during which the patient watches the video images of his/ of previous psychiatric consultation, or another comorbidity, or of her behaviour with the aim to present a different perspective against personal alcohol or substance use. It was learned that he had consulted the disease symptoms in order to make a contribuiton to the process of the dermatology clinic about a year previously for acne vulgaris and had imrovement. In the reported series of cases it has been aimed to give the been put on isotretinoin (20mg/day). He had developed restlessness and deatils of the technique and to display the benefical effects. had a sudden onset panic attack of for 10-15 minutes one month after METHOD: The patients were conducted 3 times through the 7 the therapy had started. He had attributed this attack to isotretinoin and stage ’External Look at Insight Model’ (ELIM) and each stage the had terminated the therapy by his own will. Subsequent repeat attacks patients completed the Non-functional Attitudes Scale. (NFAS), the made him consult cardiology and internal diseases polyclinics. It took Beck Hopelessness Scale (BHS), the Beck Anxiety Inventory (BAI), him about 1 year to be directed to psychiatry polyclinics by an internal the Beck Depression Inventory (BDI) and the Automatic Thoughts diseases consultant. His psychiatric examination revealed anxious mood, Questionnaire-Revised (ATQ-R). The first stage of ELIM consisted of appropriate affect, depressive symptoms, psychotic findings without search for suitability and evaluation with a goal. The second stage the suicidal ideation. He had anticipatory anxiety. He was diagnosed with model was introduced. In the 3rd, 4th and the 5th stages the video panic disorder and was started on paroxetine (20mg/day), hyoscine images were watched by the patient, and in the 5th and the 6th stages butylbromide ( 10 mg 2*1) and medazepam (10mg/day) only for one video shots of the patient were taken when responding to his/her images month. About 2 months later his symptoms had completely regressed. as if watching another person, and in the 7th stage the feedback was put Paroxetine (20mg/day) use was discontinued (by gradual dose decrease) together. after completing one year of treatment. RESULTS: The scores on the psychometric tests at each stage and the DISCUSSION: There are studies showing side effects of depression, feedback quality at the end showed positive improvements. psychosis, suicidal attempt and completed suicidal attempt after isotretinoin use. The case reported here is the second case report on DISCUSSIONNOT: It has beenPRESENTED proposed that the common positive basis of the development of panic disorder due to isotretinoin. Although the POSTER PRESENTATIONS psychotherapeutic techniques is to look at what is egosyntonic as being case reported by us did not have the premorbidity of liability to anxiety egodystonic. Use of the video based feedback in methods of improving disorder, the symptoms developed after isotretinoin use and the panic insight are considered to be cost-effective solutions in cuting down the disorder resemble the previous case report in the literature. The case duration of the therapy. The self help approach and especially being discussed in this report had seeked psychiatric help one year after the easy, makes this method recommendable and promising for particularly panic attack.This observations indicates that patients using isotretinoin treating psychopathologies with cognitive bias. It is recommended should be informed of the possible side effects of the drug, and that various forms for different diagnoses should be devloped and the psychiatric symptoms should be queried during the follow up such that possibility of application together with other techniques should be psychaitry consultation should be requested as necessary. investigated. Keywords: Acne vulgaris, isotretinoin, panic disorder Keywords: Insight, psychotherapy, video Cunliffe WJ et al., (1997) Roaccutane treatment guidelines: Results of References an international survey. Dermatology 194:351-7. SchmidtJ. Et al., (2014) An occupation-based video feedback Hull PR, D’Arcy C (2003) Isotretinoin use and subsequent depression intervention for improving self-awareness: Protocol and rationale: and suicide: presenting the evidence. Am J Clin Dermatol 4:493- Une intervention basee sur la retroaction video pour ameliorer la 505. conscience de soi: Protocole et raison d’etre.Canadian Journal of Wysowski DK, Pitss M (1997) An analysis of reports of depression and Occupational Therapy, 82(1), 54–63. suicide in patients treated with isotretinoin. J Am Acad Dermatol Vyskočilová J, Praško J (2012) Socratic dialogue and guided discovery 45:515-9. in cognitive behavioral supervision. Activitas Nervosa Superior Rediviva, 54(1), 35–45.

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INTERMETAMORPHOSIS SYNDROME OBSERVED DEVELOPMENT OF ACUTE CONFUSIONAL STATE DURING THE MANIC EPISODE OF BIPOLAR AFTER INTRAMUSCULAR CEFAZOLIN USE: CASE DISORDER: CASE PRESENTATION PRESENTATION Celaleddin Turgut1, Nermin Gündüz2, Zeynep Yıldız Akbey3 Elif Topbaş, Meliha Zengin Eroğlu, Seda Kiraz, Mecit Çalış 1Göksun State Hospital, Psychiatry Clinic, Kahramanmaraş, Consultant Haydarpaşa Numune Training and Research Hospital, Psychiatry Clinic, Dr İstanbul 2Erzurum District Training and Research Hospital, Psychiatry Clinic, AIM Consultant Dr : Use of antibiotics has been known to reveal neurological and 3Hereke State Hospital, Psychiatry Clinic, Adapazarı, Consultant Dr psychiatric states as side effects. There are frequently reported cases in the literature on acute psychosis and mania due to the use of penicillin, AIM: Intermetamorphosis syndrome, a rarely observed delusional aminoglycoside, cephalosporin and quinolone but reports on acute misidentification disorder, was first described by Courbon and Tusques confusional states are relatively fewer. In this report the case of a in 1932, as the belief by the patient of observing people change into male patient, who had 4 doses of I.M. first generation cephalosporin one another. In this report we have aimed at presenting a case of injections over 2 days when he developed acute confusional state, is intermetamorphosis delusion developed during bipolar manic attack. being discussed. CASE: The 27-year old female patient, consulting our polyclinics with CASE: When the 42-year old male patient consulted our clinic he had her family, had been followed up with the diagnosis of bipolar disorder been for nearly 3 days in a state of disinterest in his environment and since the age of 22. Her psychiatric history included one manic attack of loss of orientation with disorganised behaviour, unintelligible speech psychotic type and one depression attack, and she was being treated with and inability to implement instructions. He had already contacted lithium (900mg/day) and olanzapine (10mg/day). After a stressor event a healthcare centre when cephalosporin was stopped without any about 2 weeks previously the patient complained of sleep irregularity, replacement. He underwent detailed neurological and psychiatric irritability, increased volume of speech, increased self care and libido, assessment by us and his treatment with mirtazapine, prescribed 3 and restlessness. Also, it was learned that for the previous week she was months previously for depressive disorder, was continued. claiming that faces of people changed, such that she thought her boy friend’s face changed to that of a friend she had problems with from DISCUSSION: Although generally rated as safe, the cephalosporins time to time; that the faces of people sitting behind her at the cafe can at times give rise to neurological side effects which should not be changed and she could hear them talk about her and her boyfriend; missed in the assessment of psychiatric patients. she also believed the faces of her friends at work changed and that they Keywords: Acute confusional state, antibiotic, cephalosporin, side were planning a malicious trick on her. Haemogram, biochemical and effects hormonal tests, blood lithum and B12 level estimations gave normal results. Also EEG, cranial MRI and neurological consultations to References eliminate neurological disorders were evaluated as normal. She was Apodaca K (2015) Ertapenem ınduced delirium:a case report and followed up on outpatient basis as her family refused her to be admited literatüre review, Psychosomatics, 56(5):561-6 as an inpatient. Her olanzapine dose was increased and diazepam (5 Herd AM (1989) Acute confusıonal state with postoperative ıntravenous mg 2x1) was added to her treatment to correct the reduced sleep need. cefazolin. BMJ, 299(6695):393-4 About 3 weeks after the start of the therapy her psychotic symptoms Penttila J (2006) Delirium in an adolescent patient during treatment had regressed and the intermetamorphosis symptoms had disappeared. with cephalexin. J Adolesc Health, 39(5):782-3

POSTER PRESENTATIONS DISCUSSION: Despite the neurological aetiology of intermetamorphosis syndrome, it is also considered as a psychiatric disorder. In the case presented in this report, investigation of the patient’s PP-121 general medical condition for eliminating the involvement of other medical disorders including the results of the tests and the neurological ARACHNOID CYST AND OBSESSIVE-COMPULSIVE investigations including EEG and MRI were all within normal limits. DISORDER: CASE PRESENTATION Clinicians have to include this syndrome in the process of differential diagnosis of cases arriving with difficulty of recognising faces. Gözde Salihoğlu, Çiçek Hocaoğlu Tayyip Erdoğan University Medical School, Department of Psychiatry, Keywords : Bipolar disorder, delusional misidentification syndromes, Rize intermetamorphosis misidentification, intermetamorphosis syndrome Courbon P, Tusques J (1932) Illusions d’intermetamorfose et de la AIM: Arachnoied cyts are space occupying benign lesions containing charme. Ann Med Psychol,90: 401–406. cerebrospinal fluid, mostly of developmental origin. They represent Christodoulou GN, MalliaraLoulakaki S. (1981) Delusional 1% of the intracranial space occupying lesions. Clinical symtpoms misidentification syndromes and cerebral “ dysrhythmia ”. depend on the size of the cyst and vary according to the neighbouring Psychiatria Clin, 14: 245–51. neural structures. They can be oberved in any region of the central Sevim ME, Şahin MÖ, Özden SY (2003) Capgras Sendromu 8 Vaka nervous system (CNS). Typical localizations include the cranial Örneği ve Literatürün Gözden Geçirilmesi, Düşünen Adam, 16(4): fossa, cerebellopontine corner, supracollicular region, in the sella and 226-230 supracellar regions and the vermis. They are more frequnet in the left side and are 3 times as more frequent among males. They are asymptomatic and usually diagnosed coincidentally by radiological investgations. In some cases neurological symptoms are in the foreground while in others only psychiatric symptoms are observed. Information in the literature on arachnoid cycts and psyhiatric symptoms are included only in case

126 reports, with predominance of psychosis and bipolar disorder and to learned from his relatives that he frequently wrote letters of complaint a limited extent with obsessive-compulsive disorder (OCD), where to various institutions. He had persecutory delusions about prosecutors attention has been drawn to the late onset of OCD and lack of insight and had once complained about one prosecutor for dilatoriness. He in women with arachnoid cyst. Only in one study, an arachnoid cyst also wrote a number of petitions complaining about hospitalisation in the left temporofrontal region of a 12-year old boy with OCD and stated that he would sue the hospital. He was asked to complete behaviour has been reported. It is obvious that there is need for wider the Minnesota Multiphasic Personality Inventory (MMPI) and the scale investigations for undestamding hte comorbidity of arachnoid Rorschach test. Paranoid thoughts in the letter he wrote to the chief cysts and OCD. medical officer of the hospital lead to the diagnosis of paranoid disorder, paranoid personality disorder. He was discharged from the hospital on CASE: In this report the case of a 17-year old male lycée student has risperidone (3 mg/day) with the recommendation of 3 monthly follow been presented. About 6 months prior to psychiatric consultation, the up controls over a period of 5 years. patient had displayed behaviours of excessive cleanliness, frequent and prolonged bathing, frequent washing of hands, avoiding handling door DISCUSSION: It has been stated that the only way of access to these knobs, no being assured, excessive interest in metaphysical subjects, type of patients at the early stage of the problem is upon referral by the lack of sleep, repeating the same questions. His school performance had legal services and that psychiatric therapy was helpful in regulationg dropped, he was itraverted and missed school days. He was diagnosed emotions and limiting the harmful behaviour. As regards the case with OCD with poor insight, and his brain MRI showed a 2-cm discussed in this report, diagnosis of paranoid disorder was confirmed arachnoid cyst in the right temporal lobe. after evaluating the history given by his relations at the stage of admission to hospital, the observations made during his hospital stay DISCUSSION: It has been aimed in this case presentation to draw the including the paranoid attitude and behaviour towards the clinic attention of clinicians to similar cases by discussing the diagnosis and team, the petitions he composed while out with permission and the treatment principles. psychometric test results. It has to be kept in mind that cooperation Keywords: Arachnoid cyst, obsessive-compulsive disorder,temporal with the legal authorities helps giving the patients and their relations lobe assistance in treatment. References Keywords: paranoid disorder, psychosis, querulous paranoia Akar H et al., (2004)Nöropsikiyatrik Semptomlarla Seyreden Araknoid References Kist Olgusu. Düşünen Adam, 17: 238-243. Mullen PE, Lester G (2006) Vexatious litigants and unusually persistent Bakım B et al., (2012) Araknoid kist ve iki uçlu bozukluk: Bir Olgu complainants and petitioners: from querulous paranoia to querulous Sunumu Journal of Mood Disorders, (2):70-3. behaviour. Behav Sci Law, 24(3):333-49. Bahk WM et al., (2002) A case of brief psychosis associated with an Tewarie PR, van der Zwaard R (2016) From querulous neurosis to arachnoid cyst. Psychiatry Clin Neurosci, 56: 203-205. querulous delusion: the psychopathological aspects of persistent dysfunctional complaining. Tijdschr Psychiatr, 58(1):30-7.

PP-122 PP-123 QUERULOUS PARANOIA: CASE PRESENTATION Celaleddin Turgut1, Nermin Gündüz2, Zeynep Yıldız Akbey3 NEUROBIOLOGICAL INDICES AND 1Göksun State Hospital, Psychiatry Clinic, Kahramanmaraş, Consultant NEUROCOGNITIVE FUNCTIONS IN NEWLY Dr DIAGNOSED EARLY PHASE UNTREATED BIPOLAR 2Erzurum District Training and Research Hospital, Psychiatry Clinic, DISORDER- A COMPARATIVE STUDY POSTER PRESENTATIONS Consultant Dr 1 2 3 3Hereke State Hospital, Psychiatry Clinic, Adapazarı, Consultant Dr Siğnem Öztekin , Fatma Akdeniz , Arzu Oran , Fatma Taneli3, Ömer Aydemir1 AIM: Querulous seeking of rights is the behaviour of persistent 1Celal Bayar University, Psychiatry Department, Manisa complaint and habitual discontent that damages the social, economical 2Bolvadin Halil İbrahim Özsoy State Hospital, Afyonkarahisar and personal advantages of the individual and often disrupts the 3Celal Bayar University, Clinical Biochemistry Department, Manisa operation of courts of justice by vexacious litigations, petitions and the like. In the DSM-5, querulous paranoia is classified as the delusional AIM: It has been aimed in this study to compare the neurobiological disorder subtype of ‘maltreatment’. In this report we have aimed to signs and neurocognitive functions in young adults with a history of present the case of a patient who had written numerous petitions with episodes meeting the diagnostic criteria for bipolar disorder (BPD), complaints and had started court cases and was referred to our clinic by with the same features in age, gender and educationally matched healthy the state prosecutor’s office. individuals and in chronic BPD patients and thereby demonstrate the development of changes in the brain functions in BPD. CASE: The 42-year old male patient who had problems with his siblings on grounds of inheritance, had accused one of his siblings of METHODS: The Hypomania Check List (HCL-32R1) was used threatening him at gun point and keeping a gun at home and had made on 2757 individuals in order to determine the high risk candidates 22 petitions to the state prosecutor’s office and had started 16 court for BPD. The selected individuals were psychiatrically evaluated by cases. He had withdrawn his court applications when the conflict had interviewing on the SCID-I, and 27 individuals who had experienced been settled. But, the prosecutor’s office had filed a case against him episodes of illness with features meeting the diagnostic criteria for BPD on grounds of fabricating criminal charges and the court had referred without having been given any diagnosis or treatment were included the patient to our psychiatry service requesting to prepare a legal report in the study as the ‘newly diagnosed group’ (NDG). A healthy control on his mental status and whether a guardian should be appointed. group of 27 healthy individuals (HC) and a chronic patient group of He was admitted as an inpatient and his state was evaluated. It was 26 BPD patients under follow up (CP) were also included in the study.

127 All participants were asked to complete a battery of neurocognitive with olanzapine. Her dose was increased from 10mg/day to 20 mg/day tests, including the Wisconsin Card Sorting Test (WCST), the Stroop resulting in oculogyric crisis which necessitated switch from olanzapine test, the Rey Auditory Verbal Learning Test (RAVLT), the Trail Making to aripiprazole (10mg/day) which resulted in the regression of her Test (TMT-A and B) to evaluate executive functions, attention, tardive dyskinesia and psychiatric symptoms. She is currently under functional memory and verbal learning. Blood samples were taken follow up with maintenance treatment with aripiprazole (20mg/day). from all participants to estimate the serum levels of thiobarbituric acid DISCUSSION: The underlying mechanisms of the OGC after reactive substances(TBARS) as byproducts of lipid peroxidation, nitric antipsychotic agent use have been described as the elevated dopamine- oxide (NO), superoxide dismutase (SOD) and catalase (CAT). The acetylcholine antagonism and/or elevated striatal dopamine inhibition. data obtained were analysed by the Chi-square test, the independent Olanzapin binds the D2 receptors with moderate avidity and should variables were alaysed by the t-test and ANOVA. not be expected to give rise to OGC. But at elevated doses the affinity RESULTS: When the neurocognitive performances of the three groups for D2 receptors increases, which involves the risk of OGC, and may of participants were compared on the basis of executive functions based explain the dystonic reaction observed in the case reported here, after on the scores of WCST, the Stroop word and color-word subscales, of olanzapine dose increase from 10 to 20 mg/day. It is recommended that verbal learning based on the RAVLT scores and of functional memory when prescribing olanzapine the probability of this side effect should be and attention based on the Stroop and the TMT-B scores, the NDG kept in mind by the clinicians. performances were lower as compared to the HC performances. When Keywords: Dystonia, oculogyric crisis, olanzapine compared on the basis of the neurobiological markers, serum SOD level Chakraborty R, Chatterjee A, Chaudhury H (2008) Olanzapine was significantly higher in the HC as compared to the others(p<0,001), induced oculogyric crisis in a patient with schizophrenia. Indian J while the serum CAT was elevated in the NDG and CP groups as Sci, Vol 62 No 6 compared to the HC. Also, although the TBARS and NO levels were Desarkar P, Das A, Sinha VK (2006) Olanzapine induced oculogyric higher in the NDG as compared to the others, the differences were not crisis. Aus NZJ Psychiatry 40-374 statistically significant. Rosenhagen MC,Schmidt U, Winkelmann J, et al., (2006) Olanzapine induced oculogyric crisis.J Clin Psychopharmacol 26-431 DISCUSSION: In the early stages of BPD, there are losses in the cognitive functions which are independent of the effects of any drug therapy. Also there are indications of impairment of the intracellular redox balance with signs of oxidative stress. There is need for further PP-125 studies to clarify the significance of these findings. Keywords: Bipolar disorder, cognitive functions, early stage, oxidative TREATMENT OF VAGINISMUS WITH stress COGNITIVE BEHAVIOURAL THERAPY: CASE PRESENTATION Merve Amine Atalay Saka PP-124 Gazi University Hospital Medical School, Psychiatry Department, Ankara AIM: Vaginismus is the most frequently observed sex related chronic OCULOGYRIC CRISIS DUE TO OLANZAPINE USE: complaint in our country; and it can be put right by breaking down the CASE PRESENTATION pain related vicious circle. In this report it has been aimed to present Celaleddin Turgut1, Nermin Gündüz2, Zeynep Yıldız Akbey3 a case of vaginismus which was treated with cognitive behabioural 1Göksun State Hospital, Psychiatry Clinic, Kahramanmaraş, Consultant therapy. Dr CASE: The 21-year old female, married for 10 months and living POSTER PRESENTATIONS 2Erzurum District Training and Research Hospital, Psychiatry Clinic, with her husband, followed open educational program and was not Consultant Dr employed. She conuslted with complaint of not being able to have 3Hereke State Hospital, Psychiatry Clinic, Adapazarı, Consultant Dr sexual intercourse with her husband. On the night of her marrigae she had forced herself to have intercourse, when her entire muscular system AIM: Oculogyric crisis (OGC) is an acute dystonic reaction of the of her bodys had locked up. Subsequently any pshysical contact with ocular muscles characterised by the unilateral elevation of the bulbus her husband gave rise to contractions on her back and legs. She had tied oculi. It is observed as a side effect of typical antipsychotic agents. There to use local anaesthetic cream on the vaginal area but intercourse could are few reports on OGC cases due to olanzapine use. It has been aimed not take place on account of contractions. She as not interested in sex in this report to present a case of OGC due to olanzapine use and the realted topics. As a child she had visited a newly wed couple and had treatment protocol followed. observed that the bride moved with difficulty which gave the impression CASE: The 38-year old patient consulted the polyclinics, in the company that sexuality was a pain giving occupation. She did not have a history of the father, with the complaint of suspiciousness. She was admitted of sexual trauma, and was included in the vaginimus therapy program as inpatient and evaluated. Her history showed that she had consulted which consisted of the following stages: pscyhiatry polyclinics in 1997 with complaints of obsession on getting First session: Talking about the rational basis of the therapy. A list of soiled and compulsion of getting cleaned, and had been put on sertraline sexual myths was handed to the patient. The Kegel exerecise was shown. (100mg/day). She had consulted again in 2001 with psychomotor A sexual diet was recommended. agitation, obsession on getting soiled, coprolalia, socail isolation, and persecutory delusions. She had been hospitalised with diagnosis of brief Second session: Sexual anatomy and physiology was discussed.The psychotic disorder, and had been treated with haloperidol (10mg/day) sexual myths list was discussed. ‘My uterus is small and a penis would and biperidene (2mg/day). As EPS developed, haloperidol was switched not fit’ and ‘’vagina is a dirty place’’ thoughts were analysed. Vaginismus to olanzapine (5mg/day) and she had been discharged. She had not formulation was explained. She was recommended to look at her genital had any other subsequent psychiatric consultation. She was observed region in the mirror; and she was given the task of touching one another to have the persecutory delusions despite the 15 years of follow up over the whole body and the genital areas with the underwear on.

128 Third session: She was given the task of touching the genital areas with DISCUSSION: The observations that the BNSS total score the underwear off. correlated only with the negative symptoms subscales and the general psychopathology subscale of PANSS, without correlation with the Fourth session: She was given the task of imagining a hardened penis. positive symptoms subscales of PANSS, indicate that this new scale Fifth session: While in the mesntrual phase she was given the task of effectively rates the negative psychotic symptoms. Lack of correlation using tampons. of the total and the subscale scores (apart from the subscale Distress) with the scores on CDSS has been found useful for the discrimination 6th-9th sessions: She and her husband were given the finger exercises. of whether or not the negative psychotic symptoms develop secondarily In the 10th session the patient reported that when trying the finger to depression. Lack of correlation with ESRS, apart from the scores on exercises spontaneous intercourse had taken place without experiencing the subscales Avolition, Blunt Affect and Alogia indicated that BNSS muscular spasms. could not discriminate between the primary/secondary development of DISCUSSION: The vaginismus related symptoms of the patient, seen these symptoms. The Distress subscale is included in the scale despite with 10-day intervals, had completely disappeared after the therapy. It being unaccepted as a negative symptom on the MATRICS. Having was observed that after the discussion on sexual anatomy and physiology oberved the correlation with the CDSS has given reason for querying the anxiety of the patient had decreased. She was able to control her the validity of this item. muscles with the Kegel exercises and breath-relaxation exercises. The CONCLUSION: On the basis of these results, it has been shown at resultant spontaneous intercourse after the finger exercises is attributed the BNSS is a valid and reliable instrument for detecting the negative to the alterations in the cognitions of the patient. Complete complance symptoms in schizophrenia. of the patient with the treatment exercises, support of the husband and the absence of any comorbidity have ensured the rapidity of the Keywords: Negative symptoms, scale, schizophrenia successful results of the therapy. Keywords: Cognitive beahvioural therapy (CBT), vaginismus PP-127 References Kabakçı E, Batur S (2003) Who benefits from CBT for vaginismus? J Sex Marital 29:277-278 LEVELS OF LIFE QUALITY AND SOCIAL SUPPORT, AND THE INCIDENCE OF PSYCHIATRIC COMORBIDITIES AMONG THE LEUKAEMIA PATIENTS IN THE BONE MARROW TRANSPLANT PP-126 SCHEME AND THE EFFECT OF THESE FACTORS ON THE SUCCESS OF THE TRANSPLANT OPERATION. A NEW SCALE: USE OF THE BRIEF NEGATIVE SYMPTOM SCALE (BNSS) ON SCHIZOPHRENIA Nilay Sedes1, Mehmet Gündüz2, Pervin Topçuoğlu2, Vesile PATIENTS Şentürk Cankorur1 1 Gülser Karakoç1, Irmak Polat Nazlı1, Melis Ercan2, Ali Saffet Ankara University Medical School, Psychiatry Department, Ankara 2Ankara University Medical School, Haematology Department, Ankara Gönül1 1Ege University Medical School, Mental Health and Disorders AIM: Bone marrow transplant (BMT) is a procedure used in the Department, İzmir treatment of haematological cancers. Although the predominant point 2Buca Seyfi Demirsoy State Hospital of view is on the effectivity of psychosocial factors on BMT, there is

limited comment on the effects of these factors on the success of BMT. POSTER PRESENTATIONS AIM: The Brief Negative Symptom Scale (BNSS) has been put to use This study has aimed at determining the levels of the quality of ife (QL), in Turkey for both clinical and research purposes, after the validity and of social support (SS), of the capacity to cope with stress (SCC) and reliability study on it had been completed. In this report the results on the psychiatric comorbidities (COM) among the leukaemia patients the BNSS completed by schizophrenia patients will be presented. enrolled in the BMT program and also to evaluate the effects of these METHOD: Our study enrolled 52 schizophrenia patients consulting factors on the success of BMT. the Psychiatry Polyclinics of Ege University. The patients were asked to complete the Positive and Negative Symptoms Scale (PANSS) the METHODS: The study enrolled 45 patients who were evaluated twice, Calgary Depression Scale for Schizophrenia (CDSS), the Extrapyramidal firstly a week before the BMT and secondly, four weeks after BMT Symptom Rating Scale (ESRS) and the Brief Negative Symptom Scale for QL, SS, COM and personal hygiene. Also their SCC was assessed (BNSS). Acquired data were analysed on the SPSS 21 program, using in the first stage of evaluations. After the comparison of the first and the Spearman Correlation method on the variables not showing normal the second observational results, the relationship between each factor distribution; and the p<0.05 value was accepted as the indicator for and the neutrophil and thrombocyte engraftment dates (ED) and their statistical significance. weighted effects on these processes were investigated. RESULTS: Our results have shown that the total score and the subscale RESULTS: QL was found to be distinctly lower after BMT. Whereas scores of the BNSS correlated with the negative subscale scores and the the SS perception had not altered, perceived support by friends had general psychopathology subscale of the PANSS, but did not correlate decreased after BMT. On the other hand, the personal hygiene level with the scores on the positive subscales of the PANSS. Also, the total had increased after BMT. Before BMT, 18 (40%) of the patients had BNSS score and the scores on the subscales (excepting the subscale been diagnosed with psychiatric comorbidities the incidence of which Distress) did not correlated with the CDSS. The total score on the increased to 55% after BMT. Also, the levels of depression, anxiety BNSS did not correlate with the score on ESRS, however, the scores on and stress had significantly increased after BMT. The most frequent the BNSS subscales Avolition, Blunt Affect and Alogia correlated with methods of coping with stress were resorting to religious beliefs, active the scores on ESRS. coping and positive reinterpretation and development strategies.

129 QL criteria were found to correlate negativly with ED. It was observed DISCUSSION: Significant incidences of different psychiatric that, as the level of depression and anxiety increased, the ED for comorbidities are observed in obesity. There are reports in the thrombocytes was prolonged. Also the presence of COM correlated literature on the realitonship of emotional eating with neuroticism, with all EDs. When the combined power of the investigated factors on impulsiveness and low self discipline. The data of our study support the predicting the ED was tested on a regression model, only the effects of previous findings demonstrating the relationship of pathological eating the COM remained in the model while the effects of others remained behaviours with psychopathological characteristics. outside the model. Keywords: Impulsiveness, obesity, psychopathology DISCUSSION: This study has demonstrated the effects of psychosocial factors on the success of BMT in patients diagnosed with leukaemia. The combined risks of the disease and the BMT may impair the quality PP-129 of life and increase the incidence of psychiatric comorbidites which in turn may affect adversely the BMT outcome. EFFECTS OF ADVERSE CHILDHOOD EXPERIENCES Keywords: Bone marrow transplant, coping with stress, engraftment, AND BODY PERCEPTION ON THE EATING psychiatric disorders, psychosocial factors BEHAVIOUR OF OBESE FEMALES References CostanzoES,Juckett MB, Coe CL(2013) Biobehavioral influences on Melahat Gizem Güler1, Gizem Cesur2, Ela Arı2, Aydın recovery following hematopoietic stem cell transplantation. Brain, Karaçanta2, Firdevs Melis Cin2 behavior, and immunity, 30, S68-S74. 1The Family Female Support and Disabled Centre (AKDEM) Fann JR, Alfano CM, Roth-Roemer S et al., (2007) Impact of 2İstanbul Commerce University, Psychology Department, İstanbul delirium on cognition, distress, and health-related quality of life after hematopoietic stem-cell transplantation. Journal of Clinical AIM: The aim of this study is to investigate the effects of body perception Oncology,25(10), 1223-1231. and of adverse chilhood experiences on the eating behaviours of obese females. METHODS: The study enrolled a total of 143 females with a mean PP-128 age of 32.62 (SD = 8.81; 18-58). Data were obtained by means of the childhood experience of care and abuse questionnaire (CECA.Q), the RELATION OF EATING BEHAVIOUR IN OBESITY TO body perception Inventory (BPI) and the eating behaviour inventory test (EBIT). IMPULSIVITY AND PSYCHOPATHOLOGY RESULTS: Hierarchical regression analysis was used in order to 1 1 2 Hande Yıldırım , Irmak Polat Nazlı , Selin Bilgin determine the variables that predicted the eating habits of obese females. 1 Ege University Medical School, Mental Health and Disorders It was observed that low level of education (β=-.19, p<.05), early stage Department, İzmir obesity (β=-.23, p<.05) and CECA.Q subscale score on childhodd 2 Ege University Literary Studies Department, Psychology Division, İzmir physical abuse predicted the wrong eating habits of obese femae adults. AIM: Obesity has become a serious public health problem leading to Also, reduced body perception predicted the wrong eating habits at the morbidity and mortality; and has been labelled by the World Health limit of significance (β=.16, p=.056). Scores on the CECA.Q subscales Organisation (WHO) as an epidemic with an increasing incidence in all of emotional abuse and sexual abuse did not have the power to predict age groups. There are multiple physical factors in the aetiology of obesity. wrong eating habits in adult female obesity. However, there are also emotional eating, external eating, restrictive DISCUSSION: The observation in this study that childhood physical eating behaviours, anxiety disorder, eating disorder, poor impulse and

POSTER PRESENTATIONS abuse predicted the wrong eating habits of obese adult females is in self control, adjustment problems, dependence and similar mental agreement with the reports of others on the same topic in the general factors. The aim of this study has been to investigate the relationship population (Rayworth et al., 2004). Our results have been discussed in between the wrong eating habits and the psychopathological factors in the context of the relevant literature. obesity. Keywords: Body perception, childhood abuse experiences, eating METHODS: Our study enrolled 22 obese patients consulting Ege attittudes, obesity University Medical School Psychiatry Department Consultation Liaison Psychiatry Polyclinics for routine evaluations before bariatric surgery. References The patients were asked to complete the Dutch Eating Behaviour Rayworth BB, Wise LA, Harlow BL (2004) Childhood abuse and risk Questionnaire (DEBQ), the Barratt Impulsiveness Scale (BIS) and the of eating disorders in women. Epidemiology, 15: 271–278. Symptom Checklist-90-Revised (SCL-90-R). The acquired data were analysed on the SPSS 21 program. As the data did not exhibit a normal distribution, the nonparametric Spearman correlation test was used. RESULTS: Mean age of the participants was 35.18 (± 8.3) years, and the mean body mass index (BMI) was 37.96 (± 6.55). Correlations at significant level between the types of eating behaviour and the BMI were not oberved. Emotional eating behaviour showed a positive correlation with the scores on the SCL subscales of general symptom level, anxiety, anger-hostility and paranoid thoughts. External eating behaviour correlated with the SCL general symptom level. The total DEBQ scores showed a positive correlation with the SCL subscale scores on anxiety, anger-hostility and paranoid thoughts and a negative correlation with the BIS impulsivess subscale.

130 PP-130 Dyck DG, Short R, Vitaliano PP (1999)Predictors of burden and infectious illness in schizophrenia caregivers. Psychosom Med, INVESTIGATION OF THE FAMILY FUNCTIONS AND 61:420-423. COPING STRATEGIES AMONG THE RELATIONS OF Magliano L, Fadden G, Economou M et al., (2000) Family burden and A GROUP OF SCHIZOPHRENIA PATIENTS. coping strategies in schizophrenia: 1-year follow-up data from the BIOMED I study. Soc Psychiatry Epidemiol, 35: 109-115. Ayşe Köroğlu1, Çiçek Hocaoğlu2 1Alcohol and Substance Dependence Treatment and Research Center (AMATEM),Sivas PP-131 2Recep Tayyip Erdoğan University, Medical School, Psychiatry Department, Rize OBSESSIVE-COMPULSIVE DISORDER AND AIM: Since patients with chronic illnesses need the assistance of others in COMORBID KLEINE-LEVIN SYNDROME: CASE the management of their daily lives, chronic diseases adversely affect the PRESENTATION lives of the family members. Schizophrenia is a chronic mental disorder 1 2 of destructive psychopathological effects, progressing with variable Gözde Akbaba , Seher Naz Yeni 1 symptoms of impairment in the feelings, thoughts and behaviours İstanbul University Cerrahpaşa Medical School, Psychiatry Department, of the individual. Generally the first degree family members are the İstanbul 2 caregivers of schizophrenia patients. Important changes are brought İstanbul University Cerrahpaşa Medical School, Neurology about by the addition of a chronically ill individual into the family. Department,İstanbul In this study it has been aimed to investgate the relationships between AIM: Kleine-Levin sendromu (KLS), also known as the Sleeping Beauty the schizophrenia patients and care givers and the socidemographic and Syndrome, is a rare disease usually seen in males at early adolescence clinical details and coping strategies. with symptoms of periodic , cognitive changes, behavioural METHODS: The study enrolled 100 schizophrenia patients arriving disorders and hyperphagia. The EEG investigations give normal results consecutively at Recep Tayyip Erdoğan Training and Research Hospital, in between the attacks, but there are changes of EEG during the attacks. Psychiatry Polyclinics between 01.05.2012 and 01.05.2013 and meeting Although the aetiopathogenesis of KLS is not known, other psychiatric the inclusion criteria of the study; and also 100 caregiving relatives of the and neurological disorders have to be eliminated for definite diagnosis. It has been aimed to present a different KLS case in this report. patients. The participants were asked to complete a sociodemographic questionnaire; the patients were also asked to complete the Positive CASE: The patient, a young male, consulted with the complaints of and Negative Symptoms Scale (PANSS), the Functioning Assessment fatigue, irritability and excessive sleeping. His symptoms had apperared Short Test) (FAST) and the Social Functioning Scale (SFS); while about 6 months previously and tended to last for 1 week when he could the relatives were asked to complete the COPE-.the Coping Strategies only meet his needs for eating and using the WC facility. He had control Inventory (CTI) and the Family Evaluation Scale(FES)*. obsessions and the EEG during the attack consisted of slow waves while the EEG between attacks was within normal limits. RESULTS: Mean age of the patients was 37.4 (±10) years; and the group consisted of 57 (57%) females and 43 (43%) males. Mean disease DISCUSSION: We have aimed in this report to review a case of Kleine- duration was 14.9 (± 8) years. Relationships were observed between Levin syndrome with obsessive-compulsive disorder comobidity within the sociodemographic details and the family functions of the patients’ the context of the current knowledge in the literature and bring to family members. While there was not a relationship between the gender attention the likely difficulties involved in the differential diagnosis. of the patients and the family functions, the gender of the caregiver was Keywords: Comorbidity, Kleine-Levin Syndrome, Obsessive- POSTER PRESENTATIONS found to be related to particularly the general family functions. The Compulsive Disorder male gender of the caregiver was associated with more deterioration of the general functions. The age of the patient, duration of the illness and References the duration of caregiving were found to correlate positively with the Black JE, Brooks SN, Nishino S. (2004) Narcolepsy and syndromes of deterioration of the family functions. As regards the degree of closeness primary excessive daytime somnolence. Sem Neurol 24: 271- 82 of the caregiver with the patients, in those families where the spouse Muratori F, Bertini N, Masi G. (2002) Efficacy of lithium treatment in or the offspring were the caregivers, impairments in problem solving Kleine–Levin syndrome. Eur Psychiatry 17: 232–3. functions, communication, roles and general functions were observed. The most frequently used strategy for coping with stress among the caregivers ranked as reinterpretation and development, active coping PP-132 and taking resort in religious faith. DISCUSSION: It is believed that the positive coping strategies adapted TARDIVE BLEFAROSPASM DUE TO ARIPIPRAZOLE by the caregivers on the face of stressful conditions will be benefical in USE: CASE PRESENTATION meeting the goals of the treatment given and in the process of following Zeliha Cengiz1, Veysel Akansel1, Mehmet Diyaddin the effectiveness of the treatment. Güleken2, Ömer Akil Özer1 Keywords: Coping strategy, family functions, schizophrenia 1Sağlık Bilimleri University, Şişli Hamidiye Etfal Training and Research References Hospital, Psychiatry Clinic, İstanbul 2Sağlık Bilimleri University,Gazi Yaşargil Training and Research Hospital, Arslantaş H, et al., (2009) Effects of the psycoeducation given to the Psychiatry Division, Diyarbakır caregivers of schizophrenia patients on the clinical course and the level of mood extroversion by the cargivers. Adnan Menderes AIM: Tardive dyskinesia are athedoid or choreiform movements that Üniversitesi Tıp Fakültesi Dergisi 10:3-10. develop after at least a few month of neuroleptic agent use and generally

131 involve the tongue, lower part of the face, the chin, at times the PP-133 , the diaphragm and the abdominal muscles, arms and legs, and lasting at least for a few weeks. The subtypes include tardive dystonia, TREATMENT OF PALIPERIDONE-INDUCED tardive akathisia, tardive blefarospasm, tardive myoclonus, tardive ticks/ HYPERPROLACTINEMIA BY SWITCHING TO tourettism, tardive tremor and tardive dyskinesic walking. Tardive ARIPIPROZOLE: CASE PRESENTATION blefarospasm is the involuntary repeated and severe contraction of the 1 2 orbicularis oculi muscles. We have aimed to present the case of a bipolar Buğra Çetin , Sermin Gül Kahya 1Dr.Münif İslamoğlu State Hospital, Kastamonu disorder patient who developed ardive blefarospasm after the addition 2Zile State Hospital, Tokat of aripiprazole to his treatment. AIM: Paliperidone, an atypic antipsychotic agent, is the active CASE: The 39-year old univsersity graduate single female patient metabolite of risperidone with a higher affinity for the D2 receptors whose complaints had started in 2012 with irritability, frenzy, than risperidone; and like all D2 receptor antagonistic antipsychotics, reduced need for sleep. She was treated as an inpatient for 1 month it has the potential to cause hyperprolacatinaemia. Aripiprazole, on the with haloperidol, biperidene and quetiapine. He was diagnosed with other hand, has been developed as a partial D2 receptor agonist and is bipolar disorder and started on lithium (900mg/day). In 2013, while believed to lower the level of prolactinaemia with the intermediation on lithium treatment with the same doage, she developed symptoms of of this receptor. It has been aimed to present in this report a case of restlessness, anxiety, irritability, avolition. Aripirazole (5 mg/day) was hyperprolacatinaemia due to paliperidone use which rapidly regressed prescribed which she used for 8 months when it was disconinued, but to normal levels with switch to arpiprazole. 6 months later her symptoms repeated when aripiprazole (5 mg/day) CASE: The 35-year old female patient, with a 7-year psychiatry was restarted. After 4 months of treatment, involuntary symmetrical follow up, initially for three years with the diagnosis of depression contractions started in her eyes such that she had difficulty keeping her and subsequently with the diagnosis of bipolar mood disorder. While eyes open. The contractions increased with light, fatigue and anxiety. she was on Lithium (1200 mg/day), quetiapine (200 mg/day) and She was examined at the opthalmology and neurology units and was olanzapine ( 20 mg/day), she complained of weight gain and was diagnosed with blefarospasm. As her complaints persisted, whe was gradually switched to paliperidone (6 mg/day), 3 months after which started on clonazepam(2 mg/day) which was distinctly beneficial. Given she was complaining of amenorrhea. Her serum prolactine level was 364 the dependence risks she did not want to use clonazepam when her µg/L. She was referred to the endocrinology unit to eliminate organic complaiants became painful. She was started on gabapentine (600 mg/ pathology. When the investigations did not indicate any organic basis to day) when her pain and contractions were observed to have regressed. hyperprolactinaemia, paliperidone dose was gradually reduced and the patient was started on aripiprazole with dose ajustment to 10mg/day. In DISCUSSION : There are only few case reports in the literature her follow up controls 1 month later she did not have complaints and on tardive dyskinesia after aripiprazole use but, and a case of tardive her serum prolactin level was 18,72 µg/L. Over 1 year of follow up she blefarospasm due to arpiprazole has not been seen, the cases involving has remained in remission without any side effects, and with complete the use of clozapine, olanzapine and risperidone. The female gender and functionality. the diagnosis and affective disorder amy have constituted a risk factor in the case discussed here. Also, an elevated sensitivity of the dopamine DISCUSSION: Hyperprolactinaemia is not as frequently reported with the second generation antipsychotic agents as compared to the receptros may be considered as the side effect developed after using a typical antipsychotic agents, although risperidone and paliperidone low dose therapy with aripiprazole. This case suggests that the atypic have frequently been observed to have this side effect and studies antipsychotic aripiprazole may also give rise to blefarospasm, rare as it have shown higher levels of serum prolactin with paliperidone as may be. Since the patient refrained from long term use of clonazepam, compared to risperidone. However, aripiprazole has been the least despite benefiting from the drug, and did improve with the replacement POSTER PRESENTATIONS involved in hyperprolactinaemia and there are reports on lowering of gabapentine, this neuroleptic may be considered as a choice of treatment prolactin levels with aripirazole use. There are recommendations in the for tardive blefarospasm literature to switch to aripiprazole or to add aripiprazole to the existing Keywords: Aripiprazole, tardive blefarospasm, tardive dyskinesia treatment when hyperprolactinaemia develops with second generation antipsychotic agents. References Keywords: Aripiprazole, hyperprolactinaemia, paliperidone LernerV, Chanoch M (2011) Motor symptoms of schizophrenia: is tardive dyskinesia a symptom or side effect? A modern treatment. References Current psychiatry reports 13.4: 295-304. Holt RI, Saseen JJ, Peveler RC (2011)Antipsychotics and Miyamoto S, Duncan GE, Marx CE et al. (2005) Treatments for hyperprolactinaemia: mechanisms, consequences and management. schizophrenia: a critical review of pharmacology and mechanisms of Clin Endocrinol (Oxf), 74 (2): 141-7. action of antipsychotic drugs. Molecular psychiatry, 10.1: 79-104. Park YM, Lee SH, Lee BH et al., (2016)Prolactin and macroprolactin levels in psychiatric patients receiving atypical antipsychotics: A preliminary study. Psychiatry Res, 239: 184-9. Peuskens J, Pani L, Detraux J et al., (2014)The effects of novel and newly approved antipsychotics on serum prolactin levels: a comprehensive review. CNS Drugs, 28 (5):421-53.

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IS MEGA CISTERNA MAGNA COMORBIDITY WITH EFFECTIVITY OF COGNITIVE BEHAVIOURAL DELUSIONAL DISORDER A NEUORANATOMICAL THERAPY ON ENURESIS NOCTURNA COMORBID LIABILITY TO SHARED PSYCHOTIC DISORDER? – WITH MENTAL RETARDATION: CASE CASE PRESENTATION PRESENTATION Yasin Hasan Balcıoğlu, Simge Seren Kırlıoğlu, Güliz Özgen Semra Ulusoy Kaymak1, Serdar Süleyman Can2, Murat İlhan Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Atagün2, Görkem Karakaş Uğurlu2, Mustafa Uğurlu1, Ali Diseases and Research Hospital, İstanbul Çayköylü2 1 AIM: Original evidence draws attention to the dysfunction of the Atatürk Training and Research Hospital Psychiatry Clinic, Ankara 2 cortico-cerebellar-cortico-thalamic circuitry in psychotic disorders and Yıldırım Beyazıt University, Psychiatry Department, Ankara propose the involvement of the lesions in the posterior fossa structures, AIM: Enuresis is described as the involuntary urination after the age responsible for the stabilisation and integration of this circuitry, to when urinary control is expected to have developed. Patients who can be related to psychosis. Mega cisterna magna (MCM) is a posterior not control the urinary bladder after the age of 6 are considered to be fossa anomaly and reference to its comorbidity with neuropsychiatric enuretic. Enuresis is seen more frequently in boys than in girls. If this disorders is very limited in the literature. On the other hand, shared control has not developed since childhood, the condition is described as psychotic disorder (Folie à Deux) is the development of psychotic primary enuresis; and about 80% of the complaints are due to primary symptoms by an otherwise healthy individual after having been affected enuresis. Primary enuresis is generally observed at night, and hence by a psychotic patient. In this report it has been aimed to discuss the the term ‘enuresis nocturna’ (EN), the aetiology of which is attributed clinical relationship between the coincidentally discovered MCM, to general liability, structural and developmental factors and family comorbid with delusional disorder that developed on the basis of shared attitudes. When there is mental retardation, treatment can become psychosis, as a probable neuroanatomical basis of psychotic disorder in complicated and the problem might become chronic. It has been aimed the case presented. in this report to present a case of EN with mental retardation. CASE: The 36-year old male patient, currently working as an CASE: The 21-year old single female patient, the third of four offsprings accountant, and his brother, shared the persecutory delusions about and living with her family, has a WAIS total score of IQ: 69. Her family being followed by their coworkers with intent to harm them. The socioeconomic level had allowed private education. As learned from patient, overwhelmed by these events, harmed his mother and his herself and her family, she had not gained urinary bladder control at brother when attempting to commit suicide with a knife. The patient sleep since the early stages of childhood. Her mother thinks that they was referred to legal psychiatry services by the public prosecutor’s office might not have taken seriously the lack of a completed education on for assessment of criminal responsibility, which was lifted and he was toilet habits, given her general developmental retardation. She had been put under obligatory treatment. He did not have active psychotic under the control of physicians for EN since her primary school days, symptoms and was diagnosed with delusional disorder and started on when an underlying disorder had not been discovered and all routine risperidone (3mg/day) and quetiapine (300mg/day). His cranial MRI treatments, including sunny rainy calendar recording, waking at night revealed MCM, without neurological symptoms. He was discharged in for toilet, use of alarm, nasal desmopressine, imipramine and hypnosis remission with his ongoing treatment. The brother of the patient, who had been tried without any improvement. Her mother had given the had not been treated previously, kept insisting that their co-workers patient the responsibility of caring for her laundry but this also had were still following him, but his claim was denied by their mother as been without effect. meaningless. He was evaluated as an undiagnosed case of psychosis. DISCUSSION: After completing the evaluation of the patient together DISCUSSION: It has been emphasised that the decreases in the with her family, further interviews were conducted with the patient POSTER PRESENTATIONS dimensions and the responsiveness to stimuli of the cerebellar purkinje alone. Starting with the family attitudes, and going over the “I cannot neurons, brought about by congenital or acquired space occupying be successful anyhow’’, “I have tried everything without avail’’ type of lesions of the posterior fossa such as MCM, are associated with cognitions, she was given daily walking tasks for increasing endurance, liability to psychotic symptoms, cognitive and emotional disorders [2]. while the sleep-wake cycles were organised; taking fluids in the evening Presentation in this report of a case of share psychosis disorder, with was limited ; two alarms were used, one being away from the bed, limited objective aetiological and epidemiological data and rarely met in ringing 5 minutes apart to ensure waking up at specified times. These the clinical practice, within the context of an intracranial lesion is found measures and the task of keeping records altogether helped increase noteworthy. It is expected that this case report will contribute to the the bladder capacity and the sphincter control exercises ensured rapid literature with respect to the neuropsychiatric manifestations of MCM. results in reversing EN. This report is important in demonstrating that Keywords: Delusional disorder, mega cisterna magna, shared psychosis cognitive behavioural methods can improve quality of life with this type of problems even in the presence of mental retardation. References Andreasen NC, Pierson R (2008)The role of the cerebellum in Keywords: Cognitive behavioural therapy, enuresis nocturna, mental schizophrenia. Biol Psychiatry, 64(2):81-8. retardation Pandurangi S (2014) Psychiatric manifestations associated with mega cisterna magna. J Neuropsychiatry Clin Neurosci; 26(2):169-71.

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VIEWS OF THE INPATIENTS ON THE CONDITIONS MANIC EPISODE COMORBID WITH REPETITIVE OF HOSPITAL STAY PSEUDOCYESIS: CASE PRESENTATION Batuhan Ayık, Merve Seçkin, Hülya Özkan, Sevde Yılmaz Tuğba Göncü Akdur, Murat Yalçın, Engin Emrem Beştepe, Taşçı, Hüda Paslı, Abdullah Fenercioğlu, Ardıl Bayram Handan Yıldız Şahin, Sümeyye Bozkurt, Sefa Coşkun, Alp Üçok Erenköy Mental and Neurological Diseases Training and Research Hospital İstanbul University İstanbul Medical School Psychiatry Department AIM: Pseudocyesis is a rarely observed delusional pregnancy with multiple sysmptoms of actual pregnancy, including abdominal AIM: Patient satisfaction is an important indicator of treatment quality. distention, pigmentation and enlargement of the breasts, morning This study has been planned to evaluate the satisfaction of the inpatients sickness, typical lordotic walk, increased appetite and weight gain. In of psychiatry services, to find out their opinions and expectations on the DSM-5 it is classified with somatic symptom disorders and related the service conditions and their treatments with the aim to implement disorders as ‘another diagnosed and related suitable modifications. Studies made on the same subject have reported disorder‘; and in the ICD-10, it is categorised with ‘somatoform that inpatients are generally satisfied with the course of their treatment disorders, diagnosed’. In the case presented in this report symptoms in hospital, while, on the other hand, inpatient satisfaction was low with of pseudocyesis has repeated as a component of the manic episodes of respect to obligatory hospitalisation and on being adequately informed bipolar disorder (BPD). about their condition and treatment. CASE: The 38-year old female patient, married without children had a METHODS: The ‘The Psychiatric Out-Patient Experiences history of two abortions. Her complaints over one month consisted of Questionnaire (POPEQ), as patient satisfaction questionnaire’, used reduced sleep need, inceased mobility, irritability, refusing the take her with the psychiatric patients in Stavanger University Hospital in medication over the previous 6 weeks believeing to be pregnant, delayed Norway, was translated to Turkish to be implemented on 59 psychiatric menstruation, distention of the abdomen and the breasts, waking inpatients between March 2016 and September 2016 at I.U. İstanbul up early with repetitive morning sickness and increased libido and Medical School Psychiatry Department, on the day of their discharge appetite. She had been followed up over 6 years for BPD and had been from hospital. The data acquired on the adapted POPEQ and hospitalised 4 times, with manic episode in two incidents, when ß-hCG sociodemographic and clinical data on the same patients were put estimations were normal despite her delusions of pregnancy. She had together for analysis. Statistical analysis of numerical variables showing remained in remission over the previous 1.5 years but had discontinued her medication without consulting her physician as she was planning normal distribution for comparison between two groups were anlaysed for pregnancy. Her psychiatric examination indicated that her thought with the t-test, and in the absence of normal distribution the data were contents included mysticistic and grandiose delusions, such as she analysed using the Mann Whitney U test. Categorical variables were herself and her foetus having special powers; and she also described compared using the Chi-square test and the Fisher’s Exact test. visual and auditory hallucinations. Her physical examination did RESULTS: Mean age of the patients was 35.2 years; 22 being females confirm her claims of abdominal distention and increased pigmentation and 37 being males. The psychiatric diagnoses consisted of bipolar on both areola. About 11 days after her admission as an inpatient, her disorder (n=14), major depression (n=11), schizophrenia (n=10), delusions about pregnancy regressed, and she was discharged on the schizoaffective disorder (n=4), alcohol -substance use disorder (n=6), 31st day of admission with maintenance therapy on olanzapine (15mg/ dissociative personality disorder (n=2) and others (n=12). While day), lithium (900mg/day) and valproate (100mg/day). 49.2% of the patients found their treatment process quite satisfactory, DISCUSSION: Even though pseudocyesis has been classified with

POSTER PRESENTATIONS 32.2% expressed moderate degree of satisfaction and 17% expressed ‘somatic symptom disorders and related disorders’ in the DSM-5, disappointment; 43 (72.9%) found the time of communication with it appears in psychotic disorders and mood disorders and in many their doctors as adequate, and 44 (74.6%) expressed satisfaction with reported cases as a component of psychotic symptoms. the courtesy of the healthcare team; while 32(55.2%), an especially the Keywords: Delusional pregnancy, female, pregnancy, pseudocyesis female patients in comparison to the males, found the ward conditions inadequate with respect to activites that they could join. Factors such as References patient gender or the duration of hospital stay were not found to have Bitton G, Thibaut F, Lefevre-Lesage I (1991) Delusions of pregnancy in any effect on patient satisfaction. a man. Am J Psychiatry, 148: 811-812. Chengappa KNR, Steigard S, Brar JS et al.,(1989) Delusion of DISCUSSION: It was planned, in view of these preliminary results, to pregnancy in men. Br J Psychiatry, 155: 422- 423. reanalyse the data by increasing their numbers. Kornischka J, Schneider F (2003) Delusion of Pregnancy. Psychopathology, 36:276–278. Keywords: Patient,questionnaire, satisfaction References Gani N, Saeed K, Minhas FA et al. (2011)Assessment of patient satisfaction with mental health services in a tertiary care setting. J Ayub Med Coll Abbottabad, 23 (1):43-6. Garratt A, Bjørngaard JH, Dahle KA et al. (2006) The Psychiatric Out-Patient Experiences Questionnaire (POPEQ): data quality, reliability and validity in patients attending 90 Norwegian clinics. Nord J Psychiatry, 60(2):89-96. Kuosmanen L, Hätönen H, Jyrkinen AR et al. (2006) Patient satisfaction with psychiatric inpatient care. J Adv Nurs. ;55(6):655-63.

134 PP-138 the 1999 Marmara earthquake, and the symptoms of depression and anxiety in their offspring who had not experienced any earthquakes. LATE ONSET OR ACUTE ONSET OR CONCEALED METHOD: This study included 125 mothers with a mean age of 40.92 SCHIZOPHRENIA? – CASE PRESENTATION (SD= 5.37) years who had experienced the 1999 earth quake in the Nazlı Ateş, Zeliha Dönmez, Yücel Yılmaz province of İzmit, and their children with a mean age of 13.38 (SD=.53) Erenköy Mental and Neurological Diseases Training and Research years, consisting of 71 (56.8%) girls and 54 (43.2%) boys currently in Hospital, K1 Psychiatry Service, İstanbul the 7 th and 8th grades of first step schooling. The mothers were asked to complete the Posttraumatic Cognitions Inventory (PTCI) and their AIM: In this report the case of an adult female patient with an apparently children were asked to complete the Screen for Child Anxiety Related first time pscyhotic attack is presented. Disorders (SCARED) and the Children’s Depression Inventory (CDI). CASE: The 48-year old female patient was brought by RESULTS: Analyses of the data indicated that mothers who had and a letter from the prosecutor’s office to the emergency service. Her high scores on the PTCI subscale Negative cognitions about self, had complaints were explaiend to be irritability, agressiveness, coprolalia and children with significantly high level of depression (r =.33, p <.01) and problems with lack of sleep. She did not have any physical illness. She anxiety (r =.20, p <.05) and the mothers who had high scores on the was placed in the closed ward (K1) after her psychiatric examination. PTCI subscale Negative cognitions about the world, had children with Her mood was angry, and as she was unwilling to cooperate it was not high level of depression (r =.20, p <.05). possible to acquire information. It was learned in the detailed interview DISCUSSION: It has been seen in this study that there is a relationship with her elder sister that the patient did not have a history of psychiatric between the traumatic cognitions of the mothers who have experienced tretment as an inpatient or outpatient. Her preoccupation with religious the 1999 Marmara earthquake and the anxiety and depression levels matters had started 25 years previously and she had decided to change of their children. This observation is in agreement with the argument her dressing style, given up socialising, and had strarted to live alone by Kellerman (2001) that trauma effects are passed onto the next since the age of 28. She was known to give lectures of religious context, generation by different pathways. Considering the paucity of studies organise talk groups and had gained a lot of respect. Her symptoms inTurkey on transmitting trauma effects, it is believed that this study had started 1 month previously and it had taken time for people in her will make a contribution to the related field. vicinity to find her family, who then had brought her to the hospital. Keywords: Anxiety, depression, post traumatic cognitions DISCUSSION: As the patient whose case has been presented did not have a history of illness, the symptoms were attributed to acute onset of References schizophrenia and in order to eliminate the possibility of an underlying Kellermann, NPF (2001). Transmission of Holocaust trauma – An organic pathology, cranial MRI was planned and her treatment was integrative view. Israil Journal of Psychiatry, 64(3), 256-267. started with haloperidol IM and biperidene(4mg/day). As her angery mood did not subside, she was given 9 sessions of ECT after which she was willing to cooperate in the clinical interview. She explained that PP-140 having believed that some beings had taken hold of hermind, she had to take her family out of her life and had indulged in religious matters. She HYPERPHAGIA IN THE MANIC EPISODES OF is currently at the service and her delusions are not completely gone. As she does not deny treatment given and has partial insight, her dischage BIPOLAR DISORDER: CASE PRESENTATION has been planned. Handan Yıldız, Murat Yalçın, Engin Emrem Beştepe, Tuğba Keywords: Acute onset schizophrenia, concealed schizophrenia, late Göncü Akdur onset schizophrenia Erenköy Mental and Neurological Diseases Training and Research POSTER PRESENTATIONS Hospital, İstanbul References Kesebir S, Veznedaroğu B (2004) Geç başlangıçlı şizofreni,(Late onset AIM: Hyperphagia is the feeling of hunger and eating excessively. It schizophrenia). Düşünen Adam, 17(1 ):66-68 is observed very frequently in metabolic endocrine and gastrointestinal Tezcan AE, Kuloglu M, Atmaca M et al. (2003) Elazığ bölgesinde disorders, and can present with psychiatric disorders as in the case to be şizofreni tanısı konan hastalarda sanrıların görüngüsel özellikleri. discussed in this report. (Characteristics of the visual hallucinations of Schizophrenia CASE: The 34-year old primary school graduate, divorced female patient patients in Elazığ region) Anadolu Psikiyatri Dergisi, 4:13-19 lived alone. She consulted with complaints of reduced need for sleep, increased libido, hyperphagia, risky behaviours and reduced self care. She had been under follow up for the previous 13 years for bipolar disorder PP-139 (BPD). She had little social support and bad treatment compliance. Her history revealed that in her previous manic episodes hyperphagia POSTTRAUMATIC COGNITIONS OF THE MOTHERS presented with increased libido. She did not describe any medical illness or alcohol-substance use. Her appearance was in agreement with her age WHO EXPRIENCED THE 1999 MARMARA but her self care was poor. She looked confused, lacked attention and EARTHQUAKE AND THE DEPRESSION AND had difficulty continuing with the interview. Her thought process had ANXIETY SYMPTOMS IN THEIR CHILDREN sped up but associations tended to become incoherent. hyperphagia and Merve Alkan, Gizem Cesur, Aydın Karaçanta hypersexuality drew attention. She had poor impulse control, grandiose delusions, impaired judgement and lacked insight. She was diagnosed İstanbul Commerce University, Psychology Department, İstanbul with manic attack and was admitted to the hospital to start medical AIM: This study has been carried out to find out the relationship between treatment. As her symptoms did not improve it was planned to give her the post traumatic cognitions of the mothers who had experienced ECT starting on the 15th day of her admission. Her score on the Young

135 Mania Rating Scale was 32 at admission and had decreased to 5 after 3 DISCUSSION: Symptoms of depression, anxiety and aggression are sessions of ECT. Also, hyperphagia distinctly regressed. After ECT she in the foreground with HH, but rarely, psychotic symptoms can also was given as preventive treatment, lithuril (600mg/day). be observed. In some cases psychotic symptoms have been reported to regress after surgery. The case presented here draws attention DISCUSSION: Hyperphagia has been mostly associated with a in presenting with psychotic symptoms without neruological and hypothalamic disorder,and the frontal lobe and the limbic system hypothlamic dysfunction. It is difficult to discuss HH on the basis have also been implicated. It is frequently seen as the symptom of of structural lesion leading to psychosis without advanced level neuropsychiatric disorders such as Kleine-Levin syndrome, Klüver- studies. However, given the observations on our case, HH should be Bucy syndrome and frontotemporal dementia. Hyperphagia in the remembered among the structural lesions in the brain in the cases wiyh case discussed here was apparent only during the manic episodes of psychotic symptoms, an atypic course andresistance to treatment. BPD and regressed as soon as the manic state improved. Activation of hyperphagia in manic episodes shows that it can also be associated with Keywords: Anxiety, hypothalamic hamartoma, psychotic disorder mood disorders. Keywords: Hyperphagia, manic episode, mood disorders PP-142 References Bora E, Ozan E, Özaşkınlık S (2002) Herpes Ensefalitine Bağlı Gelişen Klüver-Bucy Sendromu: Bir Olgu Sunumu. Klinik Psikofarmokoloji CLINICAL AND SOCIODEMOGRAPHIC DETAILS Bülteni, 12:148-150 OF UNIDENTIFIED PATIENTS ADMITTED AS Onur E, Dikemn Yalınay P. (2011)Frontotemporal Demans ve INPATIENTS TO A PSYCHIATRY HOSPITAL Psikiyatrik Belirtiler. Düşünen Adam, 24:228-238 Nur Öztürk1, Utku Uzun1, Ürün Özer Çeri2 Yaluğ İ, Temiz M, Erkoç Ş et al.i (2006) Nadir Bir Nöropsikiyatrik 1Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Bozukluk Olarak Kleine- Levin Sendromu. Bir Vaka Sunumu (A Diseases and Research Hospital, No.6 Psychiatry Clinic, İstanbul Rare Neuropsychiatric Disorder, Kleine-Levin Syndrome. A Case 2Acıbadem University Atakent Hospital, İstanbul Presentation). Düşünen Adam, 19(2):110-114. AIM: Caring for inpatients without identity documents is a difficult task with medical and psychiatric evaluation on the one hand and PP-141 cooperation with the social services and the police on the other. These patients are brought by the police or the staff of emergency health services for reasons of inability to care for themselves, behaving dangerously or PSYCHOSIS COMORBID WITH HYPOTHALAMIC aimlessly roaming about. Studies on the subject have shown that these HAMARTOMA: CASE PRESENTATION people are mostly homeless, and next to many medical problems they Sakine Aktaş, Zafer Tapancı, Abdullah Yıldırım are also diagnosed with a psychiatric disorder. It has been aimed in this Yüzüncü Yıl University Medical School, Psychiatry Departmentı, Van study to investigate the sociodemographic and clinical details of these patients and the outcomes of the clinical observations. AIM: Hypothalamic hamartoma (HH) is a rare developmental malformation of the hypothalamus wth a prevalence in the 1/50000- METHODS: The patients admitted without the appropriate 100000 range. It is frequently observed in epileptic seizures and and/ identification procedures were enrolled in this study. The files kept on or presents with prekoks puberty, and with mood and anxiety disorders these patients during their stay in the hospital were investigated and in adults. sociodemographic and clinical data forms were filled.

POSTER PRESENTATIONS CASE: The 45-year old married female patient had never been to school. RESULTS: Totally there were 24 patients with 3 (12.5%) females and She was brought by her relations to our polyclinics with complaints of 21 (87.5%) males; 5(20.8%) being citizens of the Republic of Turkey, intraversion, mutism, jealousy and suspiciousness. She was admitted as 13 (54,2%) being aliens and 6 (25%) of unknown origin. Mean age inpatient. Her history indicated having had for the previous 20 years of the 7 (29,2%) patients whose birth dates could be found was 40.5 symptoms of irritability, inermittent intraversion, dressing in style not (SD 12.99). Most (n=13, 54.2%) lived alone and/or were homeless compatible with her sociocultural background. She had developed (n=14, 58.3%). The most frequently given reason for admission to deluisonal suspicions about her relations and delusional jealousy of hospital was homicide risk(n=8, 33.3%), followed by diagnosis and her husband which was the reason for living apart for the previous 6 tretment (n=9, 37.5%). Only 3(12.5%) patients had used psychoactive months. Her father had been diagnosed with depression with psychotic substance. Communication could not be established with 11 (45.8%) character, and his brother/her uncle was a schizophrenia patient. She patients. Mean duration of hospital stay was 23.1 (±15.5; 1- 67) days. had consulted over the previous 1 year different healthcare centers and The diagnoses made ranked as pscyhotic disorders (n=13, 54.2%) had been diagnosed with ‚‘non-organic psychosis‘, delusional disorders and mental retardation(n=5, 20.8%). For 12 (50.0%) patients social and with depression, psychotic type; and had been treated with investigation had been carried out; identities of 19 (79.2%) had not risperidone, mirtazapine and escitalopram without any improvement yet been determined at the day of discharge, and the relations of 21 in her clinical condition. Examination showed that her affect was (87.5%) had not been reached. restricted, mood was dysphoric and anxious, her associations were liable DISCUSSION: Just as psychiatric disorders can lead to homelessness, to loosen, her thought contents had jealous and persecutory delusions. so can homelessness facilitate the flare up of psychiatric disorders. There She had amenorrhea for the previous 3 months and the estimated fore it is important for the mental healthcare workers to find out the serum hormone levels were 123 ng/ml for prolactin ; 6,01 mıu/ml identity of the unidentified patients, reach their relatives and help them for FSH,:2,85 mıu/ml for LH,:1,79 ng/ml for GH and: 0,55 mıu/ml to reach adequate medical help and psychosocial support. forTSH. Her EEG was normal. However, MRI revealed at the inferior of hypothalamus a nodular lesion with 3mm diameter, not stained with Keywords: Homelessness, social psychiatry, unidentified patient contrast and identfied as peduncled hypothalamic hamartoma.

136 References References DJ Meagher, AG Collins (1995) The anonymous patient: clinical Altunay IK, Koslu A (2008) Psychogenic pruritus/Psikojenik pruritus. characteristics of patients unidentified at presentation Ir J Psychol Turkish Journal of Dermatology, 116-121. Med; 12(4):138-140. TJ Goon A, Ycsipovitch G, Chan YH, Goh CL(2007) Clinical Henry JM, Boyer L, Belzeaux R et al. (2010) Mental disorders among characteristics of generalized idiopathic pruritus in patients from homeless people admitted to a French psychiatric emergency a tertiary referral center in Singapore. Int J Dermatol.;46:1023-6. service. Psychiatr Serv; 61(3):264-71. Tripathi A, Nischal A, Dalal PK et al. (2013) Sociodemographic and clinical profile of homeless mentally ill inpatients in a north Indian PP-144 medical university. Asian J Psychiatr, 6:404-409. SOCIODEMOGRAPHIC AND CLINICAL CHARACTERISTICS OF GEROPSYCHIATRIC PP-143 INPATIENTS ADMITTED FOR SCHIZOPHRENIA ONSET AND OTHER DISORDERS WITH PSYCHOTIC WHICH ONE, PSYCHOGENIC PRURITUS OR SYMPTOMS IDIOPATHIC PRURITUS?: CASE PRESENTATION Ender Cesur1, Nurhan Fıstıkçı1, Gizem Dönmezler1, 1 2 1 Semiha Selük , Hatice Melek Başar , Nazan Aydın Elif Çarpar1, Güntuğ Güngör2 1 Bakırköy Mental Health and Neurological Diseases and Research 1Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Hospital,İstanbul Diseases and Research Hospital, 2 Büyükçekmece State Hospital 2İstanbul Kanuni Sultan Süleyman Training and Research Hospital, AIM: Pruritus (itch) is a disturbing symptom developing of the outer Internal Diseases Unit, İstanbul layer of the skin, frequently seen in the general population. Thre AIM: Psychotic symptoms are frequently met in the geriatric population. are many reasons of pathological itchiness. Not only in the primary In a study over 3 years on the elderly above the age of 85 years without dermatological diseases but also in haematological, metabolic, neoplasic a diagnosis of dementia, the incidence of psyhotic symptoms was seen and psychiatric disorders the clinical condition can emerge as itchiness. to vary in the 7.1%-13.7% range. This study has been planned to If the itch has an organic basis, the underlying pathology can be investigate the sociodemographic and clinical characteristics of geriatric determined by taking history, observing the symptoms of the systemic inpatients admitted for the treatment of psychotic disorders with the disease and laboratory tests, but it is not as easy to draw the diagnostic aim to increase the accuracy of diagnosis. limits of psychiatric itch. Differentiation of this type of itch from other types, referral to pscyhiatry as psychogenic itch and their treatment METHODS: This cross sectional study enrolled 96 patients above constitute difficulty for the dermatologist. In many cases when the the age of 65 years,admitted to different psychiatry clinics of Bakırköy patient is restless and tense and the physician cannot find any reason Mental Health and Neurological Diseases Hospital between June 2011 for the itch, quite often the term ‘’idiopathic pruritus’’ changes places and March 2013. Those patients with delirium and psychotic disorders with ‘’psychogenic pruritus’’ causing chaos. In the case presented here with underlying organic pathologies were excluded from the study. the difficulties involved in the diagnosis and the delay in the treatment RESULTS: The enrolled group of 96 patients consisted of 40 (41.7%) of psychogenic pruritus ae discussed. females and 56(58,3%) males, with a mean age 70 years for the total CASE: The 43-year old lycée graduate female patient, married and group. The mean age of disease onset was 48.59 years; and the mean time of hospital stay was 21 days. At admission, 64 (66,7%) had arrived with mother of one, had been to many dermatologists and used various POSTER PRESENTATIONS medications since the age of 10 when she developed an itch after her relatives, 23 (24%) with the polis/gendarmerie, 5(6.3%) by themselves, parents got divorced. As the itch never regressed she was referred to 2 (2.1%) with a carehome attendant and 1 (1%) with a friend. The psychiatry. It was learned when taking history that the itch increased reasons for admission included homicidal risk (n=52; 54.2%), refusal with stress adversely affecting her functionality, and despite moderating of treatment (n=20; 20.8%), treatment planning (n= 5 ; 5.2%) and at times, it never disappeared, such that she developed depressive unspecified reasons (n=4 ;4.2%). It was determined that 43 (44.8%) symptoms of anhedonia and social intraversion. Routine investigations patients had been socially isolated. The diagnosed disorders ranked as did not indicate any underlying pathology. She was started on schizophrenia 51% (n=49), psychotic disorders not otherwise specified moclobemide (300mg/day). Her complaints of depression and itch had 20.8% ( n=28), delusional disorder 16.7% (n=16), schizoaffective distinctly regressed 1 month later. disorder 5.2 % (n=5), psychosis due to other health reasons 5.2 % (n=5) and brief psychosis disorder 1% (n=1). DISCUSSION: PP has been classified under Somatic Symptom Disorders in DSM-5, and is not currently included in dermatological DISCUSSION: It has been ascertained that pscyhotic symptoms in or psychiatric diagnostic criteria. Its diagnosis and treatment is difficult the elderly cause burnout in the caregiver and neglect and abuse of for both the dermatologist and the psychiatrist. Regarding PP as a the patient is frequently observed. Studies on the elderly population dermatological disease may lead to unnecessary test and treatment costs with psychotic disturbances not related to organic pathologies are very and if itch secondary to systemic diseases is regarded as PP may lead to limited in numbers and there is need for further investigations on the just as unnecessary and insufficient intervention. It has been intended subject. here to draw attention that patients complaining of itch should be car Keywords: Clinical characteristics, geriatric patient, psychotic disorder efully investigated on the basis of PP as in the case presented here. References Keywords: Idiopathic pruritus, itch, pathological itch, pruritus, Östling S, Skoog, I (2002) Psychotic symptoms and paranoid ideation psychogenic pruritus, treatment in a non-demented population-based sample of the very old. Archives of General Psychiatry, 59: 53–59.

137 Schneider LS, Olin JT, Doody RS ve ark (1997) Validity and reliability References of the Alzheimer ’s Disease Cooperative Study – Clinical Global Figueroa Y, Rosenberg DR, Birmaher B, et al., (1998) Combination Impression of Change. Alzheimer Disease and Associated Disorders, treatment with clomipramine and selective serotonin reuptake 11 (2): 22–S32. inhibitors for obsessive-compulsive disorder in children and Steele C, Rovner B, Chase GA (1990) Psychiatric symptoms and nursing adolescents. J Child AdolescPsychopharmacol. 8(1):61-7. home placement of patients with Alzheimer’s disease. American Ravizza L, Barzega G, Bellino S et al.,(1996) Therapeutic effect and Journal of Psychiatry, 147: 1049–1051. safety of adjunctive risperidone in refractory obsessive-compulsive disorder (OCD). PsychopharmacolBull.32(4):677-82. Szegedi A, Wetzel H, Leal M et al.,(1996) Combination treatment with clomipramine and : drug monitoring, safety, and PP-145 tolerability data. J ClinPsychiatry. 57(6):257-64.

GENERALISED TONIC CLONIC SEIZURE AFTER CLOMIPRAMINE AND FLUVOXAMINE PP-146 COMBINATION THERAPY Celaleddin Turgut1, Abdullah Seyithanoğlu2 EFFECTS OF “INFERENTIAL CONFUSION’’ ON 1Dr. Süreyya Adanalı Göksun State Hospital, Psychiatry Clinic, REASONING AND DECISION MAKING PROCESSES Kahramanmaraş IN OBSESSIVE-COMPULSIVE DISORDER 2Dr. Süreyya Adanalı Göksun State Hospital, Neurology Clinic, Kahramanmaraş Hasan Mervan Aytaç, İbrahim Enis Kayran Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological AIM: It has been reported that in the cases of treatment resistant obsessive- Diseases and Research Hospital, İstanbul compulsive disorder (OCD), combination therapy with clomipramine and fluvoxamine is more succesful than with clomipramine alone. This AIM: It has been aimed to determine the capacities of obsessive- combination therapy has faced limitations on account of the side effects compulsive disorder (OCD) for heuristic reasoning under uncertainty of sedation, tachycardia, QT elongation, and myoclonic jerks. It has and to investigate the relationship between liability to obsessions and been aimed in this report to present a case of generalised tonic clonic inferential confusion in reasoning. seizure that developed after combination therapy with clomipramine METHODS: This study is a prospective descriptive type clinical survey and fluvoxamine. and has included 35 patients diagnosed with OCD on the basis of CASE: The 22-year old male patient developed, some 4 months SCID-1. Patients completed the Yale-Brown Obsessive-Compulsive previously, symptoms of recontrol while driving, least he hit someone Scale (Y-BOCS) to assess the severity and symptom distribution of the road, and frequently washing his hands thinking that they had been OCD; subsequently the obsessive beliefs of the patients were evaluated microbially contaminated. He had been diagnosed with OCD in a on the Obsessive Belief Questionnaire (OBQ), and the liability to healthcare center and treatment had been started on clomipramine with inferential confusion, the two factors of inferential confusion, namely dose titration from 10mg/day to 300 mg/day. As his complaints had not the mistrust in senses and the opposite inference were tested on the regressed, fluvoxamine (200mg/day) had been added to his treatment Inferential Confusion Questionnaire (ICQ). The Reasoning with which resulted in distinct regression in his symptoms. However, when he Inductive Argument Test (RIAT) was conducted by the interviewer to assess the inductive reasoning and decision making under conditions consulted our polyclinics for control, he lost consciousness for about 2-3 of uncertainty. Also the Beck Anxiety Inventory (BAI) and the Beck minutes and had total body contractions. He was sent to the emergency Depression Inventory (BDI) were used to detemine the anxiety and the

POSTER PRESENTATIONS service for observation. His haemogram, biochemical test results and depression levels of the patients. ECG results as well as the EEG and cranial MRI investigations did not indicate any underlying pathology. Since the patient did not want ot RESULTS: In the OCD group of patients the scores onthe ICQ and the continue with the existing treatment, clomipramine and fluvoxamine mean degree of alteration trust on the RIAT were found to correlate with the doses were gradually reduced for discontinuation and he was started severity of OCD symptoms. However, a correlation was not found between with fluoxetine (20mg/day) and was also put on cognitive behavioural obsessive beliefs and the symptom severity. In agreement with previous therapy. Two months later the fluoxetine dose was titrated to 50mg/day studies, a strong correlation was found between inferential confusion and the and his OCD symptoms regressed. He has been under follow up for 8 obsessive beliefs. A difference was not found between inferential confusion months without recurrence of seizure. and the strength of inference on first and the last confidence levels in RIAT. Similarly, a significant correlation was not derermined between obsessive DISCUSSION: The risk of seizures after high dosage of clomipramine beliefs and the mean degree of trust in RIAT. has been reported to vary in the 5-10% range. There is less incidence of seizures with fluvoxamine, but it has been reported with every DISCUSSION: Results of the study have shown correlations between therapeutic dose of the tricyclic antidepressants. In combination and the RIAT ‘strenght of confidence’ and between OCD symptom treatment with clomipramine and fluvoxamine, serum clomipramine severity and inferential confusion. However, a correlation between level has been demonstrated to have increased. In the case presented inferential confusion and the cahnges in the confidence levels was not in this report, seizure occurred after the addition of fluvoxamine to the demonstrable. Consequently, it can be argued that the ICQ and the treatment with clomipramine. Therefore it is emphasised here that there RIAT evaluate different factors related to OCD. is a risk for seizures as a side effect of the combination therapy with Keywords: Decision making, inferential confusion, obsessive- clomipramine and fluvoxamine. compulsive disorder, reasoning Keywords: Clomipramine, fluvoxsamine, OCD, seizure References Harvey N (2007) Use of heuristics: Insights from forecasting research. Thinking & Reasoning, 13:5-24.

138 PP-147 PP-148

PSYCHOSIS DUE TO SYNTHETIC CANNABINOID IS OBESITY A DEPENDENCE DISORDER? USE WITH DELUSIONAL INGESTION OF PINS AND Cengiz Çelebi1, Anıl Gündüz2, Yıldız Akvardar3 AA- BATTERIES: CASE PRESENTATION 1Afyonkarahisar State Hospital, Psychiatry Clinic, Afyonkarahisar Elçin Ataseven, Derya İpekçioğlu, Haluk Yeşilkaya, Mehmet 2Bilecik State Hospital, Psychiatry Clinic, Bilecik Cem İlnem, Tuba Gürbüz 3Marmara University Pendik Training and Research Hospital Psychiatry Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Department, İstanbul Diseases and Research Hospital, No 7 Psychiatry Clinic, İstanbul AIM: Neurochemical similarities are observed in the brain in cases of AIM: Synthetic cannabinoids (SC)a re among the widely used obesity and substance dependence. Excessive eating behaviour described psychoactive substances in our country. SC show the characteristics of as eating dependence may be a potential dependence. It has been aimed the Δ9- tetrahydrocannabinol found in cannabis. Many different types in this study to evaluate eating dependence in obesity. of SC are being produced; the 1-pentil-3-(1-naftoil) indole (JWH- METHODS: The study included 140 obese patients consulting 018 ), due to its ease of production and high activity, being the most for bariatric surgery. The patients completed a sociodemographic fequently used type. The psychotic symptoms due to SC use can be listed and clinical questionnaire and were conducted through an interview as irritability, agitation, epileptic seizures, persecutory and referential structured on the DSM-5 substance use disorders criteria adjusted to delusions, visual and auditory hallucinations and delirium. Although eating dependence criteria. Eating dependence was also evaluated on the the effects of the SCs resemble those of cannabis, unlike cannabis they basis of the Yale Food Addiction Scale (YFAS). lack cannabinidiol which reduces the incidence of psychosis. In this report it has been aimed to discuss the case of a patient diagnosed with RESULTS: Estimated eating dependence incidences in the obesity psychosis due to SC use. patients were 82.9% and 47.1%, respectively, on the bases of the DSM- CASE: The 37-year old male patient described a 2-year history of 5 interview and the YFAS scoring (n=66). pscyhosis. He had used cannabis for 20 years and then had given up. DISCUSSION: When evaluated on the YFAS, the incidence of He had been using Bonzai for the previous 7 years, but had stopped eating dependence was 47.1% among the obese patients consulting 1.5 months previously due to lack of sleep, agressiveness, thoughts for bariatric surgery. This finding is in agreement with the incidence of being prophetic and of having power to change stones to gold. range of 40-60% estimated in previous evaluations of obese bariatric In his examination he showed grandiose attittude and mystical and surgery patients. As against assessment on the basis of answers as ‘’yes’’ persecutory delusions. His physical examination was normal and his and ‘’no’’, the DSM-5 based interview has the dimensional component laboratory test results were within normal limits. He was started on adding the measure of continuity. The newly described concept is haloperidol and biperidene. While staying at the ward he was reported believed to be applicable to eating dependence. Increased studies on to have swallowed 2 AA batteries to help himself overcome the ongoing eating dependence are expected to contribute to the diagnosis of eating wars. When referred to the general surgery unit, 4 pins were discovered dependence, its role in obesity and the treatment of obesity. in his abdomen. While his controls at the general surgery continued, his treatment was switched to riperidone (8gm/day) but ECT was Keywords: Eating dependence, obesity, YFAS commenced when improvement was not observed. After 10 sessions his References delusions had subsided with significant decrease in his PANNS score, Corwin RL, Grigson PS (2009) Symposium overview food addiction: and he was discharged. fact or fiction? The Journal of nutrition, 139(3): 617-619. DISCUSSION: Cheapness and easy access explain the popularity of the Eichen DM, Lent MR et al., (2013) Exploration of “food addiction” in

SCs. As the side effects are more varied and serious and of the psychotic overweight and obese treatment-seeking adults. Appetite, 67:22-24. POSTER PRESENTATIONS type as compared to cannabis, SC use had to be remembered in the procedure of differential diagnosis. Since many psychiatry patients also use SC, discriminating the symptoms of one from the other becomes PP-149 a problem, and it is also difficult to get those with adverse medical outcomes accepted in other hospital units, although coping with the problems of SC users is not the sole resposibility of the pscyhiatrists. ROLE OF OBSESSIVE BELIEFS IN GENERAL It is necessary to prevent access to the SC and to inform the individual ANXIETY DISORDER at childhood. Also, when problems of internal medicine appear, Ömer Şenormancı1, Ramazan Konkan2, Oya Güçlü3, Erkan intervention by relevant branches of medicine should not be delayed. Aydın3 Keywords: Psychosis due to substance use, synthetic cannabinoid use, 1Bülent Ecevit University Medical School, Psychiatry Department,, swallowing foreign materials Zonguldak 2 References Bağcılar Training and Research Hospital, İstanbul 3 Fattore L (2016) Synthetic cannabinoids further evidence supporting Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological the relationship between cannabinoids and psychosis. Biological Diseases Training and Research Hospital, İstanbul psychiatry, 79(7): 539-548. AIM: According to the cognitive theory on obsessive-compulsive Tait RJ, Caldicott D, Mountain D et al. (2016) systematic review of disorder (OCD), obsessive beliefs contribute to the development and adverse events arising from the use of synthetic cannabinoids and the progress of the obsessive-compulsive symptoms. In some studies it their associated treatment. Clin Toxicol (Phila).54(1):1-13. has been argued that obsessive beliefs are not specific to OCD, but are a common characteristic of anxiety and depression. In this study, obsessive beliefs have been investigated only in generalised anxiety disorder (GAD) and in healthy individuals forthe purpose of comparison.

139 METHODS: The study enrolled 110 patients diagnosed at Bakırköy not observed in the EBIT scores on the basis of marital status and the Mental Health and Neurological Diseases Training Hospital with departments of work. When grouping was made with age at and below GAD on the basis of DSM-IV-TR criteria and 112 healthy individuals 27 and at or above 28, intergroup comparisons did not give significant matched with the patients with respect to sociodemographic details. difference of EBIT scores (p=,164). In the male group, for those at and The participants completed the Obsessive Belief Questionnaire (OBQ- below 27 (n=18) and those at or above 28 (n=33), the converted total 44), Generalized Anxiety Disorder test (GADT-7) and the Beck GRISS scores were, respectively, 6,05±2,12 and 4,72±2,36 (p=0,47); depression Inventory (BDI). and converted communication scores were, respectively 4,50±2,03 and 3,23±1,67 (p=0,020). The GRISS converted scores of single males RESULTS: The mean score of the GAD patients on the GADT-7 was (n=29) and the married males(n=23) were, respectively, 5,24±1,97 and 12.5 (8-16), with the median in the 25%-75% percentiles. Their mean 3,95±1,46 (p=0,010) on frequency; and were respectively, 4,13±2,08 score on the BDI was 19.5 (12-31.2.) In comparison, the corresponding and 3,08±1,44 (p=0,037) on communication. In the female group, scores of the control group on GADT and BDI were, respectively, 4 for those at and below 27 (n=32) and those at or above 28 (n=21), (3-8) and 6 (2-13). Both sets of scores were significantly higher in the converted total GRISS scores were, respectively, 5,68±2,65 the GAD group(p<0.05). The OBQ-44 total and subscale scores and 4,23±2,50 (p=0,051); and converted satisfaction scores were, were significantly higher in the GAD group(p<0.05). On the basis of respectively, 4,09±1,37 and 3,09±144, (p=0,016). The converted scores Pearson correlation analysis, correlations of moderate-poor statistical on vaginismus were, respectively, 5,90±1,78 and 4,61±1,96 (p=0,020). significance were determined between the GADT-7 test scores and the The converted total and all subscale scores of the married females OBQ-44 subscale of perfectionism/intolerance of uncertainty (r=0.30, (n=28) were significantly higher than those of the single females ( n=25) p<0.05), the OBQ-44 subscale of exaggerated responsibility/exaggerated (p=0,000). threat perception (r=0.29, p<0.05), and the OBQ-44 subscale of taking thoughts seriously/controlling thoughts (r=0.32, p<0.05). DISCUSSION: When eating behaviours are analysed on the basis of psychodynamism, oral phase characteristics are seen as the libidonal DISCUSSION: These findings have supported the proposals that phase characteristics. In this respect, it can be argued that eating attitudes obsessive beliefs are not specific to OCD, but that they may play a role and sexual attitudes and sexual function disorders may be interrelated. on the liability to get harmed in the development of GAD. Adjustments to be made in cognitive behavioural therapies for the purpose of Keywords: Eating attitudes, eating disorders, sexual attitudes, sexual determination and correction of these obsessive beliefs should be exprience, sexual satisfaction effective on the positive response to treatment in GAD. Keywords: Generalised anxiety disorder, obsessive beliefs, obsessive- compıulsive disorder PP-151

References PEDAL EDEMA RELATED TO RISPERIDONE: CASE Tolin DF, Worhunskya P, Maltby N (2006) Are ‘‘obsessive’’ beliefs PRESENTATION specific to OCD?: A comparison across anxiety disorders. Behav Res Ther, 44: 469-80 Cemre Kulakçı1, Nuran Gözpınar Ekinci2, Eda Aslan1 1Mersin University, Medical School, Mental Health And Diseases Department 2 PP-150 Mersin University, Medical School, Child and Adolescent Mental Health And Diseases Department RELATIONSHIP OF SEXUAL FUNCTION AND AIM: When cases of pedal edema due to risperidone use are investigated,

POSTER PRESENTATIONS SEXUAL SATISFACTION WITH EATING BEAHVIOUR combined multiple drug treatment draws the attention. In this report it is intended to discuss the case of pedal edema that developed on Ecenur Aydın Aşık, Emin Oryal Taşkın, Erol Özmen the 10th day of low dose risperidone treatment started for delusional Celal Bayar University, Psychiatry Department, Manisa parasitosis of a patient not previously treated with psychotropic agents AIM: It has been aimed in this study to determine the effects of CASE: Mrs.M, the 60-year old widowed female patient, with one child sexual attitudes and sexual function disorder on one another and their and living alone did not have a history of psychiatric consultation or relationship. psychiatric drug treatment. Five months previously she had started to METHODS: This study was carried out with 105 postgarduate trainees think that she had swallowed the larvae of bird fleas which started to in the Celal Bayar University Medical School. The participants were proliférate in her body and fell off when she scratched herself. Se had given, in closed envelope, a sociodemographic questionnaire without consulted a number of dermatology clinics where she was told that queries on identity, the Golombok- Rust Inventory of Sexual Satisfaction the complaints were psychological and that she was not flea infested. (GRISS) and the Eating Behaviour Inventory test (EBIT). She was last followed at the dermatology clinic of our hospital and was referred to psychiatry. The excoriation marks on the patient’s arms and RESULTS: The demographics data showed that the participant legs drew attention. In her pychiatric examination, she was conscious, population consisted of 50,4%(n=53) females; and 51,4%(n=54) were with complete orientation and normal perception. Day long ruminative at the age of 28 or above; 51,4%(n=54) were single; 62,8% (n=66) thoughts about her delusions about parasites affected her functionality. had a regularNOT sexual partner; PRESENTED 59%(n=62) had first sexual intercourse She did not have any other anomalous finding apart from the delusions. within conditions of emotional relationship; 16,1%(n=17) had never The results of her laboratory tests and the EEG and cranial MRI experienced sexual relationship. On the basis of the psychometric tests, results were all normal. She was diagnosed with delusional parasitosis the total score of the females (n=53) and the males (n=52) on the EBIT and admitted as an inpatient. On the 10th day of the treatment with were, respectively, 13,07± 7,52 and 11,53±5,62. EBIT scores of those risperidone (2mg/day) she developed bilateral pedal edema and in who had a good(n=42) and middle (n=63) economical status were, the following days she develpoed cellulitis related to the edema. Deep respectively, 14,07±8,17 and 11,14±5,17 (p=0,043). Differences were vein thrombosis was not seen with Doppler USG. All systemic reasons

140 for pedal edema (cardiac, nephrogenic and allergic) were eliminated. the 8 items had an internal consistence (Cronbach-alfa)coefficient of Risperidone treatment was discontinued and classical antipsychotic 0.72. The EFA included the remaining 23 items which were subjected therapy was planned. Also treatment for the cellulitis was planned and to principal component analysis and the varimax rotation. A 4-factor she was put under close observation. solution was found. When the eliminated 8 items were included in the factor analysis, a 5-factor solution, as in the original, was obtained. DISCUSSION: Risperidone is an atypical antipsychotic that has antagonistic effect on the 5-HT2A, D2, α-1 and α-2 adrenergic and DISCUSSION: Although the non-performing items of the scale need H1 receptors. Risperidone mechanism of action leading to oedema reorganising, the Turkish version of the scale can be used with attention has not been clearly defined. It has been proposed that vasodilatation to its limitations. and lowered vascular resistance after α-1 receptor antagonism and the Keywords: Cognitive and affective empathy, reliability and validity, vasodilatation due to increased cAMP levels after 5-HT2A blockage social cognition, are behind the observed odema. As oedema causes cellulitis, which is another important complication, further and detailed studies are References required on this side effect of risperidone. Decety J, Jackson PL (2004) The functional architecture of human empathy. Behavioral and cognitive neuroscience reviews, 3(2): 71- Keywords: Atypic antipsychotic, pedal oedema, risperidone 100. References Decety J, Moriguchi Y (2007) The empathic brain and its dysfunction Sanders RD, Lehrer DS (1998)Edema associated with addition of in psychiatric populations: Implications for intervention across risperidone to valproate treatment.Journal of Clinical Psychiatry59 different clinical conditions. BioPsychoSocial Medicine, 1(1):1. (12): 689–690. Yalug I, Osten E, Tufan AE et al. (2007) Bilateral pedal edema associated with olanzapine use in manic episode of bipolar disorder. Progr PP-153 Neuropsychopharmacol Biol Psychiatry,31:1541–2. PSORIASIS DEVELOPMENT IN LITHIUM THERAPY: CASE PRSENTATION PP-152 Yusuf Erçin Yılmaz, Salime Gürsoy VALIDITY AND RELIABILITY OF THE TURKISH Erenköy Mental and Neurological Diseases Training and Research VERSION OF THE QUESTIONNAIRE OF COGNITIVE Hospital, İstanbul AND AFFECTIVE EMPATHY: A PRELIMINARY STUDY AIM: Lithium is one of the most important therapeutic agents used in the management of and the prophylaxis of bipolar affective disorder Ahsen Büyükavşar, Hüseyin Güleç, Şakir Gıca (BAD). Lithium acts by causing changes in the cell membrane through Erenköy Mental and Neurological Diseases Training and Research Hospital the action of cAMP. As the therapeutic range is narrow, prolonged use AIM: The concept of empathy has recently gained importance in can have toxic effcects which are oberved in a dose-dependent in the neurosicences and has been increasingly researched. Many psychiatric thyroid gland, the kidneys, the gastrointestinal system and the central disorders have been found related to impairment of the brain empathy nervous system, but on the skin the effects appear independent of function and the ongoing studies are focused on effects of empathy the dose. The most frequently observed dermatological side effects is on these disorders. Many psychometric scales have been developed development or the flare up of psoriasis. We have aimed to present a case to evaluate empathy. Lately it has been proposed that empathy has of psoriasis development due to lithium therapy and its management. two different dimensions as the cognitive and affective empathy. The

CASE: The 44-year old single unemployed male patient had been on POSTER PRESENTATIONS existing scales are thought to be inadequate in evaluating the cognitive follow up for 10 years with the diagnosis of BAD. When he consulted and affective empathy concepts. Reniers et al(2011) have developed a psychiatry, his ongoing treatment consisted of sodium valproate (1500 new questionnaire of cognitive and affective empathy (QCAE) with mg/day), lithium(1200 mg/day), olanzapine (20 mg/day), propranolol the claim that the old scales had conceptual deficits and statistical (80 mg/day) and levothyroxin ( 50 mcg/day). In August 2015 he had inadequacies. QCAE has been put to use by studies on many psychiatric consulted the dermatology polyclinics for oval keratinous scales falling disorders. We have therefore aimed at making a contribution to the from his scalp which did not respond to treatment. At the time of his practice by making a preliminary study for the standardistion of QCAE consultation he did not have any psychiatric complaints. He had 12x12 in Turkish. mm papular partly scaly, erythemateous lesions on his scalp, which were METHODS: The study was carried out with 130 state and university attributed to psoriasis. Since the lesions persisted despite the previous hospital staff between June and August 2016, within the scope of dermatological treatments, it was considered to be a side effect of the project on the importance of the clinical aspect of empathy lithium, which was within therapeutic limits. The therapy was reduced and treatment foresight in psychotic disorder. After translation to by 300mg weekly and was terminated on 24 january 2016 when the Turkish and translation back to English, the final version was given lesions were found to have reduced. for completion to the participants together with a sociodemographic DISCUSSION: There are reports in the literature demonstrating the questionnaire. For the reliability analysis, item-total relationship and formation of acneiform maculopapular eruptions, alopecia or psoriasis the internal consistency (Cronbach-alpha) coefficient were investigated. flare up due to lithium treatment. Psoriasis is one of the most frequently Validity analysis was based on the exploratory factor analysis (EFA). seen side effects, but appears independently of the dose of lithium and is RESULTS: Mean age of the 130 enrolled participants was 29.93 (±6.60), resistant to dermatological treatments. Termination of lithium therapy and the group consisted of 88 females and 42 males. All participants has resulted in subsidence in some cases but has persisted in others. The had university diplomas or higher qualifications. Analysis of the item- case reported here had been on lithium for 10 years which validates total relationship showed that relationship coefficient of 8 items of the argument for occurrence of psoriasis indpendently of the lithum the 31 items was below 0.20. The 23 item scale after elimination of dosage. Nevertheless, controlled decrease of the lithium doses did result

141 in regression of these lesions in the case reported here. Investigation PP-155 of lithium therapy and its history in patients with BAD arriving with psoriasis will be important for the clinical treatment of psoriasis. SUBACUTE SUBDURAL HAEMATOMA IN MAJOR DEPRESSIVE DISORDER PSYCHOTIC FEATURES: Keywords: Lithium, psoriasis, side efect CASE PRESENTATION Nilüfer Okumuş1, Cem Cerit2 1 PP-154 Kocaeli University, Child and Adolescent Psychiatry Department, Kocaeli 2Kocaeli University, Psychiatry Department, Kocaeli PREVALENCE OF SOCIAL PHOBIA AMONG AIM: It has been aimed in this report to present the case of a patient INPATIENTS WITH SUBSTANCE AND/OR ALCOHOL followed up for major depressive disorder, who developed psychotic and threshold level neurological symptoms with MRI evidence of a subacute DEPENDENCE subdural haematoma, and to bring into attention the serious medical Gönül Kaygısız1, Merve Tekeli2, Turkan Doğan1, Erkan conditions requiring emergent treatment with symptoms that could be mistaken with the psychiatric symptoms of the patient. Kuru3 1Eskişehir State Hospital, Psychiatry Department, Eskişehir CASE: The 46-year old male patient had been diagnosed, 8 month 2Eskişehir State Hospital, Social Services Division, Eskişehir previously, at a healthcare centre with major depressive disorder and 3Karamürselbey Training Centre Command Headquartes / Gölcük started on sertraline (50mg/day) treatment, which the patient had terminated by his own will. Since his symptoms had worsened with self Military Hospital, Psychiatry Division, Kocaeli harm behaviour and suspiciousness, he was diagnosed with psychotic AIM: Social phobia is one of the most frequently met psychiatric depression disorder and started on a new treatment protocol with disorders among the alcohol and substance dependent patients. In sertraline (100mg/day) and olanzapine (5mg/day) on an inpatient recent publications the severity of substance dependence has been basis on account of risky behaviour. He had partially improved and linked to social phobia. When social phobia is comorbid with substance discharged on medical therapy. However, his complaints persisted and got further complicated such that he was brought to our services. dependence, the symptoms of dependence ar severer and the response His psychiatric examination showed that, in addition to his previous to treatment is not satisfactory. Therefore, we have aimed to investigate complaints, he had psychotic symptoms not in agreement with his the prevalence of social phobia among the patients with severe substance mood disorder, indicated with poor self care and self harm behaviour. and alcohol dependence necessitating hospital treatment on inpatient He was admitted to psychiatry clinic to clarify his clinical condition and basis. diagnosis. At admission he had head ache, power loss on right arm and leg, balance impairment and aphasia. His cranial MRI showed a 33- METHOD: The study enrolled 33 inpatients being treated at Eskişehir mm subacute subdural haematoma on the left hemisphere narrowing State Hospital AMATEM. The patients were asked to complete the the ventricle and moving the midline 11 mm to the right. He was Liebowitz Social Anxiety Scale (LSAS) on the 4th day of admission to referred to brain surgery for immediate operation. Postoperatively, his the hospital. psychotic symptoms diappeared and depressive symptoms also regressed RESULTS: Among the 33 patients the mean incidence of social considerably. phobia was rated as 24% When the patients were taken in subgroups DISCUSSION: Although there are publications on chronic subdural of substance, or alcohol or substance and alcohol dependence, social haematoma, case reports on subacute subdural haemorrhage with phobia was rated to be 50% among the patients using both substance psychiatric complication could not be found(1, 2, 3). Size of the

POSTER PRESENTATIONS and alcohol and 31% among those with substance dependence only. haematoma, and diagnosis at the subacute stage are factors increasing the risk of mortality. DISCUSSION: Prevalence of social phobia in the general population Keywords has been reported to vary in the 3-13% range. This figure rises among : Depression, psychosis, subdural haematoma the substance and alcohol dependents; and it has been reported to vary References in the 18-25% range in populations outside this country. Results of Gschwandtner U, Borgwardt S, Aston J et al., (2004) Chronic subdural our study has been seen to be in agreement with these reports. The hemorrhage in a patient with suspected schizophrenia prodrome. results indicate that in patients with combined dependence of substance Nervenarzt; 75(7):691-3. and alcohol, social phobia comorbidity should be kept in mind and the Tuman TC, Özsoy SD (2012)Delusional disorder induced by chronic subdural hematoma. Bulletin of clinical psychopharmacology22 patient should be evaluated on this basis. When planning treatments (Suppl. 1):S62. for substance dependence, the high probability of comorbid psychiatric disorders should also be taken into account. Keywords: Alohol dependence, social phobia, substance References Buckner JD, HeimbergRG, Schneier FR et al.,. (2012) The relationship between cannabis use disorders and social anxiety disorder in the National Epidemiological Study of Alcohol and Related Conditions (NESARC). Drug Alcohol Depend, 124(1-2):128-34. Zimmermann G, Pin MA, Krenz S et al., (2004) Prevalence of social phobia in a clinical sample of drug dependent patients. J Affect Disord. 15;83(1):83-7.

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HIGH DOSE ALPRAZOLAM INDUCED ROZASEA DUE TO VENLAFAXINE USE: CASE BEHAVIOURAL DISINHIBITION: CASE PRESENTATION PRESENTATION Ayşe Nur Oğuz, Yusuf Özay Özdemir, Handan Yıldız, Nazlı İlkay Keleş Altun1, Pınar Kızılay Çankaya2 Candemir 1Kanuni Training and Research Hospital Psychiatry Clinic, Trabzon Erenköy Mental and Neurological Diseases Training and Research Hospital 2Fatih State Hospital, Psychiatry Clinic, Trabzon AIM: Rozasea is a dermatological disorder presenting with different AIM: Benzodiazepines are central nervous system depressants with severities of erythema, telangiectasia, papules, pustules and sebaceous sedative, hypnotic, anxiolytic and antiepileptic side effects. They can gland hypertrophy generally over the face, and the neck. Its result in paradoxical effects of psychomotor agitation, aggression, aetiopathology has not been explained, but the implicated factors increased volume of speech, confusion, impulse control disorder and include genetic liability, infectious causes, sebacous hair follicle behavioural disinhibiton. We have aimed here to present a case of disorders, environmental factors, sun damage and fibrous tissue damage, behavioural disinhibiton induced by alprazolam use. psychogenic factors, vascular hyperreactivity, natural immune system CASE: The 34 year old single, labourer male patient with sedative and cathelicidins and reactive oxygen species. During venlafaxine use, hypnotics use disorder for the previous 3 years, had increased by side effects such as Stevens-Johnson Syndrome with development of personal decision his alprozalam dose from 2-3 mg/day to 6-7 mg/day. subepidermal sweating, blushing, hair loss, erythema on the skin and Approximately 1 month previously, after having taken 4 mg alprozalam, around the eyes, urticaria with oedema have been described. In this he could not resist the need to strip his clothes off at work and masturbate report it has been aimed to present a case of rozasea due to alprazolam when others around called the police. Two weeks after the event, he took use. 6 mg alprozalam after expriencing a difficult family situation, and he CASE: The 47-year old female patient had consulted psychiatry repeated the same act in front of the family members. He consulted polyclincs with complaints of depression symptoms. She was started on the psychiatry polyclinics with these complaints, expressing that he was aware of the acts and did remember the incidents but could not velafaxine for moderately severe episode, but developed itchy skin lesions resist the urge he felt. In his psychiatric examination he appeared his age of erythema, telangiectasia, papules and pustules on the facial midline, with appropriate self care, cooperating with the interview. His mood especially around the glabella and nasolabial sulci. Dermatology unit as anxious and affect dysphoric. His speech was intelligible, and he did consultation confirmed rozasea trriggered by medication. Alongside the not express perceptive pathology. His thought process and associations dermatological treatment given, her venlafaxine dose was discontinued were normal, and thought contents were related to his complaints. and switched from SSRIs to antidepressants, when the lesions completely Cognitive abilities, comprehension of reality and judgements were disappeared without laving scars and without repeating over one year of normal. His extraverted behaviours were normal. His alprazolam dose follow up controls. of 6mg/day was discontinued and he was put on clonazepam (4 mg/ DISCUSSION: Although there have not been other case reports on day) and haloperidol (2.5mg/day). He was informed on substance use rozacea after venlafaxine, the widescale side effect of vasodilation by dependence and the purposes of AMATEM services. The patient refused venlafaxine is thought to contribute to the development of rozasea. treatment at AMATEM, but in his first week of polyclinic control he did not have complaints of behavioural disinhibition. His clonazepam Keywords: Rozasea, vasodilation, venlafaxine dose was reduced to 2 mg/day, and was recommended follow up control References after a week. Del Rosso JQ (2006) Update on rosacea pathogenesis and correlation

DISCUSSION: There are case reports in the literature on induction with medical therapeutic agents. Cutis, 78(2): 97. POSTER PRESENTATIONS of agitation, insomnia, hypomania and temporary stammering by Lazaridou E, Giannopoulou C et al., (2011). The potential role of alprazolam. Alprazolam mechanism of action is not known, but microorganisms in the development of rosacea. JDDG: Journal der children, the elderly, alcohol dependents and patients with pscyhotic Deutschen Dermatologischen Gesellschaft, 9(1): 21-25. or behaviour disorders are among the risk groups for the cited effects. In a limited number of case reports, use of physostigmine, flumazenil and haloperidol have been indicated for treatment of the paradoxical reactions. With accumulation of information on these paradoxical PP-158 reactions, there will be more effective methods of therapy. EROTOMANIA VIEWED AS OUTCOME OF BRAIN Keywords: Alprazolam, behavioural disinhibition, paradoxical reaction EVOLUTION: CASE PRESENTATION References Bramness JG, Skurtveit S, Morland J. (2006) Flunitrazepam: Burçhan Sözer, Elif Çarpar, Şahap Erkoç psychomotor impairment, agitation and paradoxical reactions. Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Forensic Sci Int;159(2-3):83-91. Diseases and Research Hospital, Psychiatry clinic, Bakırköy / İstanbul Hall RW, Zisook S (1981) Paradoxical reactions to benzodiazepines. Br AIM: Erotomania is a delusional belief of having an emotional J Clin Pharmacol, 11:99–104S. relationship with another individual of usually higher social ranking. Kozumplik O, Uzun S, Jakovljevis M (2010) Agitation and insomnia In the evolution of the brain to establish appropriate communication during therapy with alprazolam: case report. European Psychiatry, with the inner and outer environment by processes of natural and 25(Suppl 1):963. sexual selection over long periods of time, involvement of the personal ontogeny alongside phylogenetic history are accepted. Pathological human behaviour is as much dependent on the evolutionary processes as are the natural behaviour patterns. The evolutionary processes

143 involved in the development of erotomania have been discussed within not yet been diagnosed with MS, 10% incidence of delusions and the context of a case of erotomania presented in this report 7% incidence of hallucinations have been known in MS. Considering that there is also 79% incidence of depressive symptoms, it is posible CASE: The 46-year old single female patient with a regularly working to diagnose depression with psychotic features, or atypical affective life style, had been thinking over the previous year that the teacher of her disorder and miss the neurological root of the disease. This case report niece was in love with her. Apart from meeting him from time to time is important for reminding the clinicians that cases similar to the one when leaving her niece to school she had not known this gentleman. She presented here have to be investigated for organic aetiology. believed that she was given indications by the way the cars were parked in the parking yard of the school and was trying to establish contact on Keywords: Demyelinating disease, first consultation, mood disorder the phone. demyelinating disease DISCUSSION: Erotomanic delusions can be explained within the References context of the evolutionary inheritence with its culturally unmodifed Espinola-Nadurille M, Colin-Piana R et al. (2010) Mental Disorders in age of onset, sociodemographic features, delusional contents and the Mexican Patients With Multiple Sclerosis, J Neuropsychiatry Clin object of desire. There are distinct differences between males and Neurosci, 22:1. females in the choice of a partner and the investment on the sublineage Berry N, Sagar R, Tripathi BM (2003) Catatonia and other psychiatric which lead to different adaptive charcteristics and different pathological symptoms with vitamin B12 deficiency, Acta Psychiatr Scand, 108: states. These facts have been discussed over the presentation of a case of 156–159. typical erotomanic type delusional disorder. Tacos D, Sivaswamy L (2013)Mood Disorder as the Presenting Manifestation of Demyelination, Case Rep Neurol, 5:104–109. Keywords: Erotomania, evolutionary psychiatry, partner selection References Rudden M, Sweeney J, Frances A (1990) Diagnosis and Clinical Course PP-160 of Erotomanic and Other Delusional Patients. Am J Psychiatry, 147(5):625-8. NEUROCOGNITIVE DISORDER AND DEPRESSION AFTER TRAUMATIC BRAIN DAMAGE: CASE PRESENTATION PP-159 İbrahim Yağcı1, Yüksel Kıvrak2 1 DIAGNOSIS OF DEMYELINATING DISESASE AFTER Kars Harakani State Hospital, Psychiatry Clinic, Kars 2Kafkas University Medical School, Psychiatry Department, Kars SUICIDAL ATTEMPT: CASE PRESENTATION AIM: In neurocognitive disorder due to brain damage apathy, İbrahim Akbaş, Barış Sancak, Özlem Gül indifference, reduced mobility and actions, irritability and impairment Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological of cognitive functions are observed. Comorbidity with depression Diseases and Research Hospital, No.6 Psychiatry clinic, Bakırköy / İstanbul is common but relatives and caregivers of patients often ignore this. AIM: Although psychotic disorders and mood disorder are mostly Therefore, at consultation with the hospital, depressive symptoms known to arise from organic pathological factors, the aeitology of do not come to the foreground and is often missed by the clinicians these disorders does involve to the extent of 5-10% various organic overloaded in the complicated polyclinical environment. As depression processes such as strokes, demyelinating lesions and birth related impairs the functionality of the individual the disease progress worsens. problems. Multiple sclerosis (MS) is one of the most common In the report we have presented the case of a patient whose cognitive

POSTER PRESENTATIONS demyelinating diseases known and has been seen to be comorbid with functions improved with the treatment of depression. affective, psychotic and cognitive psychiatric disorders given diagnoses CASE: The 33-year old male patient had already lived with the for depressive symptoms in 79% of the patients, of major depressive problems of amnesia, irritability, coprolalia, difficulty controlling disorder in 47% and bipolar disorder in 13%. The symptoms observed anger, and fatigue for the 2.5 previous year when he consulted us. vary as hallucinations (10%) and delusions (7%). In this report it has History taking revealed that he had suffered a traffic accident 2.5 years been aimed to discuss a case of demyelinating disease discovered after previously, spending 2.5 months at intensive care unit, with a total repeated suicidal attempts with affective/psychotic symptoms. of 3-month hospital stay when his complaints began. His psychiatric CASE: The 29-year old male patient, divorced 3 years previously, had examination showed reduced self care, depressive mood, labile affect, attempted suicide twice in the previous week. After assessment at the anhedonia, increased sleep, apathetic appearance, reduced mathematical emergency service he was referred to the psychiatry clinic. It was learned and attention abilities, poor thought contents, por judgement and from his relations that his problems had started 4 years previously by interpretation. Neurological examination indicated power loss in the an episode of memory loss, leading to persecutory delusions, visual and upper extremities. Routine biochemical test results w ere normal. auditory hallucinations. He had been followed by the neurology clinic Intracranial MRI indicated sequels of encephalomalacic changes with and had not been referred to psychiatry services. When his cranial MRI cortico-subcortical gliosis in the frontal lobe basal median, left frontal lobe basal and neighbouring temproal lobe ventral regions and the during follow up at a healthcentre indicated organic pathology, he was insular ortex. The patient, whose functionality had been good before referred to the neurology unit and the subsequent follow up controls the accident, was thought to have neurocognitive disorder due to were conducted by neurology-psychiatry cooperation. traumatic brain damage on the basis of the impairment in his intellectual DISCUSSION: Psychiatric symptoms may be the first to be observed performances and personality. He was started on sertraline (50mg/day) in demyelinating disease. The problem of the patient discussed here had and the dose was titrated gradually to 200 mg/day. Regression of the started 4 years previously when he was experiencing a problemmatic depression and the psychomotor retardation and improvement of the engagement relationship. Many studies have shown psychological functionalaity was oberved. After a short while he was able to come stresses to induce demyelinating attacks. Although the patient had byhimself from another province to keep up with his periodic controls.

144 DISCUSSION : Neurocognitive disoder can be comorbid with Rugancı N ve Gençöz T (2010) Psychometric properties of a Turkish depression after traumatic brain injury. This may be missed by the version of the Difficulties in Emotion Regulation Scale. Journal of patient’s relations adn the doctors consulted at the polyclinics. Treatment Clinical Psychology, 66, 442-455 of the depression may reduce the complaints of the patient. Therefore, psychiatric examination in cases of neurocognitive impairment after traumatic brain injury is very important. PP-162 Keywords: Depression, psychiatric treatment process, traumatic brain damage SUBSTANCE USE DISORDER DEVELOPED AFTER References PETHIDINE TREATMENT FOR POSTOPERATIVE Duffy JD, CamPPell JJ. (1994) The regional prefrontal syndromes: a ANALGESIA: CASE PRESENTATION theoretical and clinical overview. J Neuropsychiatry Clin Neurosci, 6:379-87. Hilal Seven, Başak Demirel, Hatice Yardım Özayhan, Kıvrak Y,Karademir B,Aygun H. et al. (2014) The effect of agomelatine Ali Hakan Öztürk, İbrahim Eren on the nociceptive system. Klinik Psikofarmakoloji Bulteni, SBU Konya Training and Research Hospital, Beyhekim Psychiatry Clinic, 24(3):220-5. Konya Simons JS, Spiers HJ. (2003) Prefrontal and medial temporal lobe AIM: Pethidine, the first synthetic analgesic opioid, is relatively safer interactions in long-term memory. Nature Rev Neurosci4:637-48. than In having less risk of inducing dependence and is used frequently to relieve the pre and post operative pains. On account of its distinct anticholinergic and local anaesthetic effects, it is used in PP-161 trauma, acute pancreatitis, acute pains due to nephrolithiasis and biliary colic. It is a relatively weak μ-opioid agonist with a half life of 3 hours. INVESTIGATION OF THE EFFECTS OF EMOTION Excessive dose causes respiratory depression, convulsions, and coma. REGULATION CAPACITY AND COGNITIVE Craving syndrome starts rapidly reaching a peak within 8-12 hours and subsides in 4-5 days. There are case reports in the literature on AWARENESS ON COMPULSIVE, HEDONIC AND the pethidine use disorder after iatrogenic use of pethidine. In the case UNPLANNED CONSUMPTION presented here, pethidine injections after orthopaedic surgery have led Ela Arı, Merve Karaoğlu, Dilara Birtek, Merve Akar to opioid use disorder.. İstanbul Commerce University, Psychology Department, İstanbul CASE: 27-year old single male patient, without anything unusual in AIM: The aim of this study was to investigate the effects of emotion his personal and family history, had been operated in the orthopaedics regulation capacity and cognitive awareness on compulsive, hedonic and traumatology clinic 33 times in the previous 12 years for pes and unplanned purchasing. ekinovarus, the last one being 3 month previously. Pethidine had been used as analgesic in the postoperative periods. He had been using for METHODS: The study was carried out with a total of 95 individuals approximately 1 year, daily doses of 4-5 ampıles of 100mg/2 ml of consisting of 60 (63.2%) females and 35 (36.8%) males, with a mean age pethidine i.m. He had developed tolerance to the analgesic and euphoric of 25.11 (SD = 6.07) years. Data were collected on a sociodemographic effects and had increased his daily dose to 30 ampules. When he did not questionnaire, the Difficulties in Emotion Regulation Scale. (DERS), take pethidine he had symptoms of lack of appetite, sweating, abdominal the Mindfulness Attention Awareness Scale (MAAS) and the Exploratory pain, yawning, rhinorrhea, and anhedonia. He consulted our polyclinics Buying Behavior Scale (EBBS) with the cited complaints and was admitted as an inpatient. He was started on buprenorphine/naloxone (4/1 mg) and also myorelaxant and RESULTS: Statistical analyses indicated that difficulty of regulating POSTER PRESENTATIONS emotions (β = -.17, p <.05) and cognitive awareness (β =.10, p <.05) analgesic tablets. His cravings regressed and he was discharged. predicted compulsive purchasing. Additionally, hedonic purchasing was DISCUSSION: According to the information in the literature, pethidine μ μ higher among females ( = 26.53) as compared to the males ( = 20.54) misuse is usually due to iatrogenic reasons. It has been argued that the ( t= 3.14, p <.05). As the habit of buying a certain brand increased, reasons fordependence are varied and include chronic and persistent β hedonic purchasing was also increased ( = 3.82, p <.01). Scoring on the aches, bad patient-doctor relationship, anxiety or depression based β scubscales of DERS predicted the unplanned purchasing ( =.40, p <.05). lowered tolerance, history of substance use or liability and inappropriate DISCUSSION: Results of this study demonstrating the relationship analgesic use. Patients consulting with complaint of pain and aches have between compulsive purchasing and cognitive awareness and diffculities to be psychiatrically evaluated, the comorbidities have to be diagnosed of emotional regulation are in agreement with the reported findings in and the risk facotrs have to be determined. In the use of drugs with the literature. The theoretical and the practical bases of these results dependence potential such as pethidine, the patient should be followed have been discussed within the current context of the multidisciplinary closely and alternative analgesic treatments should be reviewed. research which has gained increasing importance. Keywords: Opioid analgesic, pethidine, substance use disorder Keywords : Cognitive awareness, compıulsive, emotional regularion,, References hedonic, unplanned Evren, EC, Ögel K,Çakmak, D (2002) Esrar ve meperidin (Petidin) References kullanım bozukluğu nedeni ile yatarak tedavi gören hastaların Okutan S, Bora B ve Altunışık R (2013) Keşifsel Satın Alma Eğilimleri özelliklerinin karşılaştırılması.(Comparision of the charaacteristics ve Bu eğilimlerin Plansız, Kompulsif ve Hedonik satın Alma of patients with cannabis and meperidine (pethidine)use disorder) Tarzlarıyla Olan İlişkisinin İncelenmesi. Eskişehir Osmangazi Anadolu Psikiyatri Dergisi, 3(1), 20-27. Üniversitesi İBF Dergisi, 8(3), 117-136. Højsted J, & Sjøgren P(2007)Addiction to opioids in chronic pain Özyeşil Z, Arslan C, Kesici Ş et al., (2011) Bilinçli farkındalık ölçeği’ni patients: a literature review. European Journal of Pain, 11(5), 490- Türkçe’ye uyarlama çalışması. Eğitim ve Bilim, 36(160). 518.

145 PP-163 at the posterior of medulla oblongata and inferiorly to the cerebellum. MCM is formed by the expansion of the cisterna magna to above 10mm COMPLICATED SUICIDE: CASE PRSENTATION due its posterior membranous defect, with intact and normal cerebellar hemispheres and vermis. Cerebellum, known as the control organ of Seda Kiraz, Meliha Zengin Eroğlu, Elif Toppaş, balance and fine motor movements, has now been found, as a result of Mecit Çalışkan the development in the anatomical and fucntional imaging techniques, Sağlık Bilimleri University, Haydarpaşa Numune Training and Research to have a role in the coordination of cognitive functions. Anatomically Hospital, Psychiatry Department, İstanbul teh cerebellar hemispheres are connected with thecortical regions AIM: Complicated sucidal attemtps are the attemtps when the involved in cognitive functions, and the vermis is connected with the individual tries more than one method to achieve death, and make limbis system. It has been proposed that schizophrenia symptoms are up make up 1-1.5% of all suicidal attempts; and, and involves hang, related to cerebellar anomalies. Knowledge on the relationship is limited cutting wrists, cutting the throat, posioning, drowning and jumping by by few case reports. In this report a case of MCM comorbidity with from heights. In this report a case of complicated suicidal attempt will schizophrenia is presented. be presented. CASE: The 31-year old, single male shepherd had been noticed by his CASE: The 42-year old male patient, divoced with one child, was teacher in the prmary school with his difficulties of learning. He had brought to theemergency. Service by his relations after attempted not been able to learn reading and writing despite being kept in school suicide. It ws learned that he did not have a history of previous for 5 years. At the age of 12-13 he developed symptoms of talking to psychiatric disorder. He had lost 4-5kg weight in the previous 1 himself, irritability, mobility, short term of his memory functions and month, had diarrhea, weakness, and feelings of hopelessness for not brief episodes of memory loss. In the previous 3 years he had been being able to go to work and look after his child. He had consutled the involved in many fights and treat and insult situations on account of internal diseases polyclinics when he was examined and was started on his impulsivity; and had been refered to our clinic for a legal psychiatry pantoprazole (40 gm) and motilium (10mg). The next day the patient report on his criminal responsibility. Was learned that he had had two had attempted complicated suicidal attemtp bu using multiple drugs. similar referrals previously. He was evaluated as an atypic event. His Subsequently he had tried cutting his wrists and his neck as evinced by cranial MRI the cisterna magna was measured to be 17mm and he the dressings closing the wounds, but there was sign of hanging on his was diagnosed with MCM. He was started on olanzapine (5mg/day) neck. He found it difficult to speak and gave very brief answers to the for schizophreia diagnosis, and is under followup in our polyclinics. questions. When asked if the suicidal ideation continued he said that he Although his psychotic and impulsive symptoms improved, his did not know. His thought contents had depressive ideas. Information cognitive disorder has continued. given by his family indicated that he did not have psychotic symptoms. DISCUSSION: Schizophrenia is a polygenetic and multifactorial He was planned to be t rested in intensive care unit. disorder, with evidence of its being rooted in the brain but the DISCUSSION: Having the male gender, being single, having a physical ynderlying neuroanatomical basis is still being investigated. It has or mental disorder, having previous suicidal attempts, having in family been emphasizsed taht the studies should aldo cover the cerebellar problesm and having lost objects ar considered to be risks for suicide. functions. The early age onset of schizophrenia together with cognitive Although the case reported here did not have a history of pcychiatric losses indicate a neurodeveleopmental anomaly in the aetiology of his disorder, his physical symptoms have given rise to negative judgments. condition. Comorbidity with schizophrenia may be coincidental, but it He was also a single male living alone which are risk factors. Many cases should aldo be kept in mind that the psychiatric symtpoms may partly of unplanned compliated suicidal attempts start with experimental and be due to the cerebellar dysfunciton caused by the MCM. hesitant attempts of cutting wrists and/or he neck before attempting the effectşve methods of hanging, jumping from heights or burning self. Keywords:, Cerebellum, mega cisterna magna, schizophrenia POSTER PRESENTATIONS The case presented here had attempted cutting risk and neck before References attempting to hang himself. Ferentinos PP, Kontaxakis VP et al., (2007). Refractory psychosis and Keywords: Complicated suicide, depression, male prominent cognitive deficits in a patient with mega-cisterna magna. Prog Neuropsychopharmacol Biol Psychiatry, 31(2): 561-3. References Langarica M, Peralta V (2005) Psychosis associated to megacisterna Bohnert M,Pollak S (2003)Complex suicides--a review of the magna. An. Sist. Sanit. Navar, 28: 119-121. literatureArchiv fur Kriminologie, 213(5-6), 138-153. Pandurangi S, Pandurangi A et al., (2014) Psychiatric manifestations CanSS, Sayıl I (2004) Yineleyici intihar girişimleri.(Repetitive suicidal associated with mega cisterna magna. J Neuropsychiatry Clin attempts.) Kriz Dergisi, 12(3), 53-62. Neurosci, 26(2): 169-71

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MEGA CISTERNA MAGNA (MCM) COMORBIDITY MOOD DISORDER DEVELOPED DURING WITH PSYCHOSIS: CASE PRESENTATION DOPAMINE REPLACEMENT THERAPY IN Hilal Seven, Hatice Yardım Özayhan, Seher Serez Öztürk, PARKINSON’S DISEASE: CASE PRESENTATION Ali Baran Tanrıkulu, İbrahim Eren Özlem Akkaya1, Kambiz Moheb1, Leman İnanç1, Yasemin SBÜ Konya Eğitim ve Araştırma Hastanesi, Beyhekim Psikiyatri Kliniği, Ünal2, Ümit Başer Semiz1 Konya 1Muğla Sıtkı Koçman University Medical School, Mental Health and AIM: Cisterna magna is the space that facilitates the passage of CSF Diseases Department from the 4th ventricle through the foramen of magendie, and is localised 2Muğla Sıtkı Koçman University Medical School Neurology Department

146 AIM: The aim of this report is to provide information on the mood suspiciousness, persecutory delusions about being harmed, speaking to disorder developed after misuse of the dopamine replacement therapy himself and restlessness which increased in severity with time. He had by Parkinson’s disease patients. not eaten anything outside the house lest he got poisoned; and feared that his relations intended to kill him. He had planned on buying a CASE: The 61-year old male, lycée graduate patient, married with 5 gun and 2 days before he was brought to the hospital he shot two of children, retired, was brought to the emergency service by his relations his relatives on the legs with an unlicensed gun, accusing his victims of with complaints of sleeplessness, numbness of his body, cramps in his intent to poison him. He was taken to court and was released on bail. fingers. It was learned from his relations that he had reduced need for He did not have a previous consultation with psychiatry and also did sleep, increased mobility, increased libido, mistrust of his wife and not have a family history of psychiatric disorder. His clinical observation aggressiveness. He had bitten his wife‘s finger after an argument. He showed that his affect was intense, mood dysphoric and anxious,he had had been folowed with Parkinson’s disease for the previous 7 years and psychomotor restlessness, referential and persecutory delusions but had been implanted with a levodopa/carbidopa intestinal infusion without any pathology in perceptions. Neurological examination was pump 1 year previously with adjustment of the doses to 1300mg/day. within normal limits. EEG and routine blood tests were also normal. He was using at the same time oral levodopa, carbidopa, entacapone Cranial MRI revealed a retrocerebellar arachnoid cyst of 25x23 mm (100/25/200 mg/day), ropinirole ( 8 mg/day). For the pevious 1 year he dimensions with slight pressure on the cerebellum. had been increasing the infusion dose of dopamine without control up DISCUSSION: Various neurological symptoms are known to to 2000mg/day when he did not feel well, and also took higher doses accompany AC. Apart from these, psychiatric symptoms are observed as of the oral dopaminergic agents. He was admitted to our hospital as well and these can be cognitive symptoms or mood symptoms. Psychotic an inpatient. Quetiapine (25mg/day) was started to regulate his sleep symptoms are relatively rarer. There are increasing data on the role of the habit, and risperidone (0.5 mg/day, titrated to 1.0 mg/day) for anger cerebellum in the development of psychosis. It is difficult to establish a control and mood stabilisation. Levodopa/carbidopa infusion doses role for AC on the development of psychotic symptoms. However, the were readjusted as he had dysknesias and ropirinole was discontinued. It patient whose case has been presented here had a cerebellar localisation was understood that he had used too many saving doses of dopaminergic of the AC, the onset of the psychotic symptoms was sudden and at agents. Since his bradykinesia increased, risperidone was discontinued advanced age, and the patient did not have a history of psychosis. These and valproate (500 mg/day titrated to 750 mg7day) was started believing data were therefore open to discussion on a lesion-symptom relationship. it would be useful for mood symptoms as well. Quetiapine dose was In order to establish a relationship between AC and psychosis further increased to 50mg/day. His psychomotor activity was normalised, and research at higher level of investigations are needed. he did not have suicidal or homocidal thoughts, delusions, agitation and Keywords: Arahnoid cyst, neuroimaging, psychosis excitation. His mood elevation regressed. References DISCUSSION: It has been determined that patients misuse the Özdemir B, Gülsün M (2006) Psikotik Bozukluk ve Araknoid Kist: Bir dopaminergic agents used in the treatment of Parkinson’s disease for Olgu Sunumu. Düşünen Adam, 19: 217-220. their effects on mood, by increasing the doses, despite the induced Schmahmann, JD (2000)The role of the cerebellum in affect and dyskinesia and expose themselves to the risk of manic episodes with psychosis. Journal of Neurolinguistics, 13(2): 189-214. hypomanic and psychotic symptoms. Patients should be followed and queried on the use of appropriate doses of the dopaminergic agents precibed for Parkinson’s disease PP-167 Keywords: Dopamine, mood disorders, Parkinson, uncontrolled use CYBERCHONDRIA (DISEASE SEARCH ON THE

References POSTER PRESENTATIONS Giovannoni G, J O’Sullivan, K Turner et al., (2000) Hedonistic INTERNET BEHAVIOUR ) SEVERITY SCALE homeostatic dysregulation in patients with Parkinson’s disease on Yavuz Selvi1, Seda G Turan3, Ayça A Sayın1, Murat Boysan2, dopamine replacement therapies. J Neurol Neurosurg Psychiatry, Ali Kandeğer3 68.4: 423-428. 1Selçuk University Medical School, Psychiatry Department, Konya 2Yüzüncü Yıl University Medical School, Psychology Department, Van 3Bahçeşehir University Health Sciences Department, İstanbul PP-166 AIM: Although the internet is a valuable source of medical information, it has the potential of augmenting worry, fear and obsessive-compulsive RETROCEREBELLAR ARACHNOID CYST behaviour in especially the sensitve individuals. Research results have COMORBID WITH PSYCHOTIC DISORDER: CASE indicated that health anxiety, hypochondriasis and online health search PRESENTATION are related with increased anxiety. Cyberchondria is an increased anxiety type associated with online health information seeking by individuals in Anıl Cemre Ökmen, Ekrem Yılmaz relation to their health status. The aim of this study has been to analyse Yüzüncü Yıl University Medical School, Psychiatry Department, Van the validity and reliability of the Turkish version of the cybershondria AIM: Arachnoid cycsts (AC) are rarely seen in relation to congenital, severity scale. traumatic or inflammatory causes, coincidentally diagnosed in most METHOD: The study enrolled 337 university students with ages cases. Neurological and psychological symptoms may be observed in in the range of 16-55, with a mean age of 21.76 (SD± 5.21), with cases with AC. females making up nearly half of the participants (N = 188, 55.79%). CASE: The 44 year old male patient, not working and never schooled, Psychometric estimations were based on the Cyberchondria Severity was brought to our polyclinics by his relations. History taking Scale (CSS) (SŞÖ, the Internet Addiction Test (IAT), the Anxiety indicated that he suddenly developed 2 years previously symptoms of Sensitivity Index-3 (ASI-3) and the Health Anxiety Inventory (HAI).

147 Initially the SPSS was used to assess the exploratory statistics. Using the contents had referential and grandisoe delusions. Her judgement was LISREL, the corrected maximally possible confirmatory factor analysis insufficient and she did nto have insight. Her score on the Young Mania (CFA) was confirmed by Satorra-Bentler (SB) scaled chi-square, and the Rating Scale (YMRS) was 35. She was started on lithium (1200mg/ suitability of the original 5-factor structure of CSS was tested. Internal day) and risperidone (2 mg/day). In her follow up control, her YMRS consistency, corrected item-total correlations, Spearman inter- item score was 13, her irritability and sleep disorder had distinctly improved, correlations, tools, standard deviation, the means and the standard speech volume had decreased, the referential delusions had regressed deviation changes of the items for psychometric testing were calculated. and her insight had been partially restored.. CSS factor correlations and the relationship coefficients between DISCUSSION: The FDA had reported with emphasis that varenicline Pearson scanning tools were calculated had serious side effects with neuropsychotic symptoms and would lead RESULTS: CFA was in the interval for the most suitable value indices to the worsening of any present psychiatric disorders. It is believed that for the original 5-factor solution. CSS generally and the subscales had varenicline probably acts by the antidepressant effects and dopamine excellent internal consistency ((α = 0.91, for 33 items and Cronbach release giving rise to manic symptoms in healthy individuals as well as alpha (Cα) value interval 0.78-0.87; but, as an exception, “mistrust of bipolar disorder patients, as seen in the patient discussed in this report, medical personnel’’ subscale Cα = 0.64, was relatively lower). From poor who developed a first episode mania after varenicline which progressed to strong positive correlation was obtained for all of the 5 factors. With to a repeated episode. the exception of the correlation between the subscales ‘’compulsion’’ and Keywords: Mania, mood disorder, varenicline “mistrust of medical personnel’’, all factor correlations were statistically significant (p<0.01).Pearson relationship coefficients in the 5 factors References were powerful and statistically significant. Gecici O, Nebioglu M, Guven M (2012) Varenicline-induced manic episode. J Mood Disord, 2(2):74-6. DISCUSSION: CSS, is a reliable self-report tool to be used for the Kaur K, Kausha S, Chopra, SC(2009) Varenicline for smoking assessment of tendencies to hypochondriasis and the anxiety that cessation: A review of the literature. Current therapeutic research, develops as a result of the online health search and evaluation 70(1): 35-54. Keywords: Anxiety, Hypochondriasis, internet, scale References McElroy E, Shevlin M (2014) The development and initial validation of PP-169 the cyberchondria severity scale (CSS). Journal of anxiety disorders, 28(2):259-265. SEXUAL DYSFUNCTION IN PSORIASIS AND THE RELATIONSHIP BETWEEN SEXUAL FUNCTIONS AND SATISFACTION PP-168 Anıl Gündüz1, Volkan Topçuoğlu2, Mehmet Zihni Sungur2 1Bilecik State Hospital BIPOLAR AFFECTIVE DISORDER DUE TO 2Marmara University Pendik Training and Research VARENICLINE USE Hospital(MUPEAH), İstanbul Nazmiye Güçlü, Emine Yağmur Atay, Hüseyin Fatih Şeker, AIM: Prevalence of the chronic dermatological disease psoriasis varies in Dicle Öğüt, Bülent Kadri Gültekin the 0.5-4.6% range and comobidity with various psychiatric disorders Erenköy Mental and Neurological Diseases Hospital, Mental Health is frequently oberved. The aim of our study has been to investigate Department, İstanbul the effects of psoriasis on sexual dysfunction, sexual satisfaction, body POSTER PRESENTATIONS perception and satisfaction, depression and anxiety. AIM: Varenicline is a partial agonist of the α4x2 nicotinic receptors. It is widely used in smoking cessation therapy, but many adverse side effects METHODS: The study included a total of 216 participants, including such as deprssive mood, sleep disorders, suicide, agitation, aggression, 112 psoriasis patients followed at MUPEAH and 104 relatives of psychotic and manic reactions have been reported. It has been aimed inpatients at the surgery clinic, without dermatological complaints as the in this report to present a case of first episode mania developed after control group. The participants complete the psychiatric interview and a varenicline use, which were repetitive in character. sociodemographic questionnaire, the Golombok- Rust Inventory of Sexual Satisfaction (GRISS), Body Image Scale (BIS), the Hospital Anxiety and CASE: The 39-year old female university graduate patient, in the process Depression Scale (HADS), the Female Sexual Function Index (FSFI) and of getting divorced, unemployed and living with her mother, consulted the International Index of Erectile Function (IIEF) face to face with an the polyclinics with complaints that had flared up 2 weeks earlier. She had interviewer. The mean, standard deviation, the median, frequency, ratio, become sensitive and vulnerable, with impaired sleep hygiene, increased minimum and maximum were used in the statistical analysis of the data. volume of speech and libido and preoccupation with religious practices. Group comparisons were made with the Student t, Mann Whitney U Her history showd that she did not have previous psychiatric diagnoses, and Kruskal Wallis tests. Realtionships between parameters were analysed and her complaints has actually started 4 years previously 8 days after by the Spearman’sNOT coreelation PRESENTED analysis. The effects of risk factors on the starting to use varenicline, which therefore had been discontinued and psychometric scale scores were assessed by the linear backward regression olanzapine (5 mg/day) had been started, lasting 6 months without benefi. analyses as the multivariate analysis. Statistical significance was accepted A second repeat manic attack had occurred 2 years previously, treated on the basis of p<0.01 ve p<0.05. with valproate (1000mg/day), lithium (600mg/day) and risperidone (2 mg/day) which had benefical effects, and the patient had decided to RESULTS: Signifiant sociodemographic differences were not found terminate the therapy. At our polyclinics she was diagnosed with manic between the groups. There were significant differences between the episode with psychotic symptoms. During her psychiatric examination patient and control gorups indicating distinct impairment of sexual she was not cooperative, her attitude was defensive, mood dysphoric, function, and body image perception in the patient group. The deprssion affect irritable, speech accelerated and increased in volume and thought and anxiety symptoms of the patients were severer as compard to the

148 controls. The severity of the impairments in body image perception and References the impairment of sexual functions and satisfaction were correalted. Kessing LV, Agerbo E, Mortensen PP et al. (2003) Does the impact logistic regression analyses showed that while the negative changes of major stressful life events on the risk of developing depression in the body image perception and menopause were found to predict change throughout life? Psychol Med, 33: 1177-1184. sexual dysfunction the females; age and negative changes in body image Josepho SA,Plutchik R(1994)Stress, coping and suicide risk in perception predicted sexual dysfunction in the males. psychiatric inpatients.Suicide Life Threat Behav,24: 48-57. DISCUSSION: In the psoriasis patients body image perception was lower, sexual function disorders and sexual satisfaction were lowered and the severity of depression and anxiety was increased. The most PP-171 important risk factor for sexual dysfunction in the psoriasis patient was found to be the cody image perception and satisfaction. BENZYDAMINE HYDROCHLORIDE ABUSE: CASE Keywords: Anxiety, body image, depression, psoriasis, sexual PRESENTATION dysfunction Gökhan Bahtiyar1, Almıla Erol2, Meltem İzci Kasal1 1Katip Çelebi University Mental Health and Diseases Department,İzmir 2İzmir Atatürk Training and Research Hospital Mental Health and PP-170 Diseases Department,İzmir AIM: Benzydamine hydrochloride is a widely used analgesic and anti- REPETITIVE DEPRESSIVE DISORDER inflammatory agent that can be obtained without a prescription. It has SECONDARY TO TRAUMATIC EXPERIENCE: CASE been aimed to present a rare cse of benzydamine abuse in this report. PRESENTATION CASE: The 36-year old male patient consulted the AMATEM Hüseyin Fatih Şeker, Nazmiye Güçlü, Sertaç Alay Öztürk, polyclinic having abused alcohol and benzydamine hydrochloride for Salime Gürsoy the previous 16 years. It was learned that he had been drinking daily 2 Erenköy Mental and Neurological Diseases Hospital, Mental Health bottles (1800mg/day) of benzydamine hydrochloride mouthwash. He Department, İstanbul was admitted as an inpatient, when his vital data were wihin normal limits. His psychiatric examintaion indicated distinctly anxious affect. INTRODUCTION: Depression maintains it significance as a widely His thought contents were associated with alcohol and substance. observed health problem in the population with adverse outcomes. He did not have psychotic or depressive signs, and panic disorder or High incidence of traumatic events among psychitaric patients, which social phobia were not in his history. Treatment was started with oral may trigger or be the very reason for the disease, has been known. In this lorazepam (7.5 mg/day), thiamine and intravenous fluids. Neurological report it ahs been aimed to present the case of a patient without a history examination and his accounts on nightly leg cramps were attributed of psychiatric disorder, who developed, after a traumatic experience, to restless legs and pramipexole (0.5mg/day) was prescribed. When his repetitive episodes depression which did not respond to pharmacotherapy. detoxification therapy was over, the patient was started on acamprosate CASE: The 53-year old male primary school graduate patient, married (1000 mg/day titrated to 2000 mg/day). After rehabilitation he was and retired with disability, lived with his family. He was admitted to discharged on acamprosate (1000 mg/day), pramipexole (0.5mg/day) and multivitamin therapy. hospital as an inpatient due to persistent symptoms of discontent, anhedonia, auditory hallucinations and suicidal ideation. His complaint DISCUSSION: Benzydamine hydrochloride, a nonsteroidal analgesic had starated 6 years previously when his work place had been robbed 4 and antipyretic agent, is cheap and easily accessible. Its use for times. He had attempted suicide by injecting himself agricultural toxins pleasure giving purposes is quite frequent in Brazil and Poland and and had been treated in the intensive care unit. He had subsequaently has recently been in use for the same purpose in Turkey. Wrong use POSTER PRESENTATIONS been rehospitalised 4 times; and despite compliance with his treatment of the agent in a 6-year old girl has been reported to cause visual and episodes of depression had repeated. When examined, he was consious, tactile hallucinations. Research in Brazil in 10-18 year old youth has cooperative, fully oreitned, appearing younger than his chronological age indicated that the abuse of this substance in doses of 100-2000 mg is with moderate self care. His mood was depressive, affect was depressive, quite common, usually to increase the psychotropic effects of alcoholic speech volume and pace and psychomotor activity had decreased, He drinks, with side effects including delusions and nonspecific sensory described auditory hallucinations, and his thought contentsreflected guilt, changes, nausea and vomiting. The case reported here did not involve low self esteepartial m and helplessness. He had is judgement and insight. hallucinative experiences despite very high dosage of benzydamine His score on the HAM-D w as 32. His treatment organised as sertraline hydrochloride. The mechanism of action of the drug in augmenting the ( 50mg/day), quetiapine ( 100mg/day) and alprazolam (1mg/day), and pleasure giving effects of alcohol is a potential topic for future research. as he had not benefitted fully from pharmacotherapy he was given 10 Attention to the possible misuse of this drug is necessary. sessions of planned ECT. After the completion of the Ect, sertraline dose Keywords: Abuse, alcohol, benzydamine hydrochloride was increased to 150mg/day and lithium was added for augmentation. His HAM-D score decreased to 16 and his suicidal thoughts disappeared. He was discharged with maintenance therapy and psychotherapy. DISCUSSION: Traumatic events are among the most improtant observable reasons for psychaitric disorders. However, what leads the patient to suicidal attemtps are not the traumatic events but their inability to cope with these events. There is need for studies on the realitonship between traumatic events and problem solving capacity on the one hand and suicidal attemtps on the other Keywords: Repetitive depression, traumatic events, suiide

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CAPGRAS SYNDROME DEVELOPMENT IN RESTLESS LEGS SYNDROME IN OBSESSIVE- FRIEDREICH’S ATAXIA: CASE PRESENTATION COMPULSIVE DISORDER AFTER DISCONTINUATION OF ARIPIPRAZOLE Süha Can Gürsoy, Gonca Dokuz, Ömer Yanartaş, Volkan Topçuoğlu Gonca Dokuz, Meylin Karalar Sağdıç, Dilay Tunca, Marmara University Pendik Training and Research Hospital, Psychiatry Ekin Sönmez, Serhat Ergün, Axel Wurz, Volkan Topçuoğlu Department,İstanbul Marmara University Pendik Training and Research Hospital, Psychiatry Department, İstanbul AIM: Capgras syndrome(CS) is a delusional misidentification disorder with the afflicted individual claiming that persons or objects have been AIM: Restless legs syndrome (RLS) is a neurological disorder replaced by others. Organic factors underlie 25-40% of the cases of characterised with disturbing sensations in the legs prompting movement CS comorbidity with other psychiatric disorders. Friedriech’s ataxia to overcome the discomfort, usually occurring at rest and interrupting an autosomal recessive inherited neurodegenerative disease with a sleep. Aetiologically it can be genetically inherited, or be due to drug multisystemic involvement showing a course that includes neurological usage. It is believed to be assoicited with dopamine action impairment in the central nervous system, supported by the improving effectivity of and cardiomyopathic symptoms and diabetes. In this report it has been dopaminergic agonists and worsening by the antidopaminergic agents. aimed to discuss a case of that developed in a patient Obsessive-compulsive dsorder(OCD) is a widely observed psychiatric with Friedriech’s ataxia. disorder explained by the anomalous changes in the serotonin and CASE: The 28-year old female patient claiming that her parents were dopamine neurotransmission systems and treated with SSRIs and fakes, and that the fake mother could not cook like her real mother, had antidopaminergic agents. It has been aimed to discuss in this case report been brought 1 year previously to the emergency service. The patient the development of restless legs syndrome after discontinuation of explained that she got the idea when she was convinved that the staff at aripiprazole, which had been started for augmenting the OCD therapy. the centre for the disabled displayed different behaviours having been CASE: The 32-year old female patient was under follow up for replaced by (the mythological) helper apparitions, and that he parents obsessions of aviodance and security seeking to prevent harm being done were replaced by these apparitions while the parents were still at the to small children. Her last treatment consisted of venlafaxine (300 mg/ district they had moved house from. She had been diagnosed with day) and aripiprazole (10 mg/day), and regular cognitive behavioural Friedriech’s ataxia at the age of 13 years, and did not have a history therapy sessions, when aripiprazole was discontinued on account of of known psychiatric disorder. She was confiend to a wheelchair, had improvement in her symptoms. Immediately after discontinuation of kyphoscoliosis, nystagmus and dysarthric speech. She believed the aripiprazole, the patient experienced contractions in her legs as she was doctors to be helper apparitions and the hospital to be the mansion falling asleep, such that she could not sleep for 15 days. Her blood levels of the helper apparitions. Her mood was euthymic, and cognitive of iron and ferrition were, respectively, 52 and 11. Diagnosis by RLS funcitons were natural. She did not have perceptionalpathology or by the neurology unit and treatment with pramipexole (0,25 mg/day) another delusion. She was admitted as an inpatient due to her restricted resulted in immediate cessation of the RLS symptoms. mobility. Her EEG showed mild basic activity impairment. Her DISCUSSION: The case discussed in this report did not have schocardiography indicated apical hypertrophic cardiomyopathy. She previous complaint of RLS, the symptoms of which had started was started onNOT risperidone PRESENTED (2mg/day) which she could not tolerate and it after the discontinuation of aripiprazole. Treatment with the partial was discontinued with switch to aripiprazole (5mg/day) and metoprolol. dopaminergic agonist pramipexole led to complete disappearance of POSTER PRESENTATIONS But as tachycardia, faatigue and intraversion reappeared, aripiprazole the RLS symptoms. The incident was attributed to the withdrawal of was also discontinued and she ws started on N-acetycysteine (2400mg/ the partial dopamine agonistic effect of aripiprazole. Interestingly, the day). Her delusions partly regressed and she also gained partial insight. patient’s history included complaints resembling those of her father’s, Since she developed depressive symptoms, treatment with escitalopram such as the observed low ferritin level. Low blood levels of iron have (10mg/day). been associated with hypodopaminergic status and resultant RLS. OCD and RLS have the common aetiological factor of dopaminergic system DISCUSSION: although there are case reports the literature on the dysfunction. RLS has drawn attention in causing sleep problems, comorbidity of Friedriech’s ataxia with psychosis, the realtionship being triggered by many psychotropic agents and having a common between the two disorders is subject of debate. Choice of antipsychotic neurotransmission dysfuntion with some of the psychiatric disorders. In treatment was difficult in the case reported here as cardiomyopathy the literature there are reports on correction by aripiprazole of RLS that is a risk of mortality in Friedriech’s ataxia, and the patient could not developed after treatment with antipsycotic agents tolerate very low doses. In mutisystemic diseases like Friedriech’s ataxia, treatment of psychiatric symptoms requires extreme care. Keywords: Antipsychotic agent, aripiprazole, obsessive-compulsive disorder, restless legs syndrome Keywords: Capgras, Friedreich’s ataxia, psychosis References References Ağargün MY, Kara H, Özbek H et al. (2002). Restless legs syndrome Bhatia MS, AgrwalP, MalikSC (1996) Capgras syndrome and organic induced by mirtazapine. The Journal of clinical psychiatry, 63(12), brain dysfunction. Indian Journal of Psychiatry, 38(3), 148–153. 1179-1179. Bourget D, Whitehurst L (2004). Capgras syndrome: a review of Dichter GS, Damiano, CA,Allen, JA (2012). Reward circuitry the neurophysiological correlates and presenting clinical features dysfunction in psychiatric and neurodevelopmental disorders and in cases involving physical violence. The Canadian Journal of genetic syndromes: animal models and clinical findings. Journal of Psychiatry, 49(11), 719-725. Neurodevelopmental Disorders, 4(1), 19.

150 PP-174 The symptoms subsided with the start of menstruation. Her problems had increased in the 2 weeks previous to her consultation at the hospital. SYMPTOM VARIATION IN OBSESSIVE-COMPULSIVE Psychiatric examination indicated anhedonia, avolition, iritability and DISORDER AND THE RELATIONSHIP WITH hypersomnia. She was diagnosed with prementsrual dysphoric disorder. IMPULSIVENESS Her history was uneventful and her biochemical laboratory test results were all normal except vitamin D deficiency. She was started on Mehmet Mart, Didem Tezcan, Feride Figen Ateşci, Selim vitamin D supplementation by 2 ampules to be taken monthly. Aftr Tümkaya the use of a total of 4 ampules the patient’s symptoms had nearly totally Pamukkale University, Medical School, Psychiatry Department, Denizli disapperared. AIM: Obsesive-compulsive disorder (OCD) is a heterogenous psychiatric DISCUSSION: Vitamin D deficiency is very frequently observed in disorder characterised with repetitive and disturbing enforcement of the patient population and it has been known to trigger psychiatric obsessions and the repetitive behaviours, or compulsions, to alleviate symptoms (1), the most frequently observed type being depression. the fear and anxiety induced by these obssessive thoughts; and the Premenstrual dysphoric disorder (PDD) is associated with physical two aspects of OCD can be observed individually or together. OCD symptoms of swelling of the breasts, head ache, fatigue and weight results in impairment of the patient’s social and private functionality gain, and mental symptoms of depressive mood, irritability and tension by occupying a significant proportion of the time of daily living. during the late luteal period of the menstrual cycle, which ends with Prevşous stuides have demonstrated a relationship between OCD and the onset of menstruation (2). It should be kept in mind that PDD can impuşsiveness but the OCD symptoms that are particularly related develop secondarily to organic pathology such as vitamin D deficiency, to impulsiveness have not been outlined. Therefoe, we have aimed in especially at postpartum and lactation periods. This case also stresses the this study to investigate the relationship of OCD symptoms with the importance of considering vitamin D deficiency in pscyhiatric disorders. cognitive, motor and unplanned impulsiveness. Keywords: Premenstrual dsyphoric syndrome, psychiatry, vitamin D METHODS : This study enrolled a total of 95 patients, between References the ages of 18 and 65 years, diagnosed with OCD at Pamukkale Türkçapar AF, Türkçapar MH (2011) Premenstruel Sendrom ve University Psychiatry Clinic on the criteria of DSM-V and accepted to Premenstruel Disforik Bozuklukta Tanı ve Tedavi: Bir Gözden participate in the reseaarch with informed consent. For psychometric Geçirme. Klinik Psikiyatri Dergisi, 14(4). purposes, the Maudsley Obsessive-Compulsive Inventory (MOCI), the Hoarding Rating Scale-Interview. and the Barratt Impulsiveness Scale (BIS). Statistical analyses of the data were carried out by the Pearson correlation test.. PP-176 RESULTS: Correlations were found between impulsiveness related to attention and the OCD symptoms of control (r=.349, p<0,001), A DESCRIPTIVE STUDY ON THE RELATIONSHIP OF cleanliness (r=.232, p<0,05), slowness (r=.348, p<0,001) and hoarding THE FREQUENCY OF COMORBIDITES IN MENTAL (r=.286, p<0,05). RETARDATION OF ADOLESCENCE WITH THE GIVEN TREATMENT DISCUSSION: There are earlier studies that have demonstrated significant differences between OCD patients and healthy controls Oğuzhan Herdi, Tolgahan Tuncal, Bedriye Öncü Çetinkaya on the impulsiveness related to attention and the total BIS-11 score Ankara University Medical School, Mental Health and Diseases as well as on impıulsiveness of unplanned actions. However, there are Department, Ankara very few studies on the relation of impulsiveness to OCD symptoms.

AIM POSTER PRESENTATIONS We have shown in this study significant correlations between the OCD : Mental retardation (MR) is characterised by developmental symptoms of control, cleanliness, slowness and hoarding and the retardation of abilities of communication, motor coordination and of attention related impulsiveness disorder cognitive and social functions. Prevalence of psychiatric comorbidity in children and adolescents with MR has been estimated to be 40.7%, with Keywords: Disorder, compulsive, impulsiveness, obsessive, symptom two thirds of the cases having diagnoses of psychiatric disorders with the most frequently oberved comorbidities being affective disorders, schizophrenia, attention deficit and hyperactivity disorder(ADHD) PP-175 and behaviour disorders. Since MR does not have a specific therapeutic protocol, the treatment given has to be orientd to the psychiatric PREMENSTRUAL DYSPHORIC SYNDROME comorbidity. It has been aimed in this study to determine the incidence of comorbidity in adolescents with MR and its relationsip with the TRIGGERED BY VITAMIN D DEFICIENCY treatments given. Arzu Azime Ünlü Karakoç METHODS: The study enrolled 48 adolescents between the ages of Elazığ Mental Health and Diseases Hospital, Elazığ 14 and 21 years, diagnosed with MR and consulting as outpatients the AIM: Vitamin deficiences in the organic aetiology of psychiatric Adolescent Units of Ankara University Mental Health and Diseases disorders can be confusing. The aim in presenting this case report is to Department between January and June 2016. Data were gathered by draw attention to the relationship between vitamin D deficiency and retrospective scanning of the hospital files of the patients. The patients premenstrual dysphoric disorder (PMDD). included in the study were in remission with respect to the psychiatric comorbidities. Exploratory frequency analyses were used and the CASE: The 30-year old, primary school graduate female patient, comorbidity-treatment relationship was analysed by the Chi-square test. married with a 2-year old child, developed symptoms of avolition, discontent, tension, fatigue, head aches, sleepiness and social RESULTS:Comorbidity incidence in the enrolled group of patients intraversion at every premenstrual period after the birth of her child. with MR was 85.4%; with the most frequently diagnosed types being

151 depression (29.2%), ADHD (18.8%) and bipolar disorder (12.5%). had been admitted to the hospital either from the emergency service Psychiatric pharmacotherapy was given to 87.5 % of the patients, (73%) or from the polyclinics (27%). The most frequently diagnosed these being the patients with psychiatric comorbidities ; and the most psychiatric disorder among the males was pscyhotic disorder (34%), frequently used type of agents were atypic antipsychotic agents (54.1%), while it was bipolar disorder (17%) among the females. For 74% of the SSRIs (27.3%) and tricyclic group of antidepressants (TCAs)(23.0%). females and 66% of the males this was the first hospital admission; and 52% of the females and 46% of the males did not attend controls after DISCUSSION: The incidence of psychiatric comorbidity observed in discharge; while 12% had to be admitted back to hospital within two the patients enrolled in this study was in agreement with the results of months of their discharge. other studies on the subject. Depression was the most frequently observed comorbidity in mild MR. The use of atypic antipsychotic agents was DISCUSSION: Even if a long term treatment was required, reconsulting found to be high. This was due to the use of atypic antipsychotics in the hospital by the patients discharged before completion of treatment the treatment of depression as the incidence of psychotic symptoms, was low. The lack of a specific mental health law in our country, is manic switch and disinhibition due to antidepressant use was high in not only preventing the continuity in the treatment of the patient but this group of patients. Imipramine (TCA) was the third most frequently also leaves the healthcare workers in a dilemma on how to proceed in used group of drugs in relation to the incidence of ADHD comorbidity. handling situations of early discharge of the unready patients on surety. Keywords: Adolescent psychiatry, comorbidity, mental retardation Keywords: early discharge, involuntary admission, surety References References KaplanS (2016) , Textbook of Psychiatry, s.1180- Kalbert T, Glöckner M, Schüttwohl M (2008) Involuntary vs. 81. voluntary hospital admission: A systematic literature review on Öztürk O (2010) Çocuk ve Ergen Ruh Sağlığı Mental Retardasyon,(Child outcome diversity. European Archives of Psychiatry and Clinical and adolescent Mental Retardation) Ruh Sağlığı ve Hastalıkları Neuroscience, 258(4): 195-209. 2.Cilt, Türkiye Sinir ve Ruh Sağlığı Derneği yayını, s.813-5.

PP-178 PP-177 BRIEF PSYCHOTIC ATTACK PRESENTING DURING SOCIODEMOGRAPHIC AND CLINICAL HELICOBACTER PYLORI ERADICATION THERAPY: CHARACTERISTICS OF THE PATIENTS CASE PRESENTATION DISCHARGED BY FAMILY REQUEST BEFORE THE COMPLETION OF TREATMENT Arif Çipil, Meliha Zengin Eroğlu, Fatma Gözde Avcı, Mecit Çalışkan, Alişan Burak Yaşar Cihad Çıtak, Ender Cesur, Utku Uzun, Çağatay Karşıdağ, Sağlık Bilimleri University, Haydarpaşa Numune Training and Research Murat Erkıran Hospital, Psychiatry Department,İstanbul Bakırköy Mental Health and Neurological Diseases Hospital, İstanbul AIM: Helicobacter pylori, the first bacterium determined to be AIM: When there is the risk of self harm or harm to others as a result carcinogenic, has been found to colonise the stomachs of more than of psychiatric disorders, patients are admitted to psychiatric hospital on half the world population. It is one of the msot importan causes of an inpatient basis, with the will and in some cases irrespective of the diseases related to gastritis such as gastric ulcers, duodenal cancer, cancer unwillingness of the patient, in order to observe and/or treat until the and primary gastic B-cell lymphoma (MALT lymphoma). Patients POSTER PRESENTATIONS condition is corected. When patients are being admitted involuntarily, with gastic complaints have to be treated. The most frequently used the consent of the person accompanying the patient, if present, is taken. antibiotics are clarithromycin, metronidazole and amoxycillin. During Given the lack of a mental health law in our country, involuntary the 3-agent eradication of helicobacter pylori inciences of acute manic admission to psychiatric hospital is made upon the decision of the psychosis, bried psychotic attack and antibiomania have been observed. physician. However, if the relations of the patient request the discharge It has been aimed to present in this report a case of brief psychotic of the patient before the completion of the therapy, then irrespective attack which was found out to be due to helicobacter pylori eradication therapy. of the advice of the physician against it, the patient can be discharged with the signature of the requesting relation. The aim of our study is CASE: The 43-year old university graduate male patient, married for 20 to investiate the sociodemographic and clinical characteristics of the years and father of 4, employed at a factory as the accountantconsulted patients who have been discharged by the request of their families. the emergency service with complaints of susceptibility, suspiciousness, inablity to evaluate events, amnesia, sleep realted problems, agitation METHODS: This cross sectional study included 50 female and and intolerance. Psychiatric interview indicated that he did not have 50 male patients consecutively admitted to the psychiatry services a personal or family history of psychaitric consultation or treatment. of Bakırköy Mental Health and Neurological Diseases Hospital as It s learned that he had had endoscopic gastric investiation with the inpatients starting with 01.01.2015, and later discharged by the signed discovery of helicobactrer pylori infection and had been started with request of their families before the completions of their treatment. lansoprazole, clatithromycin and amoxycillin. He was admitted as an The sociodemographic and clinical data of this study was gathered by inpatient for investigation without psychiatric drug therapy. Upon retrospective scanning of the digital hospital files of the patients. discontinuation of the antibiotics and lanzoprazole his symptoms RESULTS: Mean age of the 100 patients included in the study was disappeared in 3-4 days. 32.41 years; the mean hospital stay of the male patients was 6.7 days and DISCUSSION: The diagnosis and follow up procedure in the case that of the female patient was 4 days. Only 5% of the patients did not reported here draw attention to the importance of history taking, have social security and these were exclusively females. These patients querying any ongoing drug therapy, physical examination and

152 laboratory tests in the diagnosis of psychiatric symptoms. In patients References with psychaitric symptoms the underlying cooexisting medical illness Garety PA, Freeman D (1999) Cognitive approaches to delusions: a and its treatment should be taken into account. critical review of theories and evidence. Br. J. Clin. Psychol. 38, 113–154. Keywords: Antibiotic, helikobacter pylori, psychosis, Yalcin-Siedentopf N et al., (2014) Facial affect recognition in References symptomatically remitted patients with schizophrenia and bipolar Neff NE, Kuo G (2002) Acute manic psychosis induced by triple disorder. Schizophrenia research, 152(2), 440-445. therapy for H. pylori. The Journal of the American Board of Family Practice, 15(1), 66-68. Ortíz-Domínguez A, Berlanga C, Gutiérrez-Mora D (2004)A case PP-180 of clarithromycin-induced manic episode (antibiomania). The International Journal of Neuropsychopharmacology, 7(01), 99-100. SOCIODEMOGRAPHIC CHARACTERISTICS, FAMILY DYNAMICS AND FRIENDSHIP FORMING STYLES AND THEIR RELATION TO THE TREATMENT GIVEN PP-179 IN THE PATIENTS CONSULTING AUMS PSYCHIATRY IN SCHIZOPHRENIA THE RELATIONSHIP OF THE DEPARTMENT ADOLESCENT UNIT FUNCTIONAL ANATOMY OF THE FACE WITH THE Safiye Zeynep Tatlı, Tolgahan Tuncal, Bedriye Öncü PERCEIVED THREAT FROM FACIAL EXPRESSION Ankara University Medical School (AUMS), Psychiatry Department, OF ANGER Ankara Melike Ezerbolat Özateş1, Oğuzhan Herdi1, Nilay Sedes1, AIM: It has been aimed to investigate the sociodemographic Eda Sonel12, Asena Ulusan2, Bora Baskak1 characteristics, family dynamics and friendhsip forming styles of the 1Ankara University Medical School, Psychiatry Department patients consulting the AUMS Psychiatry Department Adolescent 2Ankara University Medical School Unit and the qualitative evaluation of the relationship between these dynamics to the treatment given. AIM: Excessively emotional interventions of family members of schizophrenia patients and extraverted negative expressions affect the METHODS: Hospital files of 60 patients who consulted the AUMS prognosis adversely. It is known that schizophrenia patients are more Psychiatry Department Adolescent Unit between 15 July 2016 and 15 sensitive to neagative emotions of anger and fear than to positive August 2016 were scanned retrospectively. The data on the 1 to1.5-hour emotions. The aim of this study has been to evaluate the relation of the interviews with the familes and the perfomances on psychometric scales subjective threat perception by schizophrenia patients to the objective such as the Minnesota Multiphasic Personality Inventory (MMPI) intensity of anger on the face and the functional anatomy of the face. and the Beier Sentence Completion Test (BSCT) were evaluated. The The degree of the effects of disease symptoms and the failure of emotion patients’ families were divided, on the bases of the themes and codes recognition on this process have been investigated. determined, into 5 groups as ‘’concerned/supporting’’, ‘’pressurising/ interventionist’’, ‘’perfectionist’’, ‘’physically/mentally abusers’’ and METHODS: The study included 48 schizophrenia patients (SG) ‘’indifferent’’. Friendship forming styles were classified as healthy and followed at a university hospital and age and gender matched 51 healthy insecure, and those without any friends were evaluted as a third group. controls (CG). The participants were presented with 21 sequences of 6 The diagnoses made on the patients were analysed with respect to the facial pictures with expressions ranging from neutral to gradually more classifications made. distinct expression of anger, selected from the Cohn-Kanade Extended Facial Expression Database (CK+). The time and degree of threat RESULTS: Mean age of the patients as 17.8 years (14-21); and the POSTER PRESENTATIONS perceived by the participants was measured. The relationship between diagnoses ranged as depression (53%), anxiety dşsorder (12%), mood the anger recorded for the functional anatomic units and the subjective disorders (10%), attention deficit and hyperactivity disorder (ADHD, responses were investigated. Both groups of participants completed the 8.3%), schizophrenia (5%), obsessive-compulsive disorder (OCD, Emotion Matching Task (EMT) and the PG also completed the Scale 3.3%), gender personality disorder (3.3%), mental retardation (3.3%) for the Assessment of Positive Symptoms (SAPS). and eating disorders(1,7%). Family attitudes ranked as concerned/ supporting (28.3%), indifferent (28,3%), physically/mentally abusers RESULTS: Perception of threat in all sequences were higher in the PG (21.7%), pressurising/interventionist (13.3%) and prefectionist as compared to the CG; and was related to the SAPS –delusions total (5%). It was seen that only 43.3% of the patients could form healthy score. EMT score of the PG was lower than the CG score, but in both friendships,26.7% regarded their friends as unreliable and threatening groups it was not related to the total degree of threat perception or and 30% did not have any friends. Diagnoses and family attitudes did the time of perception. The calculated total emotional density during not correlate(p>0,05); but when the cases who could not form healthy the relatively higher threat expressing sequences was lower in the PG as friendships and those with ’physically/mentally abusing and indifferent compared to the CG. The difference was in the eyes and the surrounds families were anlysed together, a correlation was seen with the diagnoses which expressed the anger in the functional units. of anxiety and depression(p=0,009; t=2,693). DISCUSSION: Angry facial expressions may cause higher than normal DISCUSSION: Knowledge on the prevalence and distribution of threat perception in the schizophrenic patient. In schizophrenia, there mental problems in the adolescent group of patients in important may be a susceptibility to sense a threat even in faces with less affective expressions and this may be a reaction to the expression of anger for the provision of appropriate treatment and preventive measures. perceived in the eyes. Investigation of the family environment of the adolescent patients should be a part of the patient evalution process. Keywords: Emotion matching, functional anatomic unit, schizophrenia Keywords: Adolescent, diagnosis, family dynamics, friendship attachments

153 PP-181 AIM: Surgical treatment of the obese is increasingly preferred because of the inadequcy of weight loss by dieting methods in severe obesity which PSYCHOSIS IN HASHIMOTO’S THYROIDITIS: CASE has become a widescale health problem. On account of the differences PRESENTATION in the methodology and criteria used in the evalution of the eating disorders, the figures on the incidence are quite variable. We have aimed Meliha Zengin Eroğlu, Elif Topbaş, Mecit Çalışkan, to investigate in this study the incidence of eating disorders in the obese Gonca Erkıran, Seda Kiraz candidates for bariatric surgery. Sağlık Bilimleri University, Haydarpaşa Numune Training and Research METHODS: The study included 108 obese patients who consulted Hospital, İstanbul Haydarpaşa Numune Training and Research Hospital within the span AIM: The relationship between impairment of thyroid gland functions of 6 months for bariatric surgery. Data were gathered retrospectively and psychiatric disorders has been known for some time. The causative from the hospital files and other medical records, and consisted of mechanism of thyroid dysfunction on the psychiatric disorders has not sociodemographic details, body mass index (BMI) and the diagnostic been clarified. Hashimito’s thyroiditis is the auoimmune inflammation procedures on eating disorders. of the thyroid gland and generally presents with symptoms of RESULTS: Mean group age was 37.5 (±9,1) years; mean height was hyporthyroidism which can be associated with mental slow down, 164,6 (±8,0 )cm, and the mean body weight was 123,5 (±17,4) kg. concentration difficulty and memory disorders that can extend as far as The participants consisted of 87 (80.5%) females and 21 (19.4%9 dementia. Patients can show symptoms of depression, anxiety disorder males; with 58.3% married, 35.2% single and 6,5’% either widowed and rarely mania. As there are circulatory antibodies stimulating the or divorced. The incidences of eating disorders ranked as 11,2% (n=12) thyroid gland, the patients may have phases of hyperthyroidism. It has binge eating disorder (BED) ; 5,6% (n=6)night eating disorder (NED); been intended to present in this report the case of a patient referred and 6,5% (n=7) of both BED and NED. The group mean score on the with the preliminary diagnosis of paranoid disorder, discovered to have Beck depression inventory was 13.8% (±9,8%) and the incidence of Hashimoto’s thyroiditis and went into remission with hormone and comorbidities was 63.9%. antipsychotic therapy. DISCUSSION: It is very important to diagnose and treat the particular CASE: The 44-year old female patient, middle school drop out, married eating disorders in obese patients before or after bariatric surgery for with 2 children, consulted with complaints including dry mouth, the mental and the physcial health outcomes. Lifelong eating disorder difficulty swallowing, sleep related problems, fear of cars and neighbours incidence among bariatric surgery candidates has been reported to and suspiciousness. She had been treated on two different occasions as be29.5%, with increasing estimations on and binge inpatient in our clinic. She had been recommended propylthiouracil eating disorders. In our study reported here, the incidences of BED and treatment 13 years previously with the diagnosis of autoimmune NED were found to be higher as compared to the other eating disorders. thyroiditis. Her psychiatric symptoms had appeared 2 years previously Evaluation of these patients on psychiatric and social context not only when she was not on the therapy as her status was hypothyroid. She had elevates the individual quality of life but also prevents the occurrence of been given levothyroxine sodium (100µg). Her psychiatric symptoms adverse effects on the post operative weight losing programs gained severity in phases of hyperthyroidism. She was given psychiatric and endocrinological treatment on inpatient basis. Keywords: Bariatric surgeryi, eating disorders, obesity DISCUSSION: The diagnostic and follow up procedures on this case References daw attention to the importance of history taking, physical examination Atak H (2011) Psikiyatride Guncel Yaklasimlar-Current Approaches in and laboratory tests. Patients with pcyhiatric symptoms should be Psychiatry,3 (3): 483-512. investigated for underlying or coexisting medical disease. Korenkov M, Sauerland S (2007) Clinical update: bariatric surgery. The Lancet, 370(9604): 1988-1990. POSTER PRESENTATIONS Keywords: Hashimoto’s thyroiditis, hypothyroidism, psychosis References Alp, R et al. (2004) Psikotik Bulgularla Hastaneye Başvuran PP-183 bir Hashimato Tiroiditi: Bir Olgu Sunumu. (Hashimoto’s Thyroiditis with Psychotic Symptoms: Case Presentation) Klinik Psikofarmakoloji Bulteni, 14(2). MUSICAL OBSESSION AND NOT AUDITORY Çoşar B (1999) Endokrin ve Metabolik Bozukluklara Bağlı Psikiyatrik HALLUCINATION: CASE PRESENTATION Durumlar. Organik Psikiyatri içinde,(Psychaitric Disorders due Halise Devrimci Özgüven, Turan Ayidağa Endocrine and Metabolic Disorders) Işık E.(editör) Ankara, Tayf Ankara University Medical School, Mental Health and Diseases Matbaası. 372-374 Department, Ankara AIM: Musical obsessions are the repetitive and persistent muscial sounds and songs evoked in the mind that trigger anxiety in the patient PP-182 and supressing these obsessions is difficult. There are few case reports in the literature on musical obsessions. We have aimed in this report to EATING DISORDERS IN BARIATRIC SURGERY present a case of musical obsession and discuss the process of dagnosis CANDIDATES and treatment of a very rare incident. Meliha Zengin Eroğlu1, Seda Kiraz1, Sencan Sertçelik1, CASE: The 25-year old male patient had started to hear a continuous Eda Dağlı İçbay2 music in his mind 1 year previously, the night before he was to enter 1Sağlık Bilimleri University, Haydarpaşa Numune Training and Research a very important academic examination. He had not been able to get Hospital, rid of this music afterwards. He had feared the event and had failed 2Gaziantep Public Health Directorate the exam the next day. After the examination the sound had ceased

154 but had restarted after the announcement of the examination results. 16% senior high school and 18.5% being university graduates. Mean When he consulted a physician about theis exprience he was dianosed paternal age was 38; with 1.5% uneducated, 37% primary school, aith schizophrenia and started on olanzapine (10mg/day). After three 18.5% middle school, 20% senior high school and 23% being university months on this therapy without change in hte symptoms the patient graduates. Majority of the patients were the first children in the family. had gained 15 kg. When he consulted us we determined the presence The reasons for consultation ranked as attention deficit (25.7%), of control, cleaning and counting obsession and compulsions which mobility (21.4%), fright ( 12.6%), anger control (12%), impulsiveness had been there since his childhood. Also, after a de atiled interview, (8.5%), reading/writing problems (4.2%), fixed ideas (2.8%), refusal it was understood that the music in his mind, previously diagnosed as to attend school (2.8%), speech problem (2.8%), internet dependence auditory halluciantion, was actually musical obsession. He was started (1.4%), developmetal retardation (1.4%), speech disorder (1.4%). The on fluoxetine (40mg/day) and he was in complete remission in 8 weeks. most frequently made diagnosis was attention deficit and hyperacativity disorder (ADHD), followed by depression (13.6%), generalised anxiety DISCUSSION: When patients complain of music in the mind, it may disorder (10%), mild mental retardation (8.4%), ADHD+personal be difficult and misleading to diagnose these as obsessions, hallucinations learning+ difficulty (4.2%), general developmental disorder (2.8%), or illusions. Thry few case reports in teh literature on musical obsessions obsessive-compulsive disorder (2.8%), growth and development were also concerned young male patients with tendency to musicality or retardation (2.8%), moderate mental retardation (2.8%), severe mental students at the threshold of academic examinations. It is very important retardaiton (1.5%), verbal learning difficulty (1.5%), oppositional for giving time for detailed evaluation of the patient in order to arrive behaviour disorder (1.5%), and behavioural disorder (1.5%). The at the correct diagnosis. major consultation reason was attention deficit for the ADHD cases Keywords: Anxiety,auditory hallucination, muscal obsession (42%), anger for the depression cases (44%) and fear for the generalised anxiety disorder cases (100%). The interval for control follow up was References 5 weeks and only 14% had been called for weekly controls. Intrafamily Andrade C, Rao NSK (1997) Musical obsessions: a case report. Indian marriage incidence was 11.4%, and 37.5% of the children in this group journal of psychiatry, 39(2): 178. were mildly mentally retarded, of which 5.7 were too young to attend kindergarten, and 68.5% has attended kindergarten, with 27% of this subgroup also being mildly mentally retarded. PP-184 DISCUSSION: In the interviews the cases are evaluted with their families. Mental health of the caregiver diectly affects the prognosis on RETROSPECTIVE INVESTIGATION OF the disorder diagnosed in the patients. Terefore, the famlies are oriented SOCIODEMOGRAPHIC DATA, FAMILY to psychiatric evaluation by interviews. Results indicate that mostly CHARACTERISTICS AND CLINICAL EVALUATION male children are brought for paychiaty consultation. It is noteworthy OF PATIENTS APPLYING GENERAL OUTPATIENT that attention defict, anger and fright have come to the foreground in the ADHD, depresiion and anxiety cases, respectively. Psychiatric CLINICS OF EGE UNIVERSITY CHILDREN AND disorders, and especially ADHD, do not only affect the patient but ADOLESCENT MENTAL HEALTH AND DISEASES the society as well. Therefore, determination of the mental problems Duygu Keskin Gökçelli1, Selin Tanyeri1, Serpil Erermiş2, in children and adolescents and ensuring family support for the young Nazlı Burcu Özbaran2, Sezen Köse2, Tezan Bildik2 patients is important for the total population. 1Ege University Medical School (EUMS), Mental Health and Disorders Keywords: Attention deficit and hyperacativity disorder (ADHD), Department, İzmir child and adolescent psychiatry, depression 2Ege University Medical School, Child and Adolescent Mental Health and Disorders Department, İzmir POSTER PRESENTATIONS AIM: Development and implementation of child and adolescent PP-185 psychiatry is very important for public health in order to raise healthy individuals and to reduce the incidence of crime. We have aimed in MOVEMENT DISORDERS SECONDARY TO this study to investigate the sociodemographic and clinical details of CEREBROVASCULAR ACCIDENT IN ALCOHOL USE the child and adolescent patients recorded at the very first consultative DISORDER: CASE PRESENTATION interview at our polyclinics. Yağmur Kır1, Bilge Bilgin Kapucu2, Özlem Şeyda Uluğ1, İnci METHODS: EUMS Child and Adolescent Psychiatry general Özgür İlhan1 polyclinics work on a system for the control appointments based 1 on the emergency of the cases after the first consultative interview. Hence, Ankara University Medical School, Mental Health and Diseases 70 patients had been randomly selected from the patients consulting the Department, Ankara 2T.C Sağlık Bakanlığı Hitit University Çorum Training and Research polyclinics and their files were evaluated on the first interview records. Hospital, Mental Health and Diseases Department, Çorum Any missing information was completed by telephone contact and data on their sociodemographic and clinical details were placed on a form. AIM: Movement disorders secondary to cerebrovascular accidents After the first interview with the patients, a teacher questionnaire was (CVA) constitute 1-4% of all movement disorders. Cases on akathisia sent to the schools to collect environmental history. Also, observation secondary to CVA are very rarely reported in the literature. It has been in a functional activity room, and evaluation by psychometric tests were aimed in this report to discuss a case of akathisia secondary to CVA and carried out. Psychoeducation and family intreviews were planned. exacerbated by drug treatment. RESULTS: On the basis of the data, obtained by the above summarised CASE: The 63-year old married male patient with university diploma approaches and methodology, the mean age of the group was had developed symptoms of anxiety, insomnia and anhedonia after 106months(8.83years); 71.4% were males and 28.6% were females. the demise of his sibling and had developed alcohol use to alleviate his Mean maternal age was 35, with 7% uneducated, 40% primary school, anxiety and sleep problems. His history involved an incident of power

155 loss on the right side in 2002 and his cranial MRI report described and the Beck anxiety inventory (BAI) for assessment of the depression diffusion limiting areas on the left occipital lobe, ischaemic gliolytic and anxiety severities. All patients took, in the same session, the finger- foci bilaterally in the frontal cortex, and cerebral and cerebellar atrophy. tapping test (FTT), a purely motor test, the five-choice serial-reaction He had been treated with paroxetine (20mg/day) for depression time task (5CSRTT)to assess the motor and cognitive processes, and and anxiety symptoms and the dose was titrated to 60mg/day in his the hit testing of visual targets (HTVT) to assess the additional strategy controls, which he had partially benefited from. In 2014, when he forming component of motor and cognitive processes. The HTVT was presented with sweating, treamor, time dysorientation and ataxic gait completed twice one after the other. due to alcohol use, he had to be admitted to hospital for treatment on RESULTS: Results have indicated that MDD patients had lower scores an inpatient basis. He was found to have recent memory impairment, on the FTT(p=0.019). Performance on the SRTT.indicated that MDD anomic aphasia, and dyskinetic mouth movements. The new cranial patients took a longer time than the controls in making a choice. MRI revealed an ischaemic lesion on the pons. Although his ataxic (p=0.032). Also the MDD patients were less successful in the HTVT gait partially improved, his memory problem persisted and akathisia by making many more errors than the controls (p=0.003). The scoring was added to his symptoms. When paroxetine was restarted to treat on the HTVT decreased as the severity of depression (p=0.001) and the anxiety symptoms, severity of the akathisa symptoms increased, and the time to react in the SRTT (p<0.001) increased. The elevated scores subsided with the discontinuation of paroxetine. A similar event was on the FTT strongly correlated with the HTVT1 error scores (HVT1 encountered with venlafaxine and he did not benefit from propranolol p=0.033,HVT2 p=0.020) and the HTVT target scores (p<0.001). The and lorazepam. He had to be started on clonidine. HTVT error data were in significant correlation with the reaction time DISCUSSION: This case is significant in having developed akathisia in SRTT (HVT1 hata r =-0.390, p = 0.040). after CVA, as akathisia is a rarely met disorder following CVA. Also, DISCUSSION: The results of this study suggest that there is slow down paroxetine aggrevated the akathisia, which can also be seen with in both the motor and the cognitive functions in MDD, the reason for antidepressants. In this patient it was thought that the CVA triggered the slow down in the daily life being mainly due to cognitive factors, the akathisia as well as the liability to drug side effect. Basal ganglia, and that they experience hardship in producing new strategies which where voluntary and involuntary movement signals are collected from can only be compensated by a good motor response. various pathways, are critical centers for movement disorders although it cannot be said that every basal ganglion lesion results in movement Keywords: depresyon, psikomotor retardasyon,ince motor hareket impairment. It is the effects on interconnections between the basal ganglionic centers that detemine the movement changes. The akathisai oberved after CVA in the case reported here may be due to impairments PP-187 of the functional interconnectivity in the brain. Keywords: Akathisiai, cerebrovascular accident, EPILEPTIC SEIZURES DURING LOW DOSE References CLOZAPINE THERAPY: CASE PRESENTATION Holtbernd F, Eidelberg D (2012). Functional brain networks in Rukiye Ay movement disorders: recent advances. Current opinion in Malatya State Hospital neurology, 25(4):392. Koliscak LP, Makela, EH (2009) Selective serotonin reuptake inhibitor- AIM: Clozapine is and antipsychotic agent used for treating resistant induced akathisia. Journal of the American Pharmacists Association, schizophrenia. It has been aimed here to present a case of schizophrenia 49(2):e28-e38. with epileptic seizures after low dose clozapine treatment. CASE: The 51-year old male patient on follow up over 15 years for

POSTER PRESENTATIONS schizophrenia consulted our polyclinics with complaints of insomnia, PP-186 iritability, fright and auditory hallucinations. He was found to be on treatment with risperidon (8 mg/da7), zuclopentixole depot and EVALUATION OF THE IMPAIRMENT OF FINE olanzapine (20 mg/day). He had been followed up after his psychiatric examination, his treatment had included a varity of agents and he MOTOR MOVEMENT ABILITIES IN MAJOR had partially responded to some. In the previous 1 month he was in a DEPRESSIVE DISORDER persistent psychotic attack despite compliance with his existing therapy. Emine Hande Kılıçaslan Şahin1, Oruç Şahin2, Orhan Murat He was diagnosed with resistant schizophrenia, and the existing therapy Koçak3 was discontinued and switched to clozapine (12.5 mg/day titrated 1Kırıkkale Postgraduate Hospital, Psychiatry Clinic, Kırıkkale slowly to 150 mg/day). As the symptoms subsided the last dose was 2Kırıkkale Postgraduate Hospital, Neurology Clinic, Kırıkkale maintained. However, after 1 month he had sudden onset of loss of 3Kırıkkale University, Psychiatry Department, Kırıkkale consiousness, falling and general contractions over his body. After the incident he consulted the emergency service, and the results of AIM: Psychomotor slowing down is one of the fundemental neurological examination and EEG were evaluated as epileptic seizure. impairments leading to disability in depression. Fine motor movements He was started on levetiracetam(500mg/day) and referred to psychiatry. can be proposed to be an observational area suitable for investigating His seizure was attributed to clozapine. However, when followed with the assumed impaired processess. The aim of this study is to explain the treatment on clozapine (150mg/day) and levetiracetam (500mg/day) he with a new paradigma the manner in which the fine motor movements did not have repeated attacks of epilepsy. are affected with respect to the motor and/or cognitive processes. DISCUSSION: During clozapine therapy dose dependent epileptic METHOD: The study included 28 patients diagnosed with major seizures may occur. High doses of clozapine (≥600 mg/day) have been depressive disorder (MDD) on te basis of DSM-V-TR criteria and associated with high risk and incidence (4.4%) and low doses (≤300 28 healthy indiduals as the controls. All participants completed a mg/day) with low risk and incidence (1.0%) of seizures. Risk factors sociodemographic questionnaire, the Beck depression inventory (BDI) include rapid titration of the clozapine dose, family history of epilepsy

156 and concurrently used epileptogenic medication. Probability of epileptic PP-189 seizures with low dose clozapine therapy should not be overlooked. Keywords: Clozapine, seizure, schizophrenia HYPOTENSIVE SHOCK AND MULTIORGAN FAILURE WITH TYPICAL ANTIPSYCHOTIC USE: CASE References PRESENTATION DevinskyO, HonigfeldG, PatinJ(1991) Clozapine‐related seizures. Neurology, 41(3): 369-369. Seda Doğruel, Hatice Özdemir Rezaki, Şadiye Visal Buturak, Muhammet Sevindik, Orhan Murat Koçak Kırıkkale University, Psychiatry Department, Kırıkkale PP-188 AIM: Antipsychotics have differing affinities for different receptor types and produce side effects in relation to their mechanism of action on MUNCHAUSEN SYNDROME AND SUICIDAL these receptors. The side effects associated with the typical antipsychotic ATTEMPT: CASE PRESENTATION agents mostly involve the dopaminergic, adrenergic, cholinergic and the histaminergic systems. In the case presented in this report it has Kevser Altıntaş1, Meliha Zengin Eroğlu1, Alida Ataç2 been aimed to discuss the development of hypotensive shock with 1Haydarpaşa Numune Training and Research Hospital Psychiatry, multiorgan insufficiency after an injection of the typical antipsychotic Psychiatry Department agent zuclopentixole. 2Haydarpaşa Numune Training and Research Hospital, Family Practice CASE: The 57-year old male patient living alone had been followed AIM: Munchausen Syndrome is a factitious psychiatric disorder with for 33 years with the diagnosis of schizophrenia. He had used many the afflicted individuals inventing voluntarily, without being enforced, types of antipsychotic agents without regularity. He was admited as an mental or physical disorder symptoms and consulting medical services inpatient to the psychiatry ward on account of flare up in the positive continually with these exaggerated assumed symptoms. In psychiatry and negative symptoms. He has not used any antipsychotic agents over Munchausen syndrome is classified as a subgroup of factitious somatic the previous 6 months. As his compliance with oral treatment had not symptom and related disorders. Although there are many clinical been good, he was started on zuclopentixole acetate and decanoate symptoms and disease histories produced the patient does not have any injections. After the 9th dose of zuclopentixol acetate he developed in secondary gains or aims other than ensuring to stay in hospital or to two days, severe hypotension (60/40mmHg), with sweating and change receieve a certain medical intervention.. in consciousness and had to be referred to the intensive care unit of the internal diseases unit. He was diagnosed with prerenal failure, hepatic There are distinct inconsistencies in the disease symptoms and the failure, mixed acidosis and respiratory arrest and was entubated. He had detailed history taken together with theresults of the investigations not used any drugs other than the antipsychotic agent, and did not made. In this report, a case of suicidal attempt with drug overdose, develop rigidity or fever. referred by the emergency service to psychiatry for consultation will be discussed. DISCUSSION: Changes in consiousness and autonomic dysfunction due to antipsychotic use are evaluated within the framework of malign CASE: The 38-year old illiterate married female patient had attemtpted neuroleptic syndrome (MNS). However, the case discussed here does not to commit suicide by taking excessive dose of drugs. Her history meet the major criteria of MNS explained by dopaminergic dysfunction. included traumatic experiences, and 9 suicidal attemtps. She had The hypotension due to α1-adrenergic mechanisms is commonly seen depression symptoms and was admitted as an inpatient. It was learned with antipsychotic agents. All other causes of hypotension and changes that she had numerous polyclinic and emergency service consultations of consciousness had been eliminated in this case and he was diagnosed and 7 incidents of various surgeries. During her stay at ouır clinic, with hypotension and multiorgan failure due to antipsychotic use. In a her incompliant behaviour and continous somatic complaints drew study with an animal model, the multiorgan failure observed with the POSTER PRESENTATIONS attention. As her complaints had been examined at the dermatology, ear- typical antipsychotic agent chlorpromazine was attributed to reduced nose –throat, gynaecology and antenatal units without any pathological levels of TNF-α. results she was considered to be a factitious disorder case. As she was producing symptoms without secondary aims, she was diagnosed with Keywords: Antipsychotic, hypotension,TNF- α Munchausen syndrome and was followed on that basis. References DISCUSSION: In this case of a patient followed in our clinic, the Jansen MJ, Hendriks T, Knapen MF et al., (1998) Chlorpromazine inconsistency between the complaints and the physical examination down-regulates tumor necrosis factor-alpha and attenuates and the symptom-related investigations have led to the diagnosis of experimental multiple organ dysfunction syndrome in mice. Crit Munchausen syndrome which should be taken into consideration in Care Med, 26:1244-1250 cases presenting with similar inconsistencies. Keywords: Differential diagnosis, factitious disorder, munchausen syndrome References Asher Rn(1951) Munchausen Syndrome. Lancet1:339-341 Asma S, Erdoğan AF (2009).Kanama İle Başvuran Munchausen Sendromu Olgusu.Munchausen syndrome case consulting with haemorrhage) TAF Preventive Medicine Bulletin, 8(4).

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PLATELET/LYMPHOCYTE RATIO IN CHILDREN ONSET OF CREUTZFELDT- JAKOB DISEASE WITH WITH MAJOR DEPRESSIVE DISORDER. PSYCHOTIC DISORDER: CASE PRESENTATION Abdullah Bozkurt1, Miraç Barış Usta1, Gökçe Nur Say1, Bilgen Biçer Kanat, Özge Fındıcaklı, İbrahim Taymur, İbrahim Kartal2, Koray Karabekiroğlu1, Berkan Şahin1 Sinay Önen 1Ondokuz Mayıs University, Child and Adolescent Psychiatry Department, Bursa Postgraduate Training and Research Hospital, Psychiatry Clinic, Samsun Bursa 2Ondokuz Mayıs University, Child Haematology Department,Samsun AIM: Creutzfeld-Jakob disease, first discovered in 1921, is a AIM: Immunological and inflammatory mechansims are thought to neurodegenerative disease progressing very rapidly with dementia, partake in the pathophysiology of major depressive disorder (MDD). myoclonic contractions and EEG changes. Its incidence worldwide is The neutrophil/lymphocyte ratio (NLR) is evaluated as an inflammatory 1-2/1,000,000, and generally presents in the age range of 45-75 years. marker and is found raised in cases of colorectal cancer, coronary heart Given the sudden onset with behavioural changes, patients are often disease and schizophrenia and is a sing of bad prognosis. In a study with referred to psychiatry. Although there are case reports of comorbidity adult MDD patients, NLR of the patient group was found to be higher with psychiatric disorders during the course of the overt diase, its onset than in the controls. with psychiatric symptoms is a rare event. It has been aimed to draw attention in this report to the onset of the disease with pscyhiatric METHOD: The study included 46 MDD patient followed at the symptoms.. Ondokuz Mayıs University, Child and Adolescent Psychiatry Services between 01.01.2013 and 01.01.2016. Data on the serum levels of CASE: The 63-year old primary school graduate female patient NLR and PLR estimated on the blood samples taken at admission were married housewife was referred to psychiatry after consulting neurology retrospectively collected and analysed. The result were compared with polyclinics. She had developed 1 month previously fright, insomnia, the same parameters in the serum samples of 30 healthy children. lack of morale, and had started speaking to herself. She was admitted as inpatient. She walked with given support. She had bursts of weeping, RESULTS: Mean age of the patient group and the control group social intraversion, blunt affect, irritability and nihilistic delusions. were, respectively, was 15.2 (±1.4) years 14.8 (±1.8) without statistical Her biochemical test results were within normal limits and she was difference (p=0.329). The patient group and the control group consisted, started on lorazepam (3 mg/day). Consultation was requested from the respectively, of 63% and 53% females, and,respectively, of37.0 % and neurology unit for her hypervigilance ve myclonic contractions. She was 46.7% males (p=0.485). The patient and the control group did not differ given the preliminary diagnosis on encephalitis and EEG and cranial significantly with respect to NLR( p=0.204) and PLR ( p=0.183) values. MRI were requeseted. On the third day of her admission she developed DISCUSSION: A study carried out in 2015 with 41 adult MDD orientation impairment and respiratory insufficiency and was transferred patients, the NLR value was higher in the patient group as compared to to aneasthesia intensive care unit. Her cranial MRI showed diffusion the controls. However, in our study we have not shown any difference limitation and increased bilateral frontoparietal cortical intensity and beween the NLR values of children with MDD and of the controls. the EEG gave signals compatible with Creutzfeld- Jakob disease. In MDD the serum proinflammatory cytokine levels are increased DISCUSSION: In the middle to old age patients with onset of and the inflammatory process has been shown to change with the psychiatric symptoms complicated with neurological symptoms, the antidepressants used. An important limitation to our study is the differential diagnosis should include Creutzfeld- Jakob disease. Later investigation of serum samples while the patients were on antidepressant apperance of the positive organic signs and motor system impairment therapy. It is important to repeat these studies with patients not put on should be remembered and EEG and cranial MRI and protein any antidepressant therapy. POSTER PRESENTATIONS estimation in the CSF must be carried out Keywords: Adolescent, inflammation, major depressive disorder Keywords: Creutzfeldt-jakob, fast progressing dementia, psychotic depression PP-191 References Abudy A, Juven-Wetzler A, Zohar J (2014) The different faces of MANIC SWITCH IN AUTISM SPECTRUM DISORDER Creutzfeldt-Jacob Disease CJD in psychiatry General Hospital DUE TO ANTIDEPRESSANT USE Psychiatry, 36:245–248 Ecem Çelik, Murat Erkıran Kurne, Aslı et al.,. (2005) Creutzfeldt-Jakob Hastalığı Psikiyatrik Belirtilerle Başlayan Bir Olgu.( A Case of Creutzfeldt-Jakob Disease Bakırköy Mental Health and Neurological Diseases Hospital, İstanbul Presnting With Psychiatric Symptoms)Türk Psikiyatri Dergisi, Autism specturm disorders are neurodevelopmentsl diseases that have 16(1):55-9 lifelong chronicity. Ininidviduals diagnosed with autism, apart from the repetitive behavioural problems, comorbidity with various psychotic disorders, including anxiety disorders, depressive disorders, attention deficit hyperactivity disorder and sleep disorders, are quite common. Studis with clinical basis have reported depression as the most frequently comorbidity daignosed in autism. Depression is also widely observed in various neruopyschaitric disorders other than autism. In a case with autism spectrum diagnosis treatment of depression comorbidity with antidepressant resulted in manic switch at the end of the therapy and was evaluated in the light of the current literature. Keywords: Bipolar, manis, autism

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RELATIONSHIP OF INSTITUTIONAL WHERE IN THE BRAIN IS ‘THE OTHER’?: TWO COMMITMENT AND JOB SATISFACTION IN CASES OF CAPGRAS SYNDROME PHYSICIANS Esin Levent1, Gamze Özçürümez Bilgili1, Hamit Genç2, Güler Özkula, Arda Karagöl, Selvi Kayıpmaz, Ozan Kotan Hilal Özgüner2, Arda Yılmaz2 Başkent Ankara University, Psychiatry Department, Ankara 1Mersin University, Medical School, Psychiatry Department 2Mersin University, Medical School, Neurology Department AIM: Relationship between commitment to the entire institution described as Institutional commitment, and perceptions of different AIM: Capgras syndrome is one of the most interesting examples of aspects of the job described as job satisfaction have become frequently delusional misidentification disorders, with the afflicted individual researched topics in order to increase the efficiency in the service claiming that a closely known person has been replaced by imitations, sector. Similarly in the healthcare sector, on the basis of the powerful fakes or robots. As a symptom of psychiatric disorder, it can be observed relationship bertween the service perceived by the patients and the in paranoid schizophrenia, and with neurological, toxicological and job satisfactiono of the healthcare workers, there is similar research other organic pathologies. It has been aimed here to present two cases of carried out to increase the institutional commitment of the healthcare Capgras syndrome which can be associated with impairments in specific workers. In this respect, it has been aimed in this study to investigate regions of the brain. the institutional commitment (emotional commitment, normative commitment, continuation commitment) and job satisfaction by CASE-1: The 30-year old single female highschool graduate consulted physicians. the polyclinics with the complaints of depression, anhedonia, indifference, insomnia, lack of appetite, low self esteem and replacement METHOD: The 258 volunteering physicians employed in a trust hospital of her relations by others. She had a history of epileptic seizures were asked to complete given the Institutional and Goal Commitment starting at the age of 2. As the seizures could not be controlled she had Scale (IGCS) and the Minnesota Satisfaction Questionnaire.(MJSQ). undergone right temporal hippocampectomy 2 years previously and Data were analysed on the SPSS 17 package program. had not been using drugs for the previous 1.5 years. She was admited as RESULTS: The ‘ continuation’ subscale to IGCS and the internal an inpatient on the preliminary diagnoses of major depressive disorder, and external job satisfaction subscales of the MJSQ were negatively organic psychotic disorder and Capgras syndrome. Her physical and correlated (p<0.05). There was a positive corrrelation between normative neurological exminations were normal. The EEG indicated mild institutional commitment and internal job satisfaction (p<0.05), there bioelectrical disorganisation in the right temporal region, and cranial was not a similar correlation with external job satisfaction (p>0.05). MRI revealed postoperative changes in the right temporal lobe. She was There was not a correlation between emotional commitment and started on risperidone (3 mg/day) and carbamazepine (2x200mg/day). internal or external job satisfaction (p>0.05). Her mood symptoms regressed rapidly and her Capgras delusions had disappeared at her control follow up. DISCUSSION: The results of our study has shown in agreement with the literature that as institutinal commitment, based on factors CASE-2: The 60-year old university graduate married male patient, of concerns on inability to cope with the adverse possibilites after was brought to the psychiatry clinic after a 4-5hour interview for leaving a job, and lack of alternatives, increases inernal and external job history taking at the emergency services with unintelligible talking and satisfaction is lowered. On the other hand, as the nomative institutional sleep tendency. Cerebral CT was normal. Neurological examination commitment associated with continuing at the institution with reasons indicated impaired comprehension, naming and repeating with of responsibility and ethical values, internal job satisfaction increases. peliminary diagnoses of transient ischaemic attack, epilepsy and There are as many studies claiming that normative commitment to

encephalopathy. Biochemical tests results showed elevated TSH: 5.46, POSTER PRESENTATIONS institution is related to job satisfaction as there are which claim the low T4: 12.11, and normal anti-TPO and Anti-TG. Thyroid USG was opposite. Our results are different than those in the literature in that normal, cranial MRI was inapplicable as he had a cardiac pace maker a correlation between job satisfaciton and continuing in the institution implant; but the control CT and EEG were within normal limits. He with feeling of trust and sense of belonging was not determined. was strarted on levothyroxine sodium. Echocardiography indicated a This could be interpreted as there being less emotional institutional 4.6 cm enlargement of the left atrium with hypokinetic areas on the commitment among physicians as compared to other groups of inferior, lateral and posterior walls. He was given anticoagulant therapy. professions. On the second day of his admission he did not have orientation disorder Keywords: Institutional commitment, job satisfaction, physician but was claiming that his wife was fake and had been replaced by an alien person, while he could recognise other relations correctly. On the References day EEG showed mild electrical fault at the left frontotemporal region, Top M (2012) Hekim ve hemşirelerde örgütsel bağlılık, örgütsel güven and strong neuronal stimulation was determined. Treatment with ve iş doyumu profili.( Institutional commitment, institutional levetiracetam (2x500 mg/day) and quetiapine (25 mg/night) was started trust and job satisfaction among physicians and nurses) İstanbul and heparin was discontinued. On the 4th day Capgras delusions had University Journal of the School of Business Administration, 41: 258-277 subsided. Ülbeği İD, Yalçın A (2016) Örgütsel bağlılık ve iş doyumu ilişkisinin DISCUSSION: In these case reports it has been aimed to draw attention meta analiz yöntemiyle incelenmesi.(İnvestigation of the to the investigational evidence presented which suggests the probable relationship between institutional commitment job satisfaction by involvement of the impairment in the interconnections between the method of meta-analysis) Turk Psikol Derg,31: 80-98 frontal lobe and the right limbic areas may underlie the symptoms of Capgras delusions. Keywords: Aetiology,Capgras syndrome, pathogenesis

159 References PP-196 Capgras J, Reboul-Lachaux J (1923) L’illusion des sosies dans un delire systematise chronique. Bull Soc Clin Med Ment, 11:6-16. MULTIPLE SEWING PINS EMBEDDED ON THE LEFT David AS (1993) Cognitive neuropsychiatry. Psychol Med, 23:1-5. ARM: CASE PRESENTATION Gobbini IM, Haxby JV (2007) Neural systems for recognition of familiar faces. Neuropsychologia 45:32-41. Tuba Gürbüz, Derya İpekçioğlu, Burcu Kök, Olcay Şenay, Mehmet Cem İlnem Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological PP-195 Diseases and Research Hospital AIM: The self-mutilation concept refers to a wide scale of behaviours and POLYURIA DURING VENLAFAXINE USE: CASE ideations on attempts to hang, poison or bodly harm one’s self, generally PRESENTATION on the face of intolerable conditions of anxiety. Favazza ve Rosenthal have described pathalogical self mutilation as a delibrate behaviour to Rukiye Ay harm the body without the intent to kill one’s self. It has been aimed in Malatya State Hospital, Maltya this report to share the aetiological factors, the psychopatholgy and the AIM: Venlafaxine is a SSRI-SNRI class of agent used for the treatment treatment of a case presenting with multiple sewing pins embedded on of depressive disorders. Although side effects of hypertension, nausea, his left arm and diagnosed with ‘atypic psychosis‘‘ and ‘‘mild degree of diarrhea, and insomnia have been well recognised, there are very few mental retardation‘‘. reports on effects on the urogenital sysmtem. It has been aimed to CASE: Mr. B.H., the 45-year old male patient was brought to the present in this report a case of polyuria due to venlafaxine use. psychiatry emergency service by his family. He had symptoms of CASE: The 53-year old male patient consulted our polyclinics with aggression, fear of being killed, hositility to his family and thought of complaints of anhedonia, attention problems, avolition, and waking up harming his family members. He had sustanined the habit of pinning in the morning with fatigue, which had started 2 months previously. He sewing pins on his arm for many years. His psychiatric and physical had been diagnosed with depression approximately 8 year previously examinations and the results of psychometric tests led to the diagnoses and had used from time to time antidepressant agents. He had not used of ‘atypic psychosis‘‘ and ‘‘mild degree of mental retardation‘‘. X-ray any psychotropic agents over the previous 1 year. He was diagnosed radiography revealed 17-19 metallic objects embedded on the front with depressive disorder on the DSM-V criteria and started on aspect of his left arm. These were found to be in a risky area and venlafaxine (37,5 mg/day). Although the depressive symptoms had therefore inoperable after evaluations at the orthopaedics and general regressed in a week, he started to have complaints of polyuria on the surgery units. He was admitted as an inpatient and treatment was 20th day of his treatment. His quality of life deteriorated and he could started with haloperidol (10 mg 2×1- im), biperidene (5 mg 2×1-im), withstand this only for a week before consulting the urology polyclinics. and quetiapine (100 mg 1×1-orally). When the psychotic symptoms Since the patient did not have a history of urological pathology and subsided oral treatment was started. He was dischared on Haloperidol(( was on venlafaxine only, he was referred to the psychiatry polyclinics. 20 mg/day), biperidene ( 4 mg/day), quetiapine ( 100 mg/day) and Venlafaxine was discontinued and the therapy was switched to sertraline Zuclopentixole ( 200 mg/month). (50mg/day), when his polyuria ceased in 2 days and the side effect did DISCUSSION: Self-mutilation is not a disorder but a behaviour that not repeat with sertraline. is regulated by the underlying causes. Aetiologically a wide spectrum DISCUSSION: In the case reported here the aetiology of the observed of psychiatric causes ranging from impulsiveness to psychosis can polyuria was not associable with any medical condition and velafaxine be present. There are studies proposing that self-mutilation with treatment was thought to be the underlying cause. Previous reports on pscychiatric basis can be alleviated by electroconvulsive therapy. There POSTER PRESENTATIONS the urinary effects of velafaxine are controversial. One study has reported are other studies recommending the use of antipsychotic agents, lithium, urinary incontinance and another has reported urinary retention with β-blockers, buspirone, L-tryptophane and naltrexone to alleviate self- recommendation of venlafaxine use in stress incontinance. It is evident mutilation behaviour. that further studies on venlafaxine mechanism of action on the urinary system are needed. Keywords: Aetiopathogenesis, psychosis, self- mutilation Keywords: Depressive disorder, poliuria, velafaxine Erdinc A, Gurates B, Celik Het al. (2009)The efficacy of venlafaxine in the treatment of women with stress urinary incontinence. Archives PP-197 of gynecology and obstetrics, 279(3):343-348. Miskovic, M (2015). Comparison of Tolerance of Venlafaxine, SEXUALITY IN THE LGBTI POPULATION AND AN Paroxetine and Amitriptyline in Depression Therapy. Medical ATTEMPT TO DETERMINE THE SEXUAL PROBLEMS Archives, 69(2), 107. Ardıl Bayram Şahin1, Nur Elçin Boyacıoğlu2, Hüsniye Dinç2, Neslihan Keser Özcan2 1İstanbul University, İstanbul Medical School, Psychiatry Department İstanbul 2İstanbul University, Health Sciences Department, Midwifery Dividion, İstanbul AIM: Although the lesbain, gay, bisexual, transgender, intersex, + (LGBTİ + ) members of the population experience many sexual problems including sexual dysfunction, these problems have not been as well studied in comparison to those of the heterexual members of

160 the population. The incidences of sexual dysfuntion in the LGBTI+ clinical findings, ECT indications, response to ECT and the side effects population is reported to be in the 42.5-79% range, but there is not of ECT. enough data, or studies to determine the diagnostic criteria and the RESULTS: Over 5 years ECT had been given to 39 BPD patients, 64,1 treatment approaches. This study has been planned for making an % females and 35,9% malesi; with 59% in manic or hypomanic episode attempt to initiate a search into the sexual health problems of the and 41%’ in depressive episode. Mean hospital stay was 31.64 days, LGBTI+ community in Turkey. mean time taken for remission post- ECT program was 20,1 months, METHODS: This descriptive, cross sectional and controlled study with 87,2% reaching full remision, 7.7% partial remission, and 5.2% was carried out with 210 LGBTI+ individuals and 226 heterosexuals not responding to the therapy. Serious complications had not been as the control group. Data were collected online between August – observed in the patients after the ECT. October 2015 by means of the general health questionnaire-12 and a DISCUSSION: Results of this study, in agreement with the results of questionnaire for determining sexual health; and anlysed on the SPSS previously published work, have shown that ECT is a reliable and rapidly 20 package program, in terms of percentage distributions, the mean, effective alternative for the treatment of resistant BPD. However, there the independent t-test for group comparisons and the Spearman adn is need for further studies on ECT for BPD to endorse these results on Pearson correlation tests. a wier scale. RESULTS: When compared, the LGBTI and the control group did Keywords: Bipolar disorder, electroconvulsive therapy, resistance to not differ on grounds of positive/negative evaluation of masturbation treatment (p=.445), and the LGBT+ group were found to masturbate more frequently than the controls (p=.000). The results indicated that in comparison to the control group the LGBTI+ group experienced more sexual problems (p=.000). The most frequently faced problem in PP-199 both groups was decrease in sexual desire or the lack of it, and for the LGBTI+ group the second most frequently experienced problem was COMORBIDITY OF MARFAN SYNDROME AND associated with anal intercourse. SCHIZOPHRENIA: CASE PRESENTATION DISCUSSION: The results of this study have shown that the LGBT+ Esra Akay, İbrahim Taymur, Sinay Önen, Bilgen Biçer Kanat individuals have more sexual function problems including those of the Bursa Post Graduate Training and Research Hospital, Psychiatry Clinic, heterosexuals as well as those specific to their LGBTI+ characteristics. Bursa There should be comprehensive studies on the LGBTI+ members of the population in order to develop criteria for clinical diagnosis and AIM: Marfan syndrome is an autosomal dominant fibrous tissue disease treatment of their problems related to sexual function. caused by the mutation of the fibrillin-1 gene on the human no 15 chromosome. There are case reports on the comorbidity of Marfan Keywords:, Anal intercourse, gay, LGBTI+, sexual dysfunction, sexual syndrome with schizophrenia. Our aim is to present, within the context function, sexual health of the literature on the subject, a case of Marfan syndrome comorbidity References with schizophrenia. Hirshfield, S (2010) Sexual dysfunction in an Internet sample of US CASE: The 29-year old single female patient with a thin and tall men who have sex with men. The journal of sexual medicine, 7(9), body structure was brought by her relations to our poylcinic with 3104-3114. the complaints of talking to herself and of nonexisting events, IvankovicI, ŠevicS, Štulhofer A. (2015) Distressing sexual difficulties in suspiciousness, and susceptibility to misinterpet (events/attitudes). She heterosexual and non-heterosexual Croatian men: Assessing the role had been diagnosed with Marfan syndrome at the age of 7 when she

of minority stress. J Sex Res; 52(6), 647–658. was an intraverted individual. Her psychiatric symptoms had started POSTER PRESENTATIONS Lau JTF, Kim JH, Tsui HY. (2008) Prevalence and sociocultural at the age of 9 by talking to herself and talking of events that had not predictors of sexual dysfunction among Chinese men who have sex taken place. She had been treated with aripiprazole, quetiapine, depot with men in Hong Kong. J Sex Med; 5: 2766–79. risperidone and paliperidone at various healthcare centres but her treatment compliance had been poor. Her psychotic symptoms had increased when she terminated her treatment 4 months previously. Her psychiatric examination revealed distint auditory hallucinations PP-198 giving orders, referential and persecutory delusions, social intraversion, and irritabilty. She was admitted as inpatient and started on depot ELECTROCONVULSIVE THERAPY IN BIPOLAR paliperidone with dramatic improvement in her irritability and other DISODER: A RETROSPECTIVE STUDY psychotic symptoms. She was discharged in the third week after her Suna Soğucak, Cennet İnleyen, Gülsüm Özge Doğanavşargil admission. Baysal DISCUSSION: There are many reports in the literature to show that the Akdeniz University Psychiatry Department comorbidity of schizophrenia and Marfan syndrome is not a coincidental AIM: We have aimed at evaluating the sociodemographic characteristics phenomenon. The frequent comorbidity of the two disorders suggests of the patients who underwent electroconvulsive therapy (ECT) that the genetically transmitted Marfan syndrome may be a risk factor of schizophrenia, or schizophrenia may be a component of Marfan between 2011 and 2016 in our clinic, and determining the incidence syndrome or the two disorders may have a common aetiology. Lujan- of fast response to ECT and the differences in the effectivitiy of ECT Fryns syndrome or the X-linked dominant mental retardation with on the patients. marfanoid habitus, arising from the MED12 gene defect, is complicated METHODS: This study scanned retrospectively the filed information with schizoid symptoms. The fibrillin-1 gene defect, at the basis of accumulated over 5 years on bipolar disorder (BPD) patients treated Marfan syndrome, results in changes in the intracellular interactions with ECT, and data was collected on the sociodemographic distribution, with raised TGF- β levels which may explain the common pathology

161 of neurodegenerative changes underlying the psychotic symptoms of DISCUSSION: In schizophrenia patients on antipsychotic agent schizophrenia and of Marfan syndrome. There is need for futher studies treatment, metabolic parameters might be changed independently of including family studies to explain the comorbidity of schizophrenia the age of the patient. Patients to be started on atypic antipsychotic and Marfan syndrome. therapy should be well evaluated on the basis of metabolic parameters before starting the treatement, and should be carefully followed up Keywords: Marfan Syndrome, psychosis, schizophrenai on the changes of these parameters when on the therapy with regular References measurements of the waistline circumference. Van Den Bossche MJA, Van Wallendael KLP, Strazisar M, Sabbe B, Keywords: Diabetes, hyperlipidaemia, schizophrenia, waistline Del-Favero J (2012) Co-occurence of Marfan syndrome and circumference schizophrenia: what can be learned? Eur J Med Genet. 55:252-255. Van Buggenhout G, Fryns, JP (2006) Lujan-Fryns syndrome (mental References retardation, X-linked, marfanoid habitus). Orphanet journal of rare Mitchell AJ, Vancampfort D, Sweers K et al., (2013) Prevalence of diseases, 1(1), 1. metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders—a systematic review and meta-analysis. Schizophr Bull, 39(2):306–318 PP-200 Vancampfort D, Correll CU, Galling B et al., (2016) Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta-analysis. World INVESTIGATION OF METABOLIC PARAMETERS IN Psychiatry, 15(2):166–174. SCHIZOPHRENIA PATIENTS ON ANTIPSYCHOTIC TREATMENT AND COMPARISON WITH HEALTHY CONTROLS PP-201 İmran Gökçen Yılmaz, Erdal Özelçi, Mustafa Şahin, Almıla Erol, Ahmet Levent Mete APPROACH TO ACUTE STRESS DISORDER AFTER Katip Çelebi University Atatürk Training and Research Hospital(TRH), İSTANBUL AIRPORT TERROR ASSAULT- CASE Psychiatry Department,İzmir PRESENTATION AIM : This study has been planned to investigate the fasting blood Gizem Dönmezler, Münevver Hacıoğlu Yıldırım, glucose, and lipid profiles, waistline circumference, body weight and blood prssure parameters in the schizophrenia patients regularly Ejder Yıldırım followed up at the Atatürk TRH psychotic disorders polyclinic and to Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological compare the data with those obtained from healthy inidviduals. Diseases and Research Hospital, Trauma Therapies Group, İstanbul METHODS: The study included 110 patients diagnosed with AIM: Acute stress disorder (ASD) sums the stress reactions that schizophrenia on the DSM-V criteria and treated with antipsychotics present within the first month after exposure to traumatic events. for at least 1 year without a change in the treatment type for the previous Although tauma related reactions appear immediately after the event, 6 months. A group of 38 individuals without psychiatric disorders prospective studies have shown that the reaction symptoms are lost in onstituted the control group. Data on the patients were obtained by time. Nevertheless, some individuals do develop post traumatic stress scanning the polyclinic records. Parametric and sociodemographic disorder (PTSD) after the event. ASD has predictive power of PTSD details were compared between the patients and the controls. Chi- and if not treated may result in PTSD. Given the continuity of terror square t test and correlation analyses were used. events in the recent years in our country, healthcare workers have to be POSTER PRESENTATIONS prepared, more than ever, to handle ASD cases. In this report the case of RESULTS: Mean age of the patient group was 41.51(±9,736), with 37 an individual who was at the Atatürk airport at the time of a recent act (33.6%)being females and 73 (66.4%) being males. Mean age of the of terror and consulted us with ASD symptoms will be presented as an control group was 37.92(±11,879) with 18(47,4%) being females and example of the approach to ASD after acts of terror. 20 (52,6%) being males. The two groups did not differ significantly on the basis of age, gender and years of education. In the patient group, CASE: The 35year old male patient, married with one 11-year old as compared to the controls, incidences of being single (X2=15,96 child, working as an airport passenger services staff member, was at the p≤0,01), being unemployed (X2=57,92 p≤0,001) and living with the airport during the terror assault and got wounded and attested death. family (X2=17,43 p≤0,01) were significanly increased. He had experienced profound shock at the time of the event and was still sufering the aftermath when he consulted us 30 days after his hospital In the patient group, in comparison to the controls, the t test results treatment was over. He was observed for 3 days. The interventions showed that blood glucose (t=7,72 p≤0,01), total cholesterol (t=2,12 during the interviews consisted of taking therapeutic history, emphatic p=0,037), LDL( t=-2,98 p=0,003), HDL(t=-3,55 p=0,001), TG(t=5,27 confirmation, psychoeducation over the symptoms, position of the p≤0,001), waistline circumference(t=6,46 p≤0,001) and body reliable therapist and strengthening of the support systems. The weight(t=3,58 p=0,001)were significantly higher. Correlation analyses interviews were finalised when the symptoms of the patient subsided. on the data of the control group indicated significant correlations between age and fasting blood glucose(r=0,79); total cholesterol (r=0,35) DISCUSSION: Early and correct interventions on ASD are very and LDL (r=0,36); waistline circumference and LDL (r=0,48 p=0,008); strongly predictive for the improvement of the symptoms. The trust of total cholesterol(r=0,32; systolic BP(r=0,60) and bodyweight(r=0,88). the patient on the therapy and the therapist, and informing the patient Using the correlation analyses, significant relationships betwee age and of the therapeutic methods are predictive of the improvement of the the metabolic parameters were not demonstrated in the patient group. individual experiencing chaos with the symptoms. Many studies have However, waistline circumference was found to correlate significantly shown that those diagnosed with ASD have higher liability to develop with the parameters of TG(r=0,40),systolic BP(r=0,31), diastolic BP PTSD with bad prognosis. Although the lifelong prevalence of ASD is (r=0,35) and body weight (r=0,83). not certain, the estimations for PTSD is around 7.8%. Given the PTSD

162 prevalence, the currently high incidences of the acts of terror and the References social problems and inability to work after ASD, physcians have to be Tutkun H, Şar V, Yargç LI, et al., (1998) Frequency of dissociative prepared for implementing the suitable treatment protocols to achieve disorders among psychiatric inpatients in a Turkish University recovery, the possibility of which has been discussed in this report. Clinic. Am J Psychiatry 155(6):800-805. Keywords: Acute stress disorder, post traumatic stress disorder (PTSD), Yargıç Lİ, Tutkun H, Şar V (1994): Çocukluk çağı travmatik trauma yaşantıları ve erişkinde dissosiyatif belirtiler. Psikiyatri Psikoloji Psikofarmakoloji Dergisi 2(2): 338-347. References Bryant RA, Moulds ML, Nixon RV (2003) Cognitive behaviour therapy of acute stress disorder: a four-year follow-up. Behaviour Research and Therapy, 41(4), 489-494. PP-203 Rothbaum BO, Kearns MC, Price M, Malcoun E. et al. (2012) Early intervention may prevent the development of PTSD: A randomized INVESTIGATION OF THE SOCIODEMOGRAPHIC pilot civilian study with modified prolonged exposure.Biological AND CLINICAL CHARACTERISTICS OF INPATIENTS psychiatry, 72(11): 957. UNDERGOING ELECTROCONVULSIVE THERAPY IN A PSYCHIATRY CLINIC PP-202 Merve Tsakir Chasan, Necla Keskin, Lut Tamam Çukurova University Medical School Mental Health and Neurological CHILDHOOD TRAUMA IN PATIENTS WITH Diseases Department, Adana DIFFERENT PSYCHIATRIC DIAGNOSES AND THE AIM: Electroconvulsive therapy (ECT) is one of the first biological DISSOCIATIVE CHARACTERISITICS. treatment methods in psychiatry, which forms generalised convulsions Sinem Acar, Hasan Mervan Aytaç, Kıymet Çağlar, Sadık by stimulating the brain tissue with electrical current, and has been used Yiğit, Nalan Öztürk, Pınar Çetinay Aydın, Nazan Aydın in the treatment of many different types of psychiatric disorders. In this Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological study it has been aimed to investigate the socidemographic and clinical Diseases and Research Hospital, İstanbul details of the inpatients who were treated with ECT. AIM: It has been aimed in this study to investigate the dissociative METHODS: The study included 57 inpatients between the ages of 21 experiences and the types of childhood traumas of female inpatients, and 65 years, who were given ECT at the Çukurova University Medical who have declared a history of exposure to childhood traumas, and to School Mental Health and Neurological Diseases Hospital, Psychiatry evaluate the results on a comparative basis. Clinic between 02.02.2016 and 02.08.2016. METHODS: This prospective descriptive clinical survey was carried out RESULTS: It was determined that 22.3% of the inpatients in our clinic with 57 female inpatients of the No 15 Psychiatry Clinic of Bakırköy had been treated with ECT within 6 months. Sociodemographical data Mental Health and Neurological Diseases Hospital with a history of indicated that, mean age of these patients was 43.25 (±12.89) years; childhood trauma declared in the Childhood experience of care and abuse questionnaire. These patients were asked to complete Childhood with 56.1% being females; and 61.5% had been educated above the Traumas Questionnnaire (CTQ) and the Dissociative Experiences Scale primary school level; 77.2%,including housewives and the retired, were (DES). unemployed ; 56.1% had comorbid medical disease; and 22.8% had

been treated with ECT in the past. Mean ECT sessions carried out POSTER PRESENTATIONS RESULTS : Mean age of the 57-patient group was 36.1 (±10.6)years; were 6.98 (±3.137); with 56.1% having been diagnosed with ‘major with mean disease duration of 8.7 (±8.5) years; mean DES and CTQ depression disorder’, followed in ranking with ‘schizophrenia spectrum scores were, respectively 31.8 (±21.8) and 59.9 (±22.4). Data on the 16 and other psychotic disorders’ and ‘bipolar and related disorders’; with bipolar disorder(BPD) patients was large enough for statistical analysis; 19.3% of the patient group having lifelong suicidal attempts. It was seen and the mean DES and CTQ scores of this group were, respectively, 27.5 (±19.5) and 68.4 (±23). Mean DES and CTQ score of the 26 that after the completion of ECT sessions, there had not been further depressive disorder (DD) patients were, respectively, 35.9 (±25) and than mild memory loss or headaches in the patient complaints, and 54.6 (±21.2). CTQ childhood physical neglect subscale mean score for 54.4% of the patients had been discharged with full remission. the BPD and the DD patients were, respectively, 12.6 (±6.4) and 8.7 DISCUSSION: ECT is an effective and reliable treatment method (±3.3); and the CTQ childhood physical abuse of the BPD and the DD for fast relief of psychiatric disorders, headed by major depression, patients were, respectively, 13.8 (±5.4) and 8.6 ( ±4.7). schizophrenia and bipolar disorders, resistant to other treatments. DISCUSSION: The two groups of patients large enough to generate The results of this study have suggested that large scale randomised data for statistical analysis were the BPD and the DD patient groups. controlled studies on this subect will reduce the negative views and The childhood physical abuse and neglect scores of the BPD patients attitudes against ECT. were significantly higher than the corresponding scores of the DD patients. These are preliminary results of a study carried out to Keywords: Bipolar, Electroconvulsive therapy, major depression, emphasize the necessity of further studies that should investigate the schizophrenia childhood traumas in other psychiatric disorder in order to assess their References aetiological significance. Tomruk NB, Oral T (2007) Elektrokonvulsif tedavinin klinik kullanımı: Keywords: Bipolar, child abuse, depression, dissociative disorders, Bir gözden geçirme.(Use of electroconvulsive therapy-A review) trauma Anadolu Psikiyatri Dergisi8:302-309

163 PP-204 arrived at the emergency service, it had been 1.5 days that symptoms of restlessness,excitability, insomnia, tachycardia and nervous tension ECCHYMOSIS ON THE LEGS DUE TO VENLAFAXINE had developed. Her history indicated that she had consulted 7 months USE: CASE PRESENTATION previously a healthcentre for obsessions of not being sure and control compulsions and was on treatment for OCD with sertraline (150 gm/ Emrah Yıldız, Ahmet Ünal, Abdurrahman Altındağ day) and risperidone (1 mg/day) which she complied with and had Gaziantep University, Mental Health and Neurological Diseases benefited from. Her symptoms of restlessness, excitement, tachycardia Department, Gaziantep had increased over the previous day when studying for an examination. AIM: Serotonin and norepinephrin reuptake inhibitors (SSRS and Her vital signs were: body temperature 36.5 °C, pulse 140/min, BP SNRI)are being used for the treatment of a large number of psychiatric 150/90 mmHg. disorder cases. In the literature there are not frequently reported cases Physical examination indicated facial flushing, fasciculation around the of haemorrhage due to SNRI use. The aim of this presentation was to mouth and the abdomen. In order to eliminate a possible neurological report the development of ecchymosis in a patient on 75 mg/day dose or metabolic pathology the investgations on whole blood, biochemical of venlafaxine and to discuss the possible underlying mechanisms with tests, brain CT and consultation with the neurology unit resulted with reference to the existing literature. normality. When queried for substance use, she explained that she CASE: The 24-yer old female patient consulted our polyclinic with had drank 10 cups of coffee during 36 hours when studying for her complaints of avolition, restlessness, attention problems, lack of energy, examination and that the complaints of frequent urination, tachycardia, weepiness, sleep related problems, loss of appetite and thoughts about nausea, excitation, insomnia and fasciculation had started afterwards. life being worthless to suffer, which had developed 1 month previously She was diagnosed with caffeine intoxication and monitored in the after an academic examination. After her ğsychiatric and physical emergency service by hydration resulting in the normalistion of her examination she es dignosed on the basis of DSM-V (APA 2015) criteria condition. with depression and was strted on sertraline (50mg/day). The treatment DISCUSSION: There are reports in the literature that caffeine was switched to venlafaxine (75mg/day) on the 20th day of her first intoxication is seen more frequently in patients with pscyhiatric treatment when her symptoms were seen to persist. On thte 12th day disorders as compared to healthy members of the population and that of starting with venlafaxine, she witnessed ‘‘color change‘‘ in her skin. rarely it can be fatal. Therefore, we have wanted to draw attention to the Dermatological examination indicated two oval shaped ecchymoses with necessity of querying individuals arriving with anxiety symptoms at the about 5-cm size on the front aspect of both femurs. Her personal and emergency service for the amount of coffee consumed lately. family history did not have haemorhagic disease. She had not exprience physical trauma and had not used any medication other than given for Keywords: Anxiety, caffeine, intoxication her spcyhaitric treatment. Haematology unit diagnosed the condition as References eccymosis and the haematological test results turned out to be normal. Kerrigan, S.,NOT & Lindsey, PRESENTEDT. (2005). Fatal caffeine overdose: two case Velafaxine dose was grdually reduced and 2 weeks after discontinuation reports. Forensic Science International, 153(1), 67-69. of venlafaxine the ecchymoses started to disappear. Mackay DC, Rollins JW (1989) Caffeine and caffeinism. J R Nav Med DISCUSSION: Physicinas should not forget that care is needed Serv; 75:65-67. in the first days of venlafaxine treatment, especially in patients with Mermi O, Kilic F, Gurok MG et al., (2016) Habitual caffeine use in haematological disorders who should be regularly followed with psychiatric patients: relationship with sleep quality and symptom haemogram and haemorrhagic markers. It is believed that there should severity. Anadolu Psikiyatri Derg17(1): 26-32. be further studies on venlafaxine use in patients with haematological disorders. POSTER PRESENTATIONS Keywords: Ecchymosis, side effect PP-206

PROARRHYTHMIC ELECTROCARDIOGRAPHIC PP-205 CHANGES IN SCHIZOPHRENIA PATIENTS Selçuk Kanat1, Hakan Demirci2, Bilgen Biçer Kanat3, Ufuk CAFFEINE INTOXICATION WITH ANXIETY Aydın4, İbrahim Taymur3, Gökhan Ocakoğlu5, Sinay Önen3 SYMPTOMS: CASE PRESENTATION 1Bursa Post Graduate Training and Research Hospital Cardiology Clinic 2 Meryem Yüksel, Şeyma Selen Sevinç, Makbule Çiğdem Bursa Post Graduate Training and Research Hospital Familiy Practice Clinic Aydemir, Erol Göka 3Bursa Post Graduate Training and Research Hospital Psychiatry Clinic Ankara Numune Training and Research Hospital, Psychiatry Clinic, 4Bursa Post Graduate Training and Research Hospital Cardiovascular Ankara Surgery Clinic AIM: Caffeine is a psychoactive substance, widely used in the world 5Uludağ University Bioitatistics Department and in our country, that casues in high doses exceeding 250mg/day, AIM: In schizophrenia the most frequent causes of natural death are as specified in the DSM-V, intoxication symptoms reminiscent of the cardiovascular diseases, such as myocardial infarction, atrial fibrillation, symptoms of psychiatric disorders. In this report it has been aimed to ventricular tachycardia and torsades de pointes types of arrhythmias. present a case of caffeine intoxication arriving at the emergency service The aim of our study was to investigate in schizophrenia patients the with symptoms of restlessness, insomnia, tachycardia and nervous existence of QT dispersion that reflects the repolarisation heterogeneity, tension and was referred to psychiatry on account of anxiety. of the fragmented QRS (fQRS) that develops as a result of myocardial CASE: The 21-year old female student had been followed at a depolarisation disorder and of the P wave dispersion (PWD) which healthcare centre with obsessive-compulsive disorder (OCD). When she reflects the slow and nonhomogenous transmission of atrial activation.

164 METHODS: This study included 190 patients diagnosed on the basis severe anxiety he was referred to the psychiatry service. His complaints of DSM-V criteria with schizophrenia and being followed at the Bursa of ‚‘‘I have intense pain, they should cut these away‘‘ and ‚‘ I wish there Post Graduate Training and Research Hospital Psychiatry Clinic and was a way of getting rid of these‘‘ have led to detailed questioning when 134 healthy control individuals. The ECG records were analysed for it was discovered tht he had seen himself as afemale from very early the rhythm, existence of channelopathy, hypertrophy of the cardiac age onwards, that he was very unhappy to be a male, and kept buying chambers, relay defects, ischaemic changes, P wave duration, PWD, female clothes and underwear and wore them when alone at home. His fQRS, QT/cQT duration, and QT dispersion. Data were analysed family were aware of his condition but had threatened him such that on the SPSS 20.0 package program, using the Chi-square test, Mann- he could not share this problem with anyone. He was diagnosed with Whitney U test, logistic regression analysis, and univariate analysis. sexual identity disorder and depression and was placed under treatment and follow up control at the psychiatry polyclinic. RESULTS: Heart rate was found to be higher in the patient group (85.5’vs 70.5 /min; P<0.001). QT dispersion duration of patients DISCUSSION: In this case report it has been intended to emphasise was longer as compared to the controls (55 vs 35 milliseconds;P<0.001). that individuals with sexual function disorders can consult hospital P wave dispersion duration was higher in the patients as compared to the departments with various complaints, and that the basic problem of controls(47.50 vs 30 milliseconds;P<0.001). Fragmented QRS (fQRS) sexual function disorders have to be identified by a musltidisciplinary was higher in the patient group than in the control group (36.30% approach especially in the difficult cases (n:69) vs 7,5 % (n:10); (p=0,001). Keywords: Sexual identity disorder, sexual identity dysphoria syndrome, DISCUSSION: Cardiac diseases in schizophrenia have been attributed transsexuality to the sedantary living, metabolic syndrome, reduced self care and use of antipsychotics. The prolonging of P wave dispersion, QT dispersion and the presence of fragmented QRS could explain the increased frequency of cardiac failure, strokes and sudden cardiac death due to PP-208 atrial fibrillation, ventricular fibrillation, monomorphic or polymorphic ventricular tachycardias and arrhythmias like torsades de pointes. IMPORTANCE OF RATIONAL USE OF MEDICINES: CASE PRESENTATION Keywords: Fragmented QRS, P wave dispersion, QT wave dispersion, schizophrenia Yağmur Sever Fidan, Fikret Ferzan Gıynaş, Engin Emrem References Beştepe Liu Z, Hayano M, Hirata T et al., (1998) Abnormalities of Erenköy Mental and Neurological Diseases Hospital, İstanbul electrocardiographic P wave morphology and the relationship AIM: Medicines required for the treatment of diseases can lead to to electrophysiological parameters of the atrium in patients with undesirable outcomes if used wrongly, which can be minimised by idiopathic paroxysmal atrial fibrillation. J Cardiol 32:189-96. the rational use of medicines (RUM). The WHO has declared that ‘’Rational use of medicines requires that “patients receive medications appropriate to their clinical needs, in doses that meet their own PP-207 individual requirements, for an adequate period of time, and at the lowest cost to them and their community”. In this report we have TESTICAL PAIN AND REPEATED APPLICATIONS TO presented a case withthe aim to emphasize the importance of educating HOSPITAL UROLOGY AND EMERGENCY SERVICES : the public on RUM. A CASE OF SEXUAL IDENTITY DISORDER CASE: The 26-year old university graduate single female patient working at the university as a project assistant, consulted with 1 3 1 POSTER PRESENTATIONS Dilek Sarıkaya Varlık , Cenk Varlık , Özgür Çağla Cenker , complaints of muscular aches, tremor in the hands, amnesia and 2 Cenk Ercan inability to maintain attention. She had nearly 8 years of disease history 1 Kaçkar State Hopsital, Psychiatry Unit, Rize and had been followed for anxiety disorderduring the previous 1.5 years, 2 Recep Tayyip Erdoğan University, Psychiatry Departmentı, Rize but had not been hosptalised. She had used a drug named Valerina 3 Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Borisov, brought from overseas and given by a friend, two times per Diseases and Research Hospital, Isatnbul day for the previous 5 days to treat her symptoms of restlessness and AIM: Transsexuality may be decribed as the clinical condition of desiring anxiety. Her neurological examination did not indicate any pathology to have the primary and the secondary sexual characteristics of the except the tremor in her hands. In her psychiatric examination she was opposite gender. In addition to strong and continual self identification conscious,oriented, cooperative, with good self care, looking her age, with the opposite gender, there is the dissatisfaction with one’s own making eye contact. Her mood and affect were anxious. Speech volume gender and feeling of incompatibility between one’s anatomical gender was normal, and did not describe perception disorder, or delusions. Her and the sexual identity. It is the severest form of sexual identity dysphoria attention was normal, memory was notmal, her judgement and insight syndrome, at the very extreme and rarely seen. Most of the cases are were complete. Her biochemical test results, urinary metabolites and diagnosed with axis-1 disorders on the basis of the DSM-V criteria. haemogram were within normal limits. Transsexual patients can consult diferent clinical branches of medicine DISCUSSION: RUM can become possible by the elimination of the with a variety of complaints. mistakes in drug choice, dose and technial applications. There are CASE: The 48-year old male patient had consulted the hospital general factors that influence the drug use attitudes of the population. These surgery, urology and services 48 times over 2 include the public source of knowledge on health and drugs, the years with the complaint of testical pain. He had been admitted as an structure of the health system, the knowledge, attitude and behaviour inpatient at the urology service for the investigation of intense bilateral of the healthcare workers, cost of drugs, cultural influences, popular pain in his testes without any evidence for underlying pathological cause beliefs, communication between patient and healthcare workers, the after laboratory tests and doppler USG examination. On account of his patient support system and health literacy. Al interventions should be

165 comprehensively planned for RUM in relation to these factors. When PP-210 people, patients and users, are informed on the subject of RUM, medicines would be used rationally. FACTORS AFFECTING THE PREVALENCE OF Keywords: Drug, medicine, prevention,rational VITAMIN B12, VITAMIN D DEFICIENCY IN INPATIENTS TREATED AT A.I.B.U. PSYCHIATRY CLINIC IN 2016: A RETROSPECTIVE STUDY PP-209 Zehra Günay, Özden Arısoy, Nazente Dönmez Abant İzzet Baysal University (AIBU), Psychiatry Department, Bolu RELATIONHSIPS BETWEEN DEPRESSION, AIM: Vitamin D, synthesised in neural cells, plays a role in the ANXIETY,DISEASE PERCEPTION AND QUALITY OF regulation of neurotransmitter synthesis in the CNS, the circadien LIFE IN TYPE II DIABETES MELLITUS rhythm, neurodevelopment and the reduction of oxidative stress and inflammation. Vitamin B12 deficiency results in homocysteine Damla İnhanli, Nilüfer Alçalar accumulation implicated in excitatoxic reactions causing İstanbul University, İstanbul Medical School, Mental Health and Diseases neurodegenerative and psychiatric diseases. This study has aimed at Department, İstanbul investigating the Vitamins D and B12 levels and their relationship with sociodemographic and clinical details of psychiatric inpatients residing AIM: It has been planned to investigate in patients diagnosed with Type in Bolu province, in 2016. 2 Diabetes Mellitus the sociodemographic characteristics, depression and anxiety severity, subjective illness perception, and the effects of METHODS: Data on sociodemographic and clinical details and the these factors on health and quality of life. laboratory test results for vitamin B12 and vitamin D estimations in blood samples taken at admission were obtained from the hospital files METHODS : The study was carried out with 55 patients of 18-65 of the inpatients treated at the psychiatry clinic from the beginning years of age diagnosed with type 2 diabetes mellitus and followed up at of 2016. Kolmogrov- Smirnoff test was used to asess the normality İstanbul Med. Sch. Endocrinology and Metabolism Diseases polyclinics, of distribution for the continuos variables; and those with normal who consulted during the specified period of time. All participants distribution were analysed by the student t-test, and those not on a completed a sociodemographic questionnaire, the Beck depression normal distribution were analysed by the Mann Whitney U test. inventory (BDI), the Beck anxiety inventory (BAI), the Health status Categorical variables were compared by the Chi-square test. Relationship questionnaire (SF-36) and the Illness perception questionnaire-Revised between vitamin deficiencies and the sociodemographic and clinical (IPQ-R). data were assessed by the Spearman correlation analysis. RESULTS: Mean age of the participants was 50.3 (±9) years, and RESULTS: On the basis of sociodemographic data, 32% of the 122 63.6% of the group were females; 81.8% were married; 49% were inpatients included in the study were males; 46.3% were married; primary school and 20% were university educated. Mean duration of 67.5% were not working; 65.2% had education below the primary diabetes was 6.9 (±6; 1-30) years. Female patients had significantly school level. Psychiatric diagnoses ranked as mood disorders (43.4%), higher scores on the BDI (p= 0.001) and on BAI p< 0.001)as compared psychosis (36.1%), substance dependence (12.3%),dementia(3.3%), to the males. When compared on the SF-36 performance, female scores anxiety disorders (2.5%), delirium (1.6%); and 25.2%of the patients on all subscales, except the physical and emotional role difficulty and required antipsychotic injection in the first week of their admission. On mental health, were all significantly lower as compared to the males. the clinical basis, 24.2% had BMI >30; 34.8% had blood glucose >100 The scores on BAI and BDI correlated negatively with the scores on mg/dl; 63.6% used cigarettes; 17% used cannabis, 12.8% used other all the subscales of SF-36. On the other hand, depression and anxiety substances; 6% used alcohol. Vitamin D deficiency was seen in 87.7% levels of the patients positively correlated with the scores on the IPQ-R (estimated only in in 57%of the patients) and vitamin B12 deficiency POSTER PRESENTATIONS subscales of identity, consequences and emotional expressions(p≤ 0.01), was seen in 27.6% ( estimated in only 86.1 % of the patients). but notwith the other subcale scores. When the relationship between Differences were not determined in vitamin deficiences on gender basis the IPQ-R subscale scores and the SF-36 scores were analysed by partial ; and also correlations were not seen between v itamin deficiencies and correlation application controlled with the depression and anxiety (1) the diagnostic categories and (2)the health parameters of BMI, NLR and blood glucose. levels, statistical significance disappeared. DISCUSSION: High prevalence of vitamin D deficiency was observed DISCUSSION: These results indicate that depression and anxiety in the early months of the year in the inhabitants of Bolu, situated in levels regulate the relationship between illness perception and the northern Anatolia receiving relatively less sunlight in the year. This quality of life. In chronic illnesses such as dibetes mellitus, evaluation of result points to the necessity of vitamin D estimations routinely in the the patients for psychiatric comorbidities is recommended in order to patients of the region, especially to prevent relapse in psychiatric cases. improve the general health status and the quality of life. Keywords: Sociodemographic data, vitamin B12, vitamin D Keywords: Anxiety, depression, illness perception, quality of life, type 2 diabetes mellitus References Chekuri L, Thapa PP, Turturro CL etal., (2015) Vitamin D Levels and References Sociodemographic and Clinical Correlates in Individuals With Paschalides C,Wearden AJ, Dunkerley R et al., (2004) The associations Serious Mental Illness Admitted to an Acute Psychiatry Unit: Prim of anxiety, depression and personal illness representations with Care Companion. CNS Disord, 17(2): 10.4088/PCC.14m01726. glycaemic control and health-related quality of life in patients with Humble MB, Gustafsson S, Bejerot S. (2010) Low serum levels of type 2 diabetes mellitus. J Psychosom Res, 57: 557-64. 25-hydroxyvitamin D (25-OHD) among psychiatric out-patients Schram MT, Baan CA, Pouwer F (2009) Depression and Quality of Life in Sweden: relations with season, age, ethnic origin and psychiatric in Patients with Diabetes: A Systematic Review from the European diagnosis.J Steroid Biochem Mol Biol121(1-2):467-70. Depression in Diabetes (EDID) Research Consortium. Current Rylander M, Verhulst S. (2013) Vitamin D insufficiency in psychiatric Diabetes Reviews 5:112-119 inpatients. J Psychiatr Pract 19(4):296-300.

166 PP-211 on UCTD comorbidity with psychiatric disorders. This may be due to the presentation of the psychotic symptoms when the connective tissue EYE MOVEMENT DESENSITISATION AND disease flares up and is diagnosed. We have aimed to present in this REPROCESSING (EMDR): CASE PRESENTATION report UCTD diagnosed in a first attack psychosis patient. Ümmühan Özkal CASE: The 46-year old lycée graduate, married female without a İstanbul University Cerrahpaşa Medical School Psychiatry Department, history of psychiatry consultation, had developed 10 days previously İstanbul symptoms of insomnia which progressed in about a week to include suspiciousness and iritability. At her consultation with the emergency AIM: Eye movement desensitisation and reprocessing (EMDR) is service, she had hallucinations of derailment and clang sounds. Her the proven psychotherapy for post traumatic stress disorder (PTSD). thought contents had persecutive and referential delusions, order giving EMDR has been used successfully in the treatment of chronic pain, and type of auditory hallucinations. Her mood was irritable and affect a range of disorders including the somatoform, conversion, dissociation, was not suitable or labile. She had psychomotor excitation. She was obsessive-compulsive, panic, phobia, oncology, migraine, dependence, sexual dysfunction (incl.vaginismus), deramtological, personality, injected with haloperidol and biperidene and started on olanzapine pathological gambling and eating disorders. The model of adaptive (10mg/day). Two days after admission to hospital her associations and information processing relied on by EMDR, assumes that the traumatic hallucinations had regressed. The papular lesions observed on her arms or disturbing life experiences are coded wrongly and/or are processed and legs, developed 5-6 years previously had increased in the previous 1 inadequately, which upets the ingrating ability of the patient. month. Her finger tips cyanosed with sensation of paint when in touch with cold (Raynaud’s phenomenon). Rheumatology and dermatology CASE: The 30-year old single male patient- policeman, wounded units were consulted for investigation of a pathological aetiology. Skin and lost a friend at an incident with a suicide bomber and developed biopsy was taken. Her serum was ANA positive and ENA negative. The symptoms of anger explosions, irritability, dissociative reactions anticardiolipin IgG and IgM, AMA, anti scl-70 were negative. Antijo-1 (reliving), difficulty of concentrating, insomnia and depressive feelings antibody was positive. Cranial MRI did not show any pathology. She of guilt exacerbated by thoughts on the 2-year old child the deceased was diagnosed with UCTD and brief psychotic disorder. Her Brief friend left behind while he had survived and the inability to take care of Psychiatric Rating Scale score decreased from 53 to 5 in three weeks. his friend’s family. His examination showed depressive mood, insomnia, low self confidence, pessimistic thought. His eyes were closed during DISCUSSION: Observation of acute onset of psychotic symptoms the interview with severe flash backs. He described continual repeating, with incresed severity of dermatological lesions and concurrent involuntary, intrusive and disturbing memories he was trying to escape regression in both, together with presence of autoantibodies and fast from. He had been diagnosed with PTSD but had not benefited from respone to therapy have suggested an common organic aetiology. drug therapy. His scores were 108 on the PTSD CheckList – Civilian Psychiatric comorbidites are oberved in about a third of the patients Version (PCL-C): 43 on Montgomery–Åsberg Depression Rating with rheumatological diseases. Patients consulting with symptoms Scale (MADRS);NOT 60 on PRESENTED the Beck depression ınventory (BDI), 37 on resembling those of schizophrenia should always be investigated for HAM-D, and 46 on HAM-A. His VoC – Value of reality cognition, organic pathologies. In these cases the antipsychotic therapy should be was 7, and his score on the Subjective Units of Distress Scale (SUD) was terminated with the subsidence of the psychotic symptoms 10. At the end of 10 seessions of EMDR, indifference developed as the side effect of reprocessing. The problem with memory was reduced and Keywords: Psychosis,treatment, undifferentiated connective tissue new adaptive cognitions were developed in realtion to the experience. disease (UCTD) EMDR reduced the symptoms of the patient which ws maintained in the follow up controls over 5 months. References Aydeniz A,Altındağ Ö,Gürsoy S (2009) Belirlenemeyen Bağ Dokusu

DISCUSSION: EMDR has increasing ly drawn attention of the Hastalığı:Bir Olgu Sunumu. Turkish Journal of Rheumatology POSTER PRESENTATIONS clinicians and the researchers. Its effectiveness in treateing PTSD has 24(1):56-57. been shown in many controlled studies including comparisons with Tsuyoshi K, Airi M, and Nao O (2016) Clinical Features of Trauma focused cognitive behavioural therapy. Neuropsychiatric Syndromes in Systemic Lupus Erythematosus Keywords: Eye movement desensitisation and reprocessing (EMDR), and Other Connective Tissue Diseases. Clin Med Insights Arthritis post traumatic stress disorder (PTSD) MusculoskeletDisord.9:1–8. Hatemi G,Hamuryudan V (2008) Romatolojik Hastalıklarda Görülen Psikiyatrik Bozukluklar. Sempozyum Dizisi 62:263-268. PP-212

UNDIFFERENTIATED CONNECTIVE TISSUE PP-213 DISEASE COMORBIDITY WITH PSYCHOTIC DISORDER: CASE PRESENTATION SOCIODEMOGRAPHIC CHARACTERISTICS OF INDIVIDUALS WITH CARBONMONOXIDE (CO) Ayşegül Kervancioğlu1, Selma Çilem Uygur2, Yasir Şafak1 POISONING 1Dışkapı Yıldırım Beyazıt Training and Research Hospital, Psychiatry Clinic, Ankara İbrahim Taymur1, Ersin Budak2, Bilgen Biçer Kanat1, 2 Ankara University Medical School, Psychiatry Department, Ankara Sinay Önen1, Suna Eraybar3 AIM: Undifferentiated connective tissue disease (UCTD) is an 1Bursa Post Graduate Training and Research Hospital, Psychiatry Clinic, autoimmune connective tissue disease with a course of arthralgia, Bursa arthritis and Raynaud’s phenomenon. Connective tissue disorders can 2Bursa Post Graduate Training and Research Hospital, Psychology Unit lead to psychiatric disorders. There are not case reports in the literature 3Bursa Post Graduate Training and Research Hospital, Emergency Service

167 AIM: Between 2011 and 2013, more than 6000 people were poisoned were associated with the use of nonpsychotropic drugs. While 37% had a with CO in Turkey and about 10% died as a result. It has been psychiatric diagnosis at the time or in the past; the others had attempted reported that there are serious cognitive sequelae to CO poisoning with after crises of stressful life experiences. In 13.3% of the patients blood adverse effects on the cognitive functions. The aim of this study was to ethanol was above the threshold level. Te incidence of psychotropic drug investigate the sociodemographic characteristics and cognitive functions use was significanly higher in the patients with psychiatric diagnoses of individuals poisoned by CO. (p=0,004). İ METHODS: The study included patients brought to the emergency DISCUSSION: In agreement with the literature, this study service with CO poisoning between the years 2015 and 1016. CO levels demonstrated that there was a higher incidence of suicidal attempts were measured at the emergency service, and subsequently the patients among females and young perople, the preferred method being drug were given scores on the Glasgow Coma Scale (GCS) and the Montreal intoxication, the patients with psychiatric disorders tending to use the Cognitive Assessment (MoCA ). Also a sociodemographic information psychotropic agents, indicating that inthe psychiatry patients with risk form was completed on the patients. of suicide, drugs with narrow therapeutic indices should be chosenfor t reatment. Most of the patients did not have a previous psychiatry RESULTS: Mean age of the 52 cases inlcuded in the study was 36.57 consultation and the reasons for suicide were those of crises assocaited (±12.81) years; and 53.8% were females ; 51.9% had education under with marital or financial poblems. The study was limited by the small primary school level; 75% had immigrated from elsewhere, and 49.1% numbers of patients mostly consulting the emergency service in a lived in the peripheral zones of the city or in villages; 25% had a stable condition and the psychiatry consultation being requested before history of psychiatric treatment; 9.6% had attempted suicide; 30.8% discharge; and using retrospectively gathered data. Those cases needing had a chronic illness. For 15% of the patients this was the second intensive care may have been excluded from the study on the reason of CO poisoning event. Mean blood level of CO was 20.28% (±7.53%; death. 5.10%-34%). Mean score on the MoCA was 18.53 (±3.52), and the MoCA score correlated strongly and negatively with the age of the Keywords: Chosen methods, risk factors, suicide patients(-0.58, p<0.001). References DISCUSSION: Low econnomical status of the individuals constitutes Kısa C, Aydın DO, Cebeci S et al.,. (2001) Assesment of Psychiatric a risk factor for CO poisoning. Therefore, in the regions inhabited Emergencies and Administrations. Yeni Symposium, 39 (4): 174- by these people preventive measures, alternative solutions should be 180. planned especially in the winter months. Also the results of this study Teti GL, Rebok F, Rojas SM wr et al.,(2014) Systematic review of risk on low MoCA scoring indicates that low cognitive abilities may also be factors for suicide and suicide attempt among psychiatric patients in Latin America and Caribbean. Rev Panam Salud Publica 36(2):124- a risk factor. There is need for further studies to determine the effects of 33. low level CO poisioning on the cognitive functions of the individual. Zincir SB, Zincir S, Köşker SD et al., (2014) Yatarak tedavi gören Keywords: Carbon monoxide, cognitive abilities, sociodemographic psikiyatri hastalarında intihar girişiminin klinik özellikler ve characteristics sosyodemografik değişkenlerle ilişkisi, Journal of Mood Disorders 4(2):53-8

PP-214 PP-215 RETROSPECTIVE EVALUATION OF PATIENTS ARRIVING AT THE EMERGENCY SERVICE OF A ENCEPHALOPATHY DEVELOPED AFTER VALPROIC

POSTER PRESENTATIONS UNIVERSITY HOSPITAL AFTER SUICIDAL ATTEMPT ACID USE: ASE PRESENTATION Selma Çilem Uygur, Berker Duman, Hakan Kumbasar Dilek Çağlar Tetik, Ahsen Büyükavşar, Fikret Ferzan Ergün Ankara University Medical School(AUMS), Mental Health and Diseases Erenköy Mental and Neurological Diseases Training and Research Department, Ankara Hospital, Psychiatry Clinic, İstanbul AIM: Suicide is a serious public problem. As it is an important cause AIM: Encephalopathy induced by valproic acid is rarely seen serious of death in the young population and preventible, the risk factors for complication that can be fatal. We have aimed to present in this report a suicide should be well evaluated. In this study it has been aimed to case of encephalopathy developed after valproic acid use. assess the socidemographic data, diagnoses, the elected mode of suicide CASE: The 31-year old single male patient, unemployed and living with and to investigate the relationship between the suicide method and the his parents consulted the emergency service with complaints of head psychiatric diagnoses (if given), in the 54 suicidal attempt cases referred ache, vomiting, disorganised behaviours, problems of communication to the psychiatry department.. and impaired gait. His problems had started 10 years previously when he METHODS: Data accumulated between August 2015 and July 2016 was placed in a military hospital, and he had been placed under follow on the psychiatry constultations requested for suicidal attemtp cases up control with nonorganic psychosis. Ten days prior to his consultation were scanned retrospectively to determine the gender, age, ssuicidal with us his treatment had been planned as amisulpride (200 mg/day), method, presence of psychiatric diagnosis and blood ethanol levels. The valproic aid ( 1000 mg/ day). In his previous examination, his WAIS relationship between the psychiatric diagnoses and the psychotropic/ score had ben determined to be 74; imaging investigations had not shown any pathology. His personal and family history was uneventful, nonpsychotropic ddrug intoxiacation was investigated by the χ² somatic illnesses or alcohol-substance use were not determined. His method. functionality had been impaired. In his psychiatric examintion he had RESULTS: Mean age of the 54 cases investigated was 31.07 (±11.2) poor self care, seeming older than his age; had reduced psychomotor years, 77.8% being females and 22.2% being males. Method of suicide activity, and restricted affect. His speech was perseverative and he was intoxication by drug overdose in 81.5% of the cases; and 59.1% answered questions with perseveration. As he appeared confused his

168 thought contents could not be evaluated. His physical examination DISCUSSION: Suicidal ideation and attempts are more f requent was normal. Consultation with the neurology unit to eliminate organic among the schizophrenia patients as compared to the other psychiatric pathology gave normal results. His plantar reflexes were bilaterally poor, disorders, and the methods used are severer and fatal. There are reports in he had clonic contractions and could stand upright only with help. the literature on different methods of suicidal attempts by schizophrenia His medication was stopped and in 6 hours he returned to complete patients such as aspiraiton of metallic objects, nailing pins on the scalp, normality. His condition was named as encephalopathy induced by suffocating with toilet paper but an attempt similar to that described in valproic acid. It was planned to etimate total total carnitine esters and this report has not been found. acylcarnitine at follow up controls.. Keywords: Hydrofluoric acid, schizophrenia, suicide DISCUSSION : Valproic acid induced rare and serious complications References include haemorrhagic panreatitis, bone marrow supression, Palmer BA, Pankratz VS, Bostwick JM (2005) The lifetime risk of hepatotoxicity and encephalopathy. The typical symptoms of valproic suicide in schizophrenia: A re-examination. Arch Gen Psychiatr, acid induced encephalopathy are cognitive impairment, increased 62:247-253 frequency of seizures, background slowing down in EEG, focal Drake RE, Cotton PG. (1986) Depression, hopelessness and suicide in neurological deficits, vomiting, lethargy and coma. It has been aimed chronic schizophrenia. Br J Psychiatry, 148:554-55 here to draw attention to the encephalitis with inexplicable neurological symptoms in valproic acid use and the necessity of care in the treatment of the patients. PP-217 Keywords: Complication, encephalopathy, valproic acid References VISUAL COGNITIVE ABILITIES OF MORBIDLY Gerstner T, al., (2006). Valproic acid induced encephalopathy–19 new OBESE FEMALES: OBSERVATIONS MADE POST- cases in Germany from 1994 to 2003–a side effect associated to BARIATRIC SURGERY VPA-therapy not only in young children. Seizure, 15(6), 443-448. Segura‐BrunaN, et al., (2006)Valproate‐induced hyperammonemic Ersin Budak1, İbrahim Taymur2, Sinay Önen2, Bilgen Biçer encephalopathy. Acta Neurologica Scandinavica, 114(1), 1-7. Kanat2, Hacı Murat Çaycı3, Evren Dilektaşlı3, Selin Özcan4 1Bursa Post Graduate Training and Research Hospital, Psychology Unit 2Bursa Post Graduate Training and Research Hospital, Psychiatry Clinic, 3Bursa Post Graduate Training and Research Hospital General Surgery PP-216 Clinic 4Private Psychologist ATYPIC SUICIDAL ATTEMPT BY ‘’INTRACARDIAC HYDROFLOURIC ACID INJECTION’’ BY A AIM: Despite the description of many types of cognitive dysfunction SCHIZOPHRENIA PATIENT described in obesity, such as deficits in mental flexibility, decision making, attention and motor abilities, the visual cognitive processes Şenol Bayram, Rabia Nazik Yüksel, Aybeniz Civan Kahve, have not been adequately researched. It has therefore been aimed to Makbule Çiğdem Aydemir, Erol Göka investigate in this study the visual cognitive characteristics of morbidly Ankara Numune Training and Research Hospital, Ankara obese females with BMI>39. AIM: About one million people end their lives world wide by METHODS: The study was carried out with 22 morbidly obese patients committing suicide. Schizophrenia, as one of the most disturbing consulting for bariatric surgery, who were determined not to have any psychiatric disorders and were volunteering to participate in the study.

psychopathies resulting in multiple disabilities, involves high risk of POSTER PRESENTATIONS suicidal attempts with very serious and fatal methods. It has been aimed Preoperatively, the participants were asked to complete the Benton in this report to draw attention to an atypic and destructive method of Judgment of Line Orientation (JoLO), the Rey–Osterrieth complex suicidal attempt of a schizophrenia patient by ‘intracardiac injection of figure test (ROCF) and the Symptom Checklist-90-Revised (SCL- hydrofluoric acid‘. 90-R). The participants were re-evaluated on the same psychometric tests one year post-surgery. The Wilcoxon Test was used to deteremine CASE: The 33-year old single university graduate female patient,was whether the visual cognitive abilities and the psychopathological brought to the emergency service aaftre an attemtp to inject hydrofluric symptoms had improved after surgery. acid on the left side of her chest. It was learned that she had developed RESULTS suspicions of being followed and increased preoccupation with religion : The age range of the participants was 24-47 years. One year about 6 years previously, and about 2 years later she had become after the surgery, a mean loss of 37% was observed in body weight. intraverted with increased somatic concerns, believing her body had SCL-90 scores on all subscales, namely, on somatisation, obsessive- been changed. One year previously she had been diagnosed with compulsive, interpersonal sensitivty, depression, anxiety, anger-hostility, phobic anxiety, paranoid thoughts, psychotism and additional scales nonorganic psychotic disorder and treatment had been started with had decreased significantly after the surgery(p<0.05). A significant risperidone (2mg/day ) which she had not complied with. She had increase in the mean JoLO score was observed (p=0.014). Also, the started someNOT 3 month previously PRESENTED to talk unintelligibly and behave oddly performances on the ROCF subscales of short term visual memory which progressed to suicidal ideation. She had searched the internet (p=0.001) and long term visual memory (p=0.003) were singificantly for a painless and fast method of death and had injected herself on increased. her left breast with hydrofluoric acid purchased on line. She was given emergency surgery with left lung and left diaphragm resection and DISCUSSION: Recently made research support the possibility of chest wall repair and placed in intensive care. After stabilisation she was obesity being a mental disorder. Our obervation in this study of taken over by the psychiatry service and having been daignosed with significant improvements in the psychopathological symptoms of the schizophrenia, she was started on risperidone (50 mg depot). She was participants after weight loss with increases in the visual cognitive discharged on partial remission. abilites are also supportive to this point of view. When evaluating the

169 psychiatric iimprovements one also has to consider the positive effects Tibi L et al., ( 2015). An admixture analysis of age of onset in of the improvements in personal lives of the participants. Nevertheless, agoraphobia. J Affect Disord, 180:112-5. the results indicate that bariatric surgery has positve effects on the visual cognitive abilites of morbidly obese women. Keywords: Psychopathology, obesity, visual cognitive abilities PP-219

DETERMINATION OF VITAMIN B12 AND PP-218 VITAMIN D LEVELS AND COMPARISON WITH THE NEUTROPHIL/LYMPHOCYTE RATIO OF SOCIODEMOGRAPHIC CHARACTERISTICS OF DEPRESSION PATIENTS CONSULTING ABANT PATIENTS WITH AGORAPHOBIA IZZET BAYSAL UNIVERSITY HOSPITAL PSYCHIATRY POLYCLINIC IN THE FIRST HALF OF 2016: A Ayşegül Kart1, Burçhan Sözer1, Hakan Türkçapar2 RESTROSPECTIVE STUDY 1Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases and Research Hospital, Psychiatry Division, İstanbul Gülşah Güçlü Çelme, Özden Arısoy 2Hasan Kalyoncu University Psychology Division, Gaziantep Abant İzzet Baysal University, Psychiatry Department, Bolu AIM: Agoraphobia is described as the behaviour of avoidance of AIM: Depression is one of the most frequently observed psychiatric situations or conditions when the individual thinks it will not be disorders. Vitamin D receptor (VDR) and the activation enzyme, posible to escape or get assistance should panic or other disabling and 1-alfa-hydroxlase, are especially located in the hypothalamus and are embarrasing symptoms develop. It is classified in the Diagnostic and believed to play a role in the pathophysiology of depression. Vitamin Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as an B12 deficiency results in homocysteine accumulation implicated in independent diagnosis separate from panic disorder. Althout there are excitatoxic reactions causing neurodegenerative and psychiatric diseases such as depression. The neutrophil/lymphocyte ratio (NLR) has been many studies in the literature on the agoraphobia comorbid with panic agrued in the recent years to be a good marker of inflammatory states, disorder, there are very few reports on agoraphobia by itself. The aim and a tendency to e,increased NLR has been reported in depression (3). of this study has been to obtain more informtion about agoraphobia. Our aim has been to determine the levels of vitamin B12 and vitamin METHODS: The study was carried out with 67 patients diagnosed D in depression patients and to investigate thier relationship with NLR. with agoraphobia according to the structured clinical interview SCID -1 METHODS: Data on the vitamin B12 and vitamin D levels and the on the DSM-III axis- I disorders. These patients were asked to complete NLR have been gathered retrospectively from hospital records of the a sociodemographic questionnaire. major depression disorder patients who consecutively consulted the RESULTS: Evaluation of the data on agoraphobia patients included in psychiatry polyclinic in the first half of 2016. Kolmogrov- Smirnoff this study showed that 44(65.6%) were females and 23 (34.4%) were test was used to asess the normality of distribution for the continuos males; 36 (53.7%)were married, 27 (40.2%) were single ; 3 (4.4%) variables; and those with normal distribution were analysed by the were divorced; 1 (1.4%) was widowed; 50.7% lived with spouse and student t-test, and those not on a normal distribution were analysed children; 34.3 % lived with parents; 5.9% lived alone; 8,9% lived by the Mann Whitney U test. Categorical variables were compared by with a family group; 14 (20.8%) were primary school educated; 8 the Chi-square test. Correlation analyses were carried out using the (11.9%)middle school educated, 28 (41.7%) were lycée educated and Spearman correlation analysis. 17(25.3%)had higher education; 17.9% were unemployed; 14.9% RESULTS: Sociodemographic data showed that mean age of the were students; 29.8% were housewives; 29.8% were labourers/ office POSTER PRESENTATIONS patients investigated was 37.85; with 68% being females; 56.22% being workers; 7.4% were retired; 50,7% had low income; 29,8,% had middle married, 51.5% having primary school education; 60.3% not working income and 17,9% had high income. When asked about their origins and 90.7% living in Bolu. Clinically, 58.9% were first attack patients; between 1-12 years of age, 16(23.8%) were from villages; 51 (76,1%) 66.7% were not using any psychotropic agents at consultation; 85% were from towns; currently 4 (4.4%) lived in villages; 64 (95.6%) lived had vitamint D deficiency with lower vitamin D levels in females as in towns; 3(4.4%) had divorced parent; 20 (29.9%) had been separated compared to the males (K=14.6, E=21.5; p=0.023); and 24% had from parents during childhood; 20 (29.9%) had experienced a major vitamin B12 deficiency. There were not significant differences between displacement/migration during childhood; 26 (38.9%) had experienced Vit B12 and NLR levels on the basis of gender. Also, differences were physical abuse from the family but 41 (61.1%) had not; 26 (38.8%) had not determined between the first attack and repeating episode patients violence in the family; 18 (26.8%) had a family history of psychiatric with respect to the vitamin levels and NLR levels. Age and vitamin B disorder; 12 (18%) had a history of suicidal attempt; 37 (55.2%) used 12 level were positively correlated (r=0.239, p=0.017), and gender and cigarettes; 14 (20.9%) used alcohol; 80.5% did not havea chronic vitamin D levels were positively correlated (r=0.299, p=0.02), but a physical illness; but 29.5% did have a chronic physical illness. relationship between the NLR and the first attack or repeating episode DISCUSSION: In this study has been aimed to describe the of depression was not determined. sociodemographis details of agoraphobis patients. There is need DISCUSSION: Determination of a high incidence (85%) of vitamin for studies carried out with larger groups of patients for better D deficiency in patients consulting the psychiatry polyclinics in the first characterisation of agoraphobia. half of the year draws attention to the necessity of routine estimation Keywords: Agoraphobia, demographic factors, social environment of serum vitamin D levels and replacement of deficiencies in depression patients resident in the province of Bolu. References Keywords Wittchen HU, Gloster AT, Beesdo-Baum K (2010) Agoraphobia: a : Depression, neutrophil/lymphocyte ratio, vitamin B12, vitamin D review of the diagnostic classificatory position and criteria. Depress Anxiety, 27:113

170 References PP-221 Dana-Alamdarı L, Kheırourı S, Gholamreza Noorazar S (2014) Serum 25-Hydroxyvitamin D in Patients with Major Depressive Disorder. INTERVENTIONAL PROGRAMS TO PROTECT Iran J Public Health, 44(5): 690-697 MENTAL HEALTH SUITABLE FOR PREVENTING Demir S et al., (2015) Neutrophil–lymphocyte ratio in patients with CHILD ABUSE major depressive disorder undergoing no pharmacological therapy. İlkay Keser1, Nimet Saygın2 Neuropsychiatric disease and treatment, 11: 2253. 1Akdeniz University, Nursing School, Psychiatry Nursing Department, SeppäläJ et al., (2013) Association between vitamin b 12 levels and Antalya melancholic depressive symptoms: a Finnish population-based 2Antalya Training and Research Hospital, Child Observation Centre, study. BMC psychiatry, 13(1): 1. Antalya AIM: Child abuse is a public health problem that is increasingly being observed in the general population. Prevention of this problem is one of PP-220 the primary targets of every responsible citizen and especially the mental healthcare workers. In this organisational study it has been aimed to RELATION OF THE ANGER LEVEL TO COGNITIONS review the literature on the interventional programs for the prevention AMONG CAREGIVING RELATIVES OF PATIENTS AT of child abuse, with the purpose of selecting the procedures suitable for application to cases of children exposed to abuse and their families. EMERGENCY SERVICE: A PILOT STUDY METHODS: Current data base of the literature has been scanned for Alişan Burak Yaşar1, Çiğdem Çelik Yaşar2, Elif Çarpar5, entries made over the last 10 years under the headings of ‘child abuse, Dilara Usta3, Kadir Özdel4, Mehmet Hakan Türkçapar6 peventing abuse, intervening with abuse‘. 1 Haydarpaşa Numune Training and Research Hospital, Psychiatry RESULTS: It has been emphasised in the studies on the subject that Department, İstanbul a multidirectional approach requiring the cooperation of different 2Maltepe University, Psychiatry Department institutions is required to deal with the problem of child abuse. There 3Üsküdar University,, Psychology Department, are published programs in the literature for preventing child abuse on 4Ankara Numune Training and Research Hospital, Psychiatry Clinic the family, school and public bases. Within the context of family based 5Bakırköy Mental Health and Neurological Diseases, Psychiatry Clinic programs, investigation of the families with respect to risk factors is 6Hasan Kalyoncu University,, Psychology Department, prioritised, and the requirements for education on matters of parenting, disciplining, existing support systems and their use, child abuse and AIM: Hospital emergency services are places where life and death its prevention, conflict solving methods and effective communication cases such as wounding or high risk disease crises requiring emergent are targeted. In the school based programs, it has been aimed to get intervention are daily experienced. Therefore, these are stressful premises equipped to alleviate the effects of abuse on children andtheir related for both the emergency service workers and the patients and their behaviours, to be in cooperation with the children and the school relatives. When we look at places where violence occurs, the highest staff on prevention of child abuse, and to have the awareness and the freuency is at the emergency services. This study has been planned with knowledge for the management, among the teachers and the families, of the issue and the effects of child abuse. In the population based the aim to determine the probable relationship between the tendency of programs the aims have been to identify the risky families, to educate the patients’ relatives to violence and the associated cognitive distortions the first step healthcare workers on child abuse, to develop family values to be used in the relevant psychoeducational materials to be developed in order to increase participation and unity in living as a family and POSTER PRESENTATIONS in future. forming programs to educate the parents for interactions in the family. METHODS: The study has been carried out with 25 relatives of DISCUSSION: It has been oberved that studies have been made to patients waiting for their turn after applying to the emergency service, develop interventional programs for the prevention of child abuse and and who were asked to complete the Subjective Anger Scale (SAS), that implementation of these programs should be spread on a wider Sentence completion tests (SCT), Continuous Anger-Anger Style Scale scale in the population. We believe that mental healthcare workers (SOTO), Thinking Styles inventory (TSI). should play a more active role in the development of policies on the subject of child abuse, on informing the public for increased awareness RESULTS: It was seeen that those paraticipants who had SAS anger level of this problem and in the multidisciplinary implementation of the of 4 and above were not problem focused in the SCT and responded required interventional programs. instead in terms of avoidance or violence.The participants with high Keywords: Interventional programs, preventing child abuse, sexual level of anger blamed doctors and nurses for delibrately making them abuse of children wait and that they did not deserve their pay, and 95% of the participants expressed the belief that not enough time had been given to the patients. References Distinct differences were not observed in the quantitive scales used Akdoğan H (2006) Çocuğun Cinsel İstismarını Önlemeye Yönelik Çalışmalar. Polis Bilimleri Dergisi, 1(7):1-15. which may be attributes to the low number of the participants. Bak-Klimak A, Karatzias T, Elliott L et al., (2014) Nature of Child DISCUSSION: There is need for expanding this research in order SexualAbuseandPsychopathology in AdultSurvivors: ResultFrom A to have more new data in this area in order to determine the relevant ClinicalSample in Scotland.J Psychiatr Ment Health Nurs, 21:550- interventions to be implemented to deal with iolence and vcognitive 557. distortions among the applicants at the emergency services. Yılmaz EB (2013) Çocuk İstismarının Önlenmesinde Kullanılan Programlar ve Özellikleri Anadolu Hemşirelik ve Sağlık Bilimleri Keywords: Anger,cognitive behavioural therapy, cognitive distortions Dergisi, 16:4.

171 PP-222 AIM: Importance of family characteristics have been demonstrated in the development and continuity of dependence. The problems POST TRAUMATIC SEASONAL CONVERSION: CASE associated with dependence have adverse effets on the family members. PRESENTATION It has been aimed in this study to develop a psychometric scale that determines the intrafamily risks in relation to dependence, the needs of A. Cenk Ercan1, Selim Polat1, Özgür Çağla Cenker2, Çiçek the family members, as well as helping the programming of treatments Hocaoğlu1 for dependence to be used clinically. 1Recep Tayyip Erdoğan University, Medical School, Psychiatry METHOD: By scanning the literature on the subject of dependence, a Department, Rize pool of 44 items on 5 basic areas consisting of ‘deficit in putting down 2Kaçkar State Hospital, Psychiatry Unit, Rize rules’, ‘deficit in giving responsibility’, ‘inability to solve conflicts’, AIM: Conversion disorder is mostly triggered by a recent psychological ‘intrafamily ties’ and ‘attitudes of family members towards the factor with the continuation of the effects. However, even if a recent dependent’ was formed. Relying on the feedback from experts in the psychological stressor cannot be named, the possibility of a traumatic field and the wives and parents of dependents, a 10-question Addiction experience in the past should not be overlooked. In the seasonal Profile Index for the family (API-F) was developed. The participants conversion disorder case presented here the effects of past trauma have came from the families of the patients consulting Ege University BATI been brought to attention. Institute Substance Dependence Polyclinic and of a private dependence treatment clinic in the last 3 months of 2015; such that, 102 individuals CASE: The 38-year old male patient, married with 2 children, had over the age of 18 years related to 98 dependents over the age of 15 years, been employed by the same company for long years. In his interview he and 66 individuals from families without a dependent member accepted could not describe any mental, professional, familial or social stressor. to join the study. The participants completed a sociodemographic He did not have a history of psychiatry consultation. He had conversion questionnaire, the API-F and Family Assessment Device (FAD). The problems with motor symptoms lasting maximally for 15 minutes every API-F was repeated with 34 relatives of dependents 15 days after the day during July and August months, which had developed after the first testing Marmara earthquake of 1999. At the time he was doing his military service and was involved in clearance of the debris and helping the RESULTS: The Cronbach alpha coefficient of the API-F was 0.82. victims when a dead body fell on him. After this event he experienced bulunmuştur. In the exploratory factory analysis, 4 factors, namely his first attack. His thought contents did not relate to the traumatic ‘relational abilities’, ‘intrafamily ties’, ‘attitude towards dependence’, event during the attacks and in general he did not have a noteworthy were obtained, explaining 30,81% of the variance. The mean total avoidance of such thoughts. There was not a lasting effect of the event score on FAD and API-F mean total score were significantly correlated in his cognition and mood and he did not have clinical signs of having (r=0.52, p<0.01). The first and second sets of API-F scores were found been over stimulated, appearing to have maintained his functionality to have statistically significant correlation (r=0,67, p<0.01). and state of well being. When he had been referred to the psychiatry DISCUSSION: When the total scores of the family members with service any possible neurological or general medical organic pathology and without a dependent member in the family were compared, the had been eliminated. differences were statstically significant, which was confirmed by testing, DISCUSSION: Since taumatic events can lead to psychiatric problems, within the protocol of the study, other relations of the dependent in cases of episodic psychiatric symptoms, existence of past traumatic patients. It can be said that API-F is a valid and reliable psychometric events should be evaluated. Conducting the therapy by working on the tool for evaluation of abilites in intrafamily realtionships on putting underlying trauma would in the long term contribute to the success of down rules, giving responsibility, conflict solving and in assessing the the treatment. family ties and the attitudes of family members towards the dependent. Keywords: Conversive attack, conversition disorder, episodic, Keywords: Dependence, family, scale POSTER PRESENTATIONS seasonality, trauma References References Barrett E, Turner J. (2005) Family structure and mental health: The NicholsonTR, Aybek S, Craig T et al., (2016) Life events and escape in mediating effects of socioeconomic status, family process, and social conversion disorder. Psychological Medicine, 46(12): 2617. stress, Journal of Health and Social Behavior, 46:2, 156-169 RoelofsK, SpinhovenP (2007) Trauma and medically unexplained Calafat, M. et al., (2014) Which parenting style is more protective symptoms: Towards an integration of cognitive and neuro-biological against adolescent substance use? Evidence within the European accounts. Clinical psychology review, 27(7): 798-820. context, Drug and Alcohol Dependence, 138: 185-192 Gürol, DT, ÖgelK (2015) Aile ve Bağımlılık. (Family and Dependence) 05.09.2016 tarihinde http://www.ogelk.net/Dosyadepo/aile.pdf adresinden erişildi.(Reached on 05.09.2016 at http://www.ogelk. PP-223 net/Dosyadepo/aile.pdf ). DEVELOPMENT AND TESTING THE VALIDITY AND RELIABILITY OF A PSYCHOMETRIC SCALE TO DETERMINE THE NEEDS OF THE FAMILY IN RELATION TO DEPENDENCE Kültegin Ögel1, Hande Çelikay2, Aslı Başabak3 1Acıbadem University Mental Health And Diseases Department, İstanbul 2Ege University Substance Dependence, Toxicology and Drug Sciences Institute, Substance Dependence Consultancy, İzmir 3Neuropsychiatry Hospital, İstanbul

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DETERMINATION OF THE DEATH RELATED FIRST ATTACK HYPOMANIA IN THE ELDERLY THOUGHTS OF THE STUDENTS IN HEALTH PATIENT ON LONG TERM ANDIDEPRESSANT SERVICES PROFESSIONAL SCHOOL OF RIZE THERAPY AFTER VORTIOXETINE USE: CASE PROVINCE PRESENTATION Burcu Genç Köse, Mehtap Metin Karaaslan, Yağmur Akbal Özgür Çağla Cenker1, Tuğba Uyar2, A. Cenk Ercan3, Dilek Recep Tayyip Erdoğan University, Health Services Professional School, Rize Sarıkaya Varlık1 1 AIM: Death is described as the cessation of the vital functions such as Kaçkar State Hospital, Psychiatry Division respiration and heart beat. However, death is perceived differently at 2Kaçkar State Hospital, Neurology Division different stages of life. Fear of the unexperienced, of disappearance and 3Recep Tayyip Erdoğan University, Psychiatry Department, Rize a move towards the unknown frightens every living human being. Since AIM: This case presentation has been prepared to draw attention to the death takes place mainly in the hospitals, it places great responsibilites side effects of the recently introduced antidepressant vortioxetine when on the healthcare workers. There are close ties between the reaction of used in the elderly patients. the healthcare personnel, who try to form empathy with the patients, on facing death and the care given to the patient close to death. CASE: The 65-year old female patient, mother of 5, had developed It is possible to help the dying patient only if the healthcare worker depressive symptoms 20 years previously after the demise of her son recognises personal emotions and be able to control them. and had used many different types of antidepressant agents. She had METHODS: This study was undertaken between the years of 2014 and consulted the neurology polyclinic for amnesia, and was referred, 2015 with the aim to determine the death anxiety levels of the students without diagnosis of any neurological pathology, to psychiatry for her reading at the health services professional school. Another categorical complaints of anhedonia and attention concentration problems. She selection of the participants have not been made. decribed a normal appetite. She had been strated on sertraline (50mg/ day) one year previously for the same complaints but her amnesia had A personal information form, prepared after a review of the literature, become more pronounced. She did not have a medical problem apart and the Thorson and Powell Death Anxiety Scale (TP-DAS) was from hypertension. It was learned that her two daughters had been completed by the participants. Percentage distribution and the mean of diagnosed with depression and her son had consulted psychiatry with the data were estimated by the Kruskal Wallis variance analysis, Mann multiple substance use disorder. Sertraline was discontinued and she was Whitney U test and the One-Way Anova and the t-test. started on vortioxetine (5 mg/day) and recommended monthly follow RESULTS: Age range of 88.9% of the participants was 18-22 years; up control. Twenty days after starting with vortioxetine, it was learned 74.5% of the whole group were females ; 97.9% were single; 24.3% from her daughter that she developed increased speech, tendency to were training for elderly care, 28.0% for , 26.7% laugh, had decreased need for sleep and was spending money on gifts for for anaesthesiology assistanceship and 21.0% for medical laboratory her grandchildren which improved mother-daughter relationships. The assistanceship. The answers to the question ‘’what would you feel patient was thought to have developed hypomania, and vortioxetine was and want to do if you were about to die’’ were, ‘to be with family and discontinued and tretment was switched to quetiapine (50mg/day): Th loved ones’(51.0%); ‘’spending time on on spiritual matters’ (32.1%); patient was put under follow up control. ‘intraverting’ (11.1%); and ‘remembering the old days’ (5.8%). The DISCUSSION TP-DAS mean total score of the males (55.43±14.58) was significantly : Although the entry of a new antidepressant agents into higher than that of the females(p<0.05). The highest TP-DAS mean the market creates interest, every case presents new clinical scenes with score on the basis of training was by the students training for the care age, first attacks, comorbidities and combination therapy outcomes. POSTER PRESENTATIONS of the elderly (52.27±15.77) and the differenc with the other groups Although the incidence of hypomania due to vortioxetine use had was significant (p<0.05). The highest score was on ‘ spending time been rated as 0,1%, the case presented in this report shows that in the on spiritual matters’(53.88±13.84) and the difference with the other elderly patient even the low dose treatment has the potential of causing groups was significant (p<0.05). hypomania, which necessitates the regular and frequent conrtol of the patient. DISCUSSION: The results of the study have indicated that the students training to become the healthcare workers of the future had a high level Keywords: Antidepressant, geropsychiatry, hypomania, vortioxetine of death anxiety, and this anxiety was at a higher level among those who References had attested death or had advanced in years. D’Agostino, A, EnglishCD, Rey JA(2015). Vortioxetine (Brintellix): Keywords: Anxiety, death, student A New Antidepressant. Pharmacy and Therapeutics, 40(1): 36. References Maud C(2016) Vortioxetine in bipolar depression induces a mixed/ Koç Z,Sağlam Z (2008)Hemşirelik öğrencilerinin yaşam sonu bakım manic switch. Australas Psychiatry, 24(2):206-7. ve ölüm durumuna ilişkin duygu ve görüşlerinin belirlenmesi. (Determination of the emotions and views on end of life care and death per se of nursing school) students of Cumhuriyet Üniversitesi Hemşirelik Yüksekokulu Dergisi, 12(1), 13-21.

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BARDYCARDIA WITHOUT QT PROLONGATION DELAYED DIAGNOSIS OF CHILDHOOD AFTER QUETIAPINE USE: PRESENTATION OF 2 NARCOLEPSY: CASE PRESENTATION CASES Serkan Güneş1, Mehmet Akif Camkurt2 Mustafa İspir, Osman Bakkal, Recep Tütüncü, Servet Ebrinç 1Hatay State Hospital 2 Haydarpaşa Sultan Abdulhamit Training and Research Hospital, İstanbul Afşin State Hospital AIM: Quetiapine is a second generation antidepressant agent with AIM: Narcolepsy is a syndrome characaterised with , antagonistic action on the 5HT1A, 5-HT2A, D1, D2, H1, and the daytime sleepiness, hypnagogic hallucinations and sleep paralysis. alpha 1 and 2 receptors. It has relatively frequent side effects of sedation, Narcoleptic symptoms usually start at adolescence and may continue orthostatic hypotension, anticholinergic and metabolic changes and for life. Prevalence of narcolepsy among children has been given as 20- rarely of cardiological symptoms. This report has aimed to present 60/100.000. We have aimed to present in this report a case of childhood two cases who developed bradycardia without QT prolongation on narcolepsy which was difficult to diagnose and had required patient’s quetiapine therapy. In the literature only one case report on the same consultations with several healthcare centers. side effect has been found. CASE: The 1year old girl was brought to our polyclinic for anomalous CASE-1: The 31-year old male patient was admitted to the hospital daytime sleepiness. She had daytime sleep attaacks also observed at on complaints of anhedonia, insomnia, and problems of anger control. school. When falling asleep the child had complaints of hallucinations He had been using risperidone (1 mg/day) for the previous 1 month. but a pathological basis had not been determined. As her EEG and cranial MRI were normal she had been referred to child psychiatry and Quetiapine (150 gm/day) was added to his treatment for sedation. His treatment had been started on aripiprazole (5 mg/day). Our evaluation physical examination showed a pulse of 80 beats/min and BP of 110/80 of the patient in adult psychiatry polyclinic suggested sleep disorder and mmhg. Two hours after starting quetiapine, he developed dizziness and she was started on imipramine 50mg/day which was without benefit fatigue symptoms. His BP was measured as 70/40 mm /hg; the pulse was after 1 month of treatment. The patient had a cataleptic attack during 40 beats/min and the QT and QTc intervals were, respectively, 434ms her control at the polyclinic. On the strength of this observation, she was and 426ms. Results of the routine haematological and biochemical tests diagnosed with narcolepsy and methylphenidate (20mg/day) therapy were normal. He was monitored at the emergency service and the results was started. Over the 10-month follow up controls, her symptoms of the measurements repeated 6 hours after quetiapine were: pulse:60 regressed completely and no repetitions were observed. beats/min; BP:110 /70 mmHg. DISCUSSION: Narcolepsy at chidhood can be encountered with CASE-2: The 35-year old male patient had been followed under different psychiatric symptoms. Clinicians have to be careful in the treatment with amisulpride (200mg/day) for psychotic disorder over process of differential diagnosis and not overlook the possibility or the previous 2 years. He was admitted as an inpatient having developed narcolepsy, however rare it may be. insomnia complaints. Physical examination, routine biochemical test results and the EEG were normal. He was staated on quetiapine (100mg/ Keywords: Childhood, methylphenidate, narcolepsy day). On the 4th day of the treatment, 3 hours after taking the dose, References he developed dizziness and symptoms of fatigue. His BP was 73/42 Ito H, Mori K, Mori T et al., (2014) Case of early childhood-onset mmHg and the pulse was 44 beats/min. when the ECG showed QT narcolepsy with cataplexy: comparison with a monozygotic co-twin. ve QTc intervals of, respectively, 415 ms and 426ms. After monitoring Pediatr Int, 56(5): 789-93. for 5 hours, his signs improved with apulse of 70 beats/min and BP of Kauta SR and Marcus CL. (2012) Cases of pediatric narcolepsy after

POSTER PRESENTATIONS 120/75 mmHg. misdiagnoses. Pediatr Neurol, 47(5): 362-5. DISCUSSION: Both of the presented cases did not develop low pulse Lecendreux M (2014) Pharmacological management of narcolepsy and and hypotension symptoms without QT elongation after discontinuation cataplexy in pediatric patients. Paediatr Drugs, 16(5): 363-72. of quetiapine. The effect had a score of 4 on the Naranjo Adverse Drug Reaction Probability Scale. In conclusion it can be said that physicians should regularly monitor the patients on quetiapine for hypotension PP-228 and for bradycardia with regular ECG checks. Keywords: Antipsychotic, bradycardia, quetiapine, side effect BELIEFS ON ALCOHOL AND SUBSTANCE USE, RELAPSE FORESIGHT AND TREATEMENT References MOTIVATION IN ALCOHOL AND SUBSTANCE Janse A, Radboud MM (2009) Quetiapine-induced bradycardia without QT interval prolongation in an elderly woman. Prim Care USERS Companion J Clin Psychiatry, 11.4:172. Hande Çelikay1, Ebru Aldemir1, Hakan Türkçapar2 1Ege University Substance Dependence, Toxicology and Drug Sciences Institute, Substance Dependence Consultancy, İzmir 2Hasan Kalyoncu University, Psychology Division, Gaziantep AIM: Alcohol and substance dependence progresses with a course of remissions and relapses. In the recent years, treatment programs for prevention of relapse have come to the foregound. Investigation of the beliefs on alcohol and substance use and working on the nonfunctional beliefs constitute the basis of cognitive behavioural therapy. This is closely realted to the treatment motivation, relapse prevention,

174 remaining in treatment, joining treatment and the motivational changes At the time her score on the Beck depression inventory (BDI)was 32. throughout the treatment program. It has been aimed in this study to Her depressive symptoms had partially regressed on the second month investigate the beliefs of individuals on alcohol and substance use, their of the treatment, when her BDI score was 24 and fluoxetine dose was foresight on relapse and motivation for treatment. increased to 40 mg/day. When she came back 3 months later for her controls, she had developed over the previous 1 month a spread of 4-6 METHODS : The study was carried out with 42(34.4%) participants cm lesions of eccymoses in her lower extremities. Consultation was with a history of alcohol use and 80 (65.6%) participants with a history requested from the internal diseases unit. All of her blood and bleeding of substance use, treated as outpatients at Ege University BATI Institute parameters including her haemogram, RBC peripheral distribution, Substance Dependence Polyclinic or as inpatients at Ege University activated partial thromboplastin time- (APTT) test and INR were Medical School Hospital Psychiatry Department Dependence Service. within normal limits. Fluoxetine dose was reduced over 2 weeks and After the completion of a sociodemographic questionnaire, the discontinued. Therapy was switched to duloxetine (30mg/day, titrated participants were asked to complete Beliefs About Substance Use (BSU), to 60mg/day). Her ecchymoses improved over the 3-month control the Alcohol Craving Questionnaire (ACQ), the Relapse Prediction Scale period and did not repeat when her BDI score had become15. (RPS) and the Treatment Motivation Questionnaire (TMQ). DISCUSSION: Appearence of the ecchymoses after starting fluoxetine, RESULTS: Participants included 105 (86.1%) males and 17 (3.9% ) exclusion of other underlying causes,not using another drug, and not females ;with a mean age of 30.75 (±12.65) years; 71(58. 2%) single having seen a haemorrhagic side effect during previous escitalopram and 35 (28.7%)married; and 55 (45.1%) educated at least up to middle use have suggested fluoxetine therapy to be the cause of the patient’s school; with a mean income of 2459 TL (± 1861) TL ; 26 (21.3%) with ecchymoses. In vitro studies have shown that depletion of the platelet a history of psychiatric disorder and 44 (36.1%) with a criminal record. serotonin takes no less than7 days, in comparison the decrease in The starting age of alcohol and substance use was 16.87±4.24 years and neuronal serotonin reuptake in one day after fluoxetine, meaning the age of starting regular use was 20.81±7.33 years. Interpersonal help that the SSRI effect is not as immediate on platelets. In vitro studies seeking behaviour of the alcohol users was significantly higher than that have shown sertraline, citalopram and reboxetine to decrease platelet of the substance users (F(1,109)=10.770, p=0.001). The extraverted adhesion, while venlafaxine has been without effect and bupropione has motivations (F(1,112)=4.610, p=0.034) and mistrust of treatment impaired platelet function. Patients treated with SSRIs, and especially (F(1,112)=3.865, p=0.05) by the substance users was significantly those with risk for haemorrhage, should be regularly tested for bleeding higher than that of the alcohol users parameters. DISCUSSION: It was seen that inreased treatment motivation pulled Keywords: Duloxetine, ecchymosis,fluoxetine down the possibility of relapse, and as the belief in using alcohol or References substance use increased, the possibility of relaspe increased. Further Hallback I, Hagg S, Ericsson AC (2012) In vitro effects of serotonin and treatment oriented and wider scale studies in this field are expected to noradrenaline reuptake inhibitors on human platelet adhesion and clarify the aetiology of alcohol and substance dependence and make coagulation. Pharmacol Rep, 64:979-83 significant contributions to the treatment of these dependences Koçbıyık S, Batmaz S, Turhan L et al., (2015) Fluoksetin ve essitalopram Keywords: Dependence, relapse, treatment motivation tedavisi sonrası gelişen ekimotik lezyonların reboksetin tedavisi ile düzelmesi. Cukurova medical journal 40:90-93. References Ekinci A, Ekinci O, Türkçapar H et al.,(2012) Alkol Bağımlısı Olguların Sağlıklı Kontrollerle Emosyonel Şemalar Yönünden Karşılaştırılması ve Klinik Özelliklerle İlişkisi, Nöropsikiyatri Arşivi Dergisi, 49:286- PP-230 293. Ryan RM, PlantRW, O’Malley S (1995) Initial motivations for

FINDING SENSE IN UNALTERABLE REALITY POSTER PRESENTATIONS

alcohol treatment: Relations with patient characteristics, treatment 1 1 3 2 involvement, and dropout. Addictive behaviors, 20(3):279-297. Gülay Oğuz , Saime Çağlı , Serap Sezgin , Ferhat Jack İçöz , Murat Terzi4 1Private Psychiatry Consultant 2Private Psychology Consultant PP-229 3Ondokuz Mayıs University Healthcare Centre 4Ondokuz Mayıs University Neurology Divison ECCYMOSIS DUE TO FLUOXETINE USE: CASE AIM: It was planned to use logotherapy on 10 female patients with PREENTATION multiple sclerosis (MS) and to investigate its effects on the comorbidites Birmay Çam of depression and anxiety disorders in MS. The basic aim of the study was Manisa Mental Health and Neurological Diseases Hospital to understand better the depressive symptoms in patients with physical disabilities; to find the important data related to the extraversion of AIM: There are very fe w studies on the effects of selective serotonin depression; and to discover potential ways of preventing and treating the reuptake inhibitiors (SSRIs) on haemorrhage. A case of ecchymosis after depression in these individuals. fluoxetine use has been presented in this report. METHODS: The study was carried out with 10 MS patients in the age CASE: The 35-year old female patient consulted the psychiatry range of 25-48 years, under follow up by the Ondokuz Mayıs University polyclinics with the complaints of anhedonia, irritability and avolition Healthcare and Research Centre, Neurology polyclinic. Patients with which intensified over the previous 3 months. She had been started on the same level of MS severity were included in this study by cooperating escitalopram (10mg/day) one year previously for the same conplaints. with the neurology division. The patients were asked to complete a Her personal and family histories were uneventful. She did not use personal information form prepared by the reserachers after scanning alcohol or substance. She was diagnosed on the basis of DSM-V criteria the related literature, as well as the fatigue severity scale (FSS), Short with repetitive depression and was started on fluoxetine (20mg/day). Form Health Survey- (SF-36), the Beck depression inventory (BDI),

175 the Beck anxiety inventory (BAI), the Expanded Disability Status exercises, use of pharmacological agents such as benzodiaziepines, Scale(EDSS), and the Affective Neuroscience Personality Scale –( botulinum toxin injection and even surgical interventions have been ANPS). The participants were psychometrically tested before and after proposed. However, in the case presented here, whatever approach is the 10 session group therapy. taken for the treatment of vaginismus, the importance of psychoanalysis cannot be overlooked for the understanding of the case and detection of RESULTS: On the sociodemographic basis, 6 (60%) patients were the resistances to therapy. married, 5 (50%) were housewives and all had health insurance. Duration of MS ranged from 2to14 years; with all patients using Keywords: Castration, psychoanalysis, vaginismus medication. The origin of the MS was supratentorial in 5 (50%) of the patients and 40% were using Rebif 44(interferon beta-1a). After the therapeutic intervention, the scores on depression, anxiety, fatigue, PP-232 pain, anger, physical function and social function scores were statistically lower (p<0,05). The mean energy score was significantly elevated after the intervention (p<0,05). “HEART IS SMALL BUT THE COMPASSION IS GREAT, I GET ILL EVERY RAMADHAN’’: CASE DISCUSSION : It has ben shown in a study that group logotherapy PRESENTATION reduced anxiety and depression and improved quality of life in cancer patients. We can propose the factor causing the extraversion A. Cenk Ercan1, Özgür Çağla Cenker2, Çiçek Hocaoğlu1 of depression as the sense of understanding the meaning of life. The 1Recep Tayyip Erdoğan University, Medical School, Psychiatry existential analysis in Frankl’s theory can be a useful for the treatment Department, Rize. and prevention of depression, and the the adjustment of the individual 2Kaçkar State Hospital, Psychiatry Unit, Rize to the physical disability. AIM: Bipolar disorder (BPD)frequently displays seasonality. Not only Keywords: Depression, logotherapy, multiple sclerosis the seasons, but also the experiences and beliefs that affect the individual References can cause mood episodes to appear. Relationsip between spiritual beliefs Talebian L et al.,. (2012) The effectiveness of the therapy on depression, and psychiatric disorders are open to discussion, given the presentation anxiety and quality of life of cancer patients. the journal Psychological in this report of the case of a patient followed up for the pevious 4 years achievements martyr Chamran University, 4(2): 244,199. with the diagnosis of BPD, who regularly developed severe amnic attack requiring hospitalisation. CASE: The 34-year old male civil engineer, had experienced 4 years PP-231 preiviously at the start of the holy month of Ramadhan a manic attack necessitating hospital treatment with hte daignosis of BPD. On account A PSYCHOANALYTICAL LOOK AT VAGINISMUS: of the side effects he could not comply with his treatment with regularity such that he went through two manic attacks in the subsequent 2 years CASE PRESENTATION at the month of Ramadhan and had to be admitted to hospital again. Gamze Akçay Oruç, Yusuf Özay Özdemir His social support was poor and heeasily avoided attending his follow up Erenköy Mental and Neurological Diseases Hospital, Psychiatry Clinic, controls with the excuse that the doctors refused to change his medication İstanbul despite the side effects. However, in the periods between his yearly attacks he did not have any manic, hypomanic or depresswive episode despite AIM: Vaginismus is a sexual function disorder which makes difficult, not using his medication. In his last consultation for his 4th attack he or in its severest form, prevents intercourse by pain or the fear of pain. said tht during the Ramadhan his spirituality was raised, and his religious POSTER PRESENTATIONS Although its prevalence in the general population is not clear, it is the compliance with the rituals upset his routine of sleep and he wa s admitted most frequently made complaint of female sexual dysfunction in our to the hospital once again. After discharge he came back for the first itme country. Although a few organic causes can be named for vaginismus, to our polyclinic and was started on treatment with valproic acid and psychosocial causes play an important role in its aetiology. The learning sodium valproate monotherapy, which did not complain about, on the theory and behavioural theories argue that vaginal contraction may condition of coming to controls every two weeks. be a conditioned reaction. On the other hand the feminist point of NOT PRESENTED view criticises the traditional point of view targeting the achievement DISCUSSION: Practicing muslims who fast in the month of Ramadhan of sexual relationship based on vaginal spasm and penetration and the are elated with religious thoughts and face the difficult physical stressors related treatment approach. In the classicial literature this symptom is of fasting, hunger and thirst with lack of sufficient sleep. The experience explained as the revenge of the female of her own castration, or lack of manic attacks regularly in Ramadhan without any other symptoms of a penis, by castrating the male or her desire for anal relationship. all year long without any control of medication can be regarded as We have aimed to present a case of vaginismus as it supported the extraordinary. Relation of BPD and spiritulaism has been discussed in psychoanalytical theories on the aetiology of vaginismus. the liiterature. CASE: The 23-year old univesity graduate female patient, married for 2.5 Keywords: Antipsotic, bipolar disorder, mania, Ramadhan, religion, years, had her first intercourse at her marriage. Since all of her attemtps side effect for intercourse were unsuccessful due to pain and vaginal contraction she References seeked sexual therapy with her husband. In her clinical examination her Eddahby S, KadriN, Moussaoui D. (2014). Fasting during Ramadan condition met the diagnostic criteria in DSM-V for ‘‘Genitopelvic pain/ is associated with a higher recurrence rate in patients with bipolar penetration disorders” (Vaginismus in the DSM-IV). disorder. World Psychiatry, 13(1), 97-97. DISCUSSION: The treatment of vaginismus is an ongoing debate Grover S et al.,. (2016). Influence of religion and supernatural beliefs as there are many hypotheses on its aetiology. Behavioural therapies, on clinical manifestation and treatment practices in patients with systematic desensitization, graded dilatation techniques, relaxation bipolar disorder. Nordic journal of psychiatry, 1-8.

176 PP-233 PP-234

EFFECTS ON THE TREATMENT OF ATYPIC AVOIDANT/RESTRICTED FOOD INTAKE BRAIN IMAGING RESULTS ON INPATIENTS: A DISORDER: ADULT CASE PRESENTATION PRELIMINARY STUDY Aynur Görmez, Alperen Kılıç, İsmet Kırpınar Rukiye Tekdemir, Yavuz Selvi, Hazan Tomar Bezmialem Vakıf University, İstanbul Selçuk University, Medical School, Psychiatry Department AIM: Avoidant/Restricted food intake disorder (ARFID) is a new AIM: Space occupying lesions (SOL) cause personality changes, mood diagnostic category in.the DSM-V, included as an expanded version disorders, and disorganisation of intellectual functions in relation to of the diagnostic criteria for feeding disorders of infancy and early their localisation in the brain. At least 50% of the patients with SOL childhood in the DSM-IV. The diagnostic indicators of this disorder have psychiatric symptoms and in 18% (15-20%) of the patients the include malnutrition, low body weight and/or retarded development first symptoms of the SOL are psychiatric behavioural changes. In post and the need for synthetic food and supplements in the absence of mortem investigation of psychiatry patients under regular follow up, an any medical dondition, and/or a disorder of bodyweight/body shape incidence of 3.5-5% brain lesions has been reported which is identical perception. In this report the case of a young female with ARFID diagnosis who respondend well to cognitve behavioural therapy is to the incidence seen in the general population. In this study the effects presented. of the results of MRI and CT findings on the clinical symptoms of the inpatients have been investigated. CASE: The 27-year old univsersity graduate, single female patient, not working and living with he family consulted out polyclinic with METHODS: All records in the files and in the hospital electronic long standing complaints ofrefusing foo intake, intolerance for the system of every psychiatry patient admitted to be treated as inpatients appearance and smell of foods, nausea before or during meals, retching of the Medical School Psychiatry Clinic between 2010 and 2016 were and vomiting. She had lost 6 kg body weight in the pevious 2 months. scanned retrospectively for data on sociodemographic details, duration She weighed 443 kg and her BMI was 16. Not ea ting had affected her of hospital stay, cranial MRI results, clinical details and treatment functionality. She had been lifelong a small eater and a slim individual. resistance. She had for the pevious 2 years oligo/hypomenorrhea. She had gastritis RESULTS: The number of inpatients treated over 6 years totalled 1930, and reflux. She had an 8-year psychaitric history, had been hospitalised but cranial MRI reports were found only for 302 patients. Most of the 6 times for medical complications. She had been strated on various types reports reported ischaemic gliotic foci. Psychiatric disorders, psychotic of psychotropc agents but her eating problem had never been given a characteristics, duration of hospital stay, resistance to treatment, brain specific treatment. She had anxety about her low body weight and was MRI results, localisation of the lesions in the cortical and sub cortical awawre of the risks. She had very restricted diet and felt satisfied with areas and lobular spread, lesion types were classified and desriptive small amounts. During the 10 weeks of hospital stay she was given results were obtained. relaxation and breathing exercises and regular cognitive behavioural therapy (CBT) including systematic desensitisation. She was given DISCUSSION: It has been known that underlying general medical increasing amounts of different kinds of food. She learned to control and especially the neurological pathologies cause resistant to psychiatric her anxiety, eat more of her food and gained 2 kg body weight. She was treatment and result in an atypic clinical situation. Some of these dischareged with the condition of continuing 6 weeks more with CBT. clinical conditions are those of the patients with MRI revealed brain Currently she is in the 6th month of her discharge, and she eats 3 meals lesions although neurological symptoms are not always observed. In per day; is able to finish 80% of her food and continues to gain weight. this study we have demonstrated that patients with brain lesions on meğinin %80 kadarını bitirebilmekte ve kilo almaya almaktadır.

MRI showed atypic symptoms and resistance to psychiatric therapy in POSTER PRESENTATIONS DISCUSSION: Literature on the treatment of ARFID is very limited. relation to their localisations in the brain. These data suggest that the The experience gained with the case presented in this report it can be ischaemic gliotic foci can give rise to atypic psychiatric characteristics foreseen that CBT will be useful for ARFID cases. and complicate the treatment process. There is need for comparative studies on the subject carried out with large patient groups. Keywords: Adult, avoidant/restricted food intake disorder (ARFID), cognitive behavioural therapy (CBT) Keywords: Atypic finding, CT, MRI References FeinsteinA, Ron M. (1998)A longitudinal study of psychosis due to a PP-235 general medical (neurological) condition: establishing predictive and construct validity. The Journal of neuropsychiatry and clinical EFFECT OF DURATION OF UNTREATED PSYCHOSIS neurosciences, 10(4), 448-452. Gürsu AH, Öncü F, Karadağ F (2004) Frontal lobe syndrome: two case ON CLINICAL PROCESSESS IN SCHIZOPHRENIA: reports. Anatolian Journal of Psychiatry,5:179-187 CASE PRESENTATION Gamze Akçay Oruç, İshak Sayğılı, Didem Beşikçi Keleş, Hüseyin Güleç Erenköy Mental and Neurological Diseases Training and Research Hospital, Psychiatry Clinic, İstanbul AIM: Schizophrenia generally starts at late adolescence or early adulthood. Wasting usually occurs at the early stages of the disorder. This phase is described as the duration of untreated psychosis (DUP) and is a critical factor in the course of the disorder. Meta-analyses of the

177 first attack schizophrenia have shown the importance of DUP and its PP-236 effect on the severity of the symptoms. Prolonged DUP has been related with lowered improvement possibility. The case in this report has been CAN THYROID DSYFUNCTION BE INVOLVED IN presented with the aim to emphasise the importance of early diagnosis TREATMENT RESISTANCE IN BIPOLAR DISORDER and treatment in schizophrenia. Hazan Tomar, Yavuz Selvi, Rukiye Tekdemir CASE: The 26-year old single, middle school graduate male, had not Selçuk University Medical School Hospital, Psychiatry Department worked for 10 years and had increasing intraversion and reduction in speech, psychomotor activity,self care, socialising and funcitonality over AIM: Different biological variables directly affect the clinical the 8 previous years. He had over the previous 6 month avoided going characteristics, the course and the treatment of bipolar disorder out of the house for fear of being harmed, not watching TV and sitting (BPD). Especially thyroid dsyfunction is significant in changing and alone in a dark room. Despite these long term symptoms, he had not shaping mood. Many studies have reported the necessity of different consulted pyschiatry previously. Hence he had not been treated despite programming of the treatment of psychiatry patients with thyroid having met for years the diagnostic criteria for schizophrenia. When dysfunction. In this study we have aimed at evaluating the attack type discored after a suicidal attempt, he had ben treated as an inpatient and and duration of hospital stay of the BPD patients being followed at after discharge, he had complied only for 2 months with his treatment. our clinic and determining the relationship of the findings with thyroid Having refused taking his medicines for 1.5 years, he consulted again dsyfunction. with symptoms of speaking to himelf, irritability, aggressiveness, reduced METHODS: Hospital records on files and the electronic data system self care, paranoid-perscutory-grandiose delusions and was hospitalised of the hospital of all BPD patients admitted to the psychiatry clinic of again. His PANSS and BPRS scores were very high and his hospital stay the university medical school with the organisation of their treatments was prolonged. between 2014 and 2016 were scanned retrospectively to gather the data DISCUSSION: Traetment of the reported case had been delayed with on sociodemographic details, duration of hospital stay BPD attack type, an 8-year DUP, and his condition was detected with his suicidal attempt. and all clinical characteristics. He had severe symptoms resistant to treatment and also his treatment RESULTS: In the 2-year period the total number of psychiatry patients compliance was poor. His condition was in agreement with the reports admitted to the clinic was 846, with BPD patients numbering 152( in the literature that long DUP resulted in bad prognosis and a severe 62 males and 90 females), with a mean age of 36.7 (±13.2) years; and course of the disorder. Early diagnosis is important in schizophrenia, a mean duration of hospital stay of 16.9 (±10.5) days. The hospital as it is closely related to the prognosis of the disease and hence to the stay of those BPD patients with thyroid dysfunction was 21.5 (±10.8) costs of hospital stay and treatment as well as the severity and the days, while the hospital stay of patients with normal thyorid function damage of the disease, resulting in losses of functionality. Therefore, the was 16.0 (±10.5) days. Thyroid function based on TSH level within procesures for early diagnosis developed in many countries should also the range 0.27-4.2 is internationally accepted as the normal. TSH be integrated into the healthcare systme of our country. There is need levels of BPD patients above or below this range, irrespective of attack for studies to undersand the reasons for DUP in our patients. type, were correlated with significantly longer duration of hospital stay Keywords: Duration of untreated psychosis, early diagnosis, early as compared to the hospital stay of patients with normal TSH levels intervention programs, early treatment, schizophrenia (p<0.05). References DISCUSSION: It has been shown in this study that when the free Marshall M,Lewis S, Lockwood A et al.,(2005) Association between T4 and TSH levels, indicators of the thyroid status, were outside the duration of untreated psychosis and outcome in cohorts of first- accepted normal range values, hospital stay of the BPD patients was episode patients. Arch Gen Psychiatry,62:975-83. prolonged and the response to the treatment given was delayed. These Marshall M, Husain N, Bork N et al.,(2014) Impact of early intervention results are in agreement with those of other studies showing that BPD POSTER PRESENTATIONS services on duration of untreated psychos data from the National patients have increased sensitivity to small changes in the thyroid EDEN prospective cohort study.Schizophr res, 159(1): 1-6. function parameters, and that the dysfunction of the hypothalamic– Perkins DO, Gu H, Boteva K et al.,(2005) Relationship between pituitary–thyroid axis has effects on mood changes, and the serotonergic duration of untreated psychosis and outcome in first-episode system. schizophrenia: a critical review and meta-analysis. Am J Psychiatry, Keywords: Bipolar disorder, hospital stay, thyroid dysfunction 162(10): 1785-1804. References Aydin A, Selvi Y, Besiroglu L et al., (2013) Mood and metabolic consequences of sleep deprivation as a potential endophenotype’in bipolar disorder. J Affect Disord,150(2):284-94. Bauer M, Goetz T, Glenn T et al., (2008) The Thyroid‐Brain Interaction in Thyroid Disorders and Mood Disorders. J Neuroendocrinol, 20(10): 1101-1114. Cole DP, Thase ME, Mallinger AG et al., (2002) Slower treatment response in bipolar depression predicted by lower pretreatment thyroid function. Am J Psychiatry, 159(1):116-121.

178 AUTHOR INDEX

A Asoğlu, Mehmet 20, 35, 40, 81, 109 Boyacı, Hüseyin 38 Çengel, Hanife Yilmaz 37 Ataç, Alida 157 Boyacıoğlu, Nur Elçin 160 Çeri, Ürün Özer 136 Abay, Ercan 40 Atagün, Murat İlhan 50, 51, 112, 133 Boysan, Murat 147 Çeri, Veysi 25 Abdullayev, Emrah 111 Ataoğlu, Ahmet 86 Bozacı, Umut 86, 88 Çetin, Buğra 121, 132 Açar, Çiler 106, 108, 110 Ataseven, Elçin 79, 139 Bozkurt, Abdullah 97, 158 Çetiner, Gizem 103 Acar, Sinem 163 Atay, Emine Yağmur 101, 148 Bozkurt, Hasan 119 Çetinkaya, Bedriye Öncü 151 Afşaroğlu, Havva 29 Ateşci, Feride Figen 151 Bozkurt, Müge 37 Çetinkaya, Özlem Zekiye 85 Akansel, Veysel 125, 131 Ateşçi, Figen Çulha 92 Bozkurt, Sümeyye 134 Çetin, Sahabettin 99 Akar, Merve 145 Ateş, Nazlı 83, 135 Budak, Ersin 167, 169 Çimen, İrem Damla Manga 87, 89 Akarsu, Özlem 47 Avcı, Fatma Gözde 152 Bülbül, Öznur 3, 12 Çipil, Arif 152 Akay, Esra 161 Aydemir, Makbule Çiğdem 52, 62, Bulut, Hüseyin 76 Çıkrıkçılı, Uğur 3, 12, 114 Akbaba, Gözde 131 96, 164, 169 Bulut, Süheyla Doğan 63 Çınar, Rugül Köse 40, 57, 121 Akbaba, Nursel 23 Aydemir, Ömer 9, 88, 127 Buturak, Şadiye Visal 54, 107, 157 Çıtak, Cihad 78, 152 Akbal, Yağmur 173 Aydın, Adem 64 Büyükavşar, Ahsen 141, 168 Çobanoğlu, Cansu 97 Akbaş, İbrahim 144 Aydın, Erkan 139 Büyüköz, Derya 90 Çökmüş, Fikret Poyraz 88 Akbey, Zeynep Yıldız 48, 51, 89, 124, Aydın, Memduha 60, 61, 90, 91 Çoldur, Emine Özge 88 126, 127, 128 Aydın, Muazzez 97 C Çukurova, Merve 24, 74 Akça, Erdoğdu 93 Aydın, Nazan 83, 116, 123, 137, 163 Camkurt, Mehmet Akif 174 Akcan, Funda Engin 103 Aydın, Orkun 88 Canazlar, Elif Özlem 84 D Akdeniz, Fatma 9, 88, 127 Aydın, Özlem Altuntaş 59 Akdur, Tuğba Göncü 134, 135 Candemir, Nazlı 143 Aydın, Pınar Çetinay 83, 116, 163 Can, Güneş 50 Dağıstan, Ekin 116 Aker, Servet 98 Aydın, Ufuk 164 Akıl, Öznur 20, 35, 81, 109 Can, Kazım Cihan 119 Dalboy, Fadime 64 Ayhan, Medine Gıynas 93 Cankorur, Vesile Şentürk 129 Delibaş, Dursun Hakan 63 Akkaya, Cengiz 53, 58, 92 Ayidaga, Turan 111, 154 Akkaya, Özlem 146 Can, Serdar Süleyman 112, 133 Demiralp, Tamer 3, 15 Ayık, Batuhan 19, 134 Cebeci, Esra 13 Demirci, Hakan 164 Akkuş, Mustafa 110 Ay, Kübra 65 Ak, Mehmet 85, 102 Cengiz, Zeliha 125, 131 Demirci, Onur Okan 80 Aykut, Demet Sağlam 60, 95 Cenker, Özgür Çağla 47, 165, 172, Demirel, Başak 145 Aksoy, Sena 74 Ay, Rukiye 156, 160 Aktaş, Sakine 136 173, 176 Demir, Esra Yancar 98 Aytaç, Hafize Miray 102 Cerit, Cem 142 Demir, Meral Oran 31 Akvardar, Yıldız 139 Aytaç, Hasan Mervan 83, 138, 163 Akyürek, Fikret 23 Cesur, Ender 16, 28, 106, 137, 152 Demiroğlu, Filiz 110 Cesur, Gizem 104, 130, 135 Demir, Osman 34, 52 Akyüz, Mahmut 82 B Albayrak, Hanife 104 Ceyhun, Hacer Akgül 73 Deveci, Erdem 92 Alçalar, Nilüfer 166 Bahçeci, Bülent 100 Ceylan, Deniz 50 Dikici, Didem Suculluoğlu 88 Alçı, Deniz 88 Bahtiyar, Gökhan 122, 149 Chasan, Merve Tsakir 163 Dilektaşlı, Evren 169 Aldemir, Ebru 46, 174 Bakay, Hasan 6 Chen, Yue 38 Dinç, Hüsniye 160 Doğan, Türkan 49, 142 Algül, Reyhan 75, 78, 79 Bakkal, Osman 174 Cin, Firdevs Melis 130 Doğruel, Seda 157 Alıcı, Yasemin Hoşgören 111 Bal, Çiğdem 104 Cingöz, Murat 73 Dökmetaş, İlyas 59 Alışık, Murat 50 Balcıoğlu, Yasin Hasan 48, 49, 133 Coşgun, Büşra Nur 104 Dokuz, Gonca 150 Alkan, Merve 135 Balıkçı, Kuzeymen 88 Coşkunol, Hakan 88 Dönmez, Emin Erhan 83 Alptekin, Köksal 3 Baran, Zeynel 111 Coşkun, Sefa 134 Dönmezler, Gizem 28, 105, 106, Alpugan, Zeynep 77 Başabak, Aslı 172 Ç 137, 162 Altınbaş, Kürşat 106, 108, 110 Başar, Hatice Melek 76, 137 Dönmez, Nazente 166 Altındağ, Abdurrahman 164 Başar, Koray 66 Çağlar, Kıymet 163 Dönmez, Zeliha 83, 135 Altınöz, Ali Ercan 27, 89, 99 Başkak, Bora 111, 153 Çağlar, Nuran 3, 12, 61 Duman, Berker 168 Altıntaş, Kevser 157 Baskın, Emel Paşa 63 Çağlı, Saime 175 Duman, Taçlan 92 Altıntaş, Merih 13 Başusta, Burcu 101 Çakir, Sibel 19 Durmaz, Ercan 21 Altıntoprak, Ayşe Ender 86 Batmaz, Sedat 31, 34, 52 Çakır, Cansu 28 Duva, Yağmur 108 Altınyazar, Vesile 84 Bayram, Şenol 10, 96, 169 Çakır, Sibel 64 Altun, İlkay Keleş 81, 143 Baysal, Gülsüm Özge Doğanavşargil Çakmak, Gizem 55 E Altunova, Deniz 60, 90, 91 161 Çalışkan, Mecit 146, 152, 154 Altuntaş, Özlem 16 Baz, Fatih 93 Çalış, Mecit 126 Ebrinç, Servet 174 Amuk, Tarkan 55 Beğinoğlu, Özlem 20, 35, 81, 109 Çalıyurt, Okan 109 Ekici, Burak 104 Andreazza, Ana Cristina 50 Berberoğlu, Ertuğ 61, 120 Çam, Birmay 175 Ekinci, Esra 45 Annagür, Ali 23, 58 Berkol, Tonguç Demir 48, 49 Çankaya, Pınar Kızılay 81, 143 Ekinci, İskender 45 Annagür, Bilge Burçak 23, 58 Beştepe, Engin Emrem 134, 135, 165 Çarpar, Elif 106, 125, 137, 143, 171 Ekinci, Nuran Gözpınar 140 Aral, Armağan 97, 114 Bildik, Tezan 155 Çaycı, Hacı Murat 169 Ekinci, Suat 45 Aral, Gizem 95 Bilge, Bilgenur 59 Çayköylü, Ali 112, 115, 116, 117, 118, Ektiren, Sözdar 86, 88 Arı, Ela 130, 145 Bilgiç, Onur 17 121, 133 Elbi, Hayriye 3, 8 Arıkan, Gizem 112, 113 Bilgili, Gamze Özçürümez 159 Çeçen, Hülya 80 Emul, Murat 103 Arıkan, Özlem 110 Bilgin, Selin 8, 130 Çelebi, Cengiz 139 Enli, Yaşar 107, 113 Arısoy, Özden 166, 170 Binbay, İbrahim Tolga 3 Çelikay, Hande 46, 86, 88, 172, 174 Eraybar, Suna 167 Arpacı, Nazile 102 Bingolo, Ceren 107, 113 Çelikbaş, Zekiye 31, 34, 52 Erbay, Lale Gönenir 82 Arslan, Filiz Civil 60 Binicier, Hatice Çilem 55 Çelik, Çetin 23 Ercan, A. Cenk 47, 165, 172, 173, 176 Aşçıbaşı, Kadir 88 Birer, Nurhak Çağatay 97, 98, 108 Çelik, Ecem 158 Ercan, Melis 129 Aşık, Ecenur Aydın 88, 140 Birtek, Dilara 145 Çelikel, Feryal Cam 102 Ercan, Seda Kırcı 60 Aslan, Eda 140 Bıkmaz, Pervin Sevda 45 Çelme, Gülşah Güçlü 170 Erciş, Mete 64

179 Erdoğan, Esin 63 Güneş, Mustafa 105 Karakoç, Arzu Azime Ünlü 151 Kumbasar, Hayat 59 Ere, İbrahim 91 Güneş, Serkan 174 Karakoç, Gülser 129 Kumlu, İsa 107 Erel, Özcan 50, 51 Güneytepe, Sena 36 Karaman, Özcan 45 Kumru, Asiye 112, 113 Eren, İbrahim 60, 90, 93, 145, 146 Güngör, Güntuğ 106, 137 Karaoğlu, Merve 145 Künt, Sevilay 116 Erermiş, Serpil 155 Gürbüz, Filiz Şükrü 36 Karaosman, Tolga 97 Kuperberg, Gina 38 Ergül, Ceylan 3, 12, 15 Gürbüz, Tuba 79, 139, 160 Karapıçak, Özgün Karaer 97, 98, 108 Kural, Hanife Uğur 45 Ergün, Fikret Ferzan 168 Gürsoy, Salime 141, 149 Karka, İsmail 20, 35 , 81, 109 Kurku, Zübeyde Tekin 93 Ergün, Serhat 150 Gürsoy, Süha Can 150 Karlıdağ, Rıfat 82 Kurt, Ayşegül 97 Erkan, İbrahim 103 Güvenç, Hasibe Rengin 79 Karşıdağ, Çağatay 22, 24, 28, 74, 78, Kurt, Elif 3, 6, 15 Erkan, Serkan 110 105, 152 Kurt, Mustafa 84 Erken, Ramazan Reha 99 H Kartal, İbrahim 158 Kurtulmuş, Ayşe 77 Erkıran, Gonca 154 Kart, Ayşegül 170 Kuru, Erkan 39, 49, 142 Hacıoğlu, Melike Büşra 104 Erkıran, Murat 152, 158 Kasal, Meltem İzci 122, 149 Kuşçu, Mehmet Kemal 93 Erkoç, Şahap 13, 143 Hasoğlu, Tuna 38 Kati, Mahmut 20, 35, 81, 109 Eroğlu, Meliha Zengin 125, 126, 146, Hepdurgun, Cenan 53 Kavakçı, Önder 125 L 152, 154, 157 Herdem, Ahmet 88 Kaya, Fatma 101 Levent, Esin 159 Eroğlu, Seda 8 Herdi, Oğuzhan 119, 151, 153 Kayahan, Bülent 3 Erol, Almıla 122, 149, 162 Hınıs, Tuba 104 Kaya, Hatice 3, 98, 120 Lewandowski, Eve 38 Hocaoğlu, Çiçek 55, 65, 100, 101, Ertekin, Erhan 98 Kaya, Muratcan 27 M Ertürk, Sevgi Gül 80 124, 126, 131, 172, 176 Kaygısız, Gönül 142 Hürmeydan, Ceren Enüstün 85 Erzincan, Erkal 48 Kayhan, Fatih 93 Malla, İmadeddin 104 Kayıpmaz, Selvi Ceran 97, 98, 159 Erzin, Gamze 52, 56, 62, 96 I Mart, Mehmet 151 Eser, Hasan Hüseyin 104 Kaymak, Semra Ulusoy 112, 115, Memix, Çağdaş Öykü 84 Eşsizoğlu, Altan 27, 47, 89 Irmak, Çetin 13 116, 117, 118, 121, 133 Mete, Ahmet Levent 162 Evren, Ekrem Cüneyt 37 Işıklar, Zeynep 111 Kayran, İbrahim Enis 138 Mete, Bilgül 59 Işıklı, Serhan 21 Keleş, Didem Beşikçi 105, 177 Metin, Sinem Zeynep 122 F Kenangil, Gülay 101 Mırcık, Ali Barlas 92 Kervancıoğlu, Ayşegül 167 Fedai, Ülker 20, 35, 81, 109 İ Mısır, Emre 3 Keser, İlkay 171 Fenercioğlu, Abdullah 64, 134 İçbay, Eda Dağlı 154 Moheb, Kambiz 146 Kesim, Neriman 97 Fidan, Yağmur Sever 165 İçöz, Ferhat Jack 175 Müjdeci, Mahmut 97, 103 Keskinler, Feride 94 Fındıcaklı, Özge 158 İlhan, Ali Oğulcan 112, 113 Mutlu, Emre 66 Keskin, Necla 54, 163 Fıstıkçı, Nurhan 106, 137 İlhan, Bilge Çetin 60, 61, 90 İlhan, İnci Özgür 155 Kiçik, Ani 3, 15 N G İlhan, Mahmut Muzaffer 45 Kiraz, Seda 126, 146, 154 Nabi, Aynur 117 İlnem, Mehmet Cem 79, 139, 160 Kitiş, Ömer 53 Nazlı, Irmak Polat 8, 129, 130 Gelir, Canberk 86, 88 İnanç, Leman 146 Kılıç, Alperen 177 Nazlı, Şerif Bora 5 Genç, Hamit 159 İnce, Ezgi 59, 62, 64, 120 Kılıç, Evnur Kahyacı 57, 109, 121 Neşelioğlu, Salim 51 Genç, Selin Akışık 61 İnhanlı, Damla 61, 166 Kılıç, Neslihan 110 Noyan, Handan 3, 12 Gıca, Şakir 141 İnleyen, Cennet 161 Kılıç, Özge 36 Gıynaş, Fikret Ferzan 165 Kılıç, Tuncer 117 İpekçioğlu, Derya 79, 139, 160 O Göbelek, Meltem 20, 35, 81, 109 İslamoğlu, Sümeyye 117 Kılınçel, Oğuzhan 53, 58 Göğüş, Ali Kemal 119 İspir, Mustafa 174 Kılınçel, Şenay 53, 58 Ocakoğlu, Gökhan 164 Göka, Erol 10, 52, 62, 96, 164, 169 Kırlıoğlu, Simge Seren 48, 49, 133 Oflaz, Serap 59 Göka, Sema 96 K Kırlı, Umut 3 Oğuz, Ayşe Nur 143 Gökçeimam, Pınar 48, 49 Kırpınar, İsmet 92, 117, 177 Oğuz, Gülay 175 Kabadayı, Esra 90 Gökçelli, Duygu Keskin 155 Kır, Yağmur 155 Oğuztürk, Ömer 54 Kahiloğulları, Akfer 63 Gökmen, Emine Nihal Mete 57 Kıvrak, Yüksel 40, 59, 144 Okay, İhsan Tuncer 10 Kahraman, Nazlı 57 Gönül, Ali Saffet 8, 53, 129 Kızılateş, Gözde 8 Okci, Burak 102 Kahve, Aybeniz Civan 169 Görgülü, Yasemin 57, 121 Kızıl, Erguvan Tuğba Özel 107 Okumuş, Nilüfer 142 Kahya, Sermin Gül 121, 132 Görmez, Aynur 77, 117, 177 Kocabaşoğlu, Neşe 103 Omrak, Cansu 104 Kale, Emre 38 Güçlü, Nazmiye 101, 148, 149 Kocakaya, Hanife 31, 34, 52 Onay, Hüseyin 3 Kanat, Bilgen Biçer 158, 161, 164, Güçlü, Oya 139 Koçak, Orhan Murat 5, 54, 107, 156, Onur, Özge Şahmelikoğlu 22, 24, 66, 167, 169 Gülbahar, Duru Saygın 79 157 74, 78 Kanat, Selçuk 164 Güleç, Gülcan 47 Kocamanoğlu, Birsen 98 Oran, Arzu 9, 127 Kandeğer, Ali 119, 147 Güleç, Hüseyin 105, 141, 177 Koç, Güray 95, 96 Oruç, Gamze Akçay 176, 177 Kanmaz, Emine 104 Güleken, Mehmet Diyaddin 125, 131 Kök, Burcu 160 Ovalı, Gülgün Yılmaz 9 Güler, Melahat Gizem 130 Kaptanoğlu, Cem 27 Konkan, Ramazan 139 Gülmez, Haluk 76, 77 Kapucu, Bilge Bilgin 155 Konuk, Numan 17 Ö Gül, Özlem 144 Karaaslan, Mehtap Metin 173 Korkmaz, Şükrü Alperen 117 Gültekin, Bülent Kadri 148 Karabekiroğlu, Aytül 98 Köroğlu, Ayşe 131 Ögel, Kültegin 172 AUTHOR INDEX Gültekin, Gözde 103 Karabekiroğlu, Koray 97, 103, 158 Köroğlu, Ertuğrul 88 Öğüt, Dicle 148 Gültekin, Irmak 104 Karaboğa, Işıl 111 Köse, Burcu Genç 173 Ökmen, Anıl Cemre 147 Gümüş, Yusuf Yasin 87 Karabulut, Deniz Hazal 112, 113 Köse, Sezen 155 Ölmez, Safiye Bahar 86 Günay, Zehra 166 Karabulut, Gamze Sırmalı 98 Köşger, Ferdi 27, 47 Öncü, Bedriye 153 Gündoğan, Meltem 91 Karabulut, Ümit 63 Kotan, Vahap Ozan 10, 52, 97, 98, Önen, Sinay 158, 161, 164, 167, 169 Gündüz, Alper 59 Karaçanta, Aydın 130, 135 159 Öner, İbrahim 95, 96 Gündüz, Anıl 139, 148 Karaca, Özge 107, 113 Kotan, Zeynep 10 Öngür, Dost 38 Gündüz, Cem 92 Karacı, Rahşan 101 Koyuncu, Ahmet 15 Örsel, Sibel 39, 63 Gündüz, Mehmet 129 Karadağ, Hasan 63 Kulakçı, Cemre 140 Özalay, Özgün 53 Gündüz, Nermin 48, 51, 71, 72, 73, Karagöl, Arda 97, 98, 108, 159 Kulaksızoğlu, Burak 120 Özateş, Melike Ezerbolat 119, 153 74, 87, 89, 94, 123, 124, 126, Karakaplan, Belfu 55 Kulaksızoğlu, Sibel 120 Özayhan, Hatice Yardım 145, 146 127, 128 Karakaya, Işık 72 Kumbasar, Hakan 168 Özbaran, Nazlı Burcu 155

180 Özcan, Neslihan Keser 160 Seçkin, Merve 120, 134 Tekdemir, Rukiye 177, 178 Üstün, İsmet 80 Özcan, Selin 169 Sedes, Nilay 111, 129, 153 Tekeli, Merve 142 Özcan, Sevgi 102 Selbes, Ayşe 48, 49 Tekin, Emine 103 V Özçetin, Adnan 86 Selük, Semiha 137 Telatar, Çağla Bilgin 21 Varlık, Cenk 47, 110, 165 Özçiçek, Gamze 54, 107 Selvi, Yavuz 104, 147, 177, 178 Terzi, Murat 175 Varlık, Dilek Sarıkaya 47, 165, 173 Özdel, Kadir 39, 125, 171 Semiz, Ümit Başer 146 Tetik, Dilek Çağlar 168 Varma, Gülfizar Sözeri 107, 113 Özdel, Osman İsmail 99 Sendur, İbrahim 92 Tezcan, Didem 32, 151 Özdemir, Armağan 94, 102 Senkal, Zeynep 93 Tiryaki, Ahmet 95 W Özdemir, Emine Füsun 114 Sertçelik, Sencan 154 Titiz, Ayşe Pınar 62 Özdemir, İlker 39, 49 Sertdemir, Merve 85 Togay, Bilge 12 Wurz, Axel 150 Özdemir, Yusuf Özay 143, 176 Seven, Hilal 145, 146 Tomar, Hazan 177, 178 Özelçi, Erdal 162 Sevgi, Fatih 104 Tomruk, Nesrin Buket 94, 102 Y Özerdem, Ayşegül 50 Sevinçer, Güzin Mukaddes 17 Topak, Osman Zülkif 99 Yağcı, Hacer Paşaoğlu 59 Özeren, Özlem Çapan 76 Sevinçok, Levent 84 Topçuoğlu, Canan 10, 52 Yağcı, İbrahim 59, 144 Özer, Ömer Akil 125, 131 Sevinç, Şeyma Selen 96, 164 Topçuoğlu, Pervin 129 Yalçın, Murat 134, 135 Özer, Sinem 122 Sevindik, Muhammet 157 Topçuoğlu, Volkan 38, 148, 150 Yalçın, Suna Uysal 123 Özer, Ürün 16, 25, 75, 78, 79 Seyithanoğlu, Abdullah 138 Topçu, Seda 111 Yanartaş, Ömer 150 Özgen, Güliz 133 Sezer, Erdi 47 Toppaş, Elif 126, 146, 154 Yaşar, Alişan Burak 125, 152, 171 Öz, Gökhan 66 Sezgin, Serap 175 Trepainer, Cameron Isaacs 50 Yaşar, Çiğdem Çelik 171 Özgüner, Hilal 159 Sinici, Ebru 75 Tüfekçi, Ahmet 55 Yasar, Evren 96 Özgüven, Halise Devrimci 111, 154 Soğucak, Suna 161 Tükel, Raşit 6, 15 Yaşar, Evren 95 Özkal, Ümmühan 167 Sohtaoğlu, Suna 121 Tümkaya, Selim 32, 151 Yavuzer, Hakan 103 Özkan, Hülya 134 Sonel, Eda 153 Tunay, Şebnem 53 Yavuz, Kasım Fatih 13 Özkan, Hüseyin Utku 61 Songur, Emrah 31, 34, 52 Tunca, Dilay 150 Yaylacı, Elif Tatlıdil 62 Özkaya, Güven 10, 52 Sonkurt, Harun Olcay 27, 99 Tuncal, Tolgahan 119, 151, 153 Yazici, Halil 19 Özkınay, Ferda 3 Sonkut, Olcay 47 Tunca, Zeliha 50 Yeni, Seher Naz 131 Özkula, Güler 97, 98, 108, 159 Sönmez, Ekin 150 Tunçel, Özlem Kuman 57 Yeşil, Batuhan 104 Özlü, Mustafa 82 Sönmez, Mehmet Bülent 57, 121 Tunç, Serhat 50, 51 Yeşilkaya, Haluk 79, 139 Özmen, Erol 140 Soyata, Ahmet 120 Tural, Ümit 51 Yeşilyaprak, Nurgül 31 Özpolat, Ayşe Gül Yılmaz 54, 107 Soykan, Çağlar 117 Turan, Hatice 48, 51, 89 Yiğit, Didem 89 Özpoyraz, Nurgül 54 Sözer, Burçhan 143, 170 Turan, Seda G 147 Yiğit, Sadık 163 Öztekin, Siğnem 9, 88, 127 Subaşı, Elif 102 Turgut, Celaleddin 48, 51, 72, 100, Yıldırım, Abdullah 136 Öztürk, Ahmet 92 Sudabatmaz, Mert 98 123, 124, 126, 127, 128, 138 Yıldırım, Ejder 79, 162 Öztürk, Ali Hakan 145 Sungur, Mehmet Zihni 148 Turgut, Seda 45 Yıldırım, Hande 130 Öztürk, Hayriye Mihrimah 36 Turhan, Turan 62 Yıldırımlar, Süleyman Berk 86, 88 Öztürkmen, Ayten 95, 96 Ş Türkcan, Ahmet 114 Yıldırım, Münevver 79 Öztürk, Nalan 116, 123, 163 Türkçapar, Hakan 39, 49, 170, 171, Şafak, Yasir 39, 49, 63, 167 Yıldırım, Münevver Hacıoğlu 162 Öztürk, Nur 136 174 Şahin, Ardıl Bayram 134, 160 Yıldırım, Mustafa 59 Öztürk, Seher Serez 146 Türközer, Halide Bilge 38 Şahin, Berkan 97, 158 Yıldız, Çiğdem Ulaşoğlu 3, 6, 15 Öztürk, Sertaç Alay 149 Tütüncü, Recep 174 Şahin, Emine Hande Kılıçaslan 156 Yıldız, Dilek 59 Özyılmaz, Aysun Selimoğlu 65 Şahin, İbrahim 82 U Yıldız, Emrah 164 P Şahin, İrem 97 Yıldız, Handan 134, 135, 143 Şahin, Mustafa 162 Uğurlu, Görkem Karakaş 90, 112, Yıldızhan, Eren 94, 102 Pamir, Zahide 38 Şahin, Oruç 156 115, 116, 117, 118, 121, 133 Yıldız, Mesut 31, 34 Paslı, Hüda 61, 134 Şahmelikoğlu, Özge Onur 105 Uğurlu, Mehmet 117 Yıldız, Mustafa 89 Pirinççioğlu, Faruk 35, 81, 109 Şeker, Hüseyin Fatih 148, 149 Uğurlu, Mustafa 90, 112, 115, 116, Yıldızoğlu, Emrah 106, 108, 110 Pırıldar, Şebnem 57 Şenay, Olcay 160 117, 118, 121, 133 Yılmaz, Arda 159 Polat, Selim 55, 65, 172 Şenormancı, Ömer 139 Uğurpala, Can 61 Yılmaz, Doğan 75 Pusuroğlu, Meltem 100 Şen, Selçuk 28 Ulaş, Halis 29 Yılmaz, Ekrem 147 Şimşek, Fatma 53 Uluğ, Özlem Şeyda 155 Yılmaz, İmran Gökçen 162 R Ulukaya, Sema 78 Yılmaz, Onur 92 T Ulukol, Betül 111 Yılmaz, Pınar Topçu 61 Rezaki, Hatice Özdemir 54, 107, 157 Ulusan, Asena 153 Yılmaz, Sedef Şeyma 64 Tabak, Fehmi 59 Ulusoy, Sevinç 13 Yılmaz, Tülay 110 S Tamam, Lut 54, 163 Usta, Dilara 125, 171 Yılmaz, Yücel 135 Taneli, Fatma 9, 127 Saatcioğlu, İbrahim Ömer 102 Usta, Miraç Barış 87, 97, 103, 158 Yılmaz, Yusuf Erçin 141 Taner, Hande Ayraler 97, 98 Sağdıç, Meylin Karalar 150 Uyan, Tuğçe Taşkın 124 Yokuşoğlu, Çağdaş 3, 12, 120 Tanrıkulu, Ali Baran 60, 90, 91, 146 Saka, Merve Amine Atalay 128 Uyar, Tuğba 173 Young, Trevor 50 Tanrıtanır, Bilal 91 Salihoğlu, Gözde 100, 124, 126 Uygun, Ersin 25 Yüce, Burcu 83 Tanyeri, Selin 155

Samanlı, Hatice 12 Uygur, Selma Çilem 167, 168 Yüksel, Meryem 164 AUTHOR INDEX Tapancı, Zafer 136 Sancak, Barış 16, 114, 144 Uzun, Utku 136, 152 Yüksel, Rabia Nazik 10, 52, 62, 169 Taşan, Ertuğrul 45 Sargın, Fatma 59 Yürüyen, Mehmet 103 Taşçı, Sevde Yılmaz 134 Sarı, Burcu Akın 97, 98 Ü Yüzeren, Serra 88 Taşdelen, Yasin 40 Sarıçiçek, Aybala 122 Tas, Halil İbrahim 110 Üçok, Alp 3, 12, 61, 62, 120, 134 Sarıkavak, Talat 88 Z Taşkın, Emin Oryal 140 Ünal, Ahmet 164 Sayar, Gökben Hızlı 76, 77 Taşsöker, Melek 102 Ünal, Gülşen Teksin 66 Zeki, Şeyma Nur 104 Saygılı, İshak 105, 177 Tatlı, Mustafa 118 Ünal, Kübranur 62 Zorlu, Nabi 21, 63 Saygın, Nimet 171 Tatlı, Safiye Zeynep 153 Ünal, Yasemin 146 Züngün, Cevdet 62 Say, Gökçe Nur 56, 114, 158 Tatlı, Zeynep 90 Ünübol, Hüseyin 65 Sayın, Ayça Asena 58, 147 Taymur, İbrahim 158, 161, 164, 167, Ürer, Emre 52, 56, 97 Scola, Gustavo 50 169 Üstündağ, Mehmet Fatih 105

181 Yazarlara Bilgi

A. 9. Her şekil ve tablo ayrı bir sayfaya çizilmelidir. Şekiller fotoğraf filmi alınabi- Türk Psikiyatri Dergisi öncelikle klinik psikiyatri olmak üzere davranış bilim- lecek kalitede basılmalıdır. Tablolarla ilgili başlık ve bilgiler tablonun verildiği leri alanındaki çalışmalara yer verir. Dergiye gönderilen yazıların daha önce sayfada yer almalıdır. Metin içinde de şekil ve tabloların yerleri gösterilmelidir. yayınlanmamış ya da yayın için kabul edilmemiş olması gereklidir. Gözden 10. Kaynaklar metin içinde yazarların soyadı ve yazının yayın tarihi ile belirtil- geçirme ve araştırma yazılarının uzunluğu, şekil ve tablolar dahil çift aralıklı meli, yazar ve tarih arasında virgül konmamalıdır. İkiden fazla yazar varsa 20 sayfayı geçmemelidir. Yazılara en az 150, en çok 200 sözcükten oluşan birinci yazarın soyadı “ve ark.” ibaresiyle verilmeli, iki yazar varsa her ikisi Türkçe, en az 230, en çok 250 sözcükten oluşan İngilizce özet eklenmelidir. de belirtilmelidir. Araştırma yazılarının Türkçe ve İngilizce özetleri, şu alt başlıklar ile yazıl- malıdır: Amaç (Objective), Yöntem (Method), Bulgular (Results), Sonuç Örnekler: Bu konuda yapılan bir çalışmada (Crow 1983)..., Crow ve Snyder (Conclusion). (1981) şizofreni konusunda..., ...ilgili çalışmalar (Synder ve ark. 1982)..., ...bir 1. ARAŞTIRMA YAZILARI çalışmada (Crow ve Synder 1981)... Bilimsel yöntem ve kurallara uygun olarak yapılmış araştırmaların bildirileri Aynı yazarın aynı yıla ait değişik yayınları ise (Freud 1915a), (Freud 1915b) şek- bu bölümde yer alır. linde belirtilmelidir. Aynı noktada birden çok kaynak belirtileceği zaman kaynaklar 2. GÖZDEN GEÇİRME YAZILARI aynı ayraç içinde, birbirinden virgül ile ayrılarak verilmelidir. Örnek: (Crow 1981, En yeni bilgileri kapsamlı olarak gözden geçiren ve tartışan yazılar bu bö- Synder 1980); (Crow 1981, Synder ve ark. 1970) lümde yayınlanır. 11. Metin sonunda kaynaklar ayrı bir liste olarak alfabetik sıra ile verilmelidir. 3. OLGU SUNUMLARI Yazar(lar)ın soyad(lar)ı ve ad(lar)ının baş harf(ler)i arada nokta ya da virgül İlginç klinik olguların sunumları yer alır. Bu yazıların çift aralıklı 10 sayfayı olmadan belirtilmelidir. Bir kaynakta üçten çok yazar varsa üçüncü yazardan geçmemesi gerekir. sonra “ve ark” ibaresi yer almalıdır. Bunların ardından kaynağın basım tarihi 4. DİL SORUNLARI ayraç içinde verilmelidir. Psikiyatri alanındaki dil tartışmaları bu başlık altında yayınlanır. a) Kaynak bir makale ise tarihin ardından makalenin tam adı, yayınlandığı derginin 5. MEKTUP adı (Index Medicus’daki kısaltmalardan yararlanılmalıdır), cilt no (cilt no belirtilme- Bu bölümde Dergide yer alan değişik konularda tartışma forumu oluştura- mişse ayraç içinde sayı no) ve sayfa numaraları yazılmalıdır. bilecek mektup ve görüşler yayınlanır. 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. 6. KİTAP TANITIMI b) Bir derginin ek sayısı (supplementum) kaynak gösterileceği zaman; İlgili alanlarda yayınlanmış kitapların tanıtım ve eleştirisini içeren yazılar bu Kozkas HG, Homberg LK, Freed GD ve ark. (1987) A pilot study of MAOIs. Acta bölümde yer alır. Psychiatr Scand, 63 (Suppl. 290) 320-328. B. c) Kaynak bir kitap ise yazar(lar)ın adı ve basım tarihinden sonra kitabın adı, (bir- 1. Türk Psikiyatri Dergisi’nde yayınlanması istenen yazılar çevrimiçi (online) den çok basımı varsa) kaçıncı basım olduğu, basımyeri, basımevi ve sayfası belir- olarak gönderilmelidir. Çevrimiçi yazılar www.turkpsikiyatri.com adresindeki tilmelidir. Kitap bir çeviri ise hangi dilden çevrildiği ve çeviren(ler)in adı verilmelidir. çevrimiçi bağlantısından yüklenir. Mark IMJ (1987) Fears, Phobias and Rituals. New York Oxford University Press, s. 97. 2. Yazarlar doğrudan çalışmayı yapan ve yazan kişiler olmalıdır, çalışmayı des- tekleyen ya da çalışma ile ilgili danışılan kişilerin adları gerekliyse teşekkür d) Kaynak çok yazarlı bir kitabın bölümü ya da bir makalesi ise bölümün ya da bölümünde anılmalıdır. Araştırma yazılarında çalışmanın yapıldığı kurum be- makalenin yazarı, tarih, bölümün ya da makalenin adı, kitabın adı, kaçıncı baskı olduğu, cildi, kitabın editörleri, basım yeri sayfaları yazılmalıdır. lirtilmelidir. Meltzer HY, Lowy MT (1986) Neuroendocrin function in psychiatric disorders. 3. Yayınlanmak üzere gönderilen yazıların araştırma ve yayın etiğine uygun ol- American Handbook of Psychiatry, 2. Baskı, cilt 8, PA Berger, HKH Brodie (Ed), maları gereklidir. New York. Basic Books Inc, s. 110-117. 4. Türk Psikiyatri Dergisi’ne gönderilen ölçek geçerlik-güvenilirlik çalışmalarının e) Türkçeye çevrilmiş kitap ve dergileri kaynak gösterirken: yayına kabul edilmesi durumunda, ölçeğin kendisi (özgün ya da çeviri) Dergi 1. Hangi kaynaktan yararlandıysanız onu kaynak gösteriniz (Türkçesi veya aslı). web sitesinde yayınlanacaktır. Ölçek çalışmaları ile ilgili yazıların değerlendir- 2. Türkçeye çevrilmiş kitaplar aşağıdaki şekilde kaynak gösterilmelidir. Wise MG, Rundel JR (1994) Konsültasyon Psikiyatrisi (Çev. TT Tüzer, V Tüzer). me için kabulü aşamasında, bu koşul yazarlara bildirilecek; yazı, yazarlar bu Compos Mentis Yayınları, Ankara, 1997. koşulu kabul ettikleri takdirde değerlendirme sürecine alınacaktır. Dergi web Metin içinde “Wise ve Rundell (1994)” şeklinde verilmelidir. sitesinde ölçekle birlikte, ölçeğin kullanım ve telif hakları ile ilgili bilgiler de 3. Sık kullanılan çeviri kaynaklara örnekler: verilecektir. Amerikan Psikiyatri Birliği (1994) Mental Bozuklukların Tanısal ve Sayımsal El Kita- 5. Çevrimiçi olarak yüklenen yazılarda ilk iki sayfada sırayla Türkçe ve İngilizce bı, Dördüncü Baskı (DSM-IV) (Çev. ed.: E Köroğlu) Hekimler Yayın Birliği, Ankara, özet yer almalıdır. Özetlerin başında yazının Türkçe ve İngilizce başlığı, so- 1995. Metin içinde “Amerikan Psikiyatri Birliği (1994)” şeklinde belirtilmelidir. nuna ise mutlaka 3-6 anahtar sözcük konmalıdır. Türkçe anahtar sözcükler Dünya Sağlık Örgütü (1992) ICD-10 Ruhsal ve Davranışsal Bozukluklar Sınıflandı- http://www.bilimterimleri.com adresinden, İngilizce anahtar sözcükler ise rılması. (Çev. ed.: MO Öztürk, B. Uluğ, Çev.: F. Çuhadaroğlu, İ. Kaplan, G. Özgen, http://www.ncbi.nlm.nih.gov/mesh adresinden seçilmelidir. Özet sayfaların- MO Öztürk, M Rezaki, B Uluğ). Türkiye Sinir ve Ruh Sağlığı Derneği Yayını, Ankara, dan sonraki sayfalar numaralandırılmalıdır. Başvurularda yazının eklendiği 1993. dosyada yazar adı ve adresi bulunmamalıdır. Metin içinde “Dünya Sağlık Örgütü (1992)” şeklinde yer almalıdır. 6. Yayınlanması düşünülen yazıların eleştiri ve öneriler doğrultusunda gözden f) Sadece Internet üzerinden yayınlanan bir dergide yer alan makale kaynak olarak geçirilmesi yazarlardan istenebilir. Yazarların onayı alınmak koşulu ile yayın gösteriliyorsa: kurulunca yazılarda değişiklik yapılabilir. Gönderilen yazı ile ilgili gelişmeler 1. Tam yayın tarihi kullanılır. e-posta adresine bildirilir. Dergide yayınlanan yazılar için ücret ya da karşılık 2. Genellikle cilt ve dergi sayıları, sayfa numaraları yoktur. ödenmez. 3. Makaleye doğrudan ulaşım adresi ve indirilen tarih verilmelidir. Frederickson BL (2000, Mart 7). Cultivating positive emotions to optimize he- 7. Derginin yayın dili Türkçedir. Yazılar kolay anlaşılır olmalı, elden geldiğince alth and well-being. Prevention & Treatment 3, Makale 0001a. 20 Kasım 2000’de yabancı sözcüklerin Türkçe karşılıkları kullanılmalı, alışılmamış sözcüklerin http://journals.apa.org./prevention/volume3/pre003000-1a.html adresinden indi- yabancı dildeki karşılıkları ilk kullanımlarında ayraç içinde verilmelidir. Yazı rildi. içinde geçen ilaçların ticari adları yerine jenerik adları Türkçe okunduğu biçi- 12. Kaynakların doğruluğundan yazar(lar) sorumludur. Doğrudan yararlanılma- miyle verilmelidir. yan ya da başka kaynaklardan aktarılmış kaynaklar belirtilmemeli, basılma- 8. Yazılarda dipnot kullanılmamalı, açıklamalar yazı içinde verilmelidir. mış eserler, kişisel haberleşmeler, Medline taramalarından ulaşılan makalele- rin özetleri kaynak gösterilmemelidir.