Publications by authors named "Tunç Alkın"

25 Publications

  • Page 1 of 1

Maternal psychiatric status and infant wheezing: The role of maternal hormones and cord blood cytokines.

Pediatr Pulmonol 2021 Feb 15. Epub 2021 Feb 15.

Department of Pediatric Allergy and Pulmonology, Celal Bayar University Medical Faculty, Manisa, Turkey.

Rationale: Maternal psychosocial stress might be associated with development of allergic diseases in the offspring.

Objectives: To evaluate the association of maternal depression and anxiety with ever wheezing and recurrent wheezing among infants and to assess the role of maternal hypothalamo-pituatary-adrenal axis changes and fetal immune response in this association.

Methods: This study encompasses two designs; cohort design was developed to evaluate the association of prenatal depression with development of wheezing in infants while nested case-control design was used to assess the role of maternal cortisol and tetranectin and cord blood interleukin 13 and interferon γ.

Results: We enrolled 697 pregnant women. Elementary school graduate mother (odds ratio [OR] = 1.5, p = .06), maternal smoking during pregnancy (OR = 3.4, p = .001), familial history of asthma (OR = 2.7, p < .001) increased the risk of ever wheezing. Elementary school graduate mother (OR = 2.6, p = .002), maternal smoking during pregnancy (OR = 4.8, p < .001) and familial history of asthma (OR = 1.7, p = .01) increased the risk of recurrent wheezing. Maternal previous psychiatric disease, or Edinburgh Postnatal Depression Scale or Spielberger State-Trait Anxiety Inventory scores were not associated with wheezing. Maternal tetranectin levels were significantly higher among never wheezers compared to the ever wheezers (264.3 ± 274.8 vs. 201.6 ± 299.7, p = .04).

Conclusions: In conclusion, the major risk factors for ever wheezing and recurrent wheezing were maternal smoking, level of education and family history of asthma. However, maternal depression and anxiety were not determined as risk factors for wheezing. Maternal tetranectin carries potential as a biomarker for wheezing in the infant.
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http://dx.doi.org/10.1002/ppul.25302DOI Listing
February 2021

Vestibular migraine patients are more anxious than migraine patients without vestibular symptoms.

J Neurol 2017 Oct 9;264(Suppl 1):37-41. Epub 2017 Mar 9.

Department of Psychiatry, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.

The link between vertigo and anxiety is well known. The aim of this study is to compare anxiety disorders in 3 groups: patients with vestibular migraine (VM), patients with migraine but without vertigo (MO) and healthy controls (HC).We performed cross-sectional analysis of following tests: (a) Hamilton Anxiety Rating Scale (HAMA); (b) State-Trait Anxiety Inventory (STAI-X1 and STAI-X2); (c) Beck Depression Inventory (BDI); (d) Panic-Agoraphobic Scale and (e) Penn State Worry Questionnaire (PSWQ). ANOVA, Kruskal-Wallis and Chi-square tests were used for comparisons and least significant difference was used for further post-hoc analysis. There were 35 definite VM patients, 31 MO patients and 32 volunteer HC. There were no significant differences between three groups in age, total years of education or duration of headaches in VM and MO patients. On the other hand, vertigo severity  was moderately and positively correlated with headache severity and with headache duration. There were significant differences in scores of HARS, BDI, PSWQ, and various PAS-R sub-scales between the three groups. Our study shows that VM patients are significantly more anxious and agoraphobic than MO patients and HC, displaying higher sensitivity to separation and being more prone to seeking medical reassurance.
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http://dx.doi.org/10.1007/s00415-017-8439-6DOI Listing
October 2017

Development of social anxiety disorder secondary to attention deficit/hyperactivity disorder (the developmental hypothesis).

Early Interv Psychiatry 2018 04 1;12(2):269-272. Epub 2016 Sep 1.

Department of Psychiatry, Istanbul University, Istanbul Medical School, Istanbul, Turkey.

Social anxiety disorder (SAD) may develop secondary to childhood attention deficit/hyperactivity (ADHD) in a subgroup of the patients with SAD. Patients pass through a number of identifiable stages of developmental pathways to SAD as they grow up. Patients with ADHD have maladaptive behaviours in social settings due to the symptoms of ADHD. These behaviours are criticized by their parents and social circle; they receive insults, humiliation and bullying. After each aversive incident, the individual feels shame and guilt. A vicious cycle emerges. The patients then develop social fears and a cognitive inhibition that occurs in social situations. The inhibition increases gradually as the fear persists and the individual becomes withdrawn. Patients start to monitor themselves and to focus on others' feedback. Finally, performative social situations become extremely stimulating for them and may trigger anxiety/panic attacks. If this hypothesis is proven, treatment of 'patients with SAD secondary to ADHD' should focus on the primary disease.
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http://dx.doi.org/10.1111/eip.12372DOI Listing
April 2018

Comparison of Cognitive Impairment between Patients having Epilepsy and Psychogenic Nonepileptic Seizures.

Noro Psikiyatr Ars 2015 Jun 1;52(2):163-168. Epub 2015 Jun 1.

Department of Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.

Introduction: The aim of this study was to evaluate cognitive impairment in patients having epilepsy or psychogenic nonepileptic seizures (PNESs) using selected neuropsychological tests at different time periods related to the seizure.

Methods: In this study, selected neurocognitive tests were administered to the patients. Within 24 h, the previously applied neurocognitive tests were repeated within 24 h following the observation of typical seizures when monitoring and normalizing electroencephalography (EEG) activity. Basal neurocognitive tests were also administered to the healthy control group, and repeat neurocognitive evaluation was performed within 24-96 h.

Results: The basal neurocognitive evaluation revealed that verbal learning and memory scores as well as Stroop test interference time were significantly lower in the PNES group compared with those in the controls. In the basal cognitive tests administered to the patients with epilepsy, verbal learning and memory scores, long-term memory, and total recognition test scores were significantly lower than those of the controls. Following the repeat cognitive tests, significant progress was found in the verbal categorical fluency score of the PNES group. No significant difference was determined in the epilepsy group. Significant contraction was determined in the Stroop interference time in the control group, but no similar change was recorded in the epilepsy or PNES groups.

Conclusion: While memory problems seemed to be most prominent in the assessed patients with epilepsy, attention and executive function problems were more dominant in the patients with PNESs. These findings are probably related to numerous factors such duration of disease, mood disorders, and specific drug use. No deterioration in attention and executive functions was reported in the early post-seizure period in either patient group.
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http://dx.doi.org/10.5152/npa.2015.7290DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5353192PMC
June 2015

[Anxiety disorder due to epilepsy: a case report].

Turk Psikiyatri Derg 2015 ;26(1):71-5

Epileptic patients present with psychiatric disorders more frequently than the general population and patients with other chronic medical conditions. Psychiatric disorders can co-occur with epilepsy and can be caused by epilepsy. Personality changes, as well as psychosis, and mood or anxiety disorders can occur in association with epilepsy. Anxiety disorders due to epilepsy can manifest as generalized anxiety disorder, panic disorder, phobias, or obsessive-compulsive disorder. The risk of an anxiety disorder is higher in patients with focal epilepsy, especially those with temporal lobe epilepsy, but an anxiety disorder can also occur in patients with frontal lobe epilepsy or generalized tonic-clonic epilepsy. Herein we present a 41-year-old female patient with comorbid anxiety disorder and epilepsy that improved following initiation of antiepileptic medication. The patient's EEG showed abnormalities, particularly in the frontal lobe. Epileptic activation-associated anxiety disorder presented as phobia of swallowing and the patient exhibited features of generalized anxiety disorder. Following initiation of antiepileptic medication, the seizures stopped and the symptoms of anxiety disappeared in two weeks. The patient was receiving psychotherapy once every 2 weeks. The patient remained asymptomatic during 2-years of follow-up. This case highlights the importance of differential diagnosis of underlying epilepsy in patients with acute severe anxiety and the efficacy of proper medical treatment, which was given in the presented case for the underling pathology of anxiety.
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December 2015

Alexithymia and emotional intelligence in patients with panic disorder, generalized anxiety disorder and major depressive disorder.

Psychiatr Q 2013 Sep;84(3):303-11

Dokuz Eylül University, Izmir, Turkey.

Emotional Intelligence (EI) is a broad personality construct signifying the ability to perceive and to regulate affects within oneself. Alexithymia is another personality construct denoting difficulty in identifying and expressing emotions, with an externally oriented thinking style. Although previously considered to be independent, some studies have shown that these constructs overlap. The aim of this study was to evaluate and compare the levels of EI and alexithymia in patients with panic disorder, major depressive disorder (MDD), and generalized anxiety disorder (GAD). The subjects included 171 psychiatric patients and 56 non-clinical controls. Psychiatric diagnoses were based on DSM-IV criteria. The Emotional Intelligence Scale-34 (EIS-34) and the Toronto Alexithymia Scale (TAS-20) were used to assess EI and alexithymia. All three patient groups scored statistically significantly higher than the non-clinical controls on TAS-20 total score and the TAS-20 subfactors of difficulty identifying feelings and difficulty describing feelings. EIS-34 scores were lower in patient groups than in the non-clinical controls, but only the EIS-34 intrapersonal subscale was significant difference. Total TAS-20 and EIS-34 scores in the patient cohort were inversely and significantly correlated These results reaffirm an overlap between EI and alexithymia with the intrapersonal factor of EI to be more dependent on the difficulty identifying feelings dimension of alexithymia in subjects with MDD and GAD.
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http://dx.doi.org/10.1007/s11126-012-9246-yDOI Listing
September 2013

The validity and reliability of Turkish version of separation anxiety symptom inventory and adult separation anxiety questionnaire.

Turk Psikiyatri Derg 2012 ;23(2):108-16

Institute of Health Sciences, Department of Neuroscience, Dokuz Eylül University, Turkey.

Aim: The aim of this study is to evaluate the validity and reliability of Separation Anxiety Symptoms Inventory (SASI) that assess childhood separation anxiety retrospectively and Adult Separation Anxiety Questionnaire (ASA).

Method: The study sample included a group of 410 participants comprised of 282 adult psychiatric outpatients with anxiety and/or major depressive disorders according to DSM-IV criteria and 128 nonpsychiatric control subjects. The presence of psychiatric disorders was determined by using the M.I.N.I. (Mini International Neuropsychiatric Interview). Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), Separation Anxiety Symptoms Inventory (SASI), Adult Separation Anxiety Questionnaire (ASA), Panic Disorder Severity Scale (PDSS), "Sensitivity to Separations" subscale of Panic Agorapfobic Spectrum Scale (PAS-SR), Anxiety Sensitivity Index (ASI) were also given.

Findings: The validity assessments of the instruments revealed that SASI and ASA discriminated the psychiatric patients from control subjects. Both instruments displayed high correlation with SCI-SAS and PAS-SR, a moderate correlation with ASI and PDSS. Factor structure assessments revealed the existence of 3 factor for SASI and 5 factor for ASA. Both SASI and ASA has a high level of internal consistency (Cronbach alfa coefficients are 0.89 and 0.93 respectively) and their test-retest reliability is fairly good.

Results: Turkish versions of SASI and ASA were found to be valid and reliable. Results indicate that those instruments can be used in clinical studies for surveying adult separation anxiety disorder and determining its severity.
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February 2016

Hypersensitivity to 35% carbon dioxide in patients with adult separation anxiety disorder.

J Affect Disord 2012 Dec 28;141(2-3):315-23. Epub 2012 Apr 28.

Buca Seyfi Demirsoy Devlet Hastanesi, Turkey.

Background: Adults with panic disorder (PD) and children with separation anxiety disorder (CSAD) show higher reactivity to CO(2). Our hypothesis was patients with adult separation anxiety disorder (ASAD) would show similar hypersensitivity to CO(2). In the present study, we determined whether sensitivity to CO(2) was enhanced in adult patients with separation anxiety disorder with no history of panic attacks.

Methods: Patients with PD (n=38), adult separation anxiety disorder (ASAD) patients with no history of panic attacks (n=31), and healthy subjects (n=40) underwent a 35% CO(2) inhalation challenge procedure. Baseline and post-inhalation anxiety were assessed with the Acute Panic Inventory, Visual Analog Scale, and Anxiety Sensitivity Index-3 (ASI-3).

Results: As hypothesized the rate of CO(2)-induced panic attacks was significantly greater in PD and ASAD patient groups (55.3% and 51.6% respectively) than healthy comparison group (17.5%). Nine (69.2%) of 13 patients in PD group who have ASAD concurrent with PD had a CO(2)-induced panic attack. ASI-3 total scores were not different between PD and ASAD groups and both were significantly higher than controls. However, anxiety sensitivity did not predict the occurrence of panic attacks.

Limitations: The researchers were not blind to the diagnosis and there was no placebo arm for comparison. Besides, parameters of respiratory physiology were not evaluated.

Conclusion: ASAD was associated with CO(2) hypersensitivity quite similar to PD. This finding partly unfolds the complex relationship of 'CSAD, PD, and CO(2) hypersensitivity' and indicates that CO(2) hypersensitivity and separation anxiety extend together beyond childhood.
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http://dx.doi.org/10.1016/j.jad.2012.03.032DOI Listing
December 2012

Temperament and character dimensions of patients with adult separation anxiety disorder.

J Affect Disord 2012 Jul 21;139(2):199-203. Epub 2012 Mar 21.

Zonguldak State Hospital.

Background: There is growing evidence suggesting that separation anxiety can occur in adults. We aimed to determine temperament and character dimensions in patients with adult separation anxiety disorder (ASAD) compared to patients with panic disorder (PD) and healthy subjects.

Methods: The study sample included 77 outpatients with ASAD, 44 outpatients with a PD with or without agoraphobia diagnosis, and 35 healthy subjects. ASAD diagnoses were confirmed with Structured Clinical Interview for Separation Anxiety Symptoms. Other measures included Adulthood Separation Anxiety Checklist, Separation Anxiety Symptom Inventory, and Temperament and Character Inventory (TCI). Group comparisons according to presence or absence of PD comorbidity in ASAD were also done.

Results: Patients with ASAD scored higher in harm avoidance (HA) and scored lower in self-directedness (SD) compared to PD and control groups. Moreover, both PD patients and ASAD patients scored higher in RD, and self-transcendence dimensions than control subjects. All subscales of HA (anticipatory worry, fear of uncertainty, shyness, and fatigability) were significantly higher than controls. While HA scores were not different between ASAD and 'ASAD+PD' patients, HA levels of both groups were higher than PD alone and control groups. SD scores of patients with ASAD were lower than PD and control groups.

Limitations: Cross-sectional design and ASAD group have other anxiety disorders comorbidity which might affect the results.

Conclusion: Similar to PD and other anxiety disorders HA and RD was higher, and SD was lower in patients with ASAD compared to healthy subjects. Observed TCI profile is related to the ASAD itself since depression comorbidity was controlled.
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http://dx.doi.org/10.1016/j.jad.2012.02.034DOI Listing
July 2012

Anxiety sensitivity and its importance in psychiatric disorders.

Turk Psikiyatri Derg 2011 ;22(3):187-93

Department of Psychiatry, Izmir Ataturk Training and Research Hospital.

Anxiety sensitivity refers to the extent of beliefs that anxiety symptoms or arousal can have harmful consequences. There is growing evidence for anxiety sensitivity as a risk factor for anxiety disorders. Anxiety sensitivity is elevated in panic disorder as well as other anxiety disorders. It is thought to contribute to the maintenance and severity of anxiety symptoms. Studies have shown that anxiety sensitivity more specifically predicts the future occurrence of panic attacks. The Anxiety Sensitivity Index (ASI), which measures the construct of anxiety sensitivity, has three subscales, namely, the ASI-Physical subscale, ASI-Social subscale and ASI-Mental Incapacitation Concerns subscale. The dimension reflecting "fear of physical sensations" of anxiety sensitivity is the most predictive one of panic attacks and panic disorder. Research on the ASI has demonstrated that persons diagnosed with post-traumatic stress disorder, generalized anxiety disorder, obsessive-compulsive disorder, and social anxiety disorder all had ASI scores higher than normal controls. Depression was speculated to hold a positive correlation to high anxiety sensitivity scores. The relationships between anxiety sensitivity, alcohol and substance use disorders are still unknown. There is evidence that anxiety sensitivity is related with "drinking used as a way of coping". Since anxiety sensitivity is a cognitive construct, it should be taken into consideration when evaluating patients with anxiety and psychotherapeutic formulations.
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February 2012

Ethnic and migrational impact on the clinical manifestation of depression.

Soc Psychiatry Psychiatr Epidemiol 2012 Jul 31;47(7):1121-9. Epub 2011 Jul 31.

Department of General Psychiatry, Medical University Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.

Purpose: Depressive disorders are still underdiagnosed. Ethnic and cultural factors may influence the way depression is presented and therefore contribute to problems in assessing these disorders in different ethnic populations appropriately. In this investigation, the impact of both ethnicity and migration on the manifestation of depression was studied.

Methods: Three groups of depressed female patients (n = 136) were included in this investigation on the variation in depressive symptomatology by ethnic groups. Group 1 consisted of Austrian patients living in Austria, group 2 were Turkish patients who had migrated to Austria and group 3 were Turkish patients living in Turkey. Participants were rated using the Montgomery-Åsberg Depression Rating Scale (MADRS), the Beck Depression Inventory (BDI), the Bradford Somatic Inventory (BSI) and an additional list of physical symptoms.

Results: Both Turkish groups had significantly higher BSI scores and more somatic symptom severity. Migrated Turkish patients scored significantly higher in the items headache, backache and dry mouth than Turkish patients in Turkey. In addition, there were between-group differences in non-physical symptoms.

Conclusions: Depressive symptomatology varies between ethnic groups. These differences are mainly due to ethnicity as such but migration may play an additional role. It is essential for physicians to be aware of atypical presentation forms of depression in minority groups.
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http://dx.doi.org/10.1007/s00127-011-0417-1DOI Listing
July 2012

[The validity and reliability of the Turkish version of the anxiety sensitivity index-3].

Turk Psikiyatri Derg 2010 ;21(3):225-34

Izmir Ataturk Egitim ve Arastirma Hastanesi Narlidere Semt Poliklinigi, Izmir.

Objective: Anxiety sensitivity has been defined as an excessive fear from senses and symptoms of anxiety. The aim of the present study is to investigate the validity and reliability of Anxiety Sensitivity Index-3 (ASI-3) and adapting it into Turkish.

Method: The study group consisted of 150 healthy individuals without any psychiatric disorder and 300 patients with an anxiety disorder and/or major depressive disorder according to DSM-IV criteria. All subjects included in the study were evaluated by means of the Mini International Neuropsychiatric Interview, ASI-3, Anxiety Sensitivity Index (ASI), State-Trait Anxiety Inventory-Trait Form (STAI-T), Beck Depression Inventory (BDI) and Somatosensory Amplification Scale (SAS).

Results: The validity part of the study revealed that the scale differentiates the patients from the healthy group in all patient subgroups except for anxiety disorder NOS. The scale was found to be highly correlated to ASI (r=0.85) and moderately correlated to STAI-T (r=0.68), BDI (r=0.57) and SAS (r=0.47). In factor analysis, ASI-3 was found to be composed of 3 factors: physical, cognitive and social. It was also found that ASI-3 had a high internal consistency (Cronbachalpha=0.93) and the scale had a fairly good test-retest reliability (r=0.64, p<0.001).

Conclusion: According to the present study, the ASI-3 Turkish version was shown to be a valid and a reliable scale.
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November 2010

[Undergraduate psychiatric training in Turkey].

Turk Psikiyatri Derg 2010 ;21(3):195-202

Psikiyatri AD, Mersin University, Tip Fak., Mersin.

Objective: The current trend in medical education is to abandon the experience-based traditional model and embrace the competency-based education model (CBE). The basic principle behind CBE is standardization. The first step in standardization is to determine what students must know, what they must accomplish, and what attitude they should display, and the establishment of educational goals. One of the goals of the Psychiatric Association of Turkey, Psychiatric Training Section is to standardize psychiatric training in Turkish medical schools. This study aimed to determine the current state of undergraduate psychiatric training in Turkish medical schools.

Method: Questionnaires were sent to the psychiatry department chairs of 41 medical schools. Data were analyzed using descriptive statistical methods.

Results: Of the 41 department chairs that were sent the questionnaire, 29 (70%) completed and returned them, of which 16 (66.7%) reported that they had already defined goals and educational objectives for their undergraduate psychiatric training programs. The Core Education Program, prepared by the Turkish Medicine and Health Education Council, was predominately used at 9 (37.5%) medical schools. Pre-clinical and clinical training schedules varied between medical schools. In all, 3 of the medical schools did not offer internships in psychiatry. The majority of chairs emphasized the importance of mood disorders (49.9%) and anxiety disorders (40%), suggesting that these disorders should be treated by general practitioners. Computer technology was commonly used for lecturing; however, utilization of interactive and skill-based teaching methods was limited. The most commonly used evaluation methods were written examination (87.5%) during preclinical training and oral examination (91.6%) during clinical training.

Conclusion: The most important finding of this study was the lack of a standardized curriculum for psychiatric training in Turkey. Standardization of psychiatric training in Turkish medical schools must be developed.
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November 2010

History of suffocation, state-trait anxiety, and anxiety sensitivity in predicting 35% carbon dioxide-induced panic.

Psychiatry Res 2010 Sep 16;179(2):194-7. Epub 2010 May 16.

Department of Psychiatry, Dokuz Eylül University School of Medicine, Izmir, Turkey.

The aim of this study was to examine the effects of history of suffocation, state-trait anxiety, and anxiety sensitivity on response to a 35% carbon dioxide (CO₂) challenge in panic disorder patients, their healthy first-degree relatives and healthy comparisons. Thirty-two patients with panic disorder, 32 first-degree relatives, and 34 healthy volunteers underwent the 35% CO₂ challenge. We assessed baseline anxiety with the Anxiety Sensitivity Index (ASI) and State-Trait Anxiety Inventory (STAI1), and panic symptoms with the Panic Symptom List (PSL III-R). A history of suffocation was associated with greater risk of CO₂ reactivity in the combined sample. Patients had more anxiety sensitivity and state and trait anxiety than relatives and healthy comparisons; the difference between relatives and healthy comparisons was not significant. In female patients, trait anxiety predicted CO₂-induced panic. Having a CO₂-sensitive panic disorder patient as a first-degree relative did not predict CO₂-induced panic in a healthy relative. History of suffocation may be an important predictor of CO₂-induced panic. Trait anxiety may have a gender-specific relation to CO₂ reactivity.
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http://dx.doi.org/10.1016/j.psychres.2009.06.015DOI Listing
September 2010

Electroconvulsive therapy in an adolescent pregnant patient.

Prog Neuropsychopharmacol Biol Psychiatry 2010 Apr 24;34(3):546-7. Epub 2009 Nov 24.

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http://dx.doi.org/10.1016/j.pnpbp.2009.11.014DOI Listing
April 2010

[Character and temperament dimensions of patients with temporomandibular disorder].

Turk Psikiyatri Derg 2008 ;19(3):274-82

Objective: The nature of the relationship between personality and temporomandibular disorder is an important, but still unexplored question. The objective of this study was to assess the personality profile of a sample of patients with temporomandibular disorder using the Temperament and Character Inventory (TCI).

Method: The study included 81 patients [17 male (21%) and 64 female (79%)] with temporomandibular disorder and 80 healthy control subjects [15 male (18.75%) and 65 female (81.25%)]. A Turkish version of TCI was used for personality self-assessment. The data were evaluated with multivariate analyses of variance.

Results: Multivariate analyses of variance showed that the temperamental dimension, novelty seeking (F= 8.61, P= 0.004), was associated with temporomandibular disorder. Higher novelty seeking is thought to be linked to higher impulsiveness, exploratory excitability, and disorderliness. Also, there were significant differences between patients and healthy subjects on fatigability, purposefulness, compassion, and principled subscales of TCI. Gender differences were also found for different temperament and character dimensions. Women scored significantly higher on the self-directedness dimension, whereas male patients with temporomandibular disorder had significantly higher scores on the temperamental dimension of harm avoidance and its sub-dimension, shyness.

Conclusion: Our study offers clinical evidence of the relationship between temporomandibular disorder and the personality profile of a high level of novelty seeking, which is considered to be associated with cluster B personality disorders. Assessing personality in patients with temporomandibular disorder should be considered while implementing treatment.
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December 2008

Co-occurence of blepharospasm, tourettism and obsessive-compulsive symptoms during lamotrigine treatment.

Prog Neuropsychopharmacol Biol Psychiatry 2007 Aug 29;31(6):1339-40. Epub 2007 Apr 29.

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http://dx.doi.org/10.1016/j.pnpbp.2007.04.015DOI Listing
August 2007

Panic disorder subtypes: further clinical differences.

Depress Anxiety 2007 ;24(7):479-86

Department of Psychiatry, Medical Faculty of Dokuz Eylül University, Izmir, Turkey.

Panic disorder (PD) is a heterogeneous phenomenon with respect to symptom profile. Most studies agree that a group of patients with prominent respiratory symptoms emerged as a distinct PD subtype. In this study we compared a range of clinical features associated with PD and agoraphobia in patients with respiratory (RS) and nonrespiratory (NRS) subtypes of PD. The participants were 124 patients with PD (79 women and 45 men), with or without agoraphobia, diagnosed by DSM-IV criteria. Following the observer-rated Panic Disorder Severity Scale assessment, subjects completed self-report measures, including the Anxiety Sensitivity Index (ASI), Panic-Agoraphobia Scale; the Beck Anxiety Inventory; and the Panic-Agoraphobic Spectrum Scale (PAS-SR). Multivariate analysis of variance (MANOVA) showed significant group differences [Pillai's trace = 0.95, F (5, 118)(=)2.48, P = .036]. Patients in RS group had higher mean total scores on the ASI (F = 5.00, df = 1, P = .027) and PAS-SR (F = 11.23, df = 1, P = .001) than patients in NRS group. Also, patients with RS attained higher scores than patients with NRS on four domains of PAS-SR (panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking). A descriptive discriminant analysis of the data correctly identified 69.4% of the patient group in general and 86.1% of RS group (Wilks's lambda = 0.87, df = 8, P = .048). The significant discriminating factors of the RS and NRS groups were domains of panic-like symptoms, agoraphobia, separation sensitivity, and reassurance seeking. Our findings suggest that anxiety sensitivity and panic-agoraphobic spectrum symptoms might be particularly relevant to understanding subtypes of PD.
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http://dx.doi.org/10.1002/da.20253DOI Listing
January 2008

Basilar artery blood flow velocity changes in patients with panic disorder following 35% carbon dioxide challenge.

Prog Neuropsychopharmacol Biol Psychiatry 2007 Jan 20;31(1):115-22. Epub 2006 Sep 20.

Department of Psychiatry, Medical Faculty of Dokuz Eylül University, Izmir, Turkey.

Purpose: We compared the mean basilar artery blood flow velocity (BABFV) between patients with panic disorder and healthy subjects both at rest and immediately following carbon dioxide (CO(2)) challenge, and examined the effects of treatment on BABFV.

Methods: Twenty four patients with panic disorder with or without agoraphobia and 12 healthy comparison subjects were studied. Visual Analog Anxiety Scale was used to evaluate the anxiogenic effect of 35% CO(2) inhalation. Mean BABFV was monitored using transcranial Doppler ultrasonography at rest and 10, 20, 30, 60, 90, 120 s after 35% CO(2) challenge both before and after four weeks treatment with paroxetine.

Results: The hemodynamic response pattern of basilar artery to CO(2) inhalation was significantly different between two groups. CO(2) rapidly triggered blood flow velocity in basilar artery amongst panic patients but not in healthy comparisons. The mean time to normalization of BABFV was significantly longer in panic patients. Four weeks of treatment with paroxetine led to a significantly reduced mean BABFV after 35% CO(2) inhalation in comparison with pretreatment.

Conclusions: Patients with panic disorder had impaired cerebral regulatory mechanisms observed as a change in response characteristics in BABFV in response to CO(2) inhalation. Treatment with paroxetine reduced the increase of BABFV seen in patients after the CO(2) challenge.
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http://dx.doi.org/10.1016/j.pnpbp.2006.08.004DOI Listing
January 2007

[Factorial structure, validity, and reliability of the Turkish temperament and character inventory].

Turk Psikiyatri Derg 2005 ;16(3):190-204

Dokuz Eylül U. Psikiyatri, Izmir.

Objective: To assess the factorial structure, reliability and validity of the Turkish version of the Temperament and Character Inventory (TCI), a 240-item, self-report, paper-and-pencil test, and true-false format inventory based on Cloninger's psychobiological model of personality. It measures the four higher-order temperament dimensions and three character dimensions.

Method: Using samples consisting of 470 healthy volunteers and 544 psychiatric patients, psychometric features were explored.

Results: The internal consistency of the scales was good (Cronbach alpha coefficients between 0.68 and 0.84), but weak for Reward dependence (0.55) and Persistence (0.56). The factor structures of the temperament and character dimensions, explored separately, were in agreement with the hypothesized constructs, except for the scales NS1 (Novelty Seeking 1 = exploratory excitability) and SD4 (Self-directedness 4 -- self-acceptance). The present study also confirmed that the TCI scales were weakly related among themselves. On the whole, psychiatric patients had higher harm avoidance and lower self-directedness, persistence, cooperativeness, and self-transcendence scores than the normal subjects. Gender differences were also found for different dimensions.

Conclusion: The findings of this study suggest that the TCI can be applied in the investigation of psychiatric and normal populations.
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December 2005

Panic Disorder Severity Scale: reliability and validity of the Turkish version.

Depress Anxiety 2004 ;20(1):8-16

Department of Psychiatry, Dokuz Eylül University, Izmir, Turkey.

We assessed the reliability and validity of the Turkish version of the seven-item Panic Disorder Severity Scale (PDSS). We recruited 174 subjects, including 104 with current DSM-IV panic disorder with (n=76) or without(n=28)agoraphobia, 14 with a major depressive episode, 24 with a non-panic anxiety disorder, and 32 healthy controls. Assessment instruments were Panic Disorder Severity Scale, Panic and Agoraphobia Scale, both the observer-rated (P&Ao) and self-rating (P& Asr); Clinical Global Impression Scale (CGI); Hamilton Anxiety Scale, and Beck Depression Inventory. We repeated the measures for a group of panic disorder patients (n = 51) after 4 weeks to assess test-retest reliability. The internal consistency (Cronbach's alpha) of the PDSS was .92-94. The inter-rater correlation coefficient was .79. The test-retest correlation coefficient after 4 weeks was .63. In discriminant validity analyses, the highest correlation for PDSS was with P&Ao, P&Asr (r=.87 and.87, respectively) and CGI (r=.76) and the lowest with Beck Depression Inventory (r=.29). The cut-off point was six/seven, associated with high sensitivity (99%) and specificity (98%). This study confirmed the objectivity, reliability and validity of the Turkish version of the PDSS.
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http://dx.doi.org/10.1002/da.20011DOI Listing
December 2004

[Panic-agoraphobic spectrum].

Turk Psikiyatri Derg 2004 ;15(3):215-23

Uzm., Araş Gör., Dokuz Eylül U Tip Fak. Psikiyatri AD, Izmir.

Current diagnostic classification systems have provided reliable, objective and valid diagnoses of mental disorders. They present both categorical and dichotomous approaches to mental disorders. However, rigid usage of diagnostic criteria may cause high comorbidity rates. Moreover, these classification systems fail to identify subthreshold conditions, atypical signs and symptoms, and personality traits associated with the core symptoms of a given mental disorder. These subclinical manifestations are clinically meaningful in terms of disability and effects on quality of life. For these reasons, many researchers have begun to develop dimensional or spectral approaches for a number of mental disorders. Studies on panic disorder with or without agoraphobia have revealed a substantial clinical heterogeneity. The panic-agoraphobic spectrum concept was defined to overcome these difficulties. This concept includes DSM-IV and ICD-10 diagnostic criteria together with atypical and subthreshold symptoms of panic disorder, and constitutes a broader band of panic and agoraphobia symptoms. The panic-agoraphobic spectrum incorporates eight domains of clinical features: 1) separation sensitivity, 2) panic-like symptoms, 3) stress sensitivity, 4) medication and substance sensitivity, 5) anxious expectation, 6) agoraphobia, 7) illness phobia and hypochondriasis, 8) reassurance orientation. In this article, we reviewed the spectrum conceptualization of panic disorder and agoraphobia, particularly focusing on the domains of the panic-agoraphobic spectrum and their assessment.
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October 2004

Sertraline versus paroxetine in the treatment of panic disorder: an acute, double-blind noninferiority comparison.

J Clin Psychiatry 2004 Mar;65(3):405-13

Department of Psychiatry and Psychotherapy, University of Göttingen, von-Siebold-Strasse 5, D-37505 Göttingen, Germany.

Objective: Several classes of medications have demonstrated efficacy in panic disorder, but direct comparison of 2 proven treatments is still uncommon. The purpose of this study was to compare sertraline and paroxetine in the acute treatment of panic disorder.

Method: Adult outpatients with panic disorder with or without agoraphobia (DSM-IV and ICD-10 criteria) were randomly assigned in double-blind fashion to 12 weeks of treatment with flexible doses of sertraline (titrated up to 50-150 mg/day; N = 112) or paroxetine (titrated up to 40-60 mg/day; N = 113). Patients were then tapered off medication over 3 weeks. The primary analysis was a noninferiority analysis of Panic and Agoraphobia Scale (PAS) scores. Secondary measures included panic attack frequency and the Clinical Global Impressions-Improvement scale (CGI-I) (with responders defined as those with a CGI-I score < or = 2). Data were collected from January 2000 to June 2001.

Results: Sertraline and paroxetine were associated with equivalent levels of improvement on the PAS total score, as well as on all secondary outcome measures. Eighty-two percent of patients taking sertraline versus 78% of those taking paroxetine were CGI-I responders at endpoint. Numerically more patients on paroxetine treatment compared with sertraline treatment discontinued due to adverse events (18% vs. 12%; NS), and a significantly higher proportion of paroxetine patients showed > or = 7% weight gain (7% vs. < 1%; p <.05). During the taper period, the proportion of panic-free patients increased by 4% with sertraline but decreased by 11% with paroxetine (p <.05).

Conclusion: Sertraline and paroxetine had equivalent efficacy in panic disorder, but sertraline was significantly better tolerated and was associated with significantly less clinical worsening during taper than paroxetine.
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http://dx.doi.org/10.4088/jcp.v65n0317DOI Listing
March 2004

Assessing the severity of panic disorder and agoraphobia: validity, reliability and objectivity of the Turkish translation of the Panic and Agoraphobia Scale (P&A).

J Anxiety Disord 2002 ;16(3):331-40

School of Medicine, Dokuz Eylul University, Izmir, Turkey.

The aim of the present study was to determine the psychometric properties of the Turkish translation of both the observer-rated (P&Ao) and self-rated (P&As) versions of the Panic and Agoraphobia Scale (P&A). Discriminant and convergent validity of P&A were assessed in patients with panic disorder with or without agoraphobia (n = 119), by comparing the P&A with the Clinical Global Impression Scale (CGI), Hamilton Anxiety Scale (HAMA), Phobia and Anxiety sub-scales of Symptom Check List, Spielberger State and Trait Anxiety Inventory and the Beck Depression Inventory (BDI). Inter-rater and test-retest reliability were determined. Correlation coefficients between the CGI and the P&Ao and the P&As were .85 and .74, respectively, and .85 between the two versions of the P&A. Cronbach's alpha for the P&Ao, and the P&As was .88 and .86, respectively. The Turkish version of the P&A has yielded good psychometric properties and was found to be a reliable instrument for assessing severity in panic disorder.
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http://dx.doi.org/10.1016/s0887-6185(02)00104-4DOI Listing
February 2003