ISSN 1302-0099 | e-ISSN 2146-7153
TURKISH JOURNAL CLINICAL PSYCHIATRY - Turkish J Clin Psy: 10 (1)
Volume: 10  Issue: 1 - 2007
RESEARCH ARTICLE
1. Psychiatric Comorbidity in Patients with Chest Pain Without Cardiac Etiology
Medine Yazıcı Güleç, Çiçek Hocaoğlu, İsmet Durmuş
Pages 7 - 13
Objective: In the world and among different cultural groups, physical symptoms are the most common expressions of social problems and inconvenience; chest pain is one of the most widely seen, medically unexplained physical symptoms. Most of the time, chest pain cases where organic etiology cannot be determined for a long time and those presenting with atypical features should be evaluated as a component or an accompanying symptom of various specific psychiatric disorders primarily such as panic disorder and depression. In this study, determination of psychiatric comorbidity rate in patients with chest pain without cardiac etiology was aimed. Method: Seventy patients were included in the study that applied to the cardiology clinic with the complaint of chest pain but did not have any detected cardiac etiology. All patients were evaluated with Sociodemographic Datum Collection Form and structured clinical interview for DSM-IV. Results: In 47.1% of noncardiac chest pain group panic disorder, in 21.4% of them depressive disorders, in 5.7% generalized anxiety disorder, in 5.7% anxiety disorders not otherwise specified, in 5.7% obsessive compulsive disorder, in 2.9% undifferentiated somatoform disorder were diagnosed. 12.9% of the cases had two psychiatric diagnoses. 24.3% of the cases had no psychiatric diagnosis. Conclusion: Psychiatric disorder rates are quite high in patients with chest pain which cannot be explained car- diologically. These results show the importance of psychiatric evaluation in noncardiac chest pain or unexplained chest pain (UCP) patients. In addition, understanding the psychiatric symptom profile of these patients will make an important contribution to noncardiac chest pain treatment.

2. Investigation of the Predictors of Life Satisfaction in University Students
Duru Gündoğar, Songül Sallan Gül, Ersin Uşkun, Serpil Demirci, Diljin Keçeci
Pages 14 - 27
Objective: Because of the shortcome of the opportunities for higher education in Turkey, some of the students graduating from the high school register to departments which they do not really want, just to be a university graduate. The aim of this study is to determine the impact of the students' opinions about their department, self-reported reason for continuing their education in that specific department, satisfaction with various aspects of university experience on the student's life satisfaction. Method: 373 university students were administered Beck Depression Inventory (BDI), Beck Hopelessness Scale (BHS), Satisfaction with Life Scale (SWLS), Spielberger State-Trait Anxiety Inventory (SSAI and STAI respectively), personal data inquiry form and evaluation of the university education form. Results: Multiple linear regression analysis revealed that BHS, satisfaction with education, STAI scores, desire for being in the department, self reported mental health, job expectancies and the reason for choosing the specific department were the predictors of life satisfaction. The life satisfaction and satisfaction with education of the students who registered to the department just to be a university graduate are significantly lower, and BHS and BDI scores were higher than those of the students who entered the department because they specifically wanted that area. Conclusion: In our education system, being able to enter a university education program might seem as overcoming an important obstacle, however continuing an education in which one is not really interested in, has a negative influence on life satisfaction.

3. Symptoms, Diagnoses and Diagnostic Procedures of Patients who Presented to the Child and Adolescent Psychiatry Outpatient Clinic
Şahbal Araş, Gülşen Ünlü, Fatma Varol Taş
Pages 28 - 37
Objective: To evaluate symptoms, diagnosis and diagnostic procedures of patients who presented to the child and adolescent psychiatric outpatient clinic. Method: The files of 523 male and 299 female patients who presented to Dokuz Eylül University Child and Adolescent Psychiatry outpatient clinic over first six months of 2002 were retrospectively assessed 1 to 1.5 years after presentation. Symptoms and diagnoses recorded in the standardized parts of the patient files and diagnostic procedures recorded in the patient files during follow-up process were evaluated. Results: Rates of 'over-activity1, 'distractibiIity1 and 'academic failure' among males were significantly higher than among females. Rates of 'family relationship problem', 'unhappiness-pessimism-unwillingness', 'physical complaints' and 'suicide attempt-self harm' among females were significantly higher than among males. According to the DSM-IV diagnoses, 227 (%28.7) cases had a comorbid diagnosis. The most frequent comorbid diagnoses of attention deficit hyperactivity disorder were enuresis and learning disorders. The most frequent comorbid diagnosis of anxiety disorders was depression. Males were significantly more likely to have externalizing problems and communication disorders and females were significantly more likely to have internalizing problems. Intelligence test which was administered to %19.5 of the cases was the most frequent diagnostic procedure. The nonattendance rate was 79.3%. Conclusion: The results of this study may be useful for improving child psychiatry services.

4. Retrospective Evaluation of Women who Applied Crisis Center in Divorce Duration
Özge Uçan
Pages 38 - 45
Objectives: The aim of this descriptive study is to evaluate women's applications to Crisis Center in the aspect of the reasons and precipitant factors of divorce which yield to a crisis condition. Method: It was evaluated retrospectively as the analysis of follow-up cards of 110 women applied Ankara University, Center of psychiatric Crisis in last five years. The data reached was classified by using SPSS 10.0. In this classification, socio-demographic features, marriage type, marriage duration, the questions taking place in marriage, main factors bringing divorce up and psychiatric situations appearing in divorce duration were taken into consideration. Results: In the findings of the research, situations such as violence, problems with the husband's family, frequent alcohol usage, arguments with the husband's family as precipitant, dismissing after violence and extramarital relationship of the applicant is or the husband have been observed in the divorce process in the history of the applicant women. Under some situations, although women want to divorce, they have to continue their marriage. Conclusion: Divorce is a social experience, which deeply effects individuals and especially children, if there are any, and therefore necessitates individuals to make and adapt to some changes in their lives. Considering the negative effects of the divorce on mental health of the individuals and their children, professional aid has a great importance. Individuals should be made conscious of this subject.

CASE REPORT
5. A Case of Endocrinological Disorder that the Medical Treatments are not Sufficient
Ahmet Tiryaki, Evrim Özkorumak
Pages 46 - 52
Addison's disease is sometimes misdiagnosed as depression, hypochondriasis, and chronic anxiety disorder. Aldesterone and cortisol insufficiency is the major pathophysiological mechanism related with the symptoms and signs frequently seen in Addison's disease. Because of hormonal depletion some nonspecific clinical sings and symptoms such as fatigue, loss of weight loss may occur at early stages of the disease. The accurate diagnosis may be possible at late stage by Addisonian crisis. Missed diagnosis can result in a significant morbidity due to lethargy and weight loss and mortality due to circulatory collapse. A 37-year-old, married female patient presented with a 6-month history of depressive mood, general fatigue, loss of interest was examined with nausea, vomiting, hyperpigmentation, forgetfulness and fainting by several physician but appropriate diagnostic and therapeutic assessment was not carried out. She was admitted to psychiatric in-patient clinic in order to make a complete clinical examination and inpatient treatment. Based on mental state examination revealing depressed mood and hopelessness she was diagnosed as having depression. Following diagnosis of Addison's disease as a result of complete clinical evaluation, she was transferred to the respected department. This case highlights significance of complete evaluation and secondary psychiatric disorders with an overlooked or misdiagnosed Addison's disease presenting with psychiatric features in the early stage.

6. The Relationship of Cavum Septum Pellucidum with Obssessive Compulsive Disorder and Tourette Disorder: A Case Report
Elif Onur, Tunç Alkın, Emel Ada
Pages 53 - 57
In normal fetal development, the formation of septum pellucidum occurs at the same time with the development of the neighboring limbic system structures. It was hypothesized that the dysgenesis of these structures leads to arrest of the fusion process, and thus resulting formation of cavum septum pellucidum (CSP). There is a high variance in the prevalence of CSP in normal adults. Hence, it was suggested that only large CSP is related with pathological processes. Several magnetic resonance imaging studies have reported a higher prevalence of enlarged CSP in patients with schizophrenia than in normal subjects. However the relationship of CSP and other neuropsychiatric disorders remained unresolved. In the context of anxiety disorders only reports on the relationship of CSP and panic disorder, and post-traumatic stress disorder were available in literature. In this report we present an obsessive compulsive disorder and Tourette disorder case with enlarged CSP (18 x 13.5 x 20 mm) detected by brain tomography. The importance of enlarged CSP was discussed in the context of anxiety disorders. CSP, which is a sign reflecting neurodevelopmen- tal disturbance, should be considered in understanding the etiopathogenesis of anxiety disorders. It is relevant to investigate in future studies the prevalence and relationship of CSP with other structural abnormalities in patients with obsessive compulsive disorder.

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