Cinsiyet, aile öyküsü, stresli yaþam olaylarý, hayal kýrýklýklarý, aile iþlev bozukluklarý, yetersiz anne-baba bakýmý, erken olumsuz yaþantýlar, baðýmlý ve obsesif özellikler gibi kiþilik özellikleri, güvenli olmayan baðlanma stili, kronik psikiyatrik ve bedensel hastalýk, sosyal destek azlýðý gibi çeþitli risk etkenleri major depresyona öncüldürler ve hastalýðýn sonucunu etkilerler. Bu çalýþmanýn amacý ayaktan polikliniðe baþvuran major depresyon hastalarýnda risk etkenlerini araþtýrmaktýr. Veriler 1994-1995 yýllarý arasýnda tüm illerde, 500 psikiyatri uzmanýnýn depresyon tanýsý koyduðu 2014 hastadan elde edilmiþtir. Çalýþmada hastalar DSM- III-R, sosyodemografik bilgi formu, yaþam olaylarý öykü anketi ve Hamilton depresyon skalasý ile deðerlendirilmiþ, verilerin istatistiksel deðerlendirmesi SPSS programýnda ki-kare yöntemi ile yapýlmýþtýr. Çalýþmamýzda ailesel yüklülük, 25-44 yaþlar arasýnda ve kadýn olmak risk etkeni olarak belirlenmiþtir. Çalýþmaya katýlanlarm %17.5’i ailede psikiyatrik hastalýk öyküsü, %35’i ise kendisinde depresyon öyküsü bildirmiþtir. Risk etkeni olarak kronik hastalýk durumu kadýnlarda, ilaç/madde kullanýmý erkeklerde daha fazla bildirilmiþtir. Depresyon öncesi stresli yaþam olayý bildirimi 1534'tü (%76). Çalýþmamýzda kadýn ve erkek hastalarda yaþam olayý sýklýðý ve þiddeti birbirine benzerdi. Kadýnlar daha sýklýkla evlilik sorunlarý ve karþý cinsle iliþki sorunlarý bildirirken, erkekler daha çok iþle ve diðer kiþilerarasý iliþki-

Some risk factors such as sex, family history, stressful life events, disappointments, family dysfunction, poor parental care, early adversity, and personality traits such as dependent and obsessive, insecure attachment style, chronic psychiatric or medical diseases, lack of social support precede the onset of depression and also affect the outcome of depression. The aim of this study is to investigate the incidence of risk factors preceding the onset of depression in outpatient psychiatric population. The data were collected from 2014 depressive patients evaluated by approximately 500 psychiatrists, all over Turkey between 1994-1995. In this study depressive patients were evaluated with DSM-lll-R, Sociodemographic data form. Psychosocial Stress Factors Inventory (according to DSM-lll-R) and Hamilton Depression Inventory. Statistical analyses have been carried out by means of standard programmes according to SPSS-PC, using chi-square test. In our study, having a positive family history of mood disorder, being female and being old between 25-44 age were reported as risk factors. Also, 17.5% of patients declared psychiatric disease history in family member and 35% of patients reported previous depression. Whereas female patients has more chronic medical illness, male patients has more drug abuse and addiction problems. Reported life events were 1534 (76%). We found similar frequency and severity of life events in depressed females and males. Females mostly reported marital problems, and female to male interpersonal problems, whereas males reported upon job and interpersonal problems. A lot of risk factors such as biologic vulnerability, gender, age, stressful life events, medical illness have an important precipitating role in the genesis of depression.

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Kekemeliðin sebebi bilinmemekle birlikte genetik, psikososyal stres etmenlerine maruz kalma, obsesif, özgüveni yetersiz kiþilik özelliðine sahip olma, merkezi sinir sistemi anomalileri, ailenin ilk çocuðu olma risk etmenleri olarak bildirilmektedir. Bu çalýþmada, kekemeliði olan çocuk ve ergenlerin sosyodemografik özelliklerini, psikososyal stres etmenlerini belirlemek, düzelen ve düzelmeyen kekeme gruplar arasýndaki sosyodemografik faklýlýk- larý saptamak hedeflenmiþtir. Çocuk ve ergen psikiyatri polikliniðine baþvuran 188 çocuk ve ergen kekeme olgusu çalýþmaya alýndý. 83'üne ulaþýlarak muayeneleri yeniden yapýldý. 43 olguda son 6 aydýr kekemelik yoktu (Grup i). 40 olguda kekemelik deðiþen sýklýkta devam ediyordu (Grup 2). Grup Vdeki olgular polikliniðe daha erken yaþta baþvurmuþtu ve üç kelimeli cümle kurmaya Grup 2'deki olgulara göre daha erken baþlamýþlardý. Grup Vdeki olgularda daha fazla stres faktörü saptandý.

dal stress factors, having obsessive personality or low-selfesteem, central nervous system anomalities, being first child in family are risk factors. In this study we aimed; first, to understand sociodemographic pattern of the patients with stuttering, second, to evaluate the features of psychosocial stress factors and to find the sociodemographic differences between recovered and unrecovered groups. 188 children/adolescents with stuttering referred to the departments of child and adolescent psychiatry were enrolled this study. 83 of all children with stuttering were interviewed again, and 43 of this have not have stuttering for 6 months (Group 1). 40 of this cases have stuttering (Group 2). Group 1 was earlier referral at department of child and adolescent psychiatry than Group 2. The onset time of starting speak with sentences using three words was earlier in Group I. There was much more stress factors before begining of stuttering in Group 1.

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Bu çalýþmada intihar giriþiminde bulunan hastalarda birinci ve ikinci eksen tanýlarýnýn görülme sýklýklarýnýn belirlenmesi amaçlanmýþtýr. Çalýþma grubunu Þubat 1996 - Ocak 1997 tarihleri arasýnda intihar giriþimi nedeniyle Fýrat Üniversitesi Týp Fakültesi acil polikliniðine baþvuran 60 eriþkin hasta oluþturmuþtur Flastalara klinik görüþmeyi takiben DSM-III-R için yapýlandýrýlmýþ SCID I ve SCID II formlarý uygulanmýþtýr. Hastalarýn %46.6’smda depresif bozukluk (%18.3 major depresif bozukluk, %15 BTA depresif bozukluk, %13.3 distimi), %18.3’ünde borderline kiþilik bozukluðu, %16.7’sinde histrionik kiþilik bozukluðu saptanmýþtýr. Olgularýn %15’inde herhangi bir birinci eksen bozukluðu ve %51.7’sinde ikinci eksen bozukluðu belirlenememiþtir. Ýntihar giriþimlerinde en sýk rastlanan ruhsal bozukluk tanýsýnýn depresif bozukluklar olduðu, borderline ve histrionik kiþilik bozukluklarýnýn depresif bozukluklara sýklýkla eþlik ettiði belirlenmiþtir.

noses in a group of suicide attempters. The study group was consisted of 60 adult patients who had been consulted for suicide attempt in the emergency department of the Medical School of the University of Fýrat, between February 1996 and January 1997. Patients were evaluated SCID I and SCID II forms for the DSM-IITR following the interview. 46.6% of the patients had depressive spectrum diagnoses (18.3% major depressive disorder, 15% depressive disorder NOS, 13.3% dysthymia). Meanwhile, 18.3% was diagnosed as having borderline personality disorder, and 16.7% histrionic personality disorder. No major mental disorder in 15%, and no personality disorder in 51.7% was diagnosed. In this study, it was found that, depressive disorders were the most frequently seen mental disorder among the suicide attempters, and borderline personality and histrionic personality disorders were the most common comorbid personality disorders in these patients.

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Düþük veya tedavi amacýyla düþürülmüþ serum kolesterolünün impulsivite, saldýrgan davranýþlar ve intihar giriþimleriyle iliþkisi uzun süreden beri üzerinde durulan bir konudur. Çalýþmamýzda; þiddet içeren ve içermeyen intihar giriþiminde bulunan hastalarýn kolesterol düzeylerinin karþýlaþtýrýlarak tartýþýlmasý amaçlandý. Bu çalýþma Mayýs-Aðustos 2001 tarihleri arasýnda Fýrat Üniversitesi Fýrat Týp Merkezi Acil Polikliniði ve Psikiyatri Kliniði’nde yürütüldü. Çalýþma, intihar giriþimi nedeniyle baþvuran, 18-58 yaþlarý arasýnda ve çalýþma ölçütlerini karþýlayarak çalýþmaya katýlmayý kabul eden 26 hasta ve polikliniðimize rutin ehliyet muayenesi için baþvuran 26 saðlýklý üzerinde gerçekleþtirildi. Tüm hastalar için yatýþý takip eden 48 saat içerisinde klinik deðerlendirme yapýldý. DSM-IV tanýlarýný belirlemek amacýyla yarý yapýlandýrýlmýþ bir görüþme gerçekleþtirildi. Ayný zamanda serum kolesterol düzeyleri belirlendi. Bulgularýmýz intihar giriþiminde bulunan hastalarda kolesterol düzeyinin saðlýklý kontrollerden anlamlý olarak daha düþük olduðunu, þiddet içeren giriþimcilerde þiddet içermeyenlere göre anlamlýlýðýn daha belirgin olduðunu ortaya koymuþtur. Daha geniþ örneklemle yapýlacak ve intihar giriþiminin hangi yön/yönlerinin bu iliþkiyi açýklayacak biyolojik desteðe sahip olduðunu aydýnlatacak çalýþmalara gereksinim vardýr.

The association between low or lowered cholesterol through treatment and impulsivity, aggressive behaviors and suicide attempts has been focused on for a long period. In the present study, cholesterol levels of the patients with violent and nonviolent suicide attempt have been compared with healthy controls. The study was carried out in Firat University School of Medicine Emergency Unit and Department of Psychiatry between May- August 2001. The study was consisted of 26 violent suicide attempters and 26 healthy controls who had applied to the same center because of routine driving license examination. The clinical evaluation was performed by a trained psychiatrist within 48 hours following admission. A semi-structured clinical interview was carried out to establish DSM-IV diagnoses. On the other hand, serum total cholesterol levels were detected. The mean cholesterol level of the patients was significantly lower than that of controls. The difference was more significant in the patients with violent suicide attempt compared to those with non-violent suicide attempt. The studies with large sample that try to decipher which dimension/dimensions of suicide attempts could account for this relationship are required.

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Keþfedilmesinden yýllar sonra antikonvülzan olarak kullanýlmaya baþlanýlan valproat, ayný dönemde bipolar bozukluk tedavisinde de kullanýlmaya baþlanmýþtýr. Günümüzde anksiyete bozukluklarý, major depresif bozukluk, psikotik bozukluk, alkol yoksunluðu ve baðýmlýlýðý, tardiv disldnezi, posttravmatik stres bozukluðu, kiþilik bozukluðu, demons, impulsif þiddet davranýþlarý ile giden organik ve fonksiyonel diðer psikiyatrik durumlarda da kullanýlmaktadýr. Özellikle duygudurum bozukluklarý, anksiyete bozukluklarý, impulsif davranýþlar ve ajitaþyon gibi durumlarda iyi klinik etkinlik göstermektedir. Bu yazýda, valproatm psikiyatrik durumlarda -semptom ve bozukluklarda- kullanýmý ile ilgili literatür gözden geçirilmiþtir.

The valproate which had been started to use as anticonvulsant after years of its discovery has also been started to use in the treatment for bipolar disorder. Today, it has been used also in dementia, posttraumatic stress disorder, personality disorder, tardive dyskinesia, alcohol dependency and withdrawal, psychotic disorder, major depressive disorder, anxiety disorders and in the other organic and functional psychiatric statements which progress with impulsive severe behaviors. It acts effectively in affective disorders, anxiety disorders, the statements as impulsive disorders and agitation especially. The literature related with valproate use for psychiatric statements -in symptom and disorders- has been reviewed in this paper.

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Alkol baðýmlýlýðýnýn en önemli özelliklerinden biri süreðenleþen ve relapslarla giden doðasýdýr. Bu fenomeni açýklamak için çeþitli modeller ileri sürülmüþtür. Alkolik hastalardan hangilerinde relaps görüleceðinin öngörülmesi, hem klinisyenlerin hem de araþtýrmacýlarýn ilgi alanýdýr. Bu yazýda, ileri sürülen relaps modelleri ve relapsý öngören faktörler ilgili literatür gözden geçirilerek tartýþýlmýþtýr. Sonuçta; relaps olan ve olmayan hastalarýn biyolojik, psikolojik ve sosyal özelliklerinin farklýlýk gösterdiði görülmüþtür.

One of the most important characteristics of the alcohol dependency is its chronic and relapsing nature. Various models have been proposed to account for this phenomenon. The accurate prediction of which alcoholic patients would relapse concerns both clinicians and researchers. In this review the proposed relapse models and the factors predicting relapse were discussed by reviewing the related literature. As a result what was observed is that the patients who relapse and who do not differ in terms of biological, psychological and social characteristics.

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Santral sinir sisteminin primer anjiitisi santral sinir sistemi ile sýnýrlý, nadir görülen bir vaskülit olup, hastalýk kendisini baþaðrýsý, multifokal ve yaygýn nörolojik belirtiler þeklinde belli eder. Bu yazýda ilk yakýnmalarý major depresif bozukluk ile uyumlu olan 28 yaþýndaki bir erkek hasta ele alýndý. Çünkü anti- depresan saðaltýma raðmen, herhangi bir iyileþme gözlenmeyen hastanýn daha sonraki süreçte farklý türdeki psikiyatrik yakýnmalarýna birkaç kez olan geçici iskemik atak, baþaðrýsý, çift görme ve dengesizlik þeklindeki nörolojik yakýnmalar da eklendi. Çekilen kranyal manyetik rezonans görüntülemesinde (MRG) beynin primer lenfomasma benzeyen bir lezyon saptanmasý üzerine beyin biyopsisi yapýldý. Biyopside lenfoma olasýlýðý dýþlandý. Hastanýn yapýlan klinik ve laboratuvar incelemelerinde sistemik vaskülite neden olan hastalýklara ait bulgu saptanamamasý, radyolojik ve klinik bulgularýn streoid tedavisine yanýt vermesi santral sinir sisteminin primer anjiitisini en olasý taný olarak akla getirmektedir.

Isolated angiitis of the central nervous system (IACNS) is a rare form of angiitis limited to the central nervous system. The clinical finding of the combined series revealed that headache was the most common symptom with a combination of focal and diffuse neurological deficits. The case, a 28- year- old man, is present- ed;the clinical presentation and diagnostic difficulties are discussed. Patient's symptoms begun with an obvious atypical depression. In spite of an antidepressive treatment, his symptoms continued, being relatively worse; personality and mood changes added to the clinical picture. Meanwhile several transient ischemic attacks, six monts later, he was admitted with neurological symptoms including headache, diplopia, and cerebellar ataxia. The radiological investigation was mimicked by primary brain lymphoma. The brain biopsy excluding of lymphoma revealed parenchymal hemorrhage with nonspecific degenerative changes. In systemic investigation, any underlying cause for vasculitis could not be found. Neurological but not psychic findings and radiological lesions of the patient ameliorated with steroid theraphy. Since we could not find features of systemic vasculitis, the patient's lesions responded to corticostreoid treatment and neuropathological investigation revealed no lymphoma. We concluded that the most probable diagnosis would be IACNS.

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