Psychiatric Consultation in a Headache Unit

SYNOPSIS
Two hundred twenty nine psychiatric consultations of patients with headache were reviewed. A search was made for the presence of stress or conflict, preceding and maintaining the headache. The major finding was the patients' inability to cope with stress or conflict threatening their self-esteem. Anxiety level was raised when issues of inadequacy, insecurity and helplessness surfaced. In predisposed individuals, defenses against or repressed responses to loss of self-esteem were manifested by anger, anxiety, depression and headache.     

Influence of having a hospitalized mentally ill member in the family on attitudes toward mental patients in Turkey

Summary The influence of having a mentally ill member in the family on various attitudes was assessed. An exposed group (those having a mentally ill member) was compared with a no-exposure group. The attitudes assessed toward two vignettes included recognition of mental illness, social distance, expected burden, expected influence on one's health, treatment choice, and prognosis. The total sample consisted of 84 subjects selected from the family members of patients from psychiatric (exposed) and other (no-exposure) clinics. Direct experience with a mentally ill family member did not make a significant difference in the attitudes toward the vignettes, but the type of psychopathology did. The results were discussed within the context of findings from Western cultures.     

Reconstruction of crush injuries of the foot dorsum: is the latissimus dorsi muscle flap a reliable choice?

Thirteen patients who underwent 13 latissimus dorsi free flaps for subacute foot dorsum defects were identified over a 4-year period. The average age of the patients was 30.5 years (range: 8 to 52 years). There were eight male, five female patients. The average follow-up was 23 months (range: 2 to 47 months). The soft-tissue defect resulted from motor vehicle accident in all cases. All of the patients presented with soft-tissue loss combined with extensor tendon and/or bone injury. The wounds were treated with serial debridement and free latissimus dorsi or latissimus dorsi-serratus anterior muscle and split-thickness skin graft coverage in all cases. The mean size of the flaps was 19 x 11 cm (range: 15 to 24 cm x 9 to 16 cm). Twelve of 13 flaps survived. Complications included infection (1 case), seroma in the donor region (2 cases), total flap failure (1 case), partial flap necrosis (2 cases), and wound dehiscence (2 cases).     

Acute abdomen caused by brucellar hepatic abscess

Brucellosis is a zoonotic infection that is transmitted from animals to humans by ingestion of infected food products, direct contact with an infected animal, or aerosol inhalation. The disease is endemic in many countries, including the Mediterranean basin, the Middle East, India, Mexico, Central and South America and, central and southwest Asia. Human brucellosis is a systemic infection with a wide clinical spectrum. Although hepatic involvement is very common during the course of chronic brucellosis, hepatic abscess is a very rare complication of Brucella infection. We present a case of hepatic abscess caused by Brucella, which resembled the clinical presentation of surgical acute abdomen.     

Oxidation of apolipoprotein B-containing lipoproteins and serum paraoxonase/arylesterase activities in major depressive disorder

Major depressive disorder (MDD) is blaimed to play a role in the onset of coronary artery disease (CAD). The aim of the present study was to investigate serum paraoxonase/arylesterase activities and oxidation of apolipoprotein B-containing lipoproteins in patients with MDD. Oxidation of lipoproteins plays an important role in atherogenesis and the enzyme paraoxonase, has been shown to prevent lipoprotein oxidation. Furthermore, low paraoxonase activity was suggested to predict CAD. Eighty-six patients who fully met the fourth Diagnostic and Statistical Manual of Mental Disorders criteria for MDD and 36 healthy control subjects were included in the study. Serum paraoxonase and arylesterase activities were determined spectrophotometrically. Malondialdehyde (MDA) levels of apolipoprotein B-containing lipoproteins were determined before (basal) and after incubation with copper-sulphate, that yielded basal- and Delta-MDA values, respectively. Serum paraoxonase/arylesterase activities were significantly reduced in the post-treatment group compared with the pre-treatment group. Basal-MDA (MDA) level was significantly higher in the MDD group compared with the control group. Delta-MDA level of the severe MDD group was significantly higher than that of the control group. There was a positive correlation between the oxidizability of apolipoprotein B-containing lipoproteins and the severity of the disease. Total cholesterol, HDL-cholesterol, LDL-cholesterol, apolipoprotein B levels were significantly higher and apolipoprotein AI levels were significantly lower in the MDD group compared with those of the control group. The findings of the present study suggest that: 1) antidepressant treatment might reduce serum paraoxonase activity/mass; 2) oxidation and oxidizability of apolipoprotein B-containing lipoproteins seem to be increased in MDD.     

Reduced left uncinate fasciculus fractional anisotropy in deficit schizophrenia but not in non-deficit schizophrenia

Aims: Schizophrenia is a psychiatric disorder manifesting with heterogeneous symptom clusters and clinical presentations. The deficit syndrome is the condition defined by the existence of primarily negative symptoms, and patients with the deficit syndrome differ from non‐deficit patients on measures of brain structure and function. In the current study, by using diffusion tensor imaging (DTI), we investigated the frontotemporal connectivity that is hypothesized to differ between deficit and non‐deficit schizophrenia. Methods: Twenty‐nine patients and 17 healthy controls were included in the study. The patients had deficit (n = 11) or non‐deficit (n = 18) schizophrenia and they were evaluated clinically with the Schedule for Deficit Syndrome (SDS) and Positive and Negative Syndrome Scale (PANSS). Diffusion‐based images were obtained with a 1.5T Siemens Magnetic Resonance Imaging machine and analyses were carried out with Functional Magnetic Resonance Imaging of the Brain Library Software – Diffusion tool box software. Results: The fractional anisotropy values in the left uncinate fasciculus of schizophrenia patients with the deficit syndrome were lower than those of non‐deficit patients and the controls. There were no differences between non‐deficit schizophrenia patients and controls. Conclusion: These findings provide evidence of left uncinate fasciculus damage resulting in disrupted communication between orbitofrontal prefrontal areas and temporal areas in deficit schizophrenia patients.