Psychoanalytic Diagnosis: Understanding Personality Structure in the Clinical Process

subjects aged 7-18 years were studied. Diagnoses of bipolar disorders were established using the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present Episode Version-1986 modified for DSM-III-R criteria and for rating the number and duration of manic and hypomanic episodes, Complex cycling patterns were observed. These included numerous brief episodes suggesting continuous rapid-cycling in 80.8% of cases. Mean age of onset was early (8.5 k 4.4 years). Psychotic phenomena, suicidality, hyperactivity and 'mixed mania' were highly prevalent. Data in this report provide support for complex and rapid-cycling patterns in childhood onset bipolar disorder.

Research report Complex and rapid-cycling in bipolar children and adolescents: a preliminary study

Characteristics of menopausal women seeking assistance

Although women with serious mental illness have high rates of lifetime sexual partners, they infrequently use contraception. Consequently, the prevalence of sexually transmitted infections is high in this population. In addition, while the overall rate of pregnancy in women with schizophrenia of child-bearing age is lower than in the general population, the percentage of pregnancies that are unwanted is higher than that in the general population. The objective of this paper is to help clinicians explore knowledge of appropriate methods of contraception for women who suffer from schizophrenia. The authors reviewed recent literature on the use of contraceptive methods by women with schizophrenia treated with antipsychotic and adjunctive medications. Contraceptive counseling to women and their partners is an important part of comprehensive care for women with serious and persistent mental illness. Women with schizophrenia who smoke, are overweight, or have diabetes, migraine, cardiovascular disease, or a family history of breast cancer should be offered non-hormonal contraception. Women with more than one sexual partner should be advised on barrier methods in addition to any other contraceptive measures they are using. Clinicians should be alert for potential interactions among oral hormonal contraceptives, smoking, and therapeutic drugs. Long-lasting contraceptive methods, such as intrauterine devices, progesterone depot injections, or tubal ligation are reasonable options for women having no wish to further expand their families.

Prescribing contraceptives for women with schizophrenia.

The title of this work might lead us to expect a comprehensive text on depressive illness, but this is not the author's intent. Edith Jacobson is an outstanding psychoanalytic clinician and theoretician. This book is a collection of her papers on the psychoanalytic conceptualization and treatment of depression, as it appears in normal mood swings and in neurotic and psychotic personalities. Furthermore, the book is not designed to be a comprehensive study of all psychoanalytic views of depression. Rather, it records the struggles of one particularly gifted person to understand depression within the framework of classical Freudian psychoanalytic theory and the ego-psychological studies of Heinz Hartmann. In all of the papers Dr. Jacobson presupposes familiarity with classical psychoanalytic concepts and with the influential work of Hartmann. The book starts with a 40-page paper on the psychoanalytic theory of affects. Some readers may have difficulty following Jacobson's theoretical exposition. For them

Depression: Comparative Studies of Normal, Neurotic, and Psychotic Conditions

Antidepressant-associated mania or hypomania: a comparison with personality and bipolarity features of bipolar I disorder.

Background and aim: Despite the importance of reproductive behaviours of patients with mental illness, there are only few studies concerning the family planning needs and contraceptive use of psychiatric patients. The aim of this study is to assess family planning needs and contraceptive use in female psychiatric outpatients. Methods: The study was conducted in the outpatient clinic of Bakirkoy Neuropsychiatry Hospital, Istanbul, Turkey. Schizophrenic, bipolar and unipolar depressive patients in remission (50 patients in each group) were compared with a control group of 50 healthy individuals. A semi-structure d questionnaire was used for sociodemographic characteristics, family planning needs and contraceptive use. Results: Of schizophrenic patients only 26.6% and of bipolar patients only 37.5% had gynecological examination during the last three years compared to 56% in healthy individuals. Of schizophrenic patients only 40% discussed family planning issues with partner and of bipolar patients only 50% compared to 90% in controls. Conclusion: Schizophrenic and bipolar female patients’ awareness and attitudes on family planning and contraceptive use were unsatisfactory. Both psychiatrists and family physicians should be aware of the needs of psychiatric outpatients on contraceptive counseling.

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Family Planning Needs and Contraceptive Use in Female Psychiatric Outpatients

Tomruk NB, Saatcioglu O, Yildizhan E, Alpay N. Aripiprazole-induced tardive dyskinesia treated with quetiapine: a case report.



Background: Tardive dyskinesia (TD) is a serious, potentially irreversible side effect of antipsychotics. Although the risk is smaller, atypical antipsychotics still pose a risk. Aripiprazole is an atypical antipsychotic with a unique mechanism of action. It has a partial agonistic effect on the presynaptic D2 dopamine autoreceptor and antagonistic effect at postsynaptic D2 receptors.



Method: There have been a few case reports of aripiprazole-induced TD. A case of aripiprazole-induced TD successfully treated with another atypical antipsychotic, quetiapine, is described and discussed in line with the recent literature.



Results: TD showed rapid improvement with discontinuation of aripiprazole and initiation of quetiapine.



Conclusion: Further studies are needed to ascertain the differential effects and side effects of second-generation antipsychotics in terms of TD.

Aripiprazole-induced tardive dyskinesia treated with quetiapine: a case report.

The relationship between hormonal profile and depressive symptoms in menopausal women Objective: As the average life expectancy gets longer and the menopausal women population increases, the notion of curing menopausal complaints becomes increasingly more important. The aim of this study is to evaluate the relationship between hormonal parameters and the severity of depressive symptoms. Methods: In this study, 171 voluntary women referred to Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Gynecology and Obstetrics Department, Menopausal Clinic, from January 2009 to August 2009 and who had not had menstrual periods for at least 12 months were enrolled and questionnaires for sociodemographic data and menopausal symptoms, Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale were applied. Since surgical menopausal cases were considered as a different category, they were not included. The data were analyzed using NCSS. Results: Mild depression was found in 49.7% of the cases. 18.7% of the cases had moderate depression, 65.5% had minor anxiety and 23% had major anxiety. We found no significant relation between Follicule Stimulating Hormone (FSH) levels and depression rate whereas there was a significant relation between FSH levels and the anxiety rate. There was also significant relation between estradiol (E2) levels and depression along with anxiety. Mild depression was found higher in our cases who had atrophic vulvovajinitis. Conclusion: Levels of blood FSH and E2 are significantly related with the existence of depression and anxiety. Results suggest that although menopause itself cannot be accepted as the only reason for depressive symptoms, a multidisciplinary approach, including gynecologists, family doctors and physiciatrists, should be adopted to evaluate psychosocial and psychosomatic factors as a whole in premenopausal,

The Relationship Between Hormonal Profile and Depressive Symptoms in Menopausal Women

OBJECTIVE The aim of this study is to determine the relationship between age of onset and phenomenology of bipolar affective disorder (mania). METHOD The current and retrospective diagnoses of the patients were made according to DSM-IV Bipolar Affective Disorder (mania) criteria. Sociodemographic features, clinical features, type of episode, number and length of hospitalizations were investigated in three groups which were consisted of adolescent-onset adolescents (n=60), adolescent-onset adults (n=60) and adult-onset adults (n=60). The groups were determined according to age of onset and current age categories. All patients have been assessed by Structured Clinical Interview for DSM-IV-Clinical Version (SCID-I), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D) and Scale for the Assessment of Positive Symptoms (SAPS). RESULTS The groups were consisted of equal numbers of women and men. Rate of single (%51.7) and divorced patients (%21.7), rate of unemployment status (%70) were higher in adolescent-onset patients than adult-onsets. Adolescent-onset adolescents and adolescent-onset adults were different from adult-onset patients with respect to mixt episodes (%26.7, %15) and mood congruent or incongruent psychotic features (%35/%50, %31.7/%66.7) and length of hospitalization (23.9+/-4.8, 23.8+/-3.9). CONCLUSION Adolescent-onset of illness causes higher probability of mixt episodes, psychotic features such as mood congruent or incongruent hallucinations and delusions. This study supports the hypothesis that adolescent-onset mania may be a different subtype than adult-onset mania with respect to type of episode, phenomenology, and clinical features.

Nihat Alpay

Papers

Antidepressant-associated mania or hypomania: a comparison with personality and bipolarity features of bipolar I disorder.

Family Planning Needs and Contraceptive Use in Female Psychiatric Outpatients

Aripiprazole-induced tardive dyskinesia treated with quetiapine: a case report.

The Relationship Between Hormonal Profile and Depressive Symptoms in Menopausal Women

[Phenomenological differences between adolescent and adult onset mania: a comparative study].