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Öğe Clenched fist syndrome with palmar lichen planus(Wiley, 2005) Aytekin, S; Turhanoglu, AD; Ozkan, M; Uzunlar, AKA 16-year-old girl had a 4-year history of hyperkeratosis and fissures on the palm. The skin lesions had gradually progressed to thick hyperkeratosis with mild pruritus, diffusely covering the right palm, and leading to flexion contractures of the fingers with mild pain. There was no family history of similar lesions. Her father had died 4 years previously. Dermatologic examination revealed hyperkeratosis, scaling, a mild yellow color, fissures, and maceration on the palm and volar surface of the fingers of the right hand ( Fig. 1). There was an approximately 3 cm x 4 cm hyperkeratotic lesion on the palm of the left hand. Flexion contractures were found at the metacarpophalangeal and proximal interphalangeal joints of the three fingers of the right hand ( Fig. 1). There was no pain, tenderness in the joints of the fingers, or palpable nodular lesions on the palmar surface of the hand. Forced extension was difficult, and there was pain with passive extension. Radiography of the patient's hands revealed no abnormality, other than the clenched fingers. Electromyography of the upper extremities was normal. There were no lesions of the oral mucosa. The nails and scalp were normal. The patient showed very poor eye contact, and responded tersely and somewhat reluctantly to questions about her medical history. The patient was evaluated by psychiatry, but did not meet the diagnostic criteria for any mental disorder. There was a schizoid personality characteristic on both the structured clinical interview for DSM-IV personality disorders (SCID-II) and the Minnesota Multiphasic Personality Inventory ( MMPI). In addition, there was an increase in scores on the hostility and resentment/ aggression subscales of the MMPI. The results of routine laboratory tests were within normal limits or negative, including the venereal disease research laboratory ( VDRL) test. A skin biopsy specimen showed histopathologic changes of lichen planus ( orthokeratotic hyperkeratosis, focal hypergranulosis, acanthosis, papillomatosis, and vacuolization with dense lymphocytic reaction at the dermo- epidermal junction) ( Fig. 2). The patient was treated with topical 5% salicylic acid and 0.1% methylprednisolone aceponate ointment. Static splinting plus stretching was used for hand therapy. Active assisted motion was employed. The treatment produced a remarkable reduction in the skin lesions ( Fig. 3), but no improvement in the flexion posture of the hand. The psychiatric and clinical findings were thought to be consistent with clenched fist syndrome and lichen planus.Öğe Comorbid personality disorders in subjects with panic disorder: do personality disorders increase clinical severity?(W B Saunders Co-Elsevier Inc, 2005) Ozkan, M; Altindag, APersonality disorders are common in subjects with panic disorder. Personality disorders have been shown to affect the course of panic disorder. The purpose of this study was to examine which personality disorders affect clinical severity in subjects with panic disorder. This study included 122 adults (71 women, 41 men) who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for panic disorder (with or without agoraphobia). Clinical assessment was conducted by using the Structured Clinical Interview for DSM-IV Axis I Disorders, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and the Panic and Agoraphobia Scale, Global Assessment Functioning Scale, Beck Depression Inventory, and State-Trait Anxiety Inventory. Patients who had a history of sexual abuse were assessed with Sexual Abuse Severity Scale. Logistic regressions were used to identify predictors of suicide attempts, suicidal ideation, sexual abuse, and early onset of disorder. The rates of comorbid Axes I and II psychiatric disorders were 80.3% and 33.9%, respectively, in patients with panic disorder. Patients with panic disorder with comorbid personality disorders had more severe anxiety, depression, and agoraphobia symptoms, had earlier ages at onset, and had lower levels of functioning. The rates of suicidal ideation and suicide attempts were 34.8% and 9.8%, respectively, in subjects with panic disorder. The rate of patients with panic disorder and a history of childhood sexual abuse was 12.5%. The predictor of sexual abuse was borderline personality disorder. The predictors of suicide attempt were comorbid paranoid and borderline personality disorders, and the predictors of suicidal ideation were comorbid major depression and avoidant personality disorder in subjects with panic disorder. In conclusion, this study documents that comorbid personality disorders increase the clinical severity of panic disorder. Borderline personality disorder may be the predictor of a history of sexual abuse and early onset in patients with panic disorder. Paranoid and borderline personality disorders may be associated with a high frequency of suicide attempts in patients with panic disorder. (C) 2005 Elsevier Inc. All rights reserved.Öğe Nicotine dependency of a girl at the age of 18 months(Carfax Publ Co, 1998) Sir, A; Ozkan, MThis case report describes severe nicotine dependency developing at the age of 18 months. Familial, genetic, biological aspects of the case and the therapeutic strategy are discussed.Öğe Suicide in Batman, southeastern Turkey(Wiley, 2005) Altindag, A; Ozkan, M; Oto, RThe southeastern part of Turkey has comparatively high female suicide rates. We aimed to research social, economic, cultural, and psychiatric reasons of suicides in Batman in a case-controlled psychological autopsy study comparing suicides with matched community controls. The female suicide rate was 9.3 per 100.000 and the female/male ratio was 1.72/1. The suicides most frequently occurred in young females, mean age 20.7. The most frequent method (45%) was hanging. The most frequent stressful life events were health problems and family disruption. High suicide rates among females may be related to negative social status of females living in the region.
