Posttraumatic stress disorder (PTSD) is a disabling psychiatric condition that tends to have a chronic course and often overlooked in the elderly population. As the disorder has great implications for the quality of life, a correct diagnosis and treatment are crucial. The studies in this area have demonstrated that the elderly people do not appear more predisposed to develop PTSD compared to the young people and the symptomatology of the disorder is similar between these age groups: reexperiencing the trauma, avoidance, and hyperarousal. Symptoms may be persistent or intermittent, and the disorder may be time-limited or chronic. Increasing severity of trauma and premorbid psychiatric illness predispose to the development of PTSD, and certain personality traits and good psychosocial support protect against it. Antidepressants, group therapy, and cognitive-behavioral therapy are presently the mainstays of treatment, although to date no systematic and controlled research has been done on the treatment of PTSD in this age group. This study is a case report. Seventy years old male patient had PTSD symptoms which started after his son's death and persisted for 6 months. He also had depressive symptoms. The aim of this report is to emphasize the cases comorbide with PTSD in elders, predispozing factors for PTSD and treatment methods, in a case which had diagnosed as PTSD. Psychodynamic formulation has been made evaluating the psychiatric disease history, psychodyamic and psychosocial history and psychological test.

Short time after discovering of classical antipsychotics in 1950's, extrapyramidal side effects and movement disorders were observed in many patients, despite improvement of psychotic symptoms. In contrast to new antipsychotic agents, these side effects are occasionally seen in early periods of the treatment by classic antipsychotics; movement disorders occur as dystonia, parkinsonism, and akathisia however in the long term "tardive" diskinesia, chorea, dystonia and tics may be observed. Furthermore, these extrapyramidal side effects and movement disorders cause secondary problems such as dislocations in joints, low compliance to treatment and decreased quality of life of patients. In this case report, after intramuscular injection of zuclopenthiksol, a classical antipsychotic drug, acute dystonia was occurred which is evidenced by pain in temporomandibular joint, inability to close mouth, to swallow saliva, to speak and disproportion in face. To treat this case firstly, we used biperiden and diazepam for treatment of orofacial dystonia. After dystonia did not respond to the treatment, physical examination and clinical symptoms were reevaluated. Temporomandibular joint dislocation was diagnosed following the consultations from the related departments and radiological investigations. We sedated the patient by 15 mg of Diazepam than treat the dislocation by manual reduction. As in this case report, temporomandibular joint dislocation should be considered especially in patients with orofacial dystonia after use of classic antipsychotic agents who do not respond to medical treatment.

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 neurodevelopmental 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.

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.

Clozapine is a potent atypical antipsychotic drug being used to treat treatment-refractory schizophrenia and has fewer extrapyramidal side effects in comparison to conventional antipsyhotic drugs. It has a weaker affinity for post-synaptic D2 receptors and exhibits its actions via D1, D4 and 5HT2 receptors. Side effects of major clinical importance include agranulocytosis, seizures, orthostasis, sedation and, hypersalivation. In addition to generalized seizures, clozapine may also produce myoclonus. Myoclonus can be defined as spontaneous, paroxysmal and irregular contractions of a muscle or muscle group. It can be focal or multi-focal. Many psychotropic drugs can induce myoclonus. There has been limited amount of scientific publications on clozapine-induced myoclonus. Several researchers have emphasized the role of monoaminergic system including especially serotonin, dopamine and noradrenalin in myoclonic activity. The GABA-ergic system has also been investigated because clonazepam and valproic acid sometimes alleviate this phenomenon. It is thought that myoclonic events could be precursors of generalized seizures. Clozapine-induced miyoclonus has been reported to occur at low doses in some cases. The time of initiation of treatment with clozapine appears to be a period of greater risk for myoclonus and seizures. Slower titration may reduce seizure rates. Discontinuation of drug, lowering of dosage, addition of anticonvulsant are recommended when clozapine-induced myoclonus occurs. We present here a schizophrenia patient treated with clozapine who experienced myoclonic jerks and drop attacks and we discuss these symptoms with the related literature.

Sexual aversion disorder is a sexual dysfunction characterized with persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner. It is known that it is a rare disorder and it is hard to treat. Although it entered DSM’s classification in 1987, in books about sexual disorders it is not placed under its own title but discussed with sexual desire disorder, vaginusmus, dyspareunia or as a result of sexual abuse. There is a common opinion that it is seen more frequently with women and the most efficient treatment technique is the behavioral desensitization. This case report presents a 24-year-old woman, who had not touched her husband in her 4-year marriage and had not let him touch her and refused having sex naked. The patient, who was sexually abused when she was 8 or 9, had rarely had sex with her husband. The patient who was admitted to thearpy with her husband improved in a surprisingly short time. Treatment process, where “systematic desensitization” and general sexual therapy principles applied, was completed in 3 sessions. In this paper, clinical characteristics, diagnosis, treatment process of sexual aversion disorder, and factors that affected the treatment process positively were discussed. Moreover, it is emphasized that sexual aversion disorder could be treated in a surprisingly short time with proper therapy techniques and when patients are informed well.

We present a case with a history of bipolar disorder who developed signs and symptoms consistent with Neuroleptic Malignant Syndrome (NMS) after one day of treatment with single dose intramuscular olanzapine and the positive response to electroconvulsive treatment (ECT). The patient presented with severe elevated temperature, tremors, labile blood pressure, muscular rigidity, diaphoresis, mutism and mental status changes that had progressed over the preceeding 24 hours after one day of treatment with single dose intramuscular olanzapine. Laboratory data revealed Creatinine phosphokinase (CK) as 1863 U/L. Urine drug screening failed to reveal any evidence of amphetamine, cocaine, tricylic antidepressant, opiate, cannabis, barbiturate, or benzodiazepine exposure. Leukocyte count was 5150/uL, with a hemoglobin of 12.6g %, and a hematocrit of 39.7%. The patient 's serum sodium level was 144 mmol/L, potassium3.4 mmol/L, chloride 122 mmol/L and a creatinine 0.80 mg/dl. A computud tomography ( CT ) scan of the head were also performed and were reported as normal. Neurologic or infectious states were ruled out and the patient was diagnosed as NMS according to DSM IV criteria. The patient was admitted to the supportive care. In this case report, NMS was successfully treated with eighteen bilateral ECT under general anesthesia. Although, cases of olanzapine induced NMS were reported in the literature, our case, presenting NMS after a single dose olanzapine IM, is different from the previous ones.

Objectives: The aim of the study was to examine the tolerability and the onset of antidepressant action of mirtazapine. Method: Twenty adult outpatients with major depresion were treated with mirtazapine and assessed at baseline, and after 1, 2, 3, 4, and 8 weeks by the 17-item Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale (MADRS), and Clinical Global Impression-Severity of Illness and Clinical Global Impression-Global Improvement scales. The onset of action was measured by a reduction of more than 50% from baseline on HDRS and MADRS. Remission was defined as an HDRS score under 7. Udvalg for Kiliske Undersegelser (UKU) was used to assess the tolerability. Results: The reductions from baseline on both HDRS and MADRS were significant starting from week 1. HDRS was reduced by 46% on week 2 (n=19), and by 61% on week 3 (n=18). HDRS score reduced to 7 by week 4 (n=15). Evaluating the side effects, increased dream activity (16%), weight gain (14%), sleepiness / sedation (12%), and increased duration of sleep (12%) were the most frequent. The weight gain was significant between the baseline and the last visit (x²=24.329, df=5, p=0.0001). Conclusion: Mirtazapine, known as an NaSSA with its noradrenergic and specific serotonergic antidepressant action, seems to be a good choice in treatment of major depression with its rapid onset antidepressant activity and favorable tolerability.

Various theories that range from innate characteristics to environmental contributions exist as regarding factors affecting the development of sexual identity. Normal sexual differentiation which evolves under the influence of systemic or localized hormones in addition to chromosomal order may be broken down with genetic abnormalities, hormone secretion deficiencies and lack of response in target organs. Despite noticing and evaluation of patients with ambiguous genitalia in early period of life especially in the newborn period is important for the prevention of possible further emotional or organic deficiencies, there are still cases remained unnoticed until the adolescence or adulthood period in our country. In this case report, a 24 years old male patient with diagnosis of male pseudohermaphroditism is presented. He had been seen for preoperational psychiatric consultation upon decision of the ethical committee after being hospitalized for penis reconstruction operation and reevaluated after psychological counseling process and the decision for surgery and following post-surgical psychological counseling process was taken. The patient had gone through penis reconstruction beside left orchiectomy operation that had been performed to prevent cancer risk. After the operation he continued his life as a male. Our knowledge on normal psychosexual identity development and the factors it has been affected from is increasing with studies being conducted but still limited. In this case report, despite being raised completely as a girl the patient chose his sexual identity on the base of innate characteristics. This shows us the importance of organic factors in the selection of sexual identity.

Capgras syndrome is placed among the group of delusional misidentification syndromes and is characterized by delusions which are rare and resistant to treatment. The patient believes one of his close relatives, and even himself to be changed with a doppelganger. It is commonly accompanied by schizophrenia or organic psychosis and is very rare in its pure form. The psychosis is of the paranoid type in most of the cases. It is also known to accompany mania and psychotic depression. The etiology of this rare psychiatric syndrome remains elusive. Most of the cases are explained with psychoanalytic terms, although in later cases diffuse or localized brain lesions are suspected to be responsible. Some authors posited that organic and psychodynamic causes may coexist. In this study, a case of Capgras syndrome, in which psychodynamic causes are thought to be more prominent, is presented. Because of the facts that our patient believed his parents to be changed with their doppelganger, this delusion was more prominent than delusions of persecution, being both progressive and resistant and the presence of auditory hallucinations; Capgras syndrome with Schizophreniform disorder was diagnosed. Although, psychodynamic explanations of this phenomenon may be possible, a detailed neuropsychiatric evaluation was deemed necessary to rule out an organic cause.