Basak Yucel

Objective: To describe and discuss potential relationships between anorexia nervosa (AN) and Raynaud's phenomenon, the course and concurrent treatment of these two disorders as they appeared simultaneously, and a potential treatment modification entailed in such concurrent therapies.Background: Although Raynaud's phenomenon has been described during the course of AN, the associations and interactions between these two conditions are not clear.Method: We report the medical workup, treatment, and outcomes in a 19‐year old female patient who developed Raynaud's phenomenon following the onset of AN.Results: After treatment with nutritional rehabilitation, counseling, and individual and group therapy, the patient's weight, eating disorder‐related behaviors, and attitudes improved significantly. Raynaud's related symptoms improved, following treatment with a calcium channel blocker and antiaggregant therapy. In conjunction with nutritional efforts to treat the patient's long‐standing amenorrhea and osteopenia, the treatment team elected to also administer estrogen hormone in addition to oral calcium and vitamin D supplementation. Since oral contraceptives are to be avoided in patients with Raynaud's phenomenon who show clinical findings suggesting connective tissue disorder, the treatment team elected to treat this patient with transdermal hormone replacement therapy.Conclusion: The co‐occurrence of AN and Raynaud's phenomenon merits close and persistent follow‐up by a multidisciplinary team and may lead to alterations of usual therapeutic approaches. © 2007 by Wiley Periodicals, Inc.

Objective: Although chronic physical illness may be associated coincidentally with an eating disorder, some clinicians may overlook the possibility that another medical illness may coexist and contribute concurrently to symptoms such as peculiar eating behaviors, restrictive eating, and/or vomiting accompanied by body dissatisfaction. We present a 31‐year‐old single woman initially diagnosed with an atypical eating disorder.Method: After a gastroenterology consultation prompted by the atypical characteristics of her eating disturbance, the diagnosis of celiac disease was established.Results: Cause‐and‐effect relationships between anorexia nervosa and celiac disease are unclear, and celiac disease may lead to confusion in the differential diagnosis of anorexia nervosa.Conclusion: Particularly in atypical cases, and in cases where nausea and bloating are prominent complaints, workup for celiac sprue may reveal the presence of this condition. In such instances, patients may achieve additional relief through the implementation of gluten‐free diets. © 2006 by Wiley Periodicals, Inc. Int J Eat Disord 2006

Objective This study reports wide weight fluctuations during a week of early refeeding for 2 patients with anorexia nervosa and discusses possible mechanisms. Method Laboratory tests that consist of complete blood count, biochemistry panel, and serum protein levels were performed. Fluid intake and daily urine output of the patients were measured. Results Laboratory tests were within normal limits for both patients except for leukopenia in one patient. By the end of the Week 1, both patients had achieved significant weight gain (9 kg and 3 kg, respectively) concurrent with edema. Their daily fluid intake and urine output measurements indicated increased total body water levels. Discussion Although the pathophysiology of refeeding edema is not entirely understood, it is well known that insulin induces sodium retention by increasing distal tubular sodium reabsorbtion. In our patients, refeeding‐induced insulin secretion may be chiefly responsible for the edema and weight gain during the early refeeding period. © 2005 by Wiley Periodicals, Inc.

The syndrome of male pseudohermaphroditism, caused by a deficiency of the enzyme 5-α reductase, results in a selective decrease in dihyrotestosterone. Culture is an important part of the context in which decisions are made on sex assignment of patients with abnormalities of the external genitalia. In Turkey, patients with ambiguious genitalia are diagnosed very late and corrective surgery is usually performed during or after puberty. Here we present a case with 5-α reductase deficiency who was diagnosed at puberty and followed-up for 10 years.

The manner in which menstruation, femininity and the role of the mother are perceived, along with the social influences, are emphasized in the psychosocial dimension of premenstrual syndrome. This study attempts to investigate the perception of mothers and attitudes toward menstruation of a group of women diagnosed with premenstrual dysphoric disorder (PMDD) in a secular Muslim country. Thirty women with PMDD and 24 healthy women were studied using a semi-structured questionnaire. Menstrual attitude and the way the mother was perceived in the childhood-to-puberty period by women with PMDD, were significantly negative in comparison to the control group. In conclusion, menstrual attitudes and premenstrual experiences of women should be investigated cross-culturally and prospectively.

The aim of this study was to examine childhood traumatic experiences and dissociative characteristics in women with chronic headache and low back pain. The patients were evaluated in the multidisciplinary pain clinic of a university hospital. This study included 73 patients: 41 with chronic headache and 32 with chronic low back pain. All the patients were assessed with use of a semistructured questionnaire, the Dissociative Experiences Scale (DES), the Somatoform Dissociation Questionnaire (SDQ), and the Childhood Abuse and Neglect Questionnaire. There were no significant differences between the headache and low back pain groups in terms of prevalence of history of neglect; abuse; or sexual, physical, and emotional abuse separately. In addition, no significant differences were found between the groups with respect to the Dissociative Experiences Scale scores. However, analysis of the SDQ scores showed that the neglect rate in the two groups differed significantly. According to our findings, the neglect rate was higher in the headache group, thus warranting further research to investigate the sensitivity of the SDQ for neglect.

Psychogenic excoriation (PE), characterized by excessive scratching or picking of the skin, is not yet recognized as a symptom of a distinct DSM-IV disorder. It is a chronic disorder with a high rate of psychiatric comorbidity. The purpose of this study was to compare patients diagnosed with PE and another group of psychodermatosis patients in terms of comorbid psychiatric disorders. Thirty-one consecutive subjects were recruited from an outpatient dermatology clinic. The control group was composed of 31 patients with a dermatological disease other than PE. Subjects were interviewed using the Structured Clinical Interview for DSM-III-R, Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HARS) and the Yale-Brown Obsession and Compulsion Scale (YBOCS). Subjects also completed a semi-structured questionnaire for socio-demographic data and clinical features. Current major depressive syndrome was the most common psychiatric disorder in the PE group. There was a statistically significant difference between the two groups in terms of current major depressive syndrome (PE group 58.1%, control group 6.5%, p<0.01). Some 45.2% of the PE group was diagnosed with obsessive compulsive disorder (OCD) while the proportion was only 3.7% in the control group. This difference was also statistically significant (p<0.01). The PE group scored significantly higher in the BDI, HARS and the YBOCS. The results of this study point to a close relationship between PE and depression and OCD.