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The study is done to investigate the predictive variables of malingering among arrested/convicted cases and the clinical characteristics of malingerers.The study includes 70 arrested/convicted male cases internalized for their treatment. Aform to collect clinical or sociodemografic data, Structured Clinical Interview for DSM-IV Disorders (SCID I), Structured Clinical Interview for DSM-III-R (SCID II), Symptom Check-list (SCL-90-R) and Rey Memory Test (RMT) are applied. Two independent psychiatrists, without being part of the study diagnosed malingering.Arrested cases reported mostly psychotic like and convicted cases mostly depression like symptoms. RMT is helpful by malingering and SCL-90-R psychotic symptom and paranoid symptom subscale scores were both correlated negatively when compared to the RMT scores by malingerers. Axis-I or Axis-II diagnosis were found out to be more predictive than other clinical variables to determine malingering.This study indicate that clinicians have to take malingering into account especially by arrested and convicted cases applied for treatment and they have to be careful by doing the differential diagnosis. Large sample studies conducted with arrested and convicted cases and surveys by grouping cases according to the expertise and treatment services may provide additional data related to malingering.

To the Editor, Factitious disorder (FD) is defined as a condition in which a person voluntarily produces symptoms or illness and acts as if they are ill without an external gain (1). In the Psychiatric Disorders Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), it is divided into three types as “Factitious disorders with predominantly psychological signs and symptoms”, “Factitious disorders with predominantly physical signs and symptoms” and “Factitious disorders with combined psychological and physical signs and symptoms”. FD of the caregiver is classified under the title of “unidentified FD” (2). In the literature, mostly FD of the caregiver is emphasized and it is noted that awareness about the symptoms produced by pediatric patients themselves is low (3–6). In the study of Libow (3), in which pediatric and adolescent patients who produced disease symptoms themselves were reviewed, it was reported that 42 cases were reported in the literature. In our country, there is a small number of pediatric case reports of FD (7, 8). We wanted to emphasize that FD should be considered in the differential diagnosis in the childhood age group by presenting an adolescent patient with FD who presented with different physical and psychological signs and symptoms in this letter. A 15-year old male patient was found by police officers in the street and transported to another hospital where he was admitted because of epileptic seizure. Afterwards, he was referred to our hospital and internalized with the prediagnoses of epilepsy, mental retardation and atypical psychosis. On the first interview he stated that he had epilepsy. On the phone call performed with his grandmother, it was learned that he had faintings for 1–2 years, he was referred to many physicians and his faintings continued, although he used his drugs regularly and blood came out of his mouth occasionally. On psychiatric examination, it was found that he had delusions of persecution and delusions of reference that he was being followed and he will be murdered, auditory hallucinations as speaking sounds which said “come here” and visual halluciantions as “soldiers”. Other psychiatric examination findings were found to be normal. Physical and neurological examinations were found to be normal. Detailed laboratory tests were found to be normal. Electroencephalogram and brain magnetic resonance imaging findings were found to be normal. The blood levels of valproic acid were found to be in the efficient range. On the phone call performed with the grandmother, it was learned that he was adopted at the age of 1,5 years, he was sick from his childhood, he was always naughty and escaped from home. The family reported that they could not care for the patient. It was observed that the family did not call for the patient or visited him during his hospitalization. Treatment was started with 20 mg/day olanzapine in addition to 1 000 mg/day valproic acid which was stated to be used previously. Olanzapine was tapered and discontinued on the third day. Risperidon 2 mg/day was added and the patient was followed up with this treatment. During his hospitalization, he had complaints including fainting, cough, blood coming from the mouth, abdominal pain, crying, rocking the head, hitting the head to wall and moving all the time. Finally, he stated that he ingested screw and ate liquid soap. No pathology was found on consultations of urgent medicine, general surgery, pulmonology and neurology performed at different times. It was notable that the patient generally fainted in the presence of healthcare workers, lay down on the corridor or in front of the nurse’s deck, got up from the ground after fainting and lay down on another place. It was observed that the patient tried to draw attention by continuously explaining his complaints to healthcare workers, other patients and their relatives and demanded continuously. It was recognized that he had no distress or concern about his complaints. In contrast, he was very comfortable and willing during recurrent tests performed and was considerably happy to be in the hospital. During an interview when these behaviors were discussed, he stated that he intentionally fainted to stay in the hospital, he actually ingested no screw, he bit his cheek so that blood came from his mouth and lied about the sounds he heard. Thereupon, the patient’s symptoms, diagnostic and therapeutic process were evaluated and his diagnosis was reviewed. “Factitious disorder” was considered. It was targeted not to perform unnecessary medical investigations and consultations and new therapeutical approaches directed to the psychopathology of the patient were planned. Approximately one month after his hospitalization, the patient stated again that he ingested screw. On direct abdominal graphy in the standing position taken during urgent surgery consultation, two screws were observed. Colonoscopy was planned, but the patient leaved the hospital without permission and could not be found, although he was looked for around the hospital. FD which is a chronic disease with a high mortality leads to multiple hospitalizations and medical interventions, self-harming behavior and marked disruption in functionality (1). It has been reported that these symptoms generally start in adolescence, but the diagnosis of FD is made years later (3, 6, 9). Early diagnosis prevents unnecessary investigations and interventions and decreases the risk of self-harm (1, 7). Psychiatric assessment has an important role in the diagnosis (8). In treatment, it has been reported that confrontation does not lead acceptance of the patient that he/she artificially produces symptoms and may cause the patient to discontinue treatment. Therefore, it is recommended that confrontation should be postponed as much as possible, a supportive and emphatic approach should be displayed and the behaviors directed to produce illness should be tried to be changed in time (9, 10). Conclusively, FD should be considered in patients who have multiple hospital admissions with various physical and psychological symptoms and signs, who display a frequently changing clinical picture, who do not improve despite appropriate treatment and who has incompatibilities in history, examination and laboratory findings. We would also like to remind that considering FD in adolescent patients in the differential diagnosis will provide early diagnosis and treatment and will be beneficial in terms of preventing unnecessary investigations and therapies which may have a risk of harming the patient.

The purpose of the present study was to determine the rate of substance abuse in the juvenile detention house and to determine the relationship between crime and substance abuse and conduct disorder. Two hundred and thirty cases in the biggest juvenile detention house in Istanbul, Turkey were assessed according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria. Law files and data of crime were examined. A total of 80 out of 230 juvenile detainees (34.8%) were found to have substance abuse excluding nicotine and alcohol. The substances abused in preferential order were cannabis (72.5%), volatile substances (21.3% bally and 3.7% thinner; 25%) and sedative hypnotic drugs and biperidents (2.5%). The rate of conduct disorder was 46.3% in substance abusers and 25.3% in the others (odds ratio: 2.536). The rate of substance abuse was 48.5% in the juveniles who had committed multiple crimes and 14.1% in the others (odds ratio: 5.735). The study shows that conduct disorder was very high in juvenile detainees. Conduct disorder was higher in substance-abusing than in non-abusing juvenile detainees. Substance-abusing juvenile detainees were found to have a higher detention rate than non-abusing juvenile detainees. There was a close relation between conduct disorder and substance abuse and multiple crimes. In the light of these results, diagnosis and treatment for conduct disorder in juvenile detainees are of great importance.

LETTER TO THE EDITOR: Autism is a wide spectrum disorder and a lot of factors play role in the etiology. Autism may accompany some genetic disorders such as fragile X, tuberosclerosis, neurofibromatosis and phenylketonuria [1]. However, the absence of sufficient evidence on the etiological roles of environmental, neuroanatomical and biochemical factors has shifted the direction of research to genetics and cytology [2].

ObjectiveThis case is a presentation of three siblings diagnosed as affective disorder with polycythaemia vera during the episodes. Polycythaemia dissappearing with the remission of affective disorder is focus of attention of these cases.Method and resultsFirst sister is 28 years old, single, treated for manic and subclinic depressive episodes for almost ten years. Polycythaemia vera has been developed with beginning of every manic episode and disappeared with the remission of episode. The patient made venopunction of 500cc weekly during the manic episode. Second brother is 26 years old, single, polycythaemia and psychotic depression were developed rapidly after a stressful life event. Venopunction was made for four times during one month medication. Polycythaemia and depression remitted at the same time. Third brother is 24 years old, single, polycythaemia and nonpsychotic depression were developed after his brother's depression. Venopunction was made for three times during three weeks of treatment. Again polycythaemia and depression remitted at the same time.ConclusionThe siblings had no internal disease. Only first sister was on lithium treatment, 600mg/day for chronic affective disorder but her first polycythaemia attack was prior to lithium treatment. We found only one report upon the relationship between affective disorder and polycythaemia vera in which mania, delirium and polycythaemia rubra vera were documented. #Freeman MP, Wiegand C, Gelenberg AJLithium. İn Textbook of Psychopharmacology. Third Edition. Schatzberg AF, Nemenoff CB (editors) American Psychiatric Publishing, Washington DC. 2004, 547-565.

ObjectiveKartagener's Syndrome is a rare congenital malformation and characterized by the triad of bronchiectasis, sinusitis, and situs inversus. We presented a case diagnosed as Kartagener's syndrome and psychotic disorder not elsewhere specified.Method and resultsThe case was a male patient, 32 years old, high school educated, married, with two children. He had a history with increasing psychotic symptoms and two times of suicide attempts for the last two months needed hospitalisation. In the psychiatric examination affect was blunted, there were anxiety, fear due to auditive hallusinations and referance delusions, anhedonia, suicidal thoughts and attempts, secondary depression. Psychiatric disorder predominently with auditive hallusinations and social withdrawal had a duration of three years. He was diagnosed as Kartagener's Syndrome when he was nine years old. The patient was treated with haloperidol 20 mg/day, biperiden 5 mg/day, klorpromazin 100 mg/day during hospitalisation. The psychotic symptoms were reduced within third day. On radiography his heart was seen at the right side of his body, there was bronchial dilatation in the medial and inferior lobes of left lung, thickness of walls of bronches and increased peribronchial density.ConclusionWe assume that the biochemical disorder that is the cause of the development of Kartegener Syndrome is related with the genetic location which facilitates the development of psychosis or risk of psychosis.

IntroductionCarcinoebmryonic antigen (CEA) is mostly used to detectearly recurrences after surgery in patients with colorectalcancer [1]. In this report, we present a case in whichparoxetine use caused increase in CEA. In literature, asimilar case has not been previously presented.CaseA 61-year-old male patient, married, with a child, sufferedtwo depressive episodes, with the first one occurring 15years ago and the second one 7.5 years ago. After thesecond episode, he received paroxetine treatment for ayear, but 6 months after the cessation of treatment, a thirddepressive episode occurred, and paroxetine was startedagain at 20 mg/day. After a response was obtained, hecontinued to use 10 mg/day. Six years after the lastepisode, in routine controls, CEA levels began to increase.CEA level was 20 in April 2008, 27 in June 2008 and 34in September 2008. A whole-body cancer screening wasperformed. However, clinical examination and laboratorytests [computed tomography (CT) and ultrasound (US)]did not reveal cancer. Therefore, in this patient, theincrease in CEA was attributed to paroxetine, and thetreatment was discontinued. A month later, CEA levelbecame 17.DiscussionCEA increase during paroxetine use may be related to theincrease in serotonin, serotonin