Time Perception and Psychiatric Disorders

Year 2013, Volume: 5 Issue: 3, 355 - 377, 01.09.2013

Nil Banu Bahadırlı Can Tutuğ Hatice Ceviz Okan Çalıyurt

https://doi.org/10.5455/cap.20130524

Abstract

Time perception is an ability which we use in every moment of daily life, that guides the formation and continuation of our behaviors and from an evolutionary perspective ensures survival. Internal clock models help us to understand time perception. Time perception is known to vary between individuals and particular situations. This variability is explained with the mechanisms which is associated with the processes related to attention, the speed of the internal clock and the memory unit. It is suggested that time perception is mainly associated with the activities of dopamine and acetylcholine. Some dopaminergic psychoactive substances like cocaine and amphetamine have all been shown to change time perception by increasing the speed of internal clock while on the other hand some antipsychotic drugs make an opposite change in time perception by descreasing the speed of the clock. Similarly, time perception is affected in some psychiatric disorders and an ethiopathological relationship between time perception disturbances and psychiatric disorders is suggested. In this article time perception changes in schizophrenia, attention deficit/hyperactivity syndrome, depression, anxiety disorders and personality disorders are briefly reviewed.

Keywords

Time perception, psychiatric disorders, depression

Zaman Algısı ve Psikiyatrik Bozukluklar

Abstract

Zamanı algılama becerisi, günlük yaşamımızın her alanında kullandığımız, davranışlarımızın oluşmasında ve sürmesinde bize rehberlik eden, evrimsel açıdan bakılacak olursa hayatta kalmamızı sağlayan yeteneklerden birisidir. Zaman algısını anlamamızda, içsel saat modelleri yardımcı olmaktadır. Zaman algısının kişiler ve belirli durumlar arasında değişkenlik gösterdiği bilinmektedir. Bu değişkenlik dikkat ile ilgili süreçler, içsel saatin hızı ve bellek birimi ile ilgili mekanizmalarla açıklanmaktadır. Zaman algısının ön planda dopamin ve asetilkolin aktivitesi ile ilişkili olduğu öne sürülmüştür. Kokain ve amfetamin gibi dopamin agonisti olan psikoaktif maddelerin içsel saat hızını arttırarak zaman algısında değişime sebep olduğu gösterilmiş olup, diğer taraftan bazı antipsikotikler içsel saat hızını yavaşlatarak zaman algısında tersi yönde bir değişime sebep olmaktadırlar. Benzer şekilde bazı psikiyatrik bozukluklarda zaman algısı etkilenmektedir. Zaman algısındaki sapma ile psikiyatrik bozuklar arasında etiyopatolojik bir ilişki bulunabileceği öne sürülmüştür. Bu yazıda; şizofreni, dikkat eksikliği ve hiperaktivite bozukluğu, depresyon, anksiyete bozuklukları ve kişilik bozukluklarında görülen zaman algısı değişiklikleri gözden geçirilmiştir.

Keywords

Zaman algısı, psikiyatrik bozukluklar, depresyon

References

• Türk Dil Kurumu. Türkçe Sözlük. Ankara, Türk Dil Kurumu Yayınları, 2005.
• Matell MS, Meck WH. Neuropsychological mechanisms of interval timing behavior. Bioessays 2000; 22:94-103.
• Buhusi CV, Meck WH. What makes us tick? functional and neural mechanisms of interval timing. Nat Rev Neurosci 2005; 6:755-765.
• Meck WH. Neuropharmacology of timing and time perception. Brain Res Cogn Brain Res 1996; 3:227-242.
• Ivry RB, Spencer RM. The neural representation of time. Curr Opin Neurobiol 2004; 14:225-232.
• Koekkoek SK, Hulscher HC, Dortland BR, Hensbroek RA, Elgersma Y, Ruigrok TJ et al. Cerebellar LTD and learning-dependent timing of conditioned eyelid responses. Science 2003; 301:1736-1739.
• Coull JT, Cheng RK, Meck WH. Neuroanatomical and neurochemical substrates of timing. Neuropsychopharmacology 2011; 36:3-25.
• Ferrandez AM, Hugueville L, Lehericy S, Poline JB, Marsault C, Pouthas V. Basal ganglia and supplementary motor area subtend duration perception: an fMRI study. Neuroimage 2003; 19:1532-1544.
• Lewis PA, Miall RC. Distinct systems for automatic and cognitively controlled time measurement: evidence from neuroimaging. Curr Opin Neurobiol 2003; 13:2502
• Macar F, Vidal F, Casini L. The supplementary motor area in motor and sensory timing: evidence from slow brain potential changes. Exp Brain Res 1999; 125:2712
• Malapani C, Deweer B, Gibbon J. Separating storage from retrieval dysfunction of temporal memory in Parkinson's disease. J Cogn Neurosci 2002; 14:311-322.
• Rubia K, Overmeyer S, Taylor E, Brammer M, Williams S, Simmons A et al. Prefrontal involvement in "temporal bridging" and timing movement. Neuropsychologia 1998; 36:1283-1293.
• Ortuno F, Guillen-Grima F, Lopez-Garcia P, Gomez J, Pla J. Functional neural networks of time perception: challenge and opportunity for schizophrenia research. Schizophr Res 2011; 125:129-135.
• Gibbon J, Church RM. Comparison of variance and covariance patterns in parallel and serial theories of timing. J Exp Anal Behav 1992; 57:393-406.
• Droit-Volet S, Meck WH. How emotions colour our perception of time. Trends Cogn Sci 2007; 11:504-513.
• Buhusi CV, Meck WH. Relative time sharing: new findings and an extension of the resource allocation model of temporal processing. Philos Trans R Soc Lond B Biol Sci 2009; 364:1875-1885.
• Burle B, Casini L. Dissociation between activation and attention effects in time estimation: implications for internal clock models. J Exp Psychol Hum Percept Perform 2001; 27:195-205.
• Cheng RK, Etchegaray M, Meck WH. Impairments in timing, temporal memory, and reversal learning linked to neurotoxic regimens of methamphetamine intoxication. Brain Res 2007; 1186:255-266.
• Cheng RK, Hakak OL, Meck WH. Habit formation and the loss of control of an internal clock: inverse relationship between the level of baseline training and the clock-speed enhancing effects of methamphetamine. Psychopharmacology (Berl) 2007; 193:351-362.
• Coull JT, Cheng RK, Meck WH. Neuroanatomical and neurochemical substrates of timing. Neuropsychopharmacology 2011; 36:3-25.
• Odum AL, Lieving LM, Schaai DW. Effects of D-amphetamine in a temporal discrimination procedure: selective changes in timing or rate dependency? J Exp Anal Behav 2002; 78:195-214.
• Meck WH. Affinity for the dopamine D2 receptor predicts neuroleptic potency in decreasing the speed of an internal clock. Pharmacol Biochem Behav 1986; 25:118511
• Rammsayer T. Effects of pharmacologically induced dopamine-receptor stimulation on human temporal information processing. NeuroQuantology 2009; 7:103-113.
• Meck WH, Church RM. Cholinergic modulation of the content of temporal memory. Behav Neurosci 1987; 101:457-464.
• Asgari K, Body S, Zhang Z, Fone KC, Bradshaw CM, Szabadi E. Effects of 5-HT1A and 5-HT2A receptor stimulation on temporal differentiation performance in the fixed-interval peak procedure. Behav Processes 2006; 71:250-257.
• Stahl SM. Stahl's Essential Psychopharmacology: Neuroscientific Basis and Practical applications, 3rd edition. New York, Cambridge University Press, 2008.
• Boileau I, Assaad JM, Pihl RO, Benkelfat C, Leyton M, Diksic M et al. Alcohol promotes dopamine release in the human nucleus accumbens. Synapse 2003; 49:2262
• Heishman SJ, Arasteh K, Stitzer ML. Comparative effects of alcohol and marijuana on mood, memory, and performance. Pharmacol Biochem Behav 1997; 58:93-101.
• Lapp WM, Collins RL, Zywiak WH, Izzo CV. Psychopharmacological effects of alcohol on time perception: the extended balanced placebo design. J Stud Alcohol 1994; 55:96-112.
• Ogden RS, Wearden JH, Gallagher DT, Montgomery C. The effect of alcohol administration on human timing: a comparison of prospective timing, retrospective timing and passage of time judgements. Acta Psychol (Amst) 2011; 138:254-262.
• Terry P, Doumas M, Desai RI, Wing AM. Dissociations between motor timing, motor coordination, and time perception after the administration of alcohol or caffeine. Psychopharmacology (Berl) 2009; 202:719-729.
• Tinklenberg JR, Roth WT, Kopell BS. Marijuana and ethanol: differential effects on time perception, heart rate, and subjective response. Psychopharmacology (Berl) 1976; 49:275-279.
• Wearden, J.H., O’Donoghue, A., Ogden, R., & Montgomery, C. (in press). Subjective duration in the laboratory and the world outside.In Subjective time: The philosophy, psychology, and neuroscience of temporality (Eds V Arstila, D Lloyd). Cambridge, USA, MIT Press, 2013.
• Andreasen NC, Paradiso S, O'Leary DS. "Cognitive dysmetria" as an integrative theory of schizophrenia: a dysfunction in cortical-subcortical-cerebellar circuitry? Schizophr Bull 1998; 24:203-218.
• Andreasen NC. A unitary model of schizophrenia: Bleuler's "fragmented phrene" as schizencephaly. Arch Gen Psychiatry 1999; 56:781-787.
• Bressler SL. Cortical coordination dynamics and the disorganization syndrome in schizophrenia. Neuropsychopharmacology 2003; 28 (Suppl 1):S35-S39.
• Carroll CA, Boggs J, O'Donnell BF, Shekhar A, Hetrick WP. Temporal processing dysfunction in schizophrenia. Brain Cogn 2008; 67:150-161.
• Carroll CA, O'Donnell BF, Shekhar A, Hetrick WP. Timing dysfunctions in schizophrenia span from millisecond to several-second durations. Brain Cogn 2009; 70:181-190.
• Elvevag B, McCormack T, Gilbert A, Brown GD, Weinberger DR, Goldberg TE. Duration judgements in patients with schizophrenia. Psychol Med 2003; 33:124912
• Johnson JE, Petzel TP. Temporal orientation and time estimation in chronic schizophrenics. J Clin Psychol 1971; 27:194-196.
• Tysk L. Time estimation by healthy subjects and schizophrenic patients: a methodological study. Percept Mot Skills 1983; 56:983-988.
• Tysk L. Estimation of time and the subclassification of schizophrenic disorders. Percept Mot Skills 1983; 57:911-918.
• Tysk L. Estimation of time by patients with positive and negative schizophrenia. Percept Mot Skills 1990; 71:826.
• Wahl OF, Sieg D. Time estimation among schizophrenics. Percept Mot Skills 1980; 50:535-541.
• Waters F, Jablensky A. Time discrimination deficits in schizophrenia patients with first-rank (passivity) symptoms. Psychiatry Res 2009; 167:12-20.
• Davalos DB, Rojas DC, Tregellas JR. Temporal processing in schizophrenia: effects of task-difficulty on behavioral discrimination and neuronal responses. Schizophr Res 2011; 127:123-130.
• Fortin C, Rousseau R, Bourque P, Kirouac E. Time estimation and concurrent nontemporal processing: specific interference from short-term-memory demands. Percept Psychophys 1993; 53:536-548.
• Rammsayer TH, Lima SD. Duration discrimination of filled and empty auditory intervals: cognitive and perceptual factors. Percept Psychophys 1991; 50:565-574.
• Bonnot O, de MM, Kermarrec S, Botbol M, Walter M, Coulon N. Are impairments of time perception in schizophrenia a neglected phenomenon? J Physiol Paris 2011; 105:164-169.
• Elvevag B, Goldberg TE. Cognitive impairment in schizophrenia is the core of the disorder. Crit Rev Neurobiol 2000; 14:1-21.
• Lee J, Park S. Working memory impairments in schizophrenia: a meta-analysis. J Abnorm Psychol 2005; 114:599-611.
• Lee KH, Bhaker RS, Mysore A, Parks RW, Birkett PB, Woodruff PW. Time perception and its neuropsychological correlates in patients with schizophrenia and in healthy volunteers. Psychiatry Res 2009; 166:174-183.
• Franck N, Posada A, Pichon S, Haggard P. Altered subjective time of events in schizophrenia. J Nerv Ment Dis 2005; 193:350-353.
• Waters FA, Badcock JC, Maybery MT, Michie PT. Inhibition in schizophrenia: association with auditory hallucinations. Schizophr Res 2003; 62:275-280.
• Frith C. The neural basis of hallucinations and delusions. C R Biol 2005; 328:1691
• Waters FA, Badcock JC. First-rank symptoms in schizophrenia: reexamining mechanisms of self-recognition. Schizophr Bull 2010; 36:510-517.
• Blakemore SJ, Smith J, Steel R, Johnstone CE, Frith CD. The perception of selfproduced sensory stimuli in patients with auditory hallucinations and passivity experiences: evidence for a breakdown in self-monitoring. Psychol Med 2000; 30:1131-1139.
• Blakemore SJ, Frith CD, Wolpert DM. Spatio-temporal prediction modulates the perception of self-produced stimuli. J Cogn Neurosci 1999; 11:551-559.
• Mannuzza S, Klein RG, Bessler A, Malloy P, LaPadula M. Adult outcome of hyperactive boys: educational achievement, occupational rank, and psychiatric status. Arch Gen Psychiatry 1993; 50:565-676.
• Can H, Soysal Ş, Tan S, Ercan İ, Dikeç BE A comparative evaluation of two scales used in the assessment of adult attention deficit hyperactivity disorder. Yeni Tıp Dergisi-TheNew Journal of Medicine 2011; 28:207-212.
• Biederman J, Spencer T. Attention-deficit/hyperactivity disorder (ADHD) as a noradrenergic disorder. Biol Psychiatry 1999; 46:1234-1242.
• Faraone SV, Doyle AE, Mick E, Biederman J. Meta-analysis of the association between the 7-repeat allele of the dopamine D(4) receptor gene and attention deficit hyperactivity disorder. Am J Psychiatry 2001; 158:1052-1057.
• Klimkeit EI, Mattingley JB, Sheppard DM, Lee P, Bradshaw JL. Motor preparation, motor execution, attention, and executive functions in attention deficit/hyperactivity disorder (ADHD). Child Neuropsychol 2005; 11:153-173.
• Barkley RA, Edwards G, Laneri M, Fletcher K, Metevia L. Executive functioning, temporal discounting, and sense of time in adolescents with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). J Abnorm Child Psychol 2001; 29:541-556.
• Smith A, Taylor E, Rogers JW, Newman S, Rubia K. Evidence for a pure time perception deficit in children with ADHD. J Child Psychol Psychiatry 2002; 43:5295
• Toplak ME, Tannock R. Tapping and anticipation performance in attention deficit hyperactivity disorder. Percept Mot Skills 2005; 100:659-675.
• Cöngöloğlu MA, Türkbay T. Zaman algısı ve dikkat eksikliği hiperaktivite bozukluğu: gözden geçirme. Çocuk ve Gençlik Ruh Sağlığı Dergisi 2010; 17:97-104. Kerns KA, McInerney RJ, Wilde NJ. Time reproduction, working memory, and behavioral inhibition in children with ADHD. Child Neuropsychol 2001;7:21-31.
• Meaux JB, Chelonis JJ. Time perception differences in children with and without ADHD. J Pediatr Health Care 2003; 17:64-71.
• Sonuga-Barke EJ, Saxton T, Hall M. The role of interval underestimation in hyperactive children's failure to suppress responses over time. Behav Brain Res 1998; 94:45-50.
• Toplak ME, Rucklidge JJ, Hetherington R, John SC, Tannock R. Time perception deficits in attention-deficit/ hyperactivity disorder and comorbid reading difficulties in child and adolescent samples. J Child Psychol Psychiatry 2003; 44:888-903.
• West J, Douglas G, Houghton S, Lawrence V, Whiting K, Glasgow K. Time perception in boys with attention-deficit/hyperactivity disorder according to time duration, distraction and mode of presentation. Child Neuropsychol 2000; 6:2412
• Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 1997; 121:65-94.
• Castellanos FX, Tannock R. Neuroscience of attention-deficit/hyperactivity disorder: the search for endophenotypes. Nat Rev Neurosci 2002; 3:617-628.
• Durston S, Hulshoff Pol HE, Schnack HG, Buitelaar JK, Steenhuis MP, Minderaa RB et al. Magnetic resonance imaging of boys with attention-deficit/hyperactivity disorder and their unaffected siblings. J Am Acad Child Adolesc Psychiatry 2004; Giedd JN, Blumenthal J, Molloy E, Castellanos FX. Brain imaging of attention deficit/hyperactivity disorder. Ann N Y Acad Sci 2001; 931:33-49.
• Hwang JW, Lee JB, Kim BN, Lee HY, Lee DS, Shin MS et al. Regional cerebral perfusion abnormalities in developmental language disorder. Statistical parametric mapping analysis. Eur Arch Psychiatry Clin Neurosci 2006; 256:131-137.
• Sonuga-Barke E, Bitsakou P, Thompson M. Beyond the dual pathway model: evidence for the dissociation of timing, inhibitory, and delay-related impairments in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2010; 49:345-355.
• Pliszka SR, Liotti M, Woldorff MG. Inhibitory control in children with attention deficit/hyperactivity disorder: event-related potentials identify the processing component and timing of an impaired right-frontal response-inhibition mechanism. Biol Psychiatry 2000; 48:238-246.
• Schneider MF, Krick CM, Retz W, Hengesch G, Retz-Junginger P, Reith W, Rosler M. Impairment of fronto-striatal and parietal cerebral networks correlates withattention deficit hyperactivity disorder (ADHD) psychopathology in adults - a functional magnetic resonance imaging (fMRI) study. Psychiatry Res 2010; 183:75
• Feifel D, Farber RH, Clementz BA, Perry W, Anllo-Vento L. Inhibitory deficits in ocular motor behavior in adults with attention-deficit/hyperactivity disorder. Biol Psychiatry 2004; 56:333-339.
• Mangels JA, Ivry RB, Shimizu N. Dissociable contributions of the prefrontal and neocerebellar cortex to time perception. Brain Res Cogn Brain Res 1998; 7:15-39.
• Radonovich KJ, Mostofsky SH. Duration judgments in children with ADHD suggest deficient utilization of temporal information rather than general impairment in timing. Child Neuropsychol 2004; 10:162-172.
• Rubia K, Taylor A, Taylor E, Sergeant JA. Synchronization, anticipation, and consistency in motor timing of children with dimensionally defined attention deficit hyperactivity behaviour. Percept Mot Skills 1999; 89:1237-1258.
• Yang B, Chan RC, Zou X, Jing J, Mai J, Li J. Time perception deficit in children with ADHD. Brain Res 2007; 1170:90-96.
• Rommelse NN, Oosterlaan J, Buitelaar J, Faraone SV, Sergeant JA. Time reproduction in children with ADHD and their nonaffected siblings. J Am Acad Child Adolesc Psychiatry 2007; 46:582-590.
• Himpel S, Banaschewski T, Gruttner A, Becker A, Heise A, Uebel H et al. Duration discrimination in the range of milliseconds and seconds in children with ADHD and their unaffected siblings. Psychol Med 2009; 39:1745-1751.
• Nicolson RI, Fawcett AJ, Dean P. Developmental dyslexia: the cerebellar deficit hypothesis. Trends Neurosci 2001; 24:508-511.
• Valko L, Schneider G, Doehnert M, Muller U, Brandeis D, Steinhausen HC et al. Time processing in children and adults with ADHD. J Neural Transm 2010; 117:1213-1728.
• Marx I, Hubner T, Herpertz SC, Berger C, Reuter E, Kircher T et al. Cross-sectional evaluation of cognitive functioning in children, adolescents and young adults with ADHD. J Neural Transm 2010; 117:403-419.
• Barkley RA, Koplowitz S, Anderson T, McMurray MB. Sense of time in children with ADHD: effects of duration, distraction, and stimulant medication. J Int Neuropsychol Soc 1997; 3:359-369.
• Rubia K, Noorloos J, Smith A, Gunning B, Sergeant J. Motor timing deficits in community and clinical boys with hyperactive behavior: the effect of methylphenidate on motor timing. J Abnorm Child Psychol 2003; 31:301-313.
• Plummer C, Humphrey N. Time perception in children with ADHD: the effects of task modality and duration. Child Neuropsychol 2009; 15:147-162.
• Seri Y, Kofman O, Shay L. Time estimation could be impaired in male, but not female adults with attention deficits. Brain Cogn 2002; 48:553-558.
• Bech P. Depression: influence on time estimation and time experiments. Acta Psychiatr Scand 1975; 51:42-50.
• Blewett AE. Abnormal subjective time experience in depression. Br J Psychiatry 1992; 161:195-200.
• Kitamura T, Kumar R. Time passes slowly for patients with depressive state. Acta Psychiatr Scand 1982; 65:415-420.
• Mezey AG, Cohen SI. The effect of depressive illness on time judgment and time experience. J Neurol Neurosurg Psychiatry 1961; 24:269-270.
• Wyrick RA, Wyrick LC. Time experience during depression. Arch Gen Psychiatry 1977; 34:1441-1443.
• Hawkins WL, French LC, Crawford BD, Enzle ME. Depressed affect and time perception. J Abnorm Psychol 1988; 97:275-280.
• Kitamura T, Kumar R. Controlled study on time reproduction of depressive patients. Psychopathology 1984; 17:24-27.
• Bschor T, Ising M, Bauer M, Lewitzka U, Skerstupeit M, Muller-Oerlinghausen B at al. Time experience and time judgment in major depression, mania and healthy subjects: a controlled study of 93 subjects. Acta Psychiatr Scand 2004; 109:222-229. Grinker J, Glucksman ML, Hirsch J, Viseltear G. Time perception as a function of weight reduction: a differentiation based on age at onset of obesity. Psychosom Med 1973; 35:104-111.
• Kuhs H, Hermann W, Kammer K, Tolle R. Time estimation and the experience of time in endogenous depression (melancholia): an experimental investigation. Psychopathology 1991; 24:7-11.
• Sevigny MC, Everett J, Grondin S. Depression, attention, and time estimation. Brain Cogn 2003; 53:351-353.
• Tysk L. Time perception and affective disorders. Percept Mot Skills 1984; 58:4554
• Lemke MR, Koethe N, Schleidt M. Segmentation of behavior and time structure of movements in depressed patients. Psychopathology 2000; 33:131-136.
• Gil S, Droit-Volet S. Time perception, depression and sadness. Behav Processes 2009; Kuhs H, Hermann W, Kammer K, Tolle R. The daily course of the symptomatology and the impaired time estimation in endogenous depression (melancholia). J Affect Disord 1989; 17:285-290.
• Msetfi RM, Murphy RA, Kornbrot DE. The effect of mild depression on time discrimination. J Exp Psychol (Hove ) 2012; 65:632-645.
• Meck WH. Neuropsychology of timing and time perception. Brain Cogn 2005; 58:1Melges FT, Fougerousse CE, Jr. Time sense, emotions, and acute mental illness. J Psychiatr Res 1966; 4:127-139.
• Smith SB. Physical symptoms of discomfort associated with worry about giving a public speech. Communication Reports 2005; 18:31-41.
• Lueck MD. Anxiety levels: do they influence the perception of time? UW-L Journal of Undergraduate Research 2007; 10:1-5.
• Bagana E, Raciu A. Anxiety, impulsiveness and time perception among secondary and high school students. Procedia Soc Behav Sci 2012; 33:890-894.
• Richards JC, Bertram S. Anxiety sensitivity, state and trait anxiety, and perception of change in sympathetic nervous system arousal. J Anxiety Disord 2000; 14:413-427.
• Orme JE. Personality, time estimation and time experience. Acta Psychol (Amst) 1964; 22:430-440.
• Rammsayer TH. On the relationship between personality and time estimation. Pers Individ Dif 1997; 3:739-744.
• Berlin HA, Rolls ET. Time perception, impulsivity, emotionality, and personality in self-harming borderline personality disorder patients. J Pers Disord 2004; 18:3583 Nil Banu Bahadırlı, Dr., Trakya Üniv. Tıp Fakültesi Psikiyatri A.D, Edirne; Can Tutuğ, Doç. Dr., Dr., Trakya Üniv. Tıp Fakültesi Psikiyatri A.D, Edirne; Hatice Ceviz, Dr., Trakya Üniv. Tıp Fakültesi Psikiyatri A.D, Edirne; Okan Çalıyurt, Prof. Dr., Trakya Üniv. Tıp Fakültesi Psikiyatri A.D, Edirne. Yazışma Adresi/Correspondence: Nil Banu Bahadırlı, Dr., Trakya Üniv. Tıp Fakültesi Psikiyatri A.D, Edirne, Turkey. E-mail: [e-mail] Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemişlerdir. The authors reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol5/no3/ Çevrimiçi yayım / Published online 07 Eylül/September 07, 2013; doi:10.5455/cap.20130524