The aim of present study was to determine the psychiatric symptoms and comorbidities in patients affected by tinnitus. The study sample, between June 2004 and September 2005, consisted of 180 Turkish adults living in Elazig. Ninety consecutive tinnitus patients were enrolled on their first visit to the outpatients clinic. Control subjects were recruited partly from the social surroundings of the authors. All subjects with significant medical and/or psychiatric pathologies, such as schizophrenia, manic-depressive psychosis, dementia, and behavioural disorders with social withdrawal or suicidal risk, were excluded, as were those unwilling to take part in the study. For the psychopathological examination, patients underwent the Structured Clinical Interview for DSM-III-R (SCID-I, SCID-II). Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Symptom Check list-90 (Revised) (SCL-90-R) were also administered to patients with tinnitus and control subjects. SCL-90-R subscales scores, Beck Anxiety Inventory and Beck Depression Inventory scores were significantly higher in tinnitus patients than in normal control subjects. Twenty-four patients (26.70%) with tinnitus had at least one psychiatric diagnosis. Five control subjects (5.60%) had at least one psychiatric diagnosis. There were significant differences between the two groups (P < 0.001). Anxiety disorders and somatoform disorders were significantly higher in tinnitus patients than in normal control subjects. We conclude that psychiatric symptoms (such as symptoms of anxiety, depression or somatization) among patients with tinnitus should alert clinicians for the presence of a chronic and complex psychiatric condition (Axis-I and Axis-II disorders).

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Paradoxical therapy consists of suggesting that the patient intentionally engages in the unwanted behaviour such as performing compulsive ritual or wanting a conversion attack. In this study, the subjects were selected by the emergency unit psychiatrist from patients who were admitted to the emergency unit with pseudoseizure. The diagnoses was based on DSM-IV criteria. Paradoxical intention was applied to half of the 30 patients with conversion disorders; the other half were treated with diazepam in order to examine the efficiency of the paradoxical intention versus diazepam. In both groups the differences of the anxiety scores at the beginning of the study were found to be insignificant (z=1.08, p=0.28). Of the 15 patients who completed paradoxical intention treatment, 14 (93.3%) responded favorably to paradoxical intention. On the other hand of 15 patients who completed diazepam therapy, 9 (60%) responded well to therapy and 6 patients carried on their conversion symptoms at the end of 6 weeks. Paradoxical intention-treated patients appeared to have greater improvements in anxiety scores (z=2.43, p<0.015) and conversion symptoms (t=2.27, p=0.034) than the diazepam-treated patients. The results of the present study are encouraging in that paradoxical intention can be effective in the treatment of conversion disorder.

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