Evaluation of the Role of Affective Temperamental Features, Automatic Thoughts, and Symptom Interpretation on Disease Activity in Patients with Axial Spondyloarthritis

Objective

Axial spondyloarthritis is a systemic and chronic inflammatory disease. Psychological liability to depression and anxiety influences the disease process, prognosis, and treatment outcomes of other medical conditions. Early detection and treatment of these psychiatric conditions would also help in improving the physical functioning of patients with axial spondyloarthritis by reducing the patient's anxiety and depression symptoms. We evaluated the affective temperamental features, automatic thoughts, symptom interpretation, and their relationship with disease activity in patients with axial spondyloarthritis.

Methods

A total of 152 patients diagnosed with axial spondyloarthritis are recruited. Axial spondyloarthritis disease activity was calculated by Bath Ankylosing Spondylitis Disease Activity Index. Depression and anxiety levels were screened with Hospital Anxiety and Depression Scale while affective temperament was evaluated with Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-autoquestionnaire version and automatic thoughts were screened with Symptom Interpretation Questionnaire, and Automatic thoughts questionnaire.

Results

It was observed that 48% (n = 73) were female. The mean age was 43.5 (10.5) years, Bath Ankylosing Spondylitis Disease Activity Index score was 3.97 (1.14). According to the Bath Ankylosing Spondylitis Disease Activity Index scale, 53.30% (n = 81) of the patients were in high disease activity. We found that HAD-depression, HAD-anxiety, Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-autoquestionnaire version, Symptom Interpretation Questionnaire, and Automatic Thoughts Questionnaire scores were significantly higher in the high disease activity group.

Conclusion

Patients' temperament characteristics and mood disorders may affect composite disease activity scores such as Bath Ankylosing Spondylitis Disease Activity Index. In patients with high disease activity scores despite receiving appropriate treatment, mood disorders may need to be evaluated. There is a need to develop disease activity scores unaffected by mood disorders.

Decreased miR-15b-5p/miR-155-5p levels and increased miR-134-5p/miR-652-3p levels among BD patients under lithium treatment

BACKGROUND

There is an increasing interest about the role of miRNAs in the pathogenesis of bipolar disorder (BD). In this study, we aimed to examine the role of miRNAs as potential diagnostic and clinical biomarkers in BD.

METHODS

Fifteen miRNAs in plasmas obtained from BD patients (n = 66) and from the healthy control group (n = 66) were analyzed by a qPCR test. Clinical variables including lithium treatment response were assessed with various test batteries. The correlation of the miRNA levels with the clinical variables and scale scores was examined. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed using the DIANA-miRPath v.3.0 software to identify the possible target genes.

RESULTS

The miR-132, miR-134, miR-152, miR-607, miR-633, and miR-652 levels were significantly increased, whereas the miR-15b and miR-155 levels were found to be significantly decreased in the patient group compared to the controls. The miR-15b-5p and miR-155-5p levels and increases in the miR-134-5p and miR-652-3p levels were calculated to have 83.3 % sensitivity and 78.8 % specificity in determining the risk of BD. miR-155-5p was associated with the disease burden and severity. Fatty acid biosynthesis and metabolism, viral carcinogenesis, the EBV infection, and extracellular matrix and adhesion pathways were highlighted as target pathways.

CONCLUSION

We can conclude that miRNAs may play a role in the pathophysiology of BD through various biological pathways and that miRNAs may be used as a screening test to distinguish bipolar patients from healthy controls. Our findings will provide a basis for long-term follow-up studies with larger samples.

Association between polarity of first episode and solar insolation in bipolar I disorder

OBJECTIVE

Circadian rhythm disruption is commonly observed in bipolar disorder (BD). Daylight is the most powerful signal to entrain the human circadian clock system. This exploratory study investigated if solar insolation at the onset location was associated with the polarity of the first episode of BD I. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area of the Earth.

METHODS

Data from 7488 patients with BD I were collected at 75 sites in 42 countries. The first episode occurred at 591 onset locations in 67 countries at a wide range of latitudes in both hemispheres. Solar insolation values were obtained for every onset location, and the ratio of the minimum mean monthly insolation to the maximum mean monthly insolation was calculated. This ratio is largest near the equator (with little change in solar insolation over the year), and smallest near the poles (where winter insolation is very small compared to summer insolation). This ratio also applies to tropical locations which may have a cloudy wet and clear dry season, rather than winter and summer.

RESULTS

The larger the change in solar insolation throughout the year (smaller the ratio between the minimum monthly and maximum monthly values), the greater the likelihood the first episode polarity was depression. Other associated variables were being female and increasing percentage of gross domestic product spent on country health expenditures. (All coefficients: P ≤ 0.001).

CONCLUSION

Increased awareness and research into circadian dysfunction throughout the course of BD is warranted.

Long-acting new generation antipsychotics in the maintenance treatment of bipolar disorders

Introduction

Maintaining remission, preventing from future episodes, better treatment adherence and improving the quality of life are main aims of long-term treatment in bipolar disorders (BD). In recent years, new generation long-acting injectable (LAI) antipsychotics have been frequently used in maintenance treatment for bipolar disorders.

Objectives

We aimed to review socio-demographic and clinical characteristics of bipolar patients taking LAI treatment for maintenance treatment.

Methods

Clinical records of 44 bipolar patients who are on LAI treatment and followed in Mazhar Osman Mood Clinic (MOMC) of Selcuk University Medical Faculty were evaluated.

Results

Nearly half of the patients were male (n:24, 54%). 43,2% of the patients were married. The mean age was 36.6±11.9 years and the mean duration of education was 11.5±3.9 years. All of the patients were diagnosed with bipolar 1 disorder. Most of the patients (65.9%) was on aripiprazole LAI while remaining was receiving paliperidone LAI for maintenance treatment. Ten of the patients discontinued the treatment due to the side effects and extrapyramidal side effects was the most common side effect. Relapse was observed in 25% of the patients and there was no difference between aripiprazole and paliperidone in terms of relapse rate.

Conclusions

LAI new generation antipsychotics are taking place in long-term treatment of bipolar disorder via improving treatment adherence. Side effect profile of aripiprazole and paliperidone are different. However, we could not find any difference between two drugs in terms of side effects and relapse rates. Small sample size and shorter duration of follow-up should be considered as limitations.

Disclosure

No significant relationships.

Evaluation of the relationship between lithium treatment response and suicide attempt in bipolar disorder

Introduction

Suicide risk is 20-30 fold higher in bipolar disorder(BD) than general population. A positive family history of suicide, early-onset bipolar disorder, rapid cycling, and drug/alcohol addiction have been identified as risk factors for non-fatal suicidal behavior. Lithium is the only mood stabilizer known to have a suicide-reducing effect in patients with BD. Less than half of the bipolar patients respond lithium well. Even though mechanism of action on suicide behavior is not clearly known, it is thought that lithium significantly reduces “impulsive-aggressive” behavior via serotonergic system which might also be related with treatment response in BD.

Objectives

The aim of this study is to evaluate the relationship between lithium response and history of suicide.

Methods

Those who scored 7 points or more from the Alda total score were considered good responders. Patients were divided into those who responded well to lithium treatment and those who did not. History of suicide attemptbetween these two groups was compared.

Results

65.3% of the patients were female (n:49). The mean age of the patients was 36.82±13.35 years. 25 patients responded well to lithium treatment. Among the good responders, 32% of the patients and 25% of the non-responders had a history of suicide attempts. This difference was not statistically significant. (p=0.46 x²=0.13)

Conclusions

The insufficient number of data in the study was considered as a limitation of this study. In addition, there is a need for more studies as there are many factors that cause suicide attempts.

Disclosure

No significant relationships.

Is there a relationship between clinical stage and cardiovascular disease risk in bipolar disorder?

Introduction

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in bipolar disorders(BD). The heart age of patients with BD was found to be 8.5 years higher than gender-age matched health controls. Metabolic side effects of antipsychotics, poor diet, insufficient physical activity, smoking and sedentary life style increase the risk of cardiovascular disease in bipolar patients. QRISK-3 is an approved risk classification that calculates the 10-year risk of developing a heart attack or stroke.

Objectives

This study aims to determine whether there is a difference between cardiovascular disease risk scores and clinical stages of bipolar disorder

Methods

35 outpatients that were followed up in Selcuk University Medical Faculty were evaluated. The clinical stages and qrisk3 scores were calculated.

Results

68.6% (n:24) of the patients were female. 42.9% of patients were in stage 3b (recurrent relapses, complete remission between episodes). The mean age was 36.94 ±10.46 years. The mean heart age was 50.54±17.35. The mean Q risk3 score was 5.59±8.18. There was no difference between bipolar patients at stage 2 and stage 3 in terms of age(p=0.36 and gender(p=0.73). When we compared the qrisk3 total socres and heart age of the patients in stage 2 and 3, we could not find any difference between groups (p=0.74, p=0.57 respectively).

Conclusions

Even though we could not find any difference of qrisk scores at different clinical stages of patients with BD, the CVD risk increases with the age. Prospective longitudinal follow-up studies are required to evaluate dual interaction of clinical stages and CVD risk in BD.

Disclosure

No significant relationships.

Evaluation of the Relationship Between Suicide Behavior and SIRT-1 Gene in Patients with Schizophrenia and Other Psychotic Disorders

Introduction

Schizophrenia is a mental disorder with a high risk of suicide, which is one of the leading causes of early death in schizophrenia patients.

Objectives

It was aimed to examine the relationship between the SIRT1 gene and suicidal behavior in patients with schizophrenia, to identify specific polymorphisms and to provide individual protective approaches by predicting suicidal behavior.

Methods

100 patients with schizophrenia were included in our study. The SIRT1 gene was analyzed using the whole exome sequencing method, and 22 SNPs were identified. In addition, participants’ socio-demographic, psychiatric history, and suicidal behavior evaluation form data were recorded. A comparison was made between the two groups according to suicidal behavior.

Results

When sociodemographic and psychiatric history of the participants were compared in terms of suicidal behavior, no significant difference was found. SIRT1 gene SNP; rs2236318; (TT genotype), rs10997870 (GG genotype) was associated about 4 times increased risk in suicidal behavior; rs41299232 (CC genotype) 3.7 times; rs7896005 (AA genotype) with 3.4 times also. Although rs201230502 (TC genotype) and rs36107781 (TC genotype) were more common in the group with suicidal behavior, they lost their significance in regression analysis due to the low number of cases.

Conclusions

Our study showed that schizophrenia has many risks that increase suicidal behavior , but clinical and sociodemographic data are insufficient to predict suicidal behavior. Considering the inheritability of the disease and the effect of genetics on behavior, SIRT1 gene SNP; (rs2236318, rs10997870, rs41299232, rs7896005, rs201230502 and rs36107781) genotypes were found to be associated with suicidal behavior in schizophrenia patients.

Disclosure

No significant relationships.

Investigation of the correlation between mood disorder symptoms and disease activity and functional status in rheumatoid arthritis patients

Background/aim

To investigate the correlation between depressive-anxiety symptoms, mixed features, disease activity, and functional status in patients with rheumatoid arthritis (RA) in the light of the shared underlying etiology in both disorders.

Materials and methods

The study included 556 patients with RA. RA disease activity was measured using the Disease Activity Score 28-joint count C reactive protein (DAS28-CRP), and the patients were evaluated by a Health Assessment Questionnaire (HAQ). The Hospital Anxiety and Depression Scale (HADS), Mood Disorder Questionnaire (MDQ), and Modified Hypomania Checklist (mHCL) were used to evaluate the mixed depression and bipolarity status of the patients.

Results

Of the patients, 430 (77.3%) were female and 126 (22.7%) were male. The median age was 57 years, the median HAQ score was 0.55 points, and the median DAS28-CRP score was 4.1 points. The evaluation of the patients by DAS28-CRP revealed that 58.5% of the patients had moderate and severe disease activity, while only 23.4% of them were in remission. The group using the combination of synthetic disease-modifying anti-rheumatic drugs (sDMARD) and steroid therapy had significantly higher HAD-depression, HAD-anxiety, mHCL, DAS28-CRP, HAQ, and MDQ scores than the group using sDMARD alone. The grouping of the patients based on the DAS28-CRP cut-off scores showed that the patients with moderate and severe disease activity had significantly higher HADS, mHCL, MDQ scores than those in remission and those with mild disease activity (p < 0.001).

Conclusion

Disease severity and functional status in RA can be affected by comorbid anxiety-depressive and mixed symptoms. Therefore, clinicians should consider screening the depressive-anxiety and mixed mood symptoms of RA patients. Moreover, patients who use steroid therapy are more susceptible to mood symptoms (anxiety, depression, bipolarity), which should also be considered during the follow-up of patients.

Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

Background

Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries.

Methods

Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries).

Results

This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01.

Conclusion

A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.

Evaluation of the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients

OBJECTIVE

We aimed to evaluate the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients by comparing them with a matched control group in terms of age, gender, and education level.

METHOD

The patient group (n = 84) and the healthy controls (HCs, n = 92) filled in the questionnaire including the socio-demographic form, Hospital Anxiety Depression Scale, Multidimensional Perceived Social Support Scale, and Brief Coping Orientation to Problems Experienced through the online survey link.

RESULTS

The COVID-19 patients had higher perceived social support and coping strategies scores than the HCs. However, anxiety and depression scores did not differ significantly between the two groups. In logistic regression analysis performed in COVID-19 patients, the presence of chest CT finding (OR = 4.31; 95% CI = 1.04-17.95) was a risk factor for anxiety and the use of adaptive coping strategies (OR = 0.86; 95% CI = 0.73-0.99) had a negative association with anxiety. In addition, the use of adaptive coping strategies (OR = 0.89; 95% CI = 0.79-0.98) and high perceived social support (OR = 0.97; 95% CI = 0.93- 0,99) had a negative association with depression symptoms.

CONCLUSIONS

Longitudinal studies involving the return to normality phase of the COVID-19 pandemic are needed to investigate the effects of factors such as coping strategies and perceived social support that could increase the psychological adjustment and resilience of individuals on anxiety and depression.

Relationship between Childhood Adversities, Emotion Dysregulation and Cognitive Processes in Bipolar Disorder and Recurrent Depressive Disorder

OBJECTIVE

Cognitive development is susceptible to environmental distress, leading to cognitive distortions. Cognitive distortions may affect clinical course of psychiatric disorders. We aimed to assess whether childhood maltreatment and emotion dysregulation impair automatic thoughts (ATs) and meta-cognitions (MCs) in Bipolar Disorder (BD) and Major Depressive Disorder - Recurrent (MDB-RE) in this study.

METHOD

85 patients with BD, 81 MDD-RE in remission and 86 healthy participants were enrolled. Automatic Thoughts Scale (ATS), Metacognition Questionnaire (MCQ-30), Childhood Trauma Questionnaire (CTQ- 28), Difficulties in Emotion Regulation Strategies Scale (DERS) were the measures used.

RESULTS

ATs were determined by CTQ physical abuse (β=0.34, p<0.01), DERS goals (β=-0.37, p<0.01), impulse (β=0.53, p<0.01) and non-accept (β=0.23, p<0.05) subscales in BD (F=21.08, p<0.01) and CTQ emotional neglect (β=0.22, p<0.05), DERS strategies (β=0.39, p<0.05) in MDD-RE (F=9.97, p<0.05). MCs were predicted by sexual abuse (β=0.46, p<0.01) in BD (F=4.88, p<0.01), and emotional abuse (B=-0.30, p<0.05) in MDD-RE (F= 7.02, p<0.01).

CONCLUSION

These results suggest that emotion dysregulation and childhood adversities are associated with cognitive processes such as MCs and ATs in MDD-RE and BD. Cognitive processes can cause various clinical manifestations and emotion dysregulation and childhood traumas should be considered as psychopathological components that can affect the course of mood disorders via various components. Further follow-up studies and larger samples are needed to better understand the effects of these components.

Suicide attempts and related factors in schizophrenia patients

Objectives:

To investigate the relationship between suicide attempts and demographic-clinical variables and to assess the methods used in suicide attempts by comparing schizophrenia patients with and without suicide attempts.

Methods:

A retrospective study with a total of 223 schizophrenia patients aged 18-65 years that were admitted to the Department of Psychiatry, Selcuk University and the Beyhekim Psychiatric Clinic Konya Training and Research Hospital, Konya, Turkey, between January 2014 and January 2018 The data collection forms created by researchers were completed using hospital medical records.

Results:

It was determined that 40.8% of schizophrenia patients attempted suicide at least once and that 39.6% of schizophrenia patients who attempted suicide had recurrent suicide attempts. Those with suicide attempts had a significantly longer mean duration of untreated psychosis and a higher total number of hospitalizations compared to those without suicide attempts. In addition, the use of depot antipsychotic drugs was significantly lower in those with suicide attempts. There was a statistically significant difference in the presence of traumatic life events between those with and without suicide attempts.

Conclusion:

Suicidal behavior is an important problem in schizophrenia. Identifying risk factors and high-risk individuals will guide us in the development of preventive interventions.

Reliability and Validity Study of the Turkish Version of Bipolar Spectrum Diagnostic Scale

OBJECTIVE

The purpose of this study is to evaluate the reliability and validity of the Turkish Version of the Bipolar Spectrum Diagnostic Scale (BSDS).

METHOD

The study was carried out with 130 patients diagnosed with bipolar I disorder, 15 patients diagnosed with bipolar II disorder, and 38 patients diagnosed with major depressive disorder attending the outpatient psychiatry departments of the Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Mental Health and Neurological Diseases. The Mood Disorder Questionnaire (MDQ) was used for convergent validity. The internal consistency coefficient, itemtotal score correlation coefficients, test-retest correlation coefficient, confirmatory factor analysis, correlation with concurrent scale, and ROC curve were statistically calculated.

RESULTS

Confirmatory factor analysis indicated that the 20-item version did not show adequate goodness-of-fit. The item 4 with a relatively low regression weight was removed from the model. For the 19-item revised and corrected model, the observed goodness-of-fit indexes were RMSEA = 0.040, CFI = 0.900, GFI = 0.890, IFI = 0.900 and χ2/df = 1.230. The internal consistency Cronbach's alpha coefficient was 0.831. The correlation coefficient between the Turkish version of the BSDS and the MDQ was 0.54. The cutoff point of the scale calculated by the ROC analysis was 12 with a sensitivity of 78.6% and a specificity of 86.8%.

CONCLUSION

The Turkish Version of the BSDS, has been shown to be reliable and valid tool for screening bipolar disorder after removal of the item 4 of the original version of the scale.

[Evaluation of the Association between Lithium Treatment and GSK3β Polymorphism in Bipolar Disorder Patients]

OBJECTIVE

There is a lack of evidence regarding clinical predictors for the treatment response to lithium, which is the main stay treatment option for bipolar disorder. Studies that examined the mechanistic action of lithium revealed that glycogen synthase kinase 3β (GSK-3β) enzymeinhibition was important in regard to treatment responses. Based on this background, we aimed to investigate the association between responses to lithium treatment and five different polymorphisms of GSK-3β.

METHOD

Lithium treatment response scale (LTRS) scores for 100 patients diagnosed with bipolar disorders type I were calculated according to the hospital records. Blood samples were collected and genomic DNA was obtained using the MagNA Pure Compact automatic isolation method. The GSK-3β: rs17183904, rs17183897, rs34009575, rs34002644, and rs17183890 polymorphisms were analyzed by real time PCR.

RESULTS

In this cohort, the mean age of patients was 41.1±10.3 years, the mean age of disease onset was 24.5±8.2, and the mean LTRS score was 4.9±1.8. There was no statistically significant difference for LTRS scores between groups in terms of gender, marital status, level of education, and the type of first episode. LTRS was significantly higher in only the patients harbouring GSK-3β rs17183890 AG genotype (p=0.008, t:2.71). Interestingly, no differences were found for the remaining polymorphisms.

CONCLUSION

The specific GSK-3β polymorphism that associated with lithium-response in our study may help to predict lithium responses and to develop individualized treatment. We presume that our pharmacogenomic findings may also provide important contributions to the clinical practice in regard to future evaluation of the treatment adherence and side effects. To obtain these goals, further genome-wide scanning studies conducted on larger sample cohorts are required.

Relationship between alexithymia and chronic periodontitis

OBJECTIVE

The aim of this study was to investigate the potential relationship between alexithymia and chronic periodontitis.

MATERIALS AND METHODS

A case-control study of 222 male and female subjects aged 21-63 years was conducted. The participants were divided into a chronic periodontitis group (n = 114) and a control group (n = 108) with no history of periodontitis. The Toronto Alexithymia Scale (TAS-20) was used to evaluate alexithymia status of the subjects. Clinical data were collected on parameters such as the plaque index, bleeding on probing, probing depth, and the clinical attachment level (CAL). Socioeconomic data on the patients were also recorded.

RESULTS

Chronic periodontitis group showed higher frequency in alexithymic patients as compared to control group. The proportion of high dental anxiety did not differ between the groups. The total TAS-20 score was statistically significantly higher in male subjects than in female subjects (P < 0.05). The bivariate analyses of the psychometric measures and the periodontal parameters revealed positive correlations with the severity of periodontal disease/CAL and the total TAS-20 score (P < 0.05).

CONCLUSION

The results of the current study suggest that alexithymia is a possible risk factor for chronic periodontitis. Further research is needed to identify the underlying mechanism.

[Reliability and Validity Study of the Turkish Version of Hypomania Checklist-32-Revised]

OBJECTIVE

In this study, it is aimed to evaluate the reliability and validity of the Turkish version of Hypomania Checklist-32-Revised.

METHOD

The study was carried out with 80 patients diagnosed with bipolar I disorder, 26 patients diagnosed with bipolar II disorder and 42 patients diagnosed with major depressive disorder attending the out- and in-patient psychiatry departments of three university hospitals and one training hospital, and 116 healthy volunteers consisting of university students. Mean duration of illness was 15,1 years for the bipolar disorder group, and 9,3 years for the major depressive disorder group. For concurrent validity, Mood Disorder Questionnaire was used. In the statistical analysis, internal consistency coefficient, item-total score correlation coefficients, exploratory factor analysis, correlation with concurrent scale and ROC curve were calculated.

RESULTS

Translation into Turkish and back-translation into English of Hypomania Checklist-32-Revised were performed and thus the semantic harmony of the scale was obtained. In the internal consistency, Cronbach alpha coefficient was 0,914 and item-total score correlations were between 0,235-0.743. Solely the coefficient of item #23 was found as 0,110. In factor analysis, six factors were obtained but a two-factor solution representing 44,5% of the total variance was accepted and first factor represents overactivity and being expansive, second factor represents impulsivity and risky behaviors. Correlation of Hypomania Checklist-32-R with Mood Disorder Questionnaire was r=0,379. In the ROC analysis, the cut off point of the scale was calculated as 14 with a sensitivity of 71,0 and specificity of 69,8. The scale discriminates well between the bipolar group, and depressive and control groups.

CONCLUSION

Hypomania Checklist-32-Revised developed for screening hypomania is reported to be reliable and valid in Turkish after cutting out item #23.

Screening mixed depression and bipolarity in the postpartum period at a primary health care center

INTRODUCTION

Mixed depression is a clinical condition accompanied by the symptoms of (hypo)mania and is considered to be a predictor for bipolar disorder. Compared to pure major depression, mixed depression is worse in progress. There are limited data on the prevalence of mixed depression since it is a relatively new entity. Therefore, the present study aimed to investigate the prevalence of mixed depression during the postpartum period which is risky for mood disorders.

METHODS

The study included 63 postpartum women. The participants were administered Beck Depression Scale, Edinburgh Postnatal Depression Scale (EPDS), Mood Disorders Questionnaire (MDQ), and Modified Hypomania Symptom Checklist-32 (mHCL-32).

RESULTS

The MDQ scores of the women with expected depression according to the EPDS cut-off scores, were significantly higher than the women with lower EPDS scores (t=-4.968; p<0.001). The modified hypomania scores were significantly higher in the women with higher depression scores compared to the women under EPDS cut-off scores (t=-4.713; p<0.001). According to the EPDS and BDS results, 27 (42.9%) and 14 (22.2%) women needed additional clinical examination for depression, respectively. In addition, 3 (4.8%) women require additional clinical examination for bipolar disorder. The scores for the first item of MDQ were above the cut-off value in 11 (17.5%) women. According to the mHCL-32 results, 50 (79.4%) women had at least 1 symptom, 45 (71.4%) women had at least 3 symptoms, and 43 (68.3%) women had at least 5 symptoms of mixed depression.

CONCLUSION

Postpartum mixed depression should be promptly diagnosed by using appropriate diagnostic tools, particularly by primary health care physicians. Patients with mixed depression should be closely monitored to avoid manic switch.

Temperament characteristics in patients with panic disorder and their first-degree relatives

AIM

Panic disorder is one of the highly heritable anxiety disorders; and temperament characteristics are considered predicting liability to panic disorder. Accumulating evidence suggests temperament characteristics are intermediate phenotypes for clinical conditions. Given this background, we aimed to investigate temperament characteristics in patients with panic disorder, their first-degree relatives, and healthy controls.

METHOD

Study sample consisted of 60 patients with panic disorder, 37 first-degree relatives of these patients, and 37 age, gender, and education level matched healthy controls (HC). SCID-I, the Panic Agoraphobia Scale, and the State and Trait Anxiety Inventory were applied to assess clinical characteristics of the patient group. Temperament characteristics were assessed using the Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire (TEMPS-A).

RESULTS

Anxious, depressive, cyclothymic, and irritable temperament scores of patients were higher than those of HC. There was no difference between the patients and the relatives, with the exception of higher anxious temperament scores in patients.

CONCLUSION

Overall, our findings suggest that anxious temperament characteristic might be a trait marker for liability to panic disorder. Further research with a prospective design in a larger sample is required to confirm our findings.

Lifetime hypomanic symptoms in remitted patients with schizophrenia and other psychotic disorders

BACKGROUND

Clinical, genetic and neuroimaging studies indicated strong evidence against traditional diagnostic separation of bipolar disorder from schizophrenia. In this study, we aimed to evaluate hypomanic symptoms and influence on general functioning among psychotic patients.

SUBJECTS AND METHODS

Patients with schizophrenia and other psychotic disorders were assessed between June and September 2010. Positive and Negative Symptom Scale (PANSS), Hypomania Check List-32 (HCL-32), Mood Disorders Questionnaire (MDQ) and General Assessment of Functioning Scale (GAS) were applied to all 93 patients. Answers of self-rating scales were confirmed with hospital records.

RESULTS

Mean age was 35.7 ± 9.5 years, mean age of onset was 20.3 ± 5.3 years and duration of illness was 15.4 ± 9.2 years. 30.1% of the patients, had a history of mood stabilizer treatment taken at least one month while one five of the patients had different psychiatric diagnosis other than current diagnosis. 26.9% of the patients with psychotic disorders had positive scores on both MDQ and HCL-32 but there were no significant difference between patients in terms of general functioning (p = 0.82).

CONCLUSIONS

As reported in this study, there is no simple, clear-cut between schizophrenia and bipolar affective disorder.

Clinical potential of cariprazine in the treatment of acute mania

Cariprazine (RGH-188, trans-4-{2-[4-(2,3-dichlorophenyl)-piperazine-1-yl]-ethyl}-N,N-dimethylcarbamoyl-cyclohexyl-amine hydrochloride), is a novel antipsychotic with dopamine D2 and D3 receptors antagonist-partial agonist properties. Cariprazine has also moderate affinity for serotonin 5-hydroxytryptophan (5-HT) 1A receptors, high affinity for 5-HT1B receptors with pure antagonism and low affinity for 5-HT2A receptors. Randomized, double blind, placebo controlled, flexible-dose (3-12 mg/day) studies have demonstrated cariprazine is effective in both schizophrenia and acute manic episodes associated with bipolar disorder. The incidence of serious adverse events in cariprazine arm was no different than in placebo arm in these studies. The most common adverse events were extrapyramidal symptoms, headache, akathisia, constipation, nausea, and dyspepsia which can be explained with cariprazine's partial dopamine agonism. Although cariprazine treatment was associated with a higher incidence of treatment-emergent adverse events, particularly akathisia and tremor, common side effects of marketed second generation antipsychotics such as weight gain, metabolic disturbances, prolactin increase or QTc prolongation were not associated with cariprazine, probably due to its moderate to low binding affinity for histamine H1 and 5-HT2C receptors. Animal studies show that cariprazine may have additional therapeutic benefit on impaired cognitive functioning with D3 receptor activity, however clinical data is still scarce. The aim of this article is to review the potential use of cariprazine for the treatment of acute manic episodes in the light of the preclinical and clinical trials reported to date.

Quality of life among dually diagnosed and non-substance-using male schizophrenia outpatients

<div class="column"><p><strong>Objective. </strong><span>To assess the quality of life (QoL) in an outpatient setting among male patients dually diagnosed with schizophrenia and substance use disorder (SUD), and non-substance-using male schizophrenia patients.<br /> </span></p><p><strong>Methods. </strong><span>The study was conducted in an outpatient setting with 52 male schizophrenia patients and 49 male schizophrenia patients with SUD comorbidity, who were admitted to Bakirköy Research and Training Hospital between 1 May 2010 and 30 September 2010. The patients had been in remission for a minimum of 6 months. The subjects were re-evaluated for the persistence of the diagnosis by using the Structural Clinical Interview for DSM-IV Axis I disorders (SCID I) socio-demographic data form, and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) and positive and negative syndrome scale (PANSS) were administered to detect the factors affecting diagnostic stability and clinical course. </span></p><p><strong>Results. </strong><span>Schizophrenia patients with no SUD comorbidity had a significantly earlier age of disease onset than the comorbid group. SUD comorbidity in schizophrenia patients leads to increased rates of unemployment and homicidality. WHOQOL-Bref psychological health scores were significantly lower among patients in the comorbidity group. No statistically significant difference was identified between the groups with regard to the PANSS scores. </span></p><p><span><strong>Conclusions</strong>. </span><span>It is necessary to focus on the treatment challenges for schizophrenia patients with SUD comorbidity, such as the provision of treatment in criminal justice settings, in which a high proportion of such patients are found. </span></p></div>

Adherence to Turkish psychiatric association guideline for bipolar depression treatment in a specialized mood disorders outpatient unit

BACKGROUND

Bipolar patients spend up to one third of their lives in depression however, acute treatment guidelines mainly focused on the manic phase of illness. With recent attention to the importance of evidence-based medicine in psychiatry, a number of treatment guidelines have emerged to aid clinicians in clinical decision making. Here, we aim to measure concordance with the Turkish Psychiatric Association Treatment Guideline for Bipolar Disorders (TPATGBD) for the depressive phase of illness.

SUBJECTS AND METHODS

Bipolar patients attending the Rasit Tahsin Mood Disorders Outpatient Unit of Istanbul Bakırköy Research and Training Hospital for Psychiatry, Neurolgy & Neurosurgery, were assessed using standardized forms based on a nation-wide mood disorders follow-up program. Concordance of implementations with the TPATGBD were evaluated step by step for each level of depression severity.

RESULTS

Concordance rates with the first step recommendations of the guideline were 29.4%, 27.4% and 87.5% for mild-moderate, moderate-severe (without psychosis) and severe depression (with psychosis), respectively. Concordance rates with the second step recommendations of the guideline were lower for bipolar depressions without psychosis. Overall, adherence to the guideline did not impact on time to remission (p=0.19).

CONCLUSIONS

Despite considerable efforts to develop and disseminate evidence-based guidelines, they are not widely followed by clinicians and important opportunities clearly exist to educate clinicians about the feasibility and utility of clinical guidelines for bipolar disorder. Systematic studies in the future are required to clarify our understanding of clinicians' attitudes to the use of guidelines and to explain the discrepancy between guidelines and clinical practice.

Evaluation of Serum Ghrelin and Leptin Levels in Suicide Attempters

Previous studies have reported a relationship between cholesterol and leptin levels, and suicide attempts, impulsivity, and aggressive behaviors. An orexigenic hormone seems to be strongly associated with lipid metabolism and leptin levels. Therefore, we aimed to compare serum cholesterol, leptin, and ghrelin levels in 36 patients with suicide attempts and 25 healthy controls. Patients with suicide attempts had decreased leptin levels and significantly higher ghrelin levels compared to healthy controls. While the serum ghrelin level did not show any correlation with the demographic and clinical factors, leptin showed a correlation with body mass index (BMI), and cholesterol levels were correlated with the age, BMI, and number of suicide attempts in the suicidal group. The results suggest that suicide attempts seem to be related with higher serum ghrelin values, decreased leptin, and cholesterol levels.