The effect of emotion recognition and mindfulness on depression symptoms: A case-control study

Abnormalities in emotion recognition (ER) are frequently reported in depression, with lower recognition accuracy in patients with major depressive disorder (MDD) when compared to healthy individuals. Mindfulness was found to directly impact the severity of depressive symptoms, by recognizing negative cognitions and dysfunctional reactions. The aims of this study were to compare ER and mindfulness levels between MDD patients and healthy controls (HCs), as well as to examine whether ER and mindfulness are related to symptom severity in MDD patients. Sixty-eight patients with MDD and 93 HCs participated in the study. A sociodemographic form, reading the mind in the eyes test (RMET), five facet mindfulness questionnaire-short form (FFMQ-S) and the Montgomery-Asberg depression scale (MADRS) were administered. Group comparison in ER and mindfulness was performed using the multivariate analysis of covariance (MANCOVA). Bivariate correlations and hierarchical linear regression analyses were performed to assess the associations between depression severity, ER and mindfulness in the patient group. Higher level of mindfulness was found in HCs relative to MDD group, however, no ER difference was present between the groups. A positive association between depression severity and the non-reactivity facet of mindfulness was found. On the other hand, ER was not significantly associated with symptom severity among individuals with MDD. Non-reactivity, unlike other dimensions of mindfulness, seems to increase with the severity of depressive symptoms among MDD patients. A particular focus on this subdimension in mindfulness techniques may yield better outcomes in alleviation of depressive symptoms.

A silent scream in the pediatric emergency department: child abuse and neglect

Child abuse and neglect includes any behavior that harms the child or hinders the child's development. The aim of this study was to determine the demographic and clinical characteristics of patients with suspected child abuse or neglect in the pediatric emergency department. Between July 2017 and July 2022, patients admitted to our pediatric emergency department and consulted to the medical social services unit with a preliminary diagnosis of neglect and/or abuse were retrospectively scanned through the registry system. The patients were divided into five groups according to their victimization: physical, sexual, and emotional abuse; neglect; and medical child abuse (MCA)-Munchausen by proxy. A total of 371 children were included in the study. Two hundred twenty-two (59.8%) of the patients were female and the median age was 161 months [IQR (46-192)]. Then, 56.3% of the patients were in the adolescent age group. The most common admission time period was between 16.00 and 24.00 (n 163, 43.9%). Then, 24.2% of the patients were exposed to physical abuse, 8.8% to sexual abuse, 26.1% to emotional abuse, 50.4% to neglect, and 3.2% to MCA. One hundred eight (29.1%) patients were followed up as inpatients in the pediatric intensive care unit. Four of the patients (1%) had out-of-hospital cardiac arrest, and the deaths were in patients under 2 years of age.  Conclusion: Pediatric emergency departments are one of the important units visited by child maltreatment patients. Victimized children may reflect their silent screams with various clinical presentations. Infants are at the greatest risk of suffering serious or fatal injuries. Health professionals working in the emergency department have an important role in detecting, treating, and preventing recurrence of child neglect and abuse. What is Known: • The pediatric emergency department is an important entry point in the health care system for children who experience maltreatment. • It has a wide spectrum of physical, sexual, emotional abuse and neglect. What is New: • A high index of suspicion is required to diagnose cases of child maltreatment. • Infants are at the greatest risk of suffering serious or fatal injuries.

Emergency medical service use at a pediatric center in Turkey, during the COVID-19 pandemic period

AIM

This study aimed to evaluate aspects of pediatric patients presenting to a hospital in Turkey via emergency ambulance services, including incidence of visits to the hospital, acuity of illness and most common diagnoses, during the one-year period before and after the onset of the coronavrrus dsease 2019 (COVID-19) pandemic.

METHODS

This was a retrospective and single center analysis of children, transported by Emergency Medical Services to the Emergency Department (ED) of a children's hospital in Turkey, between 10 March 2019 and 11 March 2021.

RESULTS

Percentage of high acuity group (68.1% vs.76.9%) during pandemic period was significantly lower than prepandemic period (p < 0.001). On the contrary, the percentage of patients using emergency ambulance service with a low level of acuity increased during the pandemic period compared to the prepandemic period (31.9% vs. 23.1%) (p < 0.001). A significant decrease was observed in the cases of lower respiratory tract infections, febrile status epilepticus and excessive alcohol use during the pandemic period. No significant differences were found hospitalizations requiring PICU and mortality in ED during the pandemic period.

CONCLUSION

During the COVID-19 pandemic; also, a decrease in admissions was observed for those with high-risk conditions. On the contrary, an increase was detected in patients with low acuity levels. Efforts should be made to ensure access to safe and quality emergency care during the pandemic.

Can dose reduction be made in patients with allergic bronchopulmonary aspergillosis receiving high-dose omalizumab treatment?

Summary

Background. Allergic bronchopulmonary aspergillosis (ABPA) is an endotype of severe asthma which frequently needs biologics for their steroid sparing effect. We aimed to evaluate the outcomes of reducing the omalizumab dose in patients with ABPA who were on long-term omalizumab treatment. Methods. Once asthma was controlled, two approaches were used to reduce total monthly omalizumab dose: 1) both extending dose intervals from 2 to 4 weeks and decrease omalizumab dose, 2) to reduce omalizumab dose while keeping dose intervals stable. Results. Thirteen patients with ABPA (8F/5M, mean age 53.4 ± 13.0 years) were included. Pre-omalizumab, mean numbers of attacks and hospitalizations were 2.5 ± 1.5 and 1.3 ± 0.8, mean oral corticosteroid (OCS, as methylprednisolone) dose was 12.2 ± 10.4 mg daily. First omalizumab dose reduction was made to all patients at a median time of 35 months (min 13, max 47). The 2nd dose reduction was made in four patients at median of 23.5 months. Mean OCS decreased to 0.69 ± 0.95 mg/day (p = 0.001) in the 1st year of omalizumab, could be stopped in 11 patients in last evaluation. Attacks/hospitalizations decreased significantly to 0.31 ± 0.86 and 0, respectively, in the 1st year of omalizumab. Total omalizumab dose was reduced by median 40% (min 20, max 60) in 1st intervention and 50% (min 20, max 67) after 2nd intervention. After omalizumab dose reduction, asthma control did not deteriorate and there was no need to increase the omalizumab or OCS-dose. Conclusions. Decreasing the total omalizumab dose does not cause clinical deterioration in ABPA after the disease is controlled.

An analysis of cardiology consultation requests in infants presented to the pediatric emergency department of a tertiary children's hospital

INTRODUCTION

Cardiological emergencies are reported to constitute almost 15% of all emergency department visits. This study aimed to characterize the main signs and symptoms of the infants that necessitated pediatric cardiology consultation and to analyze the characteristics of patients diagnosed with a cardiological disorder.

MATERIAL AND METHODS

Patients aged 1 month to 1 year who were consulted to the pediatric cardiology service during a 4-year period were retrospectively evaluated. Patients' age, sex, nationality, complaints at PED, physical examination findings, reason for echocardiography (echo) and final diagnosis were recorded from the hospital medical record system for further analysis. Patients were divided into two groups according to the severity of the echo findings (patients with significant cardiovascular issues and patients without significant cardiovascular issues).

RESULTS

Of the 200 patients included in the study, 19 were in the significant cardiovascular issues, and 181 were in the without significant cardiovascular issue group. The leading complaints of the patients who were consulted to cardiology were cyanosis (22.5%), seizure (22.5%), cough (22%), and fever (19.5%). In emergency presentations, jaundice (16%), nutritional problems (21%), and cardiomegaly (21%) on x-rays were higher in patients with significant cardiovascular issues (p < 0.05).

CONCLUSION

In conclusion, congenital heart disease is usually diagnosed in the neonatal period, but some patients may be missed due to a variety of symptoms and findings. Infants with feeding problems and jaundice, especially those with cardiomegaly on chest radiographs, should be carefully evaluated for underlying serious congenital heart disease.

The role of metacognitions in cyberbullying and cybervictimization among adolescents diagnosed with major depressive disorder and anxiety disorders: A case-control study

Cyberbullying is becoming increasingly widespread as individuals use technology more widely and frequently. Recent studies have shown a growing vulnerability for cyberbullying and cybervictimization, particularly in the adolescent population. We argue that dysfunctional metacognitions, which have been found to be prominent in various psychiatric disorders, may also play a role in predicting cyberbullying and cybervictimization over and above a variety of established factors including daily Internet use, social media use, depression and anxiety. For this purpose, we recruited 121 adolescents diagnosed with major depressive disorder (MDD) and 122 adolescents diagnosed with anxiety disorders (AD) from the child and adolescent psychiatric department of 'Çankırı State Hospital' along with age and gender matched healthy controls (n = 120). Participants completed the DSM-5 Depression and Anxiety Severity Scales, the Social Media Disorder Scale (SMDS), the Metacognitions Questionnaire for Children (MCQ-C) and the Revised Cyberbullying Inventory-II (RCBI-II). Cybervictimization scores were found to be higher in the MDD and AD groups when compared with healthy controls. Cyberbullying scores in the MDD group were higher than healthy controls. Additionally, the Superstition, Punishment and Responsibility subdimension of the MCQ-C was a significant predictor of cybervictimization in the AD group while controlling for daily Internet use, social media use and anxiety. However, metacognitions were not associated with cyberbullying in the MDD and AD groups, as well as with cybervictimization in the MDD group. We concluded that dysfunctional metacognitions may be a preventive therapeutic target in reducing the impact of cyberbullying in adolescents with AD.

Dyskinesia due to mexiletine overdose: a rare presentation

BACKGROUND

Mexiletine, a class IB antiarrhythmic, is a structural analog of lidocaine. Our knowledge of mexiletine overdose is based on lidocaine overdose reports. Only a few cases of mexiletine overdose have been reported, including fatal overdoses. Mexiletine toxicity primarily affects the central nervous, cardiovascular, and gastrointestinal systems.

CASE

A 16-year-old female was brought to our hospital by ambulance after taking an unknown dose of mexiletine in a suicide attempt. Ventricular fibrillation developed while in the ambulance; cardiopulmonary resuscitation was started and spontaneous circulation returned within 1 min. The patient had been taking oral mexiletine for 1 month to treat primary erythromelalgia. Her vital signs were normal, but she was unconscious. Following gastric lavage she was transferred to the pediatric intensive care unit. Midazolam and levetiracetam were required due to uncontrolled seizures. During the first hour of hospitalization, severe dyskinesia characterized by abnormal involuntary large hyperkinetic movements in all 4 extremities was observed and successfully treated with 2 doses of intravenous biperiden. The patient was discharged on day 6 of hospitalization.

CONCLUSIONS

Mexiletine overdose can be life-threatening. In addition to rapid and effective resuscitation, rapid identification and management of cardiovascular and central nervous system manifestations are key to preventing morbidity and mortality. The presented case had severe dyskinesia that was successfully treated with repeated doses of biperiden. Biperiden did not cause arrhythmia. Based on the presented case, we think biperiden should be considered for the treatment of movement disorders in cases of mexiletine overdose.

A Novel Marker for Predicting Fulminant Myocarditis: Systemic Immune-Inflammation Index

In myocarditis, the search for effective and appropriate prognostic biomarkers can help clinicians identify high-risk patients in a timely manner and make better medical decisions in clinical practice. The prognostic value of systemic immune-inflammatory index (SII), an innovate biomarker of inflammation, in fulminant myocarditis in children has not been assessed. This study aims to (1) determine the effect of SII and other inflammatory markers on the prognosis of patients with myocarditis, and (2) characterize other factors affecting adverse outcomes in myocarditis. All patients aged between 1 months and 18 years who admitted to Pediatric Emergency Department between January 1, 2015 and October 1, 2021 and were diagnosed with myocarditis were retrospectively analyzed. 106 Eligible subjects were enrolled (67% male, 12.5 years (IQR 6-16). Fulminant myocarditis developed in 16 (15%) of the patients. The median SII was 1927 (1147.75-3610.25) in the fulminant myocarditis group and 351 (251.75-531.25) in the non-fulminant group (p < 0.001). In estimation of fulminant myocarditis, AUC was 0.87 for WBC [95% confidence interval (CI) 0.72-1.00, p = 0.002], 0.94 for ANC (95% CI 0.85-1.00), p = 0.000), 0.92 for SII (95% CI 0.82-1.00, p = 0.000). Spearman's correlation analysis showed a significant negative correlation between SII and LVEF (r = 0.576, p < 0.001). The highest AUC values were associated with ANC, SII, and WBC levels to predict fulminant myocarditis. SII, a readily available biomarker from routine blood parameters, allows early recognition of negative outcomes and can independently predict the prognosis of myocarditis in children.

The effect of mindfulness and metacognition on anxiety symptoms: a case-control study

Background

Anxiety disorders (ADs) are associated with numerous psychiatric disorders; despite the efforts in psychotherapy models targeting their etiology, novel treatment strategies are still developing. We aimed to assess whether mindfulness and metacognition differ between patients with ADs and healthy controls (HCs) and whether the symptom severity of ADs is related to mindfulness and metacognition among patients. Two-hundred participants were enrolled in this study. Structured clinical interview, sociodemographic form, Five Facet Mindfulness Questionnaire-Short Form, Metacognition Questionnaire-30, and Hamilton Anxiety Rating Scale were administered. Multivariate analysis of covariance was conducted to compare the groups in terms of mindfulness and metacognition. Correlation and multiple linear regression analyses were performed to measure the association between the variables.

Results

The main finding indicates that positive beliefs about worry are associated with reduced symptom severity of ADs. Furthermore, HCs have more positive beliefs about worry and nonjudging of inner experience compared to patients with ADs, who utilize negative beliefs about uncontrollability and danger and need to control thoughts to a greater extent.

Conclusions

This study demonstrates that dysfunctional metacognitive beliefs may influence the anxiety severity of adult patients. We suggest that focusing on reducing maladaptive metacognitions may be supportive of AD improvement.

The role of desire thinking in the problematic use of social networking sites among adults

The problematic use of social networking sites (SNS) is associated with several psychiatric disorders. This behavior closely resembles addiction in terms of neurological basis and behavioral patterns. Nevertheless, successful intervention strategies and the etiology of problematic SNS use are not yet thoroughly investigated. We aimed to study whether desire thinking is associated with problematic SNS use among adults when controlling for some confounders, including boredom, affect, and impulsivity. With the help of convenience sampling, we enrolled 546 Turkish adults in this study to whom we administered a sociodemographic form, the Social Media Addiction Scale (SMAS), the Leisure Boredom Scale (LBS), the Positive and Negative Affect Schedule (PANAS), the Barratt Impulsiveness Scale (BIS-11), and the Desire Thinking Questionnaire (DTQ). To explore the association between the variables, we performed Pearson correlational and hierarchical regression analyses. The results showed that higher scores on two sub-dimensions of desire thinking, namely verbal perseveration and imaginal prefiguration, were associated with higher scores on problematic SNS use after we controlled for boredom, affect, and impulsivity. This study demonstrates that desire thinking may play a role in problematic SNS use among adults. We recommend targeting desire thinking as a potential area in treatments which may help alleviate problematic SNS use.

What Has Changed in Injury-Related Presentations During COVID-19 Pandemic? A Single-Center Experience from a Pediatric Emergency Department

Objective:

Materials and Methods:

Results:

Conclusion:

The effect of emotion recognition and mindfulness on depression symptoms: A case-control study

Introduction

Abnormalities in emotion recognition (ER) are frequently reported in depression, with lowered recognition accuracy in patients with major depressive disorder (MDD) when compared to healthy individuals. Mindfulness was found to directly impact the severity of depressive symptoms, by negative cognition and dysfunctional reaction recognition.

Objectives

The aims of this study were to compare ER and mindfulness levels between MDD patients and healthy controls (HC), as well as to examine whether ER and mindfulness are related to symptom severity in MDD patients.

Methods

68 patients with MDD and 93 HC participated in the study. A sociodemographic form, Reading the Mind in the Eyes Test (RMET), Five Facet Mindfulness Questionnaire-Short Form (FFMQ-S) and the Montgomery Asperg Depression Scale (MADRS) were administered. Group comparison in ER and mindfulness was assessed using the Multivariate analysis of covariance (MANCOVA). Bivariate correlations and multiple linear regression analyses were performed to assess the associations between depression severity, ER and mindfulness in the patient group.

Results

Better ER and higher levels of mindfulness were found in HCs relative to the MDD group. A positive association between depression severity and the non-reactivity facet of mindfulness was found, indicating that in the MDD group non-reactivity was a significant predictor for depression severity. On the other hand, ER was not significant in predicting symptom severity.

Conclusions

Non-reactivity, unlike other dimensions of mindfulness, seems to increase with the severity of depressive symptoms among MDD patients. To particularly focus on this subdimension in mindfulness techniques may yield better outcomes in alleviation of depressive symptoms.

Disclosure

No significant relationships.

The evaluation of the effect of mindfulness and metacognition on anxiety symptoms: A case-control study

Introduction

Anxiety disorders (ADs) are pervasive, detrimental, and associated with numerous psychiatric disorders; however, their etiology and effective treatment strategies are not yet fully explored.

Objectives

We aimed to study whether the symptom severity of ADs is related to mindfulness and metacognition among adults. In addition, we wanted to compare metacognition and mindfulness between patients with ADs and healthy controls (HC).

Methods

Two hundred participants were enrolled in this study. Structured clinical interview, sociodemographic form, Five Facet Mindfulness Questionnaire-Short Form (FFMQ-S), Metacognition Questionnaire-30 (MCQ-30), and Hamilton Anxiety Rating Scale (HAM-A) were administered. Multivariate analysis of covariance (MANCOVA) was conducted to compare the groups in terms of mindfulness and metacognition. Correlation and multiple linear regression analyses were performed to measure the association between anxiety symptom severity, mindfulness, and metacognition.

Results

The main finding indicates that Positive Beliefs about Worry are associated with reduced symptom severity of ADs. Furthermore, the results suggest that HC have more Positive Beliefs about Worry and Nonjudging of Inner Experience compared to patients with ADs, who use Negative Beliefs about Uncontrollability and Danger and Need to Control Thoughts to a greater extent.

Conclusions

This study suggests that dysfunctional metacognitive beliefs may influence symptom severity of ADs among adults. We advise that focusing on reducing maladaptive metacognitions may be beneficial while treating ADs in adults

Disclosure

No significant relationships.

Zonulin and claudin-5 levels in multisystem inflammatory syndrome and SARS-CoV-2 infection in children

AIM

SARS-CoV-2 infection in children is generally asymptomatic or mild; however, it can lead to a life-threatening clinical condition, multisystem inflammatory syndrome in children (MIS-C), days or weeks after the infection. Increased intestinal permeability isa possible triggering factor at the onset of the hyperinflammation associated with MIS-C. Zonulin and claudin-5 are involved in intestinal permeability. In this study, we aimed to investigate serum zonulin and claudin-5 levels in SARS-CoV-2 infection and MIS-C disease.

METHODS

The study group consisted of children diagnosed with MIS-C or SARS-CoV-2 infection who presented to a university hospital paediatric emergency or infectious diseases departments. The control group included well patients seen at the General Pediatrics units for routine follow-up. Serum zonulin and claudin-5 levels were measured at the time of diagnosis.

RESULTS

Fifteen patients were included in the MIS-C group, 19 in the SARS-CoV-2 infection group and 21 in the control group. The mean zonulin level in the MIS-C group was significantly higher than in the control group (P < 0.001). Mean Claudin-5 levels were Psignificantly lower in the SARS-CoV-2 infection group than in the control group (P < 0.001).

CONCLUSION

These results indicate that increased intestinal permeability may be involved in the pathogenesis of SARS-CoV-2 infection and MIS-C disease. Larger clinical trials are needed to clarify the role of serum zonulin and claudin-5 on intestinal permeability in MIS-C and SARS-CoV-2 infection in children.

Psychometric validation of the desire thinking questionnaire in a Turkish adolescent sample: Associations with internet gaming disorder

BACKGROUND

Desire thinking is a conscious and voluntary cognitive process that consists of perseverative focus on information, memories, and prefiguration of images related to a desired target. The Desire Thinking Questionnaire (DTQ) is acknowledged as a reliable and valid tool to measure desire thinking in both adults and adolescents. The aim of the present study was to examine the psychometric properties of the DTQ in Turkish adolescent sample.

METHODS

A convenience sample of 200 adolescents completed the Turkish version of the DTQ (DTQ-T) and an Exploratory Factor Analysis (EFA) was performed. Subsequently, a convenience sample of 701 adolescents completed the DTQ-T and a battery of questionnaires assessing personality traits, affect, boredom, impulsivity, and Internet Gaming Disorder (IGD). A Confirmatory Factor Analysis (CFA) was performed on the DTQ-T and validity was determined by examining correlations with other measures.

RESULTS

A 9-item two-factor structure was observed in the EFA. An 8-item two-factor structure was established in the CFA. Results demonstrated that the DTQ-T yields adequate levels of reliability and concurrent validity. Additionally, an examination of incremental validity showed that DTQ-T significantly predicted IGD when controlling for personality traits, affect, boredom, and impulsivity.

CONCLUSIONS

The 8-item DTQ-T was found to be a reliable and valid measure of desire thinking among Turkish adolescents. Desire thinking may be a feasible target for mental health workers to alleviate the symptoms of IGD.

Response to `High-flow nasal cannula failure in Pediatric Emergency Department: Remarks and questions to explore the predictive factors`

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The Combined Contribution of Fear and Perceived Danger of COVID-19 and Metacognitions to Anxiety Levels during the COVID-19 Pandemic

Despite a wide base of research suggesting a major role for dysfunctional metacognitions in contributing to anxiety, their role in explaining psychological distress in the context of the COVID-19 pandemic remains unclear. In this study we investigated whether metacognitions would predict anxiety, while controlling for fear and perceived danger of COVID-19. A total of 862 individuals were included in this study. Participants completed sociodemographic questions, emotional state questions relating to COVID-19, the Metacognitions Questionnaire-30, and the Generalized Anxiety Disorder-7. Results showed that both negative beliefs about thoughts concerning uncontrollability and danger, and cognitive self-consciousness were significant predictors of anxiety beyond the fear and perceived danger of COVID-19. Future studies involving clinical populations are needed to investigate the longer-term impact of metacognitions in the maintenance and exacerbation of anxiety associated with the fear and perceived danger of COVID-19.

Examining the roles of cognitive flexibility, emotion recognition, and metacognitions in adult Attention Deficit and Hyperactivity Disorder with predominantly inattentive presentation

The evaluation of cognitive functions in Attention Deficit and Hyperactivity Disorder (ADHD) is fundamental to improve the efficacy of therapeutic interventions. However, the role of specific higher-order cognitive functions in adult ADHD, including cognitive flexibility, emotion recognition, and metacognitions, remains unclear. Therefore, in the current study, we aimed to examine these three distinct higher-order cognitive functions among adult ADHD individuals. Forty patients with ADHD with predominantly inattentive presentation and 42 healthy controls participated in the study. The Adult Attention Deficit and Hyperactivity Disorder Scale (AADHDS), the Wisconsin Card Sorting Test (WCST), the Reading the Mind in the Eyes Test (RMET), and the Metacognitions Questionnaire-30 (MCQ-30) were administered. Results indicated that patients with ADHD had worse metacognitions scores, in specific subdimensions, relative to healthy controls. However, cognitive flexibility and emotion recognition did not differ between the groups. Moreover, the cognitive confidence subdimension of the MCQ-30 was found to be sole significant predictor in the attention deficit subdimension of the AADHDS. Our findings suggest that lack of cognitive confidence may contribute to ADHD symptomatology despite regularly functioning cognitive flexibility and emotion recognition. Therefore, metacognitions could be a suitable target to alleviate the severity of ADHD symptoms.

The predictor role of metacognition and emotion recognition in internet gaming disorder among late adolescents

Introduction

Internet gaming is acknowledged as a common leisure activity among adolescents yet only a little known about the pscyhodevelopmental roots. Emotion recognition and metacognition which are proved to be determinants in behavioral disorders may be considered salient factors in also internet gaming disorder (IGD).

Objectives

The research to date has focused on psychological comorbidities rather than risk factors (e.g. dysfunctional metacognitive beliefs, emotion recognition deficits), whereas, improved early intervention would be more likely if risk factors were well defined, especially before the onset of the illness. The objective of this study was to investigate these areas by analyzing associations between metacognitive beliefs, emotion recognition, and IGD among late adolescents with tendency for pathological gaming behavior.

Methods

806 high school students were recruited and instructed to take Internet Gaming Disorder Scale (IGDT), Meta-Cognitions Questionnaire for Children and Adolescents (MCQ-C) and Reading the Mind in the Eyes Test - Children’s Version (RMET).

Results

Mean comparisons corresponding to IGD risk potential showed that positive meta-worry and superstitious, punishment, and responsibility beliefs of MCQ-C were significantly higher in the risky group, whereas; RMET neutral subtest was significantly higher in the non-risky group. Additionally, a positive correlation was found in all subtests of MCQ-C, RMET positive emotions and IGD. Regression analysis revealed that RMET positive subtest and positive meta-worry of MCQ-C predict IGD risk.

Conclusions

The findings of the study partially corroborated the early results found among early adolescents; however, they also indicated the requirement of distinct therapeutic approach for cognitive interventions of IGD in late adolescence period.

Disclosure

No significant relationships.

The relationship between cognitive test anxiety and mindfulness among university students

Introduction

Cognitive test anxiety is acknowledged as intense anxiety that prevents the effective use of the previously learned knowledge during the exam and leads to a decrease in success. Mindfulness is indicated as the ability to bring one’s attention to experiences in the present moment in a non-judgmental way. Despite promising outcomes of mindfulness techniques in regulating stress levels, much uncertainty still exists about the specific associations between cognitive test anxiety and mindfulness subcategories.

Objectives

The aim of this study was to investigate the relationship between cognitive test anxiety and subcategories of mindfulness among university students which may help improving current mindfulness interventions that show promising results to tackle cognitive test anxiety.

Methods

One hundred-eighty-two university students were recruited for the study via online forms. Mindfulness was measured with Five Facet Mindfulness (FFMQ-S) and the cognitive test anxiety was assessed with Cognitive Test Anxiety Scale-Revised (CTAR).

Results

Total scores of CTAR-R has an association between subscales of FFMQ; act-aware and non-judge in a positive direction, whereas; observe and describe in a negative direction. In addition, according to our regression model, FFMQ subscales of describing to indicated lower levels of CTAR scores, whereas act aware and non-judge indicated higher levels of CTAR scores.

Conclusions

The findings of the study partially corroborated the previous results by offering inferences about the subcategories of mindfulness. Additionally, these findings suggest that current interventions may target specific subcategories of mindfulness to maximize the positive outcomes of the treatment.

Disclosure

No significant relationships.

The role of metacognitions and emotion recognition in problematic SNS use among adolescents

BACKGROUND AND AIMS

Problematic social networking sites (SNS) use is associated with important psychological problems among adolescents. Nevertheless, research on the aetiology of problematic SNS use is limited. Our aim was to investigate the role of metacognitions and emotion recognition in predicting problematic SNS use during the late adolescence period.

METHODS

Eight hundred and sixty-one high school students were recruited for the study. Participants completed the Bergen Social Media Addiction Scale (BSMAS), the Metacognitions Questionnaire for Children (MCQ-C), and the Children's Version of Reading the Mind in the Eyes Test (RMET).

RESULTS

A stepwise multiple linear regression analysis showed that all subdimensions of metacognitions (positive meta-worry, negative meta-worry, superstition, punishment, and responsibility beliefs, and cognitive monitoring), but not emotion recognition, independently predicted the BSMAS total score controlling for daily SNS use.

CONCLUSIONS

Our findings indicate that maladaptive metacognitions are associated, independently frequency of daily SNS use, to problematic SNS use among late adolescents. Interventions targeting dysfunctional metacognitions may aid adolescents who suffer from the detrimental effects of problematic SNS use.

Predictive factors of high-flow nasal cannula oxygen therapy failure in children with respiratory distress treated in a Pediatric Emergency Department

BACKGROUND

High-flow nasal cannula (HFNC) is widely used as a feasible and tolerable respiratory support method. However, patients should be closely monitored, especially when used with moderate-severe respiratory distress indications. Because these patients can easily develop respiratory failure and escalated care may be required. The aim of this study is to determine the predictive factors in patients treated with HFNC who received escalated respiratory support for HFNC failure.

METHODS

A retrospective study of patients admitted with respiratory distress and treated with HFNC therapy between January 2014 and December 2018 was carried out. The variables evaluated were age, gender, vital signs before and two hours post HFNC therapy, underlying disease, use of steroid, salbutamol and antibiotic therapy, blood gase analysis and lactate values, hospitalization in pediatric intensive care unit, respiratory viral panel and need for escalation of respiratory support. HFNC failure was identified requiring noninvasive or invasive respiratory support despite HFNC therapy.

RESULTS

243 patients receiving HFNC therapy were included in this study. The median age was 11 months [interquartile range(IQR) 5-27]. The diagnosis of 183 patients (75.3%) were acute bronchiolitis and 60 patients (24.7%) were pneumonia. Of 243 patients, 29 (%11.9) received escalated care. 22 invasive and 7 non-invasive respiratory supports were provided. The lower pH on admission was found in the non-responder group. Moreover, heart rate and respiratory rate did not decrease two hours after HFNC therapy.

CONCLUSIONS

The careful monitoring of patients receiving HFNC therapy is critical. Because these patients are at risk for needing escalated care. We found that low pH values on admission and high pulse rate and respiratory rate observed at the second hour of follow-up period could be predictive factors for HFNC failure.

Assessing the Predictor Roles of Mindfulness and Spiritual Intelligence for Depressive and Anxiety Symptoms

The goal of this study was to examine the effects of mindfulness (MF) and spiritual intelligence (SI) as predictors of depression and anxiety, the most frequent manifestations of mental disorders – among 184 Turkish participants of diverse ages, predominantly students, living in Istanbul and Sarajevo. Four instruments were administered either directly or via web-based services: Scale for Spiritual Intelligence (SSI), Hospital anxiety and depression scale (HADS), Five Facet Mindfulness Questionnaire – Short Form (FFMQ-S) and Sociodemographic Information Form. Through the use of linear regression analysis, Actaware (b=-.19, p≤.001), Nonjudge (b=-.22, p≤.001), Nonreact (b=-.19, p≤.001) subscales of FFMQ-S were found to be negative predictors for depression and anxiety, whereas, Self-understanding subscale of SSI was not significant. Although our findings suggest that spiritual intelligence is not significant in prediction of depression and anxiety, our research provides empirical evidence for the link between MF, SI, depression and anxiety, as well as revealing MF as predictor for anxiety and depression which may be useful for further improvements in the scope of current interventions.

Metacognitions and emotion recognition in Internet Gaming Disorder among adolescents

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Metacognitions and emotion recognition predict IGD in early adolescence.

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Re-parenting, building assertiveness skills and metacognitions modification may protect adolescents from IGD.

Internet Gaming Disorder (IGD) is associated with considerable psychological distress in adolescents. However, studies which strive to shed light on the developmental background of IGD are still sparse. We aimed to examine the role of metacognitions and emotion recognition in predicting IGD during the early adolescence period. Four hundred and seventy-seven secondary school students were recruited for the study. Participants completed the Internet Gaming Disorder Test (IGDT), the Metacognitions Questionnaire for Children (MCQ-C), and the Children’s Version of Reading the Mind in the Eye Test (RMET). Correlation analyses indicated that three factors of the MCQ-C (positive meta-worry, negative meta-worry, and superstition, punishment, and responsibility) and its total score were positively correlated with the majority of factors of the IGDT. The negative factor of the RMET was positively correlated with the salience, tolerance, and relapse factors and total score of the IGDT. Daily internet use was positively correlated with all factors of the IGDT and its total score. Hierarchical regression analyses indicated that daily internet use and metacognitions (in different combinations) were significant independent predictors of IGDT factors and its total score, and that the negative factor of the RMET was a significant independent predictor of the salience and tolerance factors of IGDT and its total score. The implications of these findings are discussed.

The relationship between dysfunctional metacognitive beliefs and problematic social networking sites use

Social networking sites (SNSs) enrol new subscribers each day. However, problematic SNS use has undesirable effects on psychological functioning. Therefore, it is important to identify the factors that contribute to the development of problematic SNS use. Very few studies have focused on revealing the underlying mechanisms of problematic SNS use. Although many past studies have examined the relationship between metacognitive beliefs and Internet addiction, the association between metacognitive beliefs and problematic SNS use has not been adequately explored. In this study, we aimed to explore the association between metacognitive beliefs and problematic SNS use among young adults. A total of 308 individuals participated in this study. A socio-demographic data form, the Metacognitions Questionnaire-30 (MCQ-30), and Social Media Addiction Scale (SMAS) were administered. Group comparisons were performed using multivariate analysis of covariance. Pearson's correlational and multiple linear regression analyses were conducted to examine the associations between metacognitive beliefs and problematic SNS use. The SNS addicts scored higher in all of the SMAS assessments. When compared to non-addicts, SNS addicts obtained higher scores on all the subtests of the SMAS and MCQ-30 except cognitive self-consciousness. The negative beliefs about the uncontrollability and danger of worry, cognitive confidence, and need for control thoughts were associated with SMAS mood modification, relapse and conflict subdimensions. Our findings revealed that dysfunctional metacognitive beliefs are related to problematic SNS use among young adults. These findings indicate that mental health workers should consider the modification of metacognitive beliefs in the treatment of problematic SNS use.

Associations between emotion recognition and social networking site addiction

With the widespread use of the internet today, many studies have been conducted regarding the use of social networking sites (SNS). Despite the growing literature on the effects of SNS on human life, there are limited successful therapeutic interventions for SNS addiction. Our study aimed to elucidate the potential role of emotion recognition in the development of SNS addiction and to propose novel strategies for alleviating problems emerging from SNS addiction. A total of 337 individuals participated in the study. A sociodemographic data form, the Reading the Mind in the Eyes Test (RMET), and the Social Media Addiction Scale (SMAS) were administered. The results revealed the presence of emotion recognition deficits among individuals with SNS addiction, relative to non-addicts. RMET positive and negative scores were associated with SNS addiction in a negative direction. Additionally, RMET negative scores predicted SNS addiction. Our findings indicate a possible link between SNS addiction and emotion recognition, which might serve as a crucial target in novel treatment strategies.

The trait anxiety as a predictor of the suicidal risk in patients with cancer

Studies investigating the psychological aspects of cancer have gained importance in recent years. In these studies, the rates of depression and anxiety in cancer patients were examined, but the risk of suicide had not been examined. This study investigated the psychiatric diagnoses of depression, anxiety, and suicide risk in cancer patients. Eighty patients who met the inclusion criteria were administered the Beck Depression Inventory, State-Trait Anxiety Inventory, Structured Clinical Interview for DSM (SCID), and Suicide Probability Scale. The examination of the relationships across variables was assessed with Pearson's correlation analysis and stepwise multiple regression analysis. Due to SCID assessment, 45% of patients were found to have depression diagnosis, and 11.25% were found to have anxiety diagnosis. In the patients who had previous psychiatric diagnosis and treatment, total suicide probability scores demonstrated statistically significant differences. The frequency of depressive disorders and anxiety disorders in cancer patients is high. The studies investigating that suicide are rare, and in our findings, previous psychiatric diagnosis and treatment were risk factors. In the past studies, depression has been reported to be the most important factor in increasing the risk of suicide in cancer. Contrary to previous findings, according to the data obtained from this study, anxiety is the most important predictor of suicidal risk among all the determinants.

The evaluation of metacognitive beliefs and emotion recognition in panic disorder and generalized anxiety disorder: effects on symptoms and comparison with healthy control

Background: The impairments in metacognitive functions and emotion recognition are considered as liable factors in anxiety disorders. Aims: The better understanding of these cognitive abilities might lead to develop more accurate treatment methods for patients who suffer from anxiety. Methods: Forty-four patients with panic disorder (PD), 37 individuals with generalized anxiety disorder (GAD) and 44 healthy control (HC) were participated in our study. Metacognition questionnaire-30 (MCQ-30), Reading The Mind From The Eyes Test and symptom severity tests were administered. Results: Statistical analyses estimated the dysfunctional metacognitive beliefs and disrupted emotion recognition in patients relative to HC. The 'need to control thoughts' aspect of metacognitive beliefs was accounted for symptom severity in GAD. Improper metacognitive beliefs were significantly predicted the PD and GAD. In addition, impoverished emotion recognition predicted the GAD. Conclusions: Our study revealed the role of inconvenient metacognitive beliefs and distorted emotion recognition in PD and GAD. These findings might facilitate the treatment management in cognitive therapies of anxiety disorders via pointing out more reasonable targets across improper cognitive fields.

Assessing the relationship between attachment, parental attitude and plasma oxytocin in schizophrenia patients and their unaffected siblings

BACKGROUND

It is widely acknowledged that schizophrenia patients tend to have insecure attachment styles and improper parenting. However, the biological processes related to these adversities remain unclear and that the disturbance in oxytocin system is considered as one of the strongest predictors of such adversities.

METHODS

Thirty-four patients with schizophrenia and their unaffected thirty-four healthy siblings were recruited for the study and they were compared with thirty-one healthy controls. We examined attachment styles via Experience in Close Relationship-Revised Test and perceived parental attitudes with the My Memories of Upbringing-Short Version Test. In addition, we evaluated plasma oxytocin levels across groups.

RESULTS

The patients with schizophrenia had lower plasma oxytocin levels and obtained higher levels for attachment anxiety and avoidance with more parental rejection and over protection. There was a significantly negative relationship between the levels of plasma oxytocin in blood and parental over protection in the healthy sibling and healthy control groups. In contrast, there was a significantly positive relationship between the levels of plasma oxytocin in blood and parental over protection in the schizophrenia group. Results of the regression analyses revealed that the plasma oxytocin levels and over protection were notable factors in discriminating the groups from each other.

CONCLUSION

Our findings suggested that disturbance in oxytocin is associated with susceptibility to schizophrenia predisposition. In sum, therapeutic interventions that address oxytocin and over protection may influence the outcomes in this severe mental disorder.

[The Effect of Theory of Mind Capacities of Mothers of Patients with Schizophrenia on the Severity of the Diseases]

OBJECTIVE

Studies conducted with patients with schizophrenia and first-degree relatives show that, the pathology in theory of mind may be related to the risk of psychosis. The theory of mind capacities of the mothers may be effective in the prognosis of schizophrenia. The purpose of this study is to examine the effects of theory of mind capacities of patient mothers on the severity of the disease.

METHOD

The study was conducted with 34 schizophrenic patients and their mothers, and 31 healthy mothers. Sociodemographic data was captures for all groups. In addition, PANSS was collected from patients and Reading the Mind in the Eyes Test was collected from the each patient mother.

RESULTS

There was no statistically significant difference between the age and education levels of the groups. The mothers of patients with schizophrenia performed significantly worse in the Reading the Mind in the Eyes Test than the control group. There was an inverse correlation between theory of mind capacity and the medication dose, PANSS general condition and PANSS total score.

DISCUSSION

The significant difference between the groups suggests that the impairment in the function of the theory of mind can be regarded as an endo-phenotype for schizophrenia. The low theory of mind capacities of the mothers of schizophrenia patients can cause the mothers to misunderstand the feelings of their patient which could lead to increase in disease severity and drugs use.

The Effect of Medical Education on Attitudes Towards Schizophrenia: A Five-Year follow-Up Study

OBJECTIVE

It has been widely acknowledged that the community and health professionals hold negative attitudes toward patients with impaired mental health. This constitutes a majör obstacle for those patients in coping with their disease, managing their care, and hence regulating their lives. Although studies carried out in Turkey document the presence of stigma, they provide limited information about the ways for solving this problem. Drawing on the litrature, the present study investigated the effect of medical education on stigmatization.

METHOD

During 2008/2009 academic year, 106 freshmen who were majoring in the Medical School at Celal Bayar University volunteered to participate in the present study. Participants have not yet received any theoretical or practical training on psychiatry. At the beginning of the study, they were informed about the purpose of the study and accordingly requested to fill a consent form. The 32-item schizophrenia subscale of the Attitude Questionnaire developed by Psychiatric Investigations and Education Center (PAREM) was administered to the participants. Along with the questionnaire, they were also requested demographic information. After 5 years, the participants who completed their psychiatry internship were reassessed with the same instrument.

RESULTS

106 volunteers participated in the present study. The majority of the participants were females (54.7%) with equal balance of income and expidentures (65.1%) having a mental disease percentage of 5.6%. Findings showed that students' attitudes towards schizophrenic patients changed significantly positive as they proceed from first year to the fifth year. Results demonstrated that as students move through the years they report more positive attitudes in the areas of etiology of schizophrenia (p<0.01), treatment options (p<0.01), approach to schizophrenic patients (p<0.01), and social interactions (p<0.01).

CONCLUSION

We claim that the development of positive attitudes should be integrated in to the mental health curriculum not only in particular years but also throughout the whole years of education. Along this continuum, we believe that students would become more aware of the needs of the schizophrenic patients and gain an on going intuition toward the difficulties that the patients encounter. Viewed together, at the stage of acquiring medical/psychological skills students should be given the opportunity to have direct contact with patients in order to give adequate response to patients' needs and thus observe the improvement at the end of the treatment.

Effects of tamoxifen on survival of cutaneous and myocutaneous flap (experimental study)

OBJECTIVES

Breast cancer is the most common non-skin malignancy in women. In breast cancer, the basic principle of endocrine therapy is to deprive tumor cell from the growth-stimulating effect of estrogens. The oldest, best-known and most widely used endocrine therapy medicine is tamoxifen, which is a selective estrogen receptor blocker. All factors that are known to have adverse effects on flap and pre-reconstruction flap survive should be eliminated 3 weeks before the surgery and started at the end of the 3rd week after the surgery. When the literature is reviewed, there are limited studies about that tamoxifen increases the risk of deep vein thrombosis and pulmonary embolism. The aim of this study was to research whether tamoxifen had adverse effects on the skin flap and muscle-skin flap survive.

MATERIALS AND METHODS

In this study, 32 female Sprague-Davley rats were used. Their weights ranged from 220 to 250 g. 4 groups, each consisting of 8 rats, were formed. In this experimental study, in which rat models were used caudal based rat dorsal skin flap and superior pedicle rectus abdominis musculocutaneous flaps were applied. Control groups were formed for both flap models. Study groups were treated with tamoxifen citrat and control groups were treated with placebo.

RESULTS

As a result of the statistical evaluation done by measuring the surviving flap areas, it was found out that tamoxifen had no negative effect on flap survive.

CONCLUTIONS

Based on these findings, it was concluded that there was no need to stop tamoxifen as long as 6-7 weeks in patients undergoing breast reconstruction with pedicle flap techniques.