An evaluation of the differences in DNA damage in lymphocytes and repair efficiencies in patients with schizophrenia and schizoaffective disorder

Schizophrenia and schizoaffective disorder are chronic and debilitating psychiatric disorders. The present study was designed to determine DNA damage in patients with schizophrenia and schizoaffective disorder to assess the roles of oxidative metabolism and DNA repair mechanisms in this process, to assess the contribution of drugs, and thus to demonstrate the differences between schizophrenia and schizoaffective disorder. Thirty schizophrenia and 30 schizoaffective disorder patients, each having at least five years of disease history, aged between 18 and 60 years with no physical or neurological diseases, and 30 healthy volunteers participated in the study. Psychometric scales were applied, and 5 ml of blood was taken from all participants. The DNA damage was measured in lymphocytes by the comet assay method; the total oxidative parameters by ELISA; OGG1 and NEIL1 gene expressions by real-time PCR; and the role of drugs by in vitro assays. The most important finding in this study was that patients with schizophrenia had significantly greater DNA damage than schizoaffective disorder patients and the controls. This study also provides evidence of high oxidative stress statuses and inadequate DNA repair capacities in patients with schizophrenia. Moreover, psychotropic drugs did not induce any DNA damage to the lymphocytes according to in vitro analyses. The use of clozapine and adequate repair processes of the patients were the decisive factors in the prevention of DNA damage. The results of this study provide a reexamination of schizoaffective disorder within the schizophrenia spectrum and indicate that schizoaffective disorder may be considered a different diagnostic category.

Involuntary social cue integration in patients with obsessive compulsive disorder

OBJECTIVE

Patients with obsessive compulsive disorder (OCD) have inferior social functioning compared to healthy controls, but the exact nature of these social deficits, and the underpinning mechanisms, are unknown. We sought to investigate social functioning in patients with OCD by measuring their involuntary/spontaneous processing of social cues using a specifically designed test, which might reveal deficits in these patients that explicit voluntary tasks do not detect.

METHODS

The sample of the study consisted of an OCD group (n = 25) and a control group (n = 26). Both groups performed an adaptation of the Social Distance Judgment Task (SDJT; Jellema et al., 2009), in which participants have to judge the geometrical distance between two human cartoon figures presented on a computer screen. Head/gaze direction and body direction were manipulated to be either compatible, i.e. both directed to the left or to the right (Compatible condition) or incompatible, i.e. body directed toward the observer (frontal view) and head/gaze directed to the left or right (Incompatible condition).

RESULTS

In the Compatible condition, controls nor OCD patients were influenced by the social cues in their judgments of the geometrical distances. However, in the Incompatible condition, where the attentional cue was more conspicuous, both groups were influenced by the cues, but the controls to a significantly larger extent than the OCD patients.

CONCLUSIONS

This study showed that patients with OCD are less likely, compared to controls, to automatically/spontaneously integrate the other's direction of attention into their visual percept. This may have resulted in their judgments of the geometrical distances between the agents to be more accurate than those of controls. The suggested impairment in automatically integrating social cues may have important repercussions for the social functioning of OCD patients.

Situation awareness in obsessive-compulsive disorder

Past studies have suggested that OCD patients suffer memory impairment on tasks using complex stimuli that require memory for combined elements to be maintained, but not for more simplistic memory tests. We tested this with 42 OCD patients and 42 healthy controls performed a computerized situation awareness task. In addition, participants completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Maudsley Obsessive-Compulsive Inventory (MOCI). The OCD patients had poorer accuracy in integration/comprehension and perception levels than controls. There were significant correlations between situational awareness scores (i.e., visuo-spatial monitoring and processing) and Y-BOCS obsession-compulsion and slowness and doubt scores of MOCI in OCD patients. In addition, there were also significant correlations between situational awareness and controlling, cleaning, slowness, rumination and total scores of MOCI in control group. Results indicated that (I) OCD patients have problems of perception, integration, and comprehension of complex visual perceptions; (II) situation awareness deficits associated with severity and prevalence of obsessions and compulsions.

The comparison of pre- and post-treatment (99m)Tc HMPAO brain SPECT images in patients with obsessive-compulsive disorder

The objective of the present study was to compare brain activation in patients with obsessive-compulsive disorder (OCD) who received pharmacotherapy (selective serotonin reuptake inhibitor (SSRI) or a SSRI-risperidone combination) with that in healthy controls using (99m)Tc-hexamethyl propyleneamine oxime (HMPAO) brain single photon emission tomography (SPECT). Twelve OCD patients achieving clinical response (seven SSRI responders, five patients responded to SSRI plus risperidone) underwent post-treatment SPECT scan. The baseline regional cerebral blood flow (rCBF) was significantly reduced in a large part of the cerebral cortex and the left cingulate gyrus in OCD patients compared with controls. After a 50% reduction of the OCD symptoms, bilaterally increased rCBF in the thalamus showed a significant effect of time in both of the patient groups. In the remitted state, although rCBF in the cingulate gyrus did not differ in SSRI responders compared with controls, patients who responded to the combination of SSRI+ risperidone showed significant hypoperfusion in the left anterior cingulate gyrus. SSRI responders had normalized rCBF in the frontal region relative to the control group. Consequently, based on our results, we attribute the observed thalamic rCBF alteration to SSRI treatment. Our results also suggested that brain perfusion changes associated with clinical remission may differ across patient subgroups.

A proton magnetic resonance spectroscopy study in schizoaffective disorder: comparison of bipolar disorder and schizophrenia

The aim of this study was to compare schizoaffective disorder, bipolar disorder and schizophrenia based on (1)H-MRS metabolite values in dorsolateral prefrontal cortex and executive functions. The subjects comprised 15 patients with bipolar disorder type I (BD), 15 with schizophrenia (SCH), 15 with schizoaffective disorder (SAD) and 15 healthy controls. We performed proton magnetic resonance spectroscopy ((1)H-MRS) of the dorsolateral prefrontal cortex (DLPFC) bilaterally. Levels of N-acetyl aspartate (NAA), choline-containing compounds (Cho) and creatine-containing compounds (Cr) were measured in the DLPFC using (1)H-MRS. We administered the Wisconsin Card Sorting Test (WCST) and the Stroop Test (ST) to evaluate executive functions. The SAD, BD and SCH patients had lower levels of NAA than the control group. The SAD and BD patients had low levels of Cho compared to the control group. The left DLPFC Cr levels in all of the patient groups and the right DLPFC Cr levels in the BD and SAD groups were lower than in the control group. The levels of NAA Cho and Cr were not related to executive functions and attention performance. Cr level were related to attention processes, only in SCH. Our results indicate that NAA levels are reduced in schizoaffective disorder, bipolar disorder and schizophrenia, but the reduction in the levels of NAA is not a distinctive feature among these three illnesses. Schizoaffective and bipolar disorders have similar features related to the levels of compounds containing Cho and Cr. This similarity may be related to these illnesses both having an affective basis.

Characteristics of suicidal behavior in a Turkish sample

BACKGROUND

Suicidal behavior is one of the most important problems in psychiatric clinics. Several sociodemographic and clinical characteristics may have different effects on suicidal behavior.

AIMS

To examine the sociodemographic and clinical characteristics of a sample of 144 suicide attempters admitted to a Turkish emergency clinic for a suicide attempt.

METHODS

All subjects were interviewed by a consultant psychiatrist. For all individuals, data on DSM-IV psychiatric diagnoses, sociodemographic data, Beck's Hopelessness Scale (BHS), Becks's Suicidal Ideation Scale (SIS), and Beck's Suicidal Intention Scale (BSIS) were collected.

RESULTS

The majority of suicide attempters were females characterized by low educational status and low religious orientation. Drug overdose was the most common method of suicide attempt and conflict within the family was the most frequent psychological stress factor. Three-quarters of attempters (74.6%) met DSM-IV criteria for at least one psychiatric diagnosis. Of these, 28.5% met criteria for major depressive disorder. Suicide attempters with depression tended to be immigrant, urban dwellers with high scores on the suicide intent scale.

CONCLUSIONS

In the present study, the findings are useful in showing the risk factors related to suicidal behavior.

Schizophrenia with obsessive-compulsive disorder and obsessive-compulsive disorder with poor insight: a neuropsychological comparison

Schizophrenia patients with obsessive-compulsive disorder (OCD) may be a subgroup of schizophrenia, and OCD patients with poor insight may show psychotic-like symptoms. The aim of this work is to compare the neuropsychological performance of those patients with schizophrenic patients who do not have OCD symptoms and with OCD patients who have good insight. The sample consisted of 89 patients (16 OCD-schizophrenic patients, 30 non-OCD schizophrenic patients, 30 OCD patients with good insight, 13 OCD patients with poor insight). Neuropsychological evaluation included executive functions, verbal and visual memory and attention tasks. While schizophrenic patients with OCD did not differ from the non-OCD schizophrenia and OCD with poor insight groups on long-term visual and verbal memory performance, they showed poorer performance than the OCD group on long-term visual and verbal memory tests. Considering executive function, the OCD group with poor insight performed significantly worse than their counterparts with good insight, and the latter group performed better than the schizophrenia patients. The results of this study suggest that the neuropsychological performance of schizophrenia patients with OCD did not differ from that of non-OCD schizophrenic patients, and that OCD patients with poor insight were more likely to share similar cognitive characteristics with the schizophrenia groups. Our results also provide neuropsychological support for the hypothesis that OCD and schizophrenia may be a spectrum disorders.

Cognitive functions in euthymic patients with bipolar disorder

BACKGROUND

Recent studies have focused on the nature of cognitive dysfunction in bipolar patients. The purpose of the current study was to investigate cognitive performance of individuals with bipolar disorder compared to healthy control subjects during a well-established euthymic period.

METHODS

The sample consisted of 27 bipolar euthymic patients and 21 control subjects. Verbal and visual memory performance, attention, executive functions and psychosocial functions were evaluated for each participant.

RESULTS

Bipolar patients showed significant attentional deficit and executive dysfunction and also poor performance on verbal and visual memory tasks compared to the controls. Illness duration and lifetime total episode number and previous episode with psychotic features was associated with worsened performance on attention, executive and memory tasks. Psychosocial functioning was not associated with cognitive deficit.

CONCLUSIONS

The present study showed persistent cognitive impairment on inhibitory control and selective attention as well as poor performance on verbal and visual memory tests in a group of bipolar euthymic patients. The impaired neuropsychological performance was associated with duration of illness, total number of episodes per lifetime, and previous episodes with psychotic features. Attentional dysfunction seemed to be a trait abnormality for the sample studied.

The role of RELN in lissencephaly and neuropsychiatric disease

Reelin is an extracellular matrix-associated protein important in the regulation of neuronal migration during cerebral cortical development. Point mutations in the RELN gene have been shown to cause an autosomal recessive human brain malformation termed lissencephaly with cerebellar hypoplasia (LCH). Recent work has raised the possibility that reelin may also play a pathogenic role in other neuropsychiatric disorders. We sought, therefore, to define more precisely the phenotype of RELN gene disruption. To do this, we performed a clinical, radiological, and molecular study of a family in whom multiple individuals carry a chromosomal inversion that disrupts the RELN locus. A 6-year-old girl homozygous for the pericentric inversion 46,XX,inv7(p11.2q22) demonstrated the same clinical features that have been previously described in association with RELN point mutations. The girl's brain magnetic resonance imaging (MRI) findings, including pachygyria and severe cerebellar hypoplasia, were identical to those seen with RELN point mutations. Fluorescence in situ hybridization confirmed that one of the breakpoints of this inversion mapped to within the RELN gene, and Western blotting revealed an absence of detectable serum reelin protein. Several relatives who were heterozygous for this inversion were neurologically normal and had no signs of psychotic illness. Our findings demonstrate the distinctive phenotype of LCH, which is easily distinguishable from other forms of lissencephaly. Although RELN appears to be critical for normal cerebral and cerebellar development, its role, if any, in the pathogenesis of psychiatric disorders remains unclear.

OCD symptoms in a sample of Turkish patients: a phenomenological picture

This study aimed to investigate the clinical features of obsessive-compulsive disorder (OCD) and the possible association between obsessive-compulsive symptoms and culture-related characteristics in a sample of Turkish patients with OCD. We studied 141 patients with OCD (according to DSM-IV criteria) consecutively admitted to our outpatient clinic during the period from February 1998 to December 2003. We used the Turkish version of the Structured Clinical Interview for DSM-IV (SCID) to interview all patients, and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to assess obsessive-compulsive symptoms and severity. The onset of OCD symptoms was earlier in males. Major depression was the most common comorbid disorder (30.5%). The most commonly occurring obsessions were contamination (56.7%), aggression (48.9%), and somatic (24.1%), followed by religious (19.9%), symmetry (18.4%), and sexual imagery (15.6%). Symmetry and sexual obsessions, and checking compulsions and rituals, tended to be more common in male patients. Dirt and contamination obsessions and washing compulsions were slightly more common in females. The vast majority of patients with religious obsessions (83%) and half of the patients with sexual obsessions had compulsions that included religious practices. Also, patients with sexual and religious obsessions had delayed seeking professional help.

Does corticosteroid usage in rhinoplasty cause mood changes?

In this study, the psychological effects of single-dose corticosteroids administered to patients who had undergone rhinoplasty were assessed. A total of 30 rhinoplasty patients were included in the study and were randomly assigned to 1 of 2 groups. Preoperatively, patients completed the Bech Rafaelsen Mania Scale and the Beck Depression Inventory. Dexamethasone 10 mg was given intravenously just before surgery to the first group, but no medication was administered to the second group. On the first postoperative day, patients were seen again, and the Bech Rafaelsen Mania Scale and the Beck Depression Inventory were again completed. Periorbital edema and ecchymosis were graded, and psychological well-being was measured on a standard visual analog scale. All patients and physicians were blinded to treatment until the end of the study. Results show that administration of a single-dose of dexamethasone 10 mg caused neither euphoria nor depression. No significant differences were observed between steroid and control groups in terms of patients' psychological well-being. With single-dose dexamethasone, periorbital edema was significantly reduced on the first 2 postoperative days, and upper eyelid ecchymosis was significantly decreased only on the first postoperative day. However, reoperative steroid administration had no influence on ecchymosis of the lower eyelid. The authors conclude that single-dose dexamethasone 10 mg can be used safely to reduce periorbital edema and ecchymosis in rhinoplasty patients.

Memory function in patients with obsessive compulsive disorder and the problem of confidence in their memories: a clinical study

AIM

To examine obsessive-compulsive patients for memory of obsessive-compulsive relevant material and confidence in their memory.

METHODS

Memory function was examined by a recognition task using neutral and obsessive-compulsive relevant sentences in 32 patients with obsessive-compulsive disorder and 31 control subjects. We also investigated the participants' confidence in the accuracy of their recognition. The severity of obsessive-compulsive disorder was evaluated by using the Yale-Brown Obsessive Compulsive Scale. The Maudsley Obsessive Compulsive Questionnaire, the Hamilton Depression Rating Scale, and the State-Trait Anxiety Inventory were also administered to the two groups.

RESULTS

Whereas obsessive-compulsive disorder patients were not significantly different from control subjects on measures of recognition memory for both obsessive-compulsive relevant and neutral material, they were significantly less confident in the memory for obsessive-compulsive relevant and neutral sentences. Also, the State-Trait Anxiety Inventory (STAI) scores were negatively correlated with the recognition performance of obsessive-compulsive disorder relevant sentences and the levels of confidence in memory in the obsessive-compulsive disorder group. The obsessive-compulsive patients with checking compulsions were not different from non-checking obsessive-compulsive patients.

CONCLUSION

Our results suggest that obsessive-compulsive patients experience difficulties in confidence in their memory, possibly related to anxiety rather than primary memory deficits.

Depressive symptomatology among university students in Denizli, Turkey: prevalence and sociodemographic correlates

AIM

To determine overall and subgroup prevalence of depressive symptomatology among university students in Denizli, Turkey during the 1999-2000 academic year, and to investigate whether sociodemographic factors were associated with depressive symptoms in university students.

METHODS

A stratified probability sample of 504 Turkish university students (296 male, 208 female) was used in a cross-sectional study. Data were obtained by self-administered questionnaire, including questions on sociodemographic characteristics and problem areas. The revised Beck Depression Inventory (BDI) was used to determine depressive symptoms of the participants. BDI scores 17 or higher were categorized as depressive for logistic regression analysis. Student t-test and linear regression were used for continuous data analysis.

RESULTS

Out of all participants, 26.2% had a BDI score 17 or higher. The prevalence of depressive symptoms increased to 32.1% among older students, 34.7% among students with low socioeconomic status, 31.2% among seniors, and 62.9% among students with poor school performance. The odds ratio of depressive symptoms was 1.84 (95% confidence interval [CI], 1.03-3.28) in students with low socioeconomic status and 7.34 (95% CI, 3.36-16.1) in students with poor school performance in the multivariate logistic model. The participants identified several problem areas: lack of social activities and shortage of facilities on the campus (69.0%), poor quality of the educational system (54.8%), economic problems (49.3%), disappointment with the university (43.2%), and friendship problems (25.9%).

CONCLUSIONS

Considering the high frequency of depressive symptoms among Turkish university students, a student counseling service offering mental health assistance is necessary. This service should especially find the way to reach out to poor students and students with poor school performance.

Psychiatric morbidity among cancer patients and awareness of illness

A significant proportion of cancer patients experience psychiatric morbidity. Potential predictors of psychiatric morbidity include patient disease-related factors and factors relating to the patient's environment. The aim of this study was to investigate the prevalence of psychiatric morbidity and the relationship between the clinical or personal factors, especially psychiatric morbidity, and awareness of cancer diagnosis among a group of Turkish cancer patients. A total of 117 cancer patients were assessed using the Structured Clinical Interview for DSM-IV (SCID), the Hospital and Anxiety Depression Scale (HADS) and the General Health Questionnaire (GHQ). Of these patients, 30% had a psychiatric diagnosis. Adjustment disorders comprised most of the psychiatric diagnoses. Awareness of the diagnosis of cancer, history of previous psychiatric disorders, pain and stress factors were correlated with psychiatric morbidity. Of the 117 patients, 64 (54.7%) were unaware of the diagnosis of cancer. Most of the patients (67.9%) who were considered to be aware of the cancer diagnosis stated that they had guessed their illness from the treatment process or drug adverse effects. Psychiatric morbidity was significantly higher in the patients who knew that they had a cancer diagnosis (P=0.03). These findings suggest that the awareness of cancer diagnosis is related to the presence of psychiatric morbidity. In particular, the understanding of the diagnosis indirectly may be stressful to the patient because it arouses suspicion about the cancer and treatment, and consequently can lead to psychiatric disturbance. In Turkey honest disclosure of the true diagnosis is still not common for cancer patients and it seems to be essential to improve this situation.

The complementary role of different neurophysiological methods to demonstrate organicity in male with premature ejaculation and erectile dysfunction

Erectile dysfunction and premature ejaculation are the most common male sexual disorders. Generally, it is considered that erectile dysfunction is related to organic factors whilst premature ejaculation is related to psychological factors. A detailed history along with physical examination such as using penile doppler, penile tumesans and ultrasonography are insufficient for differential diagnosis in 15-20% of cases. Therefore the role of neurophysiological techniques are important. In this study urological and biochemical investigations were used in conjunction with other neurophysiological methods. According to our results, using a neurophysiological test study on its own was ineffective. As a conclusion our study has shown that neurophysiological methods are important differential diagnosis of revealing suspicious organicity--generally believed to be due to psychological factors- in male sexual disorders.

[Psychiatric disorders in cancer patients and associated factors]

OBJECTIVE

There is a high prevalence of psychiatric disorders, especially depression and anxiety, among cancer patients. If they are left untreated, especially depressive disorders, they may result in poor treatment compliance, increased hospital stays and reduced quality of life. The aim of this prospective study is to investigate the prevalence of psychiatric morbidity among cancer patients and the factors that predict psychiatric morbidity.

METHOD

One hundred and fifty patients with the diagnosis of cancer who were treated in different departments of the Pamukkale University Hospital were included in this study. Psychiatric diagnoses were made according to the criteria of DSM-IV with the SCID-I interview. In addition, all patients were evaluated using the General Health Questionnaire (GHQ) and the Hospital and Anxiety Depression Scale (HADS).

RESULTS

28.7% of cancer patients were found to have a DSM-IV Axis I diagnosis. The most common diagnoses were adjustment disorder with depressed mood (14%) and major depressive disorder (11.3%). Female gender, awareness of the diagnosis of cancer, history of previous premorbid psychiatric disorders and stress factors were correlated with psychiatric morbidity.

CONCLUSION

In this study, the most common diagnoses were adjustment disorder with depressed mood and major depressive disorder, suicidal ideations were also frequently found. Awareness of the nature of the illness, female gender and the duration of the illness were the parameters which predicted psychiatric morbidity. Careful attention should be paid to cancer patients in order to diagnose and treat their psychiatric disorders. Furthermore, two screening instruments (GHQ and HADS) performed satisfactorily for screening of psychiatric disorders in cancer patients.

[An anorexia nervosa case and an approach to this case with pharmacotherapy and psychodrama techniques]

Anorexia nervosa in an eating disorder that primarily affects female adolescents and is more commonly seen in westernized countries. Although it is a sociocultural problem of developed societies, nowadays it is also increasing rapidly in developing cultures such as Turkey. Difficulties in the treatment of anorexia nervosa have directed clinicians to understand the disorder better. Although it is well known that various factors play a role in the etiology of anorexia nervosa, psychodynamic factors also have considerable importance. In addition, social and familial interactions contribute to the development of anorexia nervosa. In the light of these facts, treatment with psychotherapy and pharmacotherapy might be used to cure this disorder. In this article, the definitive features and process of anorexia nervosa along with its psychodynamics were discussed on the basis of a case. In the treatment of the patient, psychodrama techniques with drugs were thought to be useful. The patient became aware of the unfavourable relationship and improved by the use of this method. Thus she gained emotional-cognitive insight.

Quantitative EEG analysis in obsessive compulsive disorder

Quantitative analysis of the EEG (q-EEG) in patients with obsessive compulsive disorder (OCD) showed a decreased beta and an increased theta power at frontotemporal regions. The patients who had higher scores in doubting test (Maudsley Obsessive Compulsive Questionnaire) and more severely ill patients shared similar q-EEG features. The relative theta powers were significantly increased and alpha powers were significantly decreased in these patients, particularly in the frontotemporal region. It was suggested that the q-EEG may be useful in investigating the OCD patients with heterogeneous characteristics.