The Relationship Among Seasonality, Night Eating, and Chronotype in Bipolar Disorder: Exploring the Mediating Role of Sleep Quality.

ABSTRACT: The purpose of the study was to explore the association among chronotype, seasonality, sleep quality, and night eating syndrome (NES) among patients with bipolar disorder (BD) and the mediating role of sleep quality in this relationship. Ninety-two individuals with BD type 1 who had been euthymic for at least 8 weeks and 87 healthy controls were included. In addition to sociodemographic/clinical data, chronotype, seasonality, sleep quality, and NES were evaluated using the Morningness-Eveningness Questionnaire (MEQ), Seasonal Pattern Assessment Questionnaire, Pittsburgh Sleep Quality Index, and Night Eating Questionnaire. The prevalence of NES (17.4%) was higher among BD than the controls. BD patients with NES had poorer sleep quality, greater seasonality, and lower MEQ scores. Chronotype had an indirect effect that was partially mediated by sleep quality on night eating symptoms in BD patients, in addition to a direct effect. Seasonality was found to have a direct effect on night eating symptoms. Therapeutic interventions that target both sleep and circadian disruption should be implemented when addressing NES in patients with BD.

One Patient, Three Providers: A Multidisciplinary Approach to Managing Common Neuropsychiatric Cases.

BACKGROUND: Neuropsychiatric cases require a multidisciplinary approach for effective management. This paper presented case-based discussions on migraine, dementia, epilepsy, mood disorders, neuralgia, and psychosis from the perspectives of a family physician, neurologist, and psychiatrist. The goal was to highlight the importance of collaboration between healthcare providers in managing these complex cases. METHODS: The paper was based on the proceedings of the Mediterranean Neuropsychiatry Symposium, where experts from family medicine, neurology, and psychiatry came together for comprehensive case-based discussions. The CARE framework (Case Report, Appraisal, Research, and Education) was developed to guide reporting and evaluation of case reports in clinical practice. RESULTS: Six cases were presented and discussed, highlighting the importance of a multidisciplinary approach in managing neuropsychiatric cases. The cases included chronic migraine with medication overuse, memory dysfunction with language and behavioral problems, refractory epileptic seizures with subjective sensory symptoms, bipolar affective disorder with normal pressure hydrocephalus, postherpetic neuralgia in a case with bipolar affective disorder, and psychosis with recurrent attacks with the abuse of several substances. CONCLUSION: A biopsychosocial multidisciplinary approach is essential for managing neuropsychiatric cases effectively on behalf of the patients and public health of the country. The CARE framework can guide the reporting and evaluation of case reports in clinical practice, ensuring that patients receive comprehensive and effective care. Healthcare providers should collaborate to provide the best possible care for patients with complex and multifaceted needs.

The effect of perceived social support on quality of life in Turkish men with alcohol, opiate and cannabis use disorder.

OBJECTIVE: The purpose of this study was to investigate the effect of perceived social support on the quality of life of male patients with alcohol, opiate and synthetic cannabinoid use disorders by considering sociodemographic factors and mood, and to compare these three groups in terms of social support and quality of life. METHOD: One hundred and thirtyone (131) patients who were hospitalized at Addiction Clinic of Istanbul Erenkoy Psychiatric and Neurological Diseases Training and Research Hospital in Turkey and diagnosed as alcohol, opiate and synthetic cannabinoid use disorder were included in the study. Sociodemographic Data Form, Turkish version of the World Health Organization Quality of Life Questionnaire Scale (WHOQOL-BREF-TR), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Multidimensional Scale of Perceived Social Support (MSPSS), API (Addiction Profile Index) were applied to the participants. RESULTS: A total of 131 male patients were 32 synthetic cannabinoids, 51 opiates and 48 alcohol use disorders diagnosed. The mean age of alcohol users was higher than the other groups. Separation/divorce rate was higher in alcohol users and single rate in opiate users. Alcohol use was higher in living alone and opiate users lived with first degree relatives. The crime history was higher in the cannabis group. Prison experience, probation and self-injury were higher among opiate users. Family history of substance use was higher in opiate users. Crime was found to be less in alcohol users. In the comparison of alcohol and substance (opiate, cannabis) groups, the rate of self-injury (93.8%) was found to be significantly higher in the substance user' group. There was no statistically significant difference between the groups in terms of depression and anxiety scores. When the alcohol and substance (opiate, cannabis) comparisons were made between the groups, the mean depression (21.02 ± 11.6) and anxiety (20.09 ± 17.49) of the alcohol group was significantly higher. The "effect on life" (31.8 ± 6.13) and "motivation" subscales (10.38 ± 2.39) of API was found to be significantly higher in patients with substance use. In the opioid group, physical, environmental and psychological subscales of the WHOQOL-BREF-TR did not show significant correlation with MSPSS, and the family, friend' subscales and total perceived social support were significantly correlated with the social subscale of WHOQOL-BREF-TR. In the alcohol group, the environmental and social subscales of WHOQOL-BREF-TR showed a significant correlation with perceived social support from the family and private person and total perceived support. CONCLUSION: Addiction is a recurrent and chronic disease and inevitably reduces quality of life. Social support has an important role on the quality of life. Improving the quality of life seems to be one of the main goals during the addiction treatment. For this purpose, it is very important to provide psychosocial support with pharmacological treatment by evaluating the medical, mental and social needs of the dependent patient as a whole.

The Relationship Between Suicidal Behavior, Neurocognitive Functions, and Insight in Patients with Schizophrenia.

Background: In schizophrenia, the relationship between suicide and cognition is unclear. We aimed to assess cognitive functions and insight in schizophrenia patients with and without suicide attempts. Methods: In our study consisting of 77 patients, 36 of the patients had attempted suicide at least once in their lives and the remaining 41 had never attempted suicide. Sociodemographic data scale, Beck Cognitive Insight Scale, and Cambridge Neurophysiological Assessment Battery were applied. Results: In this study, patients with schizophrenia who attempted suicide had higher Beck Cognitive Insight Scale self-reflectiveness scores (P = .004), lower Beck Cognitive Insight Scale self-certainty scores (P = .040), and higher Beck Cognitive Insight Scale total score (P = .004). Delay aversion (P = .003) and risk-taking scores (P = .044) of Cambridge Neurophysiological Assessment Battery Cambridge gambling task were higher in patients who attempted suicide. In logistic regression analysis, as independent factors, the number of hospitalizations increased the risk of suicide 1.5 times per hospitalization (P = .021), Cambridge gambling task delay aversion increased the risk of suicide 8.4 times per score (P = .044), and the Beck Cognitive Insight Scale self-certainty score was shown as the factor that decreased the risk of suicide by 0.78 times (P = .024). Conclusion: The causes of suicide attempts in schizophrenia still preserve its uncertainty. Our results proposed a statistically significant relationship between cognitive insight and increased suicide attempts. This study also sustains that cognitive impulsivity is associated with suicidal behavior in patients with schizophrenia.

Emotional Information Processing and Assessment of Cognitive Functions in Social Anxiety Disorder: An Event-Related Potential Study.

The aim of our study was to determine deficits in cognitive areas, including social cognition such as emotion recognition capacity, theory of mind, and electrophysiological alterations in patients with social anxiety disorder (SAD) and to identify their effects on clinical severity of SAD. Enrolled in our study were 26 patients diagnosed with SAD and 26 healthy volunteers. They were administered the Liebowitz Social Anxiety Scale (LSAS), Reading Mind in the Eyes Test (RMET), and Cambridge Neuropsychological Test Automated Battery. EEG monitoring was performed for electrophsiologic investigation. In the patient group, total reading the mind scores were lower (P = .027) while P300 latencies and emotion recognition latency during the Emotion Recognition Task (ERT) were longer (P = .038 and P = .012, respectively). The false alarm scores in the Rapid Visual Information Processing Task (RVP) were higher in the patient group (P = .038). In a model created using multivariate linear regression analysis, an effect of ERT and RVP scores on LSAS scores was found. Results of our study confirm that particularly impairment of cognitive functions such as sustained attention and emotion recognition may seriously affect the clinical presentation negatively. P300 latency in the parietal region may has the potential to be a biological marker that can be used in monitoring treatment.

Psychiatric emergency visit trends and characteristics in a mental health epicenter in Istanbul during COVID-19 lockdown.

BACKGROUND: We aimed to explore the impact of the preventive measures and partial lockdown to the psychiatric emergency department (PED) visits during COVID-19 pandemic in a mental health epicenter in Istanbul. METHODS: A total of 5839 patients admitted to PED during the lockdown period (LP) between March 30 and May 31, 2020, were enrolled in this retrospective cohort study. Data of these patients were compared to those of patients in the same period in 2019 between April 1 and June 2, 2019 (non-LP). We also investigated the monthly number of PED visits and hospitalizations between March 1 and December 31, 2020, and compared it to the same period in 2019. RESULTS: The volume of PED visits and hospitalizations in LP decreased by 12% and 41.6%, respectively. The rates of patients presenting anxiety and depressive disorders and bipolar disorders were found to significantly increase in LP than non-LP (p < 0.001; p < 0.001; p < 0.01, respectively). Depressive disorders, prior history of mental illness, and aggressive behavior were found to predict frequent PED visits while decrease in age and male gender found to predict hospitalizations. Regarding suicide attempt, younger patients and those with new-onset mental disorders were found to be at high risk in LP. Patients diagnosed with COVID-19 in PED visits were mostly with psychotic and bipolar disorders. CONCLUSION: Policy-makers should focus on studies on mental health services to reorganize and enhance such services, which are crucial to prevent and manage adverse mental health consequences of the pandemic and congestion in PEDs.

Black cohosh associated mania in a patient with unipolar depression.

Black cohosh (actaea racemosa, cimicifuga racemosa) a popular complementary medicine, is commonly prescribed as an alternative drug to hormone replacement therapy for the treatment of menopause symptoms and menstrual pain. Studies on the black cohosh's psychological effects are generally focused on the perimenopausal depression and anxiety; and, its effects have been considered to be affiliated with its serotonergic and dopaminergic activities. We report a patient presenting with acute onset mania associated with black cohosh use, probably due to its psychopharmacological activities on serotonergic and dopaminergic receptors. We suggest that black cohosh must be used cautiously in the patients with history of unipolar depression or bipolar disorder.

Sexual Adverse Effects and Erectile Dysfunction During Buprenorphine/Naloxone Combination Treatment for Opioid Use Disorders.

BACKGROUND AND OBJECTIVES: Compliance and maintenance of abstinence is a major issue in substance use disorders. Adverse effects of opioid maintenance treatments (OMT) include sexual dysfunctions. There is a vast amount of studies regarding sexual adverse effects of conventional OMTs; however, information regarding buprenorphine/naloxone (Bup/Nal) combination is limited, mostly evaluated in western populations and controversial. In this study, we aimed to assess the sexual adversities of Bup/Nal treatment in a Turkish alcohol and substance use disorder treatment center sample. MATERIALS AND METHODS: We recruited 100 subjects continuing sublingual Bup/Nal combination and 35 control subjects. Subjects were evaluated via the the Golombok-Rust Inventory of Sexual Satisfaction (GRISS) for sexual dysfunction and for erectile dysfunction (ED) with the International Index of Erectile Function-5 (IIEF-5) as a comparison. RESULTS: The mean dose of our treatment was 9.05. Overall sexual dysfunction scores were not significantly different in between groups with GRISS. ED and noncommunication scores were significantly higher in the Bup/Nal treatment group than the control group (p = 0.002, p = 0.02, respectively). Along with the increased ED scores in GRISS, IIEF-5 total scores also revealed more significant severity of the ED in the Bup/Nal group (p = 0.001). CONCLUSION: Buprenorphine/naloxone combination lead to a higher degree of ED severity than the non-treatment controls. Noncommunication seems to play a role as a risk factor for ED in patients with opioid use disorder. Thus, effective communication can be a key factor for sexual assertivity and disclosing the sexual adverse effects to the clinicians as well as staying in the treatment.

Urinary Incontinence during Sleep Associated with Extended Release Form of Bupropion HCI.

Bupropion hydrochloride (HCI) is an antidepressant that acts as a norepinephrine and dopamine reuptake inhibitor and has three different dosage forms including immediate release (IR), sustained release (SR), and extended release (ER). Despite its relatively safe side effect profile bupropion may cause several side effects. Here, we aimed to report a case with major depression using extended release form of bupropion hydrochloride who was presented with urinary incontinence during sleep, an uncommon side effect of bupropion.

Social phobia in Parkinson's disease: Prevalence and risk factors.

OBJECTIVE: We aimed to investigate the frequency of social phobia in patients with Parkinson's disease (PD). In addition, we explored the relationship between social phobia and the clinical characteristics of PD, and the frequency of comorbid psychiatric disorders in PD patients. METHODS: This study included 80 consecutive patients with PD admitted to the Parkinson's disease and Movement Disorders Clinic at the Erenkoy Research and Training Hospital for Neurologic and Psychiatric Disorders, Istanbul, Turkey and used demographic and clinical data. The PD patients were evaluated during the "on state", using the Hoehn and Yahr scale, the Unified Parkinson's Disease Rating Scale, and the Schwab England Activities of Daily Living Scale. Psychiatric evaluations were conducted using the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition structured clinical interview, the Liebowitz Social Anxiety Scale (LSAS), and the Hamilton Depression Rating Scale. RESULTS: Social phobia was diagnosed in 42.5% of PD patients. Social phobia was comorbid with depression in 20 patients (58.8%), generalized anxiety disorder in 18 patients (52.9%), and panic disorder in six patients (17.6%). Social phobia was more frequent in males, early-onset PD, patients with a long duration of disease, the presence of postural instability, and with the use of a high Levodopa equivalent daily dose. A logistic regression analysis revealed the predictive factors of social phobia to be the sex of the patient (more frequent in males) and the presence of postural instability. There was a statistically significantly negative correlation between the LSAS score and the age of disease onset (r=-0.503; P=0.002) and a positive correlation between LSAS score and the duration of disease (r=0.374; P=0.023). CONCLUSION: Social phobia is frequently observed in PD patients. Therefore, the assessment of PD patients should always include psychiatric evaluations, particularly for social phobia. The early detection and treatment of social phobia in PD patients is very important for the quality of life of patients as well as caregivers.

The Relationship of Childhood Abuse and Neglect with Suicide Attempts in an Adult Unipolar Depression Sample.

INTRODUCTION: Unipolar depression is an important psychiatric disorder that leads to an increased risk of suicide. However, not all depression patients attempt suicide. This reflects the presence of other factors that may be related to suicide other than the sole presence of psychopathology. Drawing upon the clinical evidence linking childhood abuse and neglect experiences with suicide; this study aimed at investigating the relationship of childhood abuse and neglect experiences with suicide attempts in patients with unipolar depression. METHOD: One hundred six unipolar depressed patients between the ages of 18 and 65 were included in the study. Patients with comorbid psychiatric disorders, neurological disorders, alcohol-substance abuse problems, and a Beck Depression Inventory (BDI) score of <17 were excluded from the study. The BDI, Childhood Trauma Questionnaire (CTQ-28), State-Trait Anger Expression Inventory (STAXI), and the Suicide Behavior Questionnaire (SBQ) were administered to all patients. Suicidal and non-suicidal cases were determined according to clinic interviews and the patients' responses in the SBQ. RESULTS: Sixty-four patients have previously attempted suicide. Although there was no significant difference between unipolar depression patients with a history of suicide attempts and patients with no history of suicide attempts in terms of average age, education and marital status, however, female/male ratio in the former group was determined to be significantly higher. BDI, STAXI continuous anger and outward anger average scores, and average CTQ-28 emotional abuse, physical abuse and total scores were significantly higher in the group with a history of suicide attempts. The predictors of suicide attempts were higher BDI and CTQ-28 physical abuse scores and female gender. The predictors for average SBQ scores were determined as higher BDI, CTQ-28 sexual abuse, and STAXI outward anger and continuous anger scores. CONCLUSION: Childhood physical and sexual abuse experiences are important factors in evaluating the presence of suicide attempts and risk of suicide in patients with unipolar depression. Careful questioning of traumatic childhood experiences during psychiatric examinations and monitoring of depression patients is crucial in determining treatment protocols and preventing suicide attempts.