Cognitive Functions in Obsessive Compulsive Disorder and Its Relationship with Oxidative Metabolism.

Introduction: While data on oxidative stress in psychiatric disorders are increasing, studies on obsessive-compulsive disorder (OCD) are limited. Although many studies report neurocognitive deficits in OCD, to our knowledge, no study exists examining the relationship between neurocognitive functions and oxidative stress in OCD. This study investigated the neurocognitive functions in OCD and its relationship with OCD severity and oxidative metabolism. Methods: In our study, 50 OCD patients and 50 healthy controls were included. The groups were well-matched for age, gender, education years, and other socio-demographic characteristics. Comorbid psychiatric diagnoses were excluded. To assess cognitive functions, a battery of neurocognitive tests was used. Oxidative metabolism parameters such as oxidants homocysteine, malondialdehyde, nitric oxide and antioxidants; sialic acid and glutathione peroxidase were measured. Obsessive-compulsive disorder severity was assessed with Yale-Brown-Obsession-Compulsion-Scale (YBOCS). Patients with OCD and control groups were compared in terms of neurocognitive functions, oxidative stress and OCD severity. Results: OCD group performed significantly worse in various aspects of attention, memory, executive functions (p<0.05). Homocysteine, nitric oxide, malondialdehyde, sialic acid levels were significantly (p<0.05) higher, glutathione peroxidase was significantly (p<0.05) lower in patients versus controls. Yale-Brown-Obsession-Compulsion-Scale scores correlated negatively with most of neurocognitive functions. The relationship between oxidative parameters and cognitive tests was contradictory as some results were opposite to what was expected. Conclusions: Cognition is affected by OCD and worsens with disorder severity. Considering oxidative parameters were meaningful in patients, oxidative metabolism may be a risk factor for OCD. However, more studies are needed to evaluate the effect of oxidative metabolism on cognitive functions.

The Effects of Transcranial Focused Ultrasound Stimulation of Nucleus Accumbens on Neuronal Gene Expression and Brain Tissue in High Alcohol-Preferring Rats.

We investigated the effect of low-intensity focused ultrasound (LIFU) on gene expression related to alcohol dependence and histological effects on brain tissue. We also aimed at determining the miRNA-mRNA relationship and their pathways in alcohol dependence-induced expression changes after focused ultrasound therapy. We designed a case-control study for 100 days of observation to investigate differences in gene expression in the short-term stimulation group (STS) and long-term stimulation group (LTS) compared with the control sham group (SG). The study was performed in our Experimental Research Laboratory. 24 male high alcohol-preferring rats 63 to 79 days old, weighing 270 to 300 g, were included in the experiment. LTS received 50-day LIFU and STS received 10-day LIFU and 40-day sham stimulation, while the SG received 50-day sham stimulation. In miRNA expression analysis, it was found that LIFU caused gene expression differences in NAc. Significant differences were found between the groups for gene expression. Compared to the SG, the expression of 454 genes in the NAc region was changed in the STS while the expression of 382 genes was changed in the LTS. In the LTS, the expression of 32 genes was changed in total compared to STS. Our data suggest that LIFU targeted on NAc may assist in the treatment of alcohol dependence, especially in the long term possibly through altering gene expression. Our immunohistochemical studies verified that LIFU does not cause any tissue damage. These findings may lead to new studies in investigating the efficacy of LIFU for the treatment of alcohol dependence and also for other psychiatric disorders.

COVID-19 infection, vaccine status, and avoidance behaviors in adults with attention deficit and hyperactivity disorder: A cross-sectional study.

Objective: We aim to examine infection risk and vaccine status of COVID-19 in attention deficit and hyperactivity disorder and evaluate the impact of demographic, clinical, and COVID-19-related factors on the infection status and behavioral avoidance of COVID-19. Methods: This cross-sectional study assessed adults with attention deficit and hyperactivity disorder recruited from an outpatient psychiatry clinic. Patients and healthy controls completed a survey on sociodemographic data, COVID-19 infection status, and vaccine status. COVID-19 Disease Perception Scale, COVID-19 Avoidance Attitudes Scale, Attitudes toward COVID-19 Vaccine Scale, Adult Attention Deficit and Hyperactivity Disorder Self-report Screening Scale for DSM-5, Adult Attention Deficit and Hyperactivity Disorder Self-Report Scale Symptoms Checklist, Patient Health Questionnaire-9, and State-Trait Anxiety Inventory were applied. Results: Ninety patients and 40 healthy controls participated. Patients did not differ from controls in COVID-19 infection and vaccine status, and behavioral avoidance of COVID-19. No demographic and clinical factor significantly affected the COVID-19 infection status. Patients scored higher than controls in the perception of COVID-19 as contagious (p = 0.038), cognitive avoidance of COVID-19 (p = 0.008), and positive attitudes toward the COVID-19 vaccine (p = 0.024). After adjustment of possible factors, a positive perception of the COVID-19 vaccine and a perception of COVID-19 as dangerous were the two factors significantly affecting behavioral avoidance of COVID-19 [R 2 = 0. 17, F(2) = 13.189, p < 0.0001]. Conclusion: Infection and vaccine status of COVID-19 in patients did not significantly differ from controls. No demographic and clinical factor significantly affected the COVID-19 infection status. Approximately four-fifths of the patients were fully vaccinated as recommended by national and global health organizations. This has increased the knowledge base showing that the COVID-19 vaccine is acceptable and receiving the vaccine is endorsed by ADHD patients. Attention deficit and hyperactivity disorder itself may provoke no kind of mental disturbance in sense of perception of the danger of this disease. Our findings have increased the knowledge base showing that the COVID-19 vaccine is acceptable and the actual practice of receiving the vaccine is endorsed in this population. Our message for practice would be to take into account not only the core symptoms and the comorbidities of the disorder but also the perception of the disease while exploring its link with COVID-19.

ADHD and Anxiety Disorder Comorbidity in Children and Adults: Diagnostic and Therapeutic Challenges.

PURPOSE OF THE REVIEW: In this review, we focus on overlapping features of ADHD and anxiety disorders, and will discuss how an anxiety disorder comorbidity leads to diagnostic and treatment challenges in patients with ADHD, in consideration of the accumulated available knowledge. RECENT FINDINGS: The presence of overlapping symptoms, changes in the diagnostic criteria, and the use of divergent diagnostic tools and informant effects can complicate the diagnosis of this comorbidity. Due to the ongoing debate about the etiology, psychopathology, and diagnostic features of the association between ADHD and anxiety disorders, choosing appropriate treatment options emerges as a challenge. A novel methodology, standardized interview tools, and new statistical analysis methods are needed to define the phenotype of this co-occurrence more clearly. It is important to uncover the developmental nature of this comorbidity with follow-up studies that may explain the etiology and underlying neurobiological basis, and ultimately lead to more effective treatment approaches.

Evaluation of the parents' anxiety levels before and after the diagnosis of their child with a rare genetic disease: the necessity of psychological support.

BACKGROUND: The diagnosis of the rare genetic diseases has great importance in treating multisystemic conditions, preventing potential complications, and estimating disease risk for family members. The duration of obtaining genetic test results is varies. The demand to learn the diagnosis of a possible untreatable illness involves a struggle between uncertainty and a lifetime chronic disease. The current uncertainty of their child's condition and the long wait for a diagnosis may increase the parents' anxiety level and cause difficulties in the continuation of diagnostic procedures in some families. This study aimed to investigate the prediagnosis and postdiagnosis anxiety levels of parents who have a child with a rare genetic disease. METHOD: The parents in this study, mothers or fathers, admitted their children to the Bezmialem Vakif University Medical Genetics Clinic due to a suspected rare genetic disease (n = 40). Researchers created "The Sociodemographic Questionnaire" and used it to analyze the parents' sociodemographic status. In addition, they used the State-Trait Anxiety Inventory (STAI) to determine the anxiety levels of the parents. RESULTS: The state anxiety levels of parents decreased significantly after learning the diagnosis. However, there was no statistically significant decrease observed in trait anxiety levels. CONCLUSION: Data from this study revealed that informing parents about their child's disease and properly explaining to them the expected difficulties might help to reduce their anxiety levels. Psychological support for parents is necessary to reduce their long-term stress, thus increasing the patient's compliance with treatment.

[The Validity and Reliability of the Trypophobia Questionnaire Turkish Form]. / ripofobi Anketi’nin Türkçe Formu’nun Geçerlik ve Güvenirlik Çalismasi.

OBJECTIVE: It was aimed in this study to translate the 19-item Trypophobia Questionnaire (TQ) to Turkish and determine its psychometric reliability and validity. METHOD: The study included 154 volunteers consisting of the students and employees of Bezmialem Vakif University, and their family members. The Sociodemographic Questionnaire prepared by the researchers, the Turkish version of the Structured Clinical Interview for axis-1 disorders (SCID-I) of the Diagnostic and Statistical Manual of Mental Disorders (DSM- IV-TR), the Turkish versions of the Disgust Sensitivity Scale-Revised Form (DS-R-TR) and the Hamilton Anxiety Rating Scale (HAM-A-TR) were used. RESULTS: Turkish Trypophobia Questionnaire (TQ-TR) discriminated between healthy and phobic individuals. Factor analysis on the TQ-TR resulted in a single factor structure as in the original study. The TQTR showed a high level of internal consistency with a Cronbach's α coefficient of 0.955. CONCLUSION: TQ-TR is a valid and reliable psychometric tool to assess trypophobia in the Turkish population.

Does psychotherapy improve alexithymia? A comparison study among patients with mild or moderate depression

Abstract Background Alexithymia is reported to be a risk factor for depression. Psychotherapy is efficient for treatment of depression. Yet, the effect of psychotherapies on alexithymia is poorly understood. Objectives We aimed to compare Cognitive Behavioral Therapy (CBT), Existential Psychotherapy (ExP) and Supportive Counseling (SUP) for therapeutic efficacy and effect on alexithymia in depression. Methods There were 22 patients for each patient group. Sessions were performed as eight consecutive weekly and following two monthly boosters. Sixty six healthy controls were added. Prior to the sessions, patients received Sociodemographic Data Form, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1), Hamilton Depression Rating Scale (HDRS) and 20-item Toronto Alexithymia Scale (TAS-20). The control group received Sociodemographic Data Form, SCID-1 and TAS-20. Patients additionally received HDRS and TAS-20 after their weekly and booster sessions. Results Patients' mean TAS-20 score was greater than of controls, however, it did not have a significant change throughout the study. Mean HDRS scores of ExP and CBT groups were lower than SUP group at the end. Discussion Alexithymia did not improve with psychotherapy. The exception was effect of ExP on externally oriented thinking. Psychotherapies all improved depression. CBT and ExP were more helpful than SUP.

Effects of Cognitive Behavioral Therapy, Existential Psychotherapy and Supportive Counselling on Facial Emotion Recognition Among Patients with Mild or Moderate Depression.

OBJECTIVE: This study compared the effects of cognitive behavioral therapy (CBT), existential psychotherapy (ExP) and supportive counseling (SUP) on facial emotion recognition among mildly and moderately depressed patients. METHODS: 21 patients for CBT, and 20 each for ExP and SUP groups with 60 healthy controls were investigated. Eight consecutive weekly sessions and following two monthly boosters were performed. Prior to the sessions, all subjects received Sociodemographic Data Form, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-1), and Facial Emotion Recognition Test (FERT). Patients received Hamilton Depression Rating Scale (HDRS) and FERT at the onset and after weekly and booster sessions. RESULTS: Patients' ability to recognize surprised and neutral emotions were lower than controls. ExP group improved recognition of almost all emotions, CBT group improved only happy emotions and SUP group did not improve any emotions. HDRS scores declined in all patient groups, ExP and CBT groups had lower scores than SUP. CONCLUSION: MDD patients recognized surprised and neutral emotions lower than controls. ExP improved ability to recognize almost all emotions, CBT improved only happy emotions, SUP did not improve at all. ExP, CBT and SUP all led to a reduction in MDD. ExP and CBT had comparable effects and both were more helpful than SUP.

Temperament and character differences of patients with polycystic ovary syndrome.

AIM: There is an unclear relationship between Polycystic Ovary Syndrome and psychiatric disorders including anxiety and depression. We aimed to evaluate temperamental and personal characteristics of patients with PCOS. METHODS: Fifty patients with PCOS and 41 healthy controls were included in the study. Hormonal and demographic characteristics were recorded after gynecologic and psychiatric evaluation. Socio-demographical Data Form, Beck Depression Inventory, Beck Anxiety Inventory and the Cloninger's Temperament and Character Inventory were performed for all participants. RESULTS: Patients with Policystic Ovary Syndrome had significantly higher depression and anxiety scores when compared to the controls (p < 0.05). There were no significant difference in any of the subdimensions neither for temperament nor for character between patient and control groups (p > 0.05). Testosteron levels and the degree of hirsutism, LH/FSH ratio and body mass index of the patients did not have significant correlations with depression or anxiety scores or any of the Cloninger subdimentions (p > 0.05). However, there was a negative correlation between age and novelty seeking and age and reward dependence (r:-0.33, p:0.018; r:-0.295, p:0.037, respectively). CONCLUSIONS: This preliminary study showed no significant difference between patients and healthy controls regarding temperament and character. Patients had higher anxiety and depression scores. Further research is needed to enlighten this subject.

Mean platelet volume and neutrophil to lymphocyte ratio decrease in patients with depression with antidepressant treatment

Abstract Objective Not only white blood cells but also platelets are being considered in inflammatory reactions from now on. Mean platelet volume (MPV) and neutrophil to lymphocyte ratio (NLR) have been shown to change in inflammatory diseases like myocardial infarction, stroke and implicated in psychiatric disorders nowadays. Our first aim is to investigate the relation of MPV and NLR with depression and secondly to assess if they change with the treatment of depression. Methods Forty-nine patients diagnosed with major depressive disorder (MDD) and hospitalized in a university hospital psychiatry inpatient unit retrospectively included in the study. Control group consisted of 48 hospital workers with no known disease. Complete blood count, Hamilton Depression Rating Scale (HAM-D) and Clinical Global Impression-Severity Scale (CGI-S) scores at admission and at discharge were noted and compared for the patient group. Discussion MPV of depressed patients was higher than controls. When we look at admission and discharge scores of clinical scales, decrement is statistically significant for both HAM-D and CGI-S. There was decline both in MPV and NLR which were both statistically significant. Conclusion Decreasing MPV and NLR values with the treatment of depression confirm the involvement of inflammatory processes in the pathophysiology of depression.

Psychological Evaluation of Patients Seeking Rhinoplasty.

OBJECTIVE: The aim of this study was to evaluate different determinants of the patient's psychosocial functioning that might possibly affect the outcome of rhinoplastic surgery. MATERIALS AND METHODS: Forty-one patients undergoing rhinoplasty, consecutively admitted to and operated upon at the Department of Otolaryngology, Erzurum Regional Training and Research Hospital, Turkey, were studied with regard to their psychological characteristics. RESULTS: In the patient group, Liebowitz anxiety, Liebowitz/avoidance, and Liebowitz/total scores were significantly higher than the control group (p<0.001). No significant differences were found between the patient and control groups according to Rosenberg self-esteem scale and The Hospital Anxiety and Depression Scale. In the Quality of Life SF-36 results, significant differences were found between the patient and control groups apart from SF-36 scores of pain (p<0.05), vitality (p<0.05), social functioning (p<0.05) and emotional role difficulties (p<0.05). CONCLUSION: Patient selection must be done very carefully to obviate not only physical, but also psychological postoperative complications. The SF-36 questionnaire may be of value in screening-patients for psychological problems prior to rhinoplasty.

Investigation of facial emotion recognition, alexithymia, and levels of anxiety and depression in patients with somatic symptoms and related disorders.

BACKGROUND: The concept of facial emotion recognition is well established in various neuropsychiatric disorders. Although emotional disturbances are strongly associated with somatoform disorders, there are a restricted number of studies that have investigated facial emotion recognition in somatoform disorders. Furthermore, there have been no studies that have regarded this issue using the new diagnostic criteria for somatoform disorders as somatic symptoms and related disorders (SSD). In this study, we aimed to compare the factors of facial emotion recognition between patients with SSD and age- and sex-matched healthy controls (HC) and to retest and investigate the factors of facial emotion recognition using the new criteria for SSD. PATIENTS AND METHODS: After applying the inclusion and exclusion criteria, 54 patients who were diagnosed with SSD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria and 46 age- and sex-matched HC were selected to participate in the present study. Facial emotion recognition, alexithymia, and the status of anxiety and depression were compared between the groups. RESULTS: Patients with SSD had significantly decreased scores of facial emotion for fear faces, disgust faces, and neutral faces compared with age- and sex-matched HC (t=-2.88, P=0.005; t=-2.86, P=0.005; and t=-2.56, P=0.009, respectively). After eliminating the effects of alexithymia and depressive and anxious states, the groups were found to be similar in terms of their responses to facial emotion and mean reaction time to facial emotions. DISCUSSION: Although there have been limited numbers of studies that have examined the recognition of facial emotion in patients with somatoform disorders, our study is the first to investigate facial recognition in patients with SSD diagnosed according to the DSM-5 criteria. Recognition of facial emotion was found to be disturbed in patients with SSD. However, our findings suggest that disturbances in facial recognition were significantly associated with alexithymia and the status of depression and anxiety, which is consistent with the previous studies. Further studies are needed to highlight the associations between facial emotion recognition and SSD.

Age of onset in social anxiety disorder: Relation to clinical variables and major depression comorbidity.

BACKGROUND: The aim of this study was to determine the rates of early- and late-onset social anxiety disorder (SAD) and to investigate the effects of onset time on clinical characteristics and the course of SAD. METHODS: A total of 377 patients with SAD were assessed using a sociodemographic data form, the Liebowitz Social Anxiety Scale (LSAS), Beck Depression Inventory (BDI), and the Global Assessment of Functioning (GAF). Three hundred patients with SAD onset before age 18 were classified as members of the early-onset group, whereas 77 patients with SAD onset at age ≥ 18 comprised the late-onset group. The 2 groups were compared in terms of sociodemographic and clinical characteristics, comorbidity, and scale scores. RESULTS: The rate of SAD onset before age 18 was 79.6%. Compared with the late-onset group, the early-onset group had a younger age at first depressive episode, higher rate of atypical depression, higher LSAS and BDI scores, and lower GAF scores. CONCLUSIONS: In cases of early onset of SAD, symptom severity of both SAD and comorbid depression increased and functionality decreased. It is important to assess and treat SAD patients at a younger age because early-onset SAD may be associated with a more severe course and higher rate of major depression comorbidity.

Relationship between atypical depression and social anxiety disorder.

In this study, we aimed to investigate the effects of atypical and non-atypical depression comorbidity on the clinical characteristics and course of social anxiety disorder (SAD). A total of 247 patients with SAD were enrolled: 145 patients with a current depressive episode (unipolar or bipolar) with atypical features, 43 patients with a current depressive episode with non-atypical features and 25 patients without a lifetime history of depressive episodes were compared regarding sociodemographic and clinical features, comorbidity rates, and severity of SAD, depression and functional impairment. Thirty four patients with a past but not current history of major depressive episodes were excluded from the comparisons. 77.1% of current depressive episodes were associated with atypical features. Age at onset of SAD and age at initial major depressive episode were lower in the group with atypical depression than in the group with non-atypical depression. History of suicide attempts and bipolar disorder comorbidity was more common in the atypical depression group as well. Atypical depression group has higher SAD and depression severity and lower functionality than group with non-atypical depression. Our results indicate that the presence of atypical depression is associated with more severe symptoms and more impairment in functioning in patients with SAD.

Relationship of asymmetrical dimethylarginine, nitric oxide, and sustained attention during attack in patients with major depressive disorder.

We investigated the relationship of serum nitric oxide (NO) and asymmetrical dimethylarginine (ADMA) levels with cognitive functioning in patients with major depressive disorder (MDD). 41 MDD patients (Beck depression scale scores>16) and 44 controls were included in the study. Rey verbal learning and memory test, auditory consonant trigram test, digit span test, Wisconsin card sorting test, continuous performance task (TOVA), and Stroop test scores were found to be impaired in patients with major depressive disorder when compared to healthy controls. There was no significant difference between patient and control groups in terms of serum NO and ADMA. Serum NO levels were correlated with TOVA test error scores and Stroop test time scores, whereas serum ADMA levels were negatively correlated with TOVA test error scores. Metabolic detriments especially in relation to NO metabolism in frontal cortex and hypothalamus, psychomotor retardation, or loss of motivation may explain these deficits.

Development of a Psychometric Instrument Based on the Inference-Based Approach to Obsessive-Compulsive Disorder: The Obsessional Probabilistic Inference Scale.

INTRODUCTION: The current article addresses the validation of the construct of obsessional probabilistic inference in clinical and non-clinical samples. Obsessional probabilistic inference or obsessional doubt refers to a type of inferential process resulting in the belief that a state of affairs "maybe" causes development of a maladaptive cognitive coping style in terms of obsessing. METHODS: The latent structure of the Obsessional Probabilistic Inference Scale (OPIS) was evaluated with confirmatory factor analysis. RESULTS: Explanatory and confirmatory factor analyses indicated that a one-factor solution was satisfactory for the instrument, assessing a unidimensional psychological construct. The OPIS was shown to have high internal consistency in all samples, as well as temporal stability, relying on predominantly non-clinical individuals. The scale exhibited high convergent validity and successfully discriminated patients with obsessive-compulsive disorder from both depressive patients and controls. CONCLUSION: The findings replicated and extended the role of reasoning process in the development and maintenance of obsessive compulsive symptoms. The results are discussed in regard to assumptions of the inference-based approach to obsessive-compulsive disorder.

Neurocognitive functioning in a group of offspring genetically at high-risk for schizophrenia in Eastern Turkey.

We assessed major cognitive domains in symptom-free children of patients with schizophrenia compared to the healthy children of parents with no psychopathology using neurocognitive tests. We hypothesized that, offspring at high-risk for schizophrenia would have significant impairment in major domains: attention, memory, verbal-linguistic ability and executive functions. Thirty symptom-free children (17-males, 13-females; intelligence quotient=99.6+/-13.6; age=12.69+/-2.32 and education=5.8+/-2.3 years) having a parent diagnosed with schizophrenia and 37 healthy children matched for gender (19-males, 18-females), IQ (106.05+/-14.70), age (12.48+/-2.58) and years of education (6.0+/-2.5) were evaluated. The study group showed significant poor performance in cognitive domains, such as working memory (assessed with Auditory consonant trigram test), focused attention (Stroop test), attention speed (Trail making test), divided attention (Auditory consonant trigram test), executive functions (Wisconsin card sorting test), verbal fluency (Controlled word association test) and declarative memory (Rey verbal learning and Short-term memory test). However, no group differences were detected either on verbal attention (Digit span forward test) or sustained attention (TOVA, a continuous performance task); the latter as consistently reported to be a predictor of schizophrenia. In order to determine the cognitive endophenotype of schizophrenia, it seems more rational to conduct comprehensive evaluation of neurocognitive domains in well-matched groups via using sufficiently challenging tests to detect slight deficits. In addition, longitudinal studies with a larger sample size evaluating neurocognitive functions combined with genetic analysis may provide clues about explaining the genetic background of the disorder within the endophenocognitype concept and serve as new targets for early interventions.

Male genital self-mutilation as a psychotic solution.

BACKGROUND: Male genital self-mutilation (GSM) is a rare, but serious phenomenon. Some of the risk factors for this act are: presence of religious delusions, command hallucinations, low self-esteem and feelings of guilt associated with sexual offences. Other risk factors include failures in the male role, problems in the early developmental period, such as experiencing difficulties in male identification and persistence of incestuous desires, depression and having a history of GSM. The eponym Klingsor Syndrome, which involves the presence of religious delusions, is proposed for GSM. DATA SECTION: Four male GSM cases are presented: Case 1 and Case 2 were diagnosed with schizophrenia, Case 3 with schizophrenia and depressive disorder, not otherwise specified, and Case 4 with bipolar depression with psychotic features. DISCUSSION: All definite and probable motives and cultural aspects for their GSM are discussed. Atonement is proposed as a new concept in formulating religiously themed psychotic male GSM.