Short and Long-term Effects of Cognitive Behavioral Therapy on Sleep Problems and Psychotic Symptoms in Patients with Psychotic Disorders: A Meta-Analysis Study.

OBJECTIVE: Sleep problems are common in patients with psychotic disorders, especially schizophrenia. Although pharmacological methods are at the forefront of treatment, this method has some drawbacks. Cognitive behavioral therapy for insomnia (CBT-I) is an option for the treatment of individuals with insomnia. In recent years, there has been an increasing interest in its use in patients with psychotic disorders. This meta-analysis aims to evaluate the effectiveness of CBT-I on sleep problems in patients with psychotic disorders. METHODS: A systematic search was conducted using PubMed, Scopus, and EBSCO (MEDLINE) databases to identify relevant studies. The study included RCTs and uncontrolled studies that focused on participants diagnosed with schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorders not otherwise specified, bipolar disorders, or unipolar depression with psychotic features, who had sleep problems for at least one month, and who were receiving treatment. The initial search yielded 246 studies, and eight studies were selected for the meta-analysis after screening and applying inclusion and exclusion criteria.The statistical analysis was conducted using the R software. RESULTS: CBT-I significantly ameliorates insomnia and sleep quality in patients with psychotic disorders during short and long-term periods. In addition to this, CBT-I leads to a significant improvement in psychotic symptoms in the short-term period and contributes significantly to the improvement in mental well-being in both short and long-term periods. CONCLUSIONS: CBT-I is an effective and valuable method for sleep problems in patients with psychotic disorders and its use is recommended to be widespread.

Is Every Thyroid Antibody a Bad Sign?: The Complex Relationship of Antithyroid Antibodies and Obsessive-compulsive Symptoms.

Objective: : Several immunological factors are emphasized in the etiology of autoimmune thyroid diseases and obsessivecompulsive disorder. Obsessive-compulsive symptoms (OCS) are commonly seen in patients with autoimmune thyroid diseases. This study aims to evaluate the relationship between OCS and antithyroid antibodies. Methods: : The study included 145 patients with Hashimoto thyroiditis or Graves' disease and 42 healthy controls. Thyroid function tests and serum thyroid autobody levels (anti-thyroglobulin [TG], anti-thyroid peroxidase [TPO], and anti-thyroid stimulating hormone [TSH]) of the patients were measured. The socio-demographic data and OCS of the participants were evaluated with Dimensional OCS (DOCS). Results: : DOCS scores were higher in patients than in the control group. There was not found a significant relationship between free T3, free T4, and TSH levels and DOCS scores. Anti-TG positivity in females was associated with lower DOCS scores. Anti-TPO positivity in males had a positive correlation with DOCS scores. There was no correlation between sex and the presence of anti-TSH in terms of OCS severity. Univariate analysis found the highest OCS scores in anti-TPO positive, anti-TG, and anti-TSH negative patients. The group with the lowest OCS scores was found to be anti-TG positive, anti-TPO, and anti-TSH negative patients. Conclusion: : OCS severity could be affected by different thyroid autoantibody profiles in patients with autoimmune thyroid diseases. While anti-TG serves a protective role against OCS in females, the presence of anti-TPO may worsen the OCS in men. Additionally, the co-existence of different antithyroid antibodies may affect the severity of OCS differently according to sex.

The effects of psychological flexibility and resilience on psychopharmacological treatment response in patients with obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a challenging psychiatric condition to treat. Previous research has explored various aspects of treatment response, but limited attention has been given to the significance of psychological flexibility and resilience. This study aimed to investigate the correlation between psychological flexibility, resilience, and different dimensions of OCD, as well as their role in treatment response specifically concerning OCD symptom sub-dimensions. The study involved 50 OCD patients and 42 healthy individuals as controls. Participants completed the Dimensional Obsessive-Compulsive Scale (DOCS), Acceptance and Action Questionnaire (AAQ-2), and Resilience Scale for Adults (RS). Initial scale scores were compared to post-treatment scores obtained after a 3-month follow-up using pharmacotherapy. The patient group exhibited significantly higher AAQ-2 scores and lower RS scores compared to the control group. During the post-treatment follow-up, a reduction in DOCS and AAQ-2 scores was observed, along with an increase in RS scores. The impact of differences in AAQ-2 and RS scores on the change in DOCS total scores was analyzed using mixed model linear regression analysis. The results showed a statistically significant effect of changes in AAQ-2 and RS sub-dimension scores on the change in DOCS total scores. The findings highlight the importance of flexibility and resilience in influencing treatment response among patients with OCD. When conventional pharmacotherapy and psychotherapy approaches prove insufficient, interventions focused on enhancing flexibility and resilience may contribute to improved treatment outcomes.

Childhood Trauma as an Environmental Determinant of Risk of Violence in Bipolar Disorder.

Introduction: The complex interaction of violent behavior, childhood trauma and bipolar disorder (BD) is unclear. Therefore, we aimed to investigate the risk factors of violence in BD and studied the relationship between different types of childhood trauma and violence. Methods: We assessed 105 remitted patients diagnosed with BD I (n=91) or BD II (n=14). All patients were evaluated with the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Childhood Trauma Questionnaire (CTQ), Buss-Perry Aggression Questionnaire (BPAQ) and Violence Tendency Scale (VTS). Uni- and Multivariable Linear Regression Analyses were conducted to predict violent behavior. Results: All patients scored high points on CTQ and violence scales. In the univariate regression analysis, CTQ total and subscale scores (except physical neglect), age and presence of lifetime suicide attempts were correlated with both VTS and BPAQ. Emotional and sexual abuse subtypes had a significant correlation with violence. In the multivariate analysis, only CTQ total score and age were significantly correlated with violence. There was a negative relationship between age and violence. Conclusion: All types of childhood traumas seem to be correlated with violent behavior in patients with BD. Childhood trauma and younger age are significant determinants of violence in BD. The VTS, which emerged in Turkey, may assist clinicians to detect potentially aggressive behavior before it becomes obvious.

The effect of early or late initiation of long-acting antipsychotics on the caregiver burden in schizophrenia.

The effective treatment in the early stages of schizophrenia is of critical importance to improve the prognosis. Schizophrenia affects patients' relatives too. The effects of early or late initiation of long-acting injectable antipsychotics (LAI-APs) on the patient have been shown, yet their effects on the caregiver are still unknown. We aimed to determine how the time of initiation of LAI-APs affects the caregiver burden by comparing the patients who were started on LAI-APs in the first 5 years of diagnosis and those who were started at a later period. Patients were classified as 'early-LAI' and 'late-LAI' according to the time of initiation of a LAI-AP. Their caregivers were also classified as the same way, as 'caregiver-early' and 'caregiver-late' and were compared in terms of caregiver burden. The quality of life, depression, anxiety, and caregiver burden scores of the caregiver-late group were significantly worse. The time of initiation of LAI-APs and the functioning levels of the patients were found to be determinant factors for the caregiver burden. This is the first study to investigate the effects of LAI-AP's initiation time on the caregivers to our knowledge. The use of LAI-APs in the early stages is associated with better outcomes for the caregiver.

Is co-occurrence of adult adhd with bipolar disorder a risk factor for violent behavior?

Research has shown that individuals with psychiatric disorders such as bipolar disorder (BD) and attention deficit and hyperactivity disorder (ADHD) have a higher likelihood of violent behavior. This study investigated the frequency of comorbid BD and ADHD in adultpatients and the relationship between this comorbidity and violent behavior. We assessed 105 remitted patients diagnosed with BD I (n = 91) or BD II (n = 14). The patients were administered the Sociodemographic Data Scale, the Wender-Utah Rating Scale (WURS), the Adult ADHD Self-Report Scale (ASRS), the Buss-Perry Aggression Questionnaire (BPAQ), and theViolence Tendency Scale (VTS) as self-reports. The same clinician administered the Diagnostic Interview for ADHD in adults (DIVA 2.0) to patients who scored≥36 on the WURS. Comorbid ADHD was diagnosed in 15.2% of patients according to the DIVA 2.0. In the multiple linear regression analysis, there was a statistically significant positive effect of the ASRS total score on the VTS and the BPAQ total score. Furthermore, it was found that male gender had a statistically significant positive effect on VTS total score and young age had a statistically significant positive effect on BPQA total score. These findings demonstrate an association between BD, comorbid ADHD, and violent behavior.

Internalized Stigma and Resistance Against Stigma as Risk Factors for Suicide in Individuals with Schizophrenia: A Cross-Sectional Study.

Introduction: Identifying the relationship between internalized stigma and suicide is critical in dealing with schizophrenia. We aimed to examine how internalized stigma and its subcomponents affect suicidality in patients with schizophrenia. The second aim of this study was to identify the risk factors for internalized stigma in schizophrenia. Methods: We assessed 114 patients diagnosed with schizophrenia. Structured Clinical Interview for the DSM-5 (SCID-5), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS), Internalized Stigma of Mental Illness (ISMI), and Suicide Probability Scale (SPS) were applied to the sample. Multivariable linear regression analysis was conducted to determine the risk factors of internalized stigma. Results: Statistically significant correlation between stigma resistance and all SPS scores was found. The correlation between stigma resistance and suicidal thought was independent of the CDS and PANSS scores of the sample. Stigma resistance and depressive situation were the predictive factors for SPS. Only depressive state of the group predicted the level of internalized stigma in the regression analysis. Conclusions: Stigma resistance is an important risk factor for suicide in schizophrenia. Clinicians should focus on interventions to increase resistance against stigma and to determine the depressive situation of patients with schizophrenia.

Satisfaction of Patients and Their Relatives Who Are Reminded of Their Appointments and Treatments with "Treatment Collaboration Portal".

Background: Community Mental Health Centers have been established in Turkey for patients with chronic psychiatric disorders actively engaged in treatment. The Treatment Collaboration Portal is a web-based voice response platform offered to Community Mental Health Centres to support the treatment compliance processes of patients. The Treatment Collaboration Portal automatically reminds patients or their families of injection treatments and psychiatry appointments at regular intervals. The purpose of this study is to determine the satisfaction of patients or their relatives enrolled in the Treatment Collaboration Portal and the reasons why. Methods: A semi-structured 1-item 6-point satisfaction questionnaire, which we prepared for the Treatment Collaboration Portal reminder calls, was administered to the volunteer participants who registered to the Treatment Collaboration Portal and Community Mental Health Centre. Satisfaction levels were determined first with the questionnaire, and then the reasons for satisfaction were investigated for each patient and their relatives. Results: The questionnaire was given to 132 participants. About 121 participants were satisfied and 11 of them were dissatisfied. When the reasons for those who were satisfied with the application reminders were examined, it was seen that the most frequent one was "prevention of forgetfulness" (53.7%). A significant difference was found between the Treatment Collaboration Portal registration reasons and satisfaction status. Also, there was a difference between the people who patients live with and the "satisfied" and "unsatisfied" groups (P = .023). Conclusion: All the reasons given by the group satisfied with Treatment Collaboration Portal use contribute to patients remaining in remission. Therefore, in clinical practice, it is very important to recognize these reasons.

Could the Thyroid Gland Dominate the Brain in Obsessive-Compulsive Disorder?

Thyroid hormones have an essential role in brain maturation and neuronal functioning. The comorbidity of thyroid disorders and several mental disturbances is frequently reported. We aimed to evaluate the literature on the potential relationship between thyroid disorders and obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS). We searched the literature using PUBMED, ProQuest, Google Scholar, and PsycInfo electronic databases for original studies (cross-sectional, case series, case report) on the association between thyroid dysfunctions and OCD and OCS between 1977 and 2021. Eleven studies met the inclusion criteria. Despite some methodological limitations, the OCD rates in patients with autoimmune thyroid disorders were found to be higher than the normal population in two studies. The findings on thyroid dysfunction in OCD patients were inconclusive. In the light of available data, it could be proposed that there might be a possible association between thyroid disorders and OCD. Some shared immunological mechanisms could play a role in the pathophysiology of both thyroid diseases and OCD. New research is needed to confirm this association and elucidate the underlying common mechanisms between these disorders.

Prospective analysis of serum prolactin levels, clinical symptomatology and sexual functions in patients with schizophrenia switched to paliperidone palmitate 3-monthly from paliperidone palmitate 1-monthly: Preliminary findings of the first 3 months.

OBJECTIVE: Long-acting injectable (LAI) antipsychotics were developed to improve adherence to schizophrenia treatment. Paliperidone palmitate (PP) has two LAI forms: Monthly (PP1M) and three-monthly (PP3M). PP3M shows less difference in Peak-to-Trough drug concentration levels. This could be related to a lower incidence of hyperprolactinemia, which may negatively affect adherence. We aimed to compare prolactin levels and investigate relationships between prolactin levels, symptomatology and sexual function in patients with schizophrenia after switching from PP1M to PP3M. METHODS: Twenty-five patients were enrolled. The sociodemographic data form, the Positive and Negative Syndromes Scale (PANSS) and the Arizona Sexual Experience Scale (ASEX) were used. Morning blood samples were drawn to determine prolactin levels. RESULTS: Prolactin level (p < 0.001), the total score and arousal sub-score of ASEX (respectively; p = 0.015, p = 0.020) and the total score and positive scale of PANSS (respectively; p = 0.017, p = 0.021) were decreased on the 90th day (±15 days). CONCLUSIONS: After switching to PP3M, the decreases in prolactin levels and potentially related sexual side effects was statistically significant. There may be a difference between two formulations of the same drug in terms of side effects, and there is a need for prospective follow-up studies with larger samples.

A comprehensive study of oxidative stress in patients with somatic symptom disorder.

OBJECTIVE: To investigate oxidative stress parameters [total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), paraoxonase (PON), arylesterase (ARE) and thiol-disulphide homeostasis] in patients who were diagnosed as having somatic symptom disorder in accordance with Diagnostic and Statistical Manual of Mental Disorders-5. METHODS: The study included 41 medication-free patients with somatic symptom disorder and 47 age, sex, and sociodemographic-matched healthy individuals. The patients were administered the Patient Health Questionnaire-15, Somatic Symptom Amplification Scale, Beck Depression Inventory, and Beck Anxiety Inventory. TOS, TAS, OSI, PON, ARE thiol, disulphide levels, and routine biochemical parameters were compared between the two groups. RESULTS: TOS, OSI, disulphide levels, disulphide/native thiol, and disulphide/total thiol ratios were found significantly higher in the patient group compared with the control group (p < 0.001). There was no significant difference in PON, ARE, and TAS parameters between the two groups (p > 0.05). CONCLUSION: This study showed that the level of oxidants increased and oxidative balance was impaired in somatic symptom disorder. Oxidative stress may play a role in the aetiopathogenesis of this disorder. This is the first study to report an association between oxidative stress and somatic symptom disorder.

Neurochemical differences between bipolar disorder type I and II in superior temporal cortices: A proton magnetic resonance spectroscopy study.

BACKGROUND: Despite the diagnostic challenges in categorizing bipolar disorder subtypes, bipolar I and II disorders (BD-I and BD-II respectively) are valid indices for researchers. Subtle neurobiological differences may underlie clinical differences between mood disorder subtypes. The aims of this study were to investigate neurochemical differences between bipolar disorder subtypes. METHODS: Euthymic BD-II patients (n = 21) are compared with BD-I (n = 28) and healthy comparison subjects (HCs, n = 30). Magnetic Resonance Imaging (MRI) and proton spectroscopy (1H MRS) were performed on a 3T Siemens Tim Trio system. MRS voxels were located in the left/right superior temporal cortices, and spectra acquired with the single voxel Point REsolved Spectroscopy Sequence (PRESS). The spectroscopic data were analyzed with LCModel (Version 6.3.0) software. RESULTS: There were significant differences between groups in terms of glutamate [F = 6.27, p = 0.003], glutamate + glutamine [F = 6.08, p = 0.004], inositol containing compounds (Ino) (F = 9.25, p < 0.001), NAA [F = 7.63, p = 0.001] and creatine + phosphocreatine [F = 11.06, p < 0.001] in the left hemisphere and Ino [F = 5.65, p = 0.005] in the right hemisphere. Post-hoc comparisons showed that the BD-I disorder group had significantly lower metabolite levels in comparison to the BD-II and the HC groups. LIMITATIONS: This was a cross-sectional study with a small sample size. In addition, patients were on various psychotropic medications, which may have impacted the results. CONCLUSIONS: Neurochemical levels, in the superior temporal cortices, measured with 1H-MRS discriminated between BD-II and BD-I. Although further studies are needed, one may speculate that the superior temporal cortices (particularly left hemispheric) play a critical role, whose pathology may be related to subtyping bipolar disorder.

Hypersexuality associated with paliperidone.

We report a case of unusual sexual symptoms in a 43-year-old female patient with schizophrenia (according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition), who was being treated with a depot formulation of paliperidone palmitate, an atypical antipsychotic medication. The symptoms included increased sexual desire, sexual preoccupation, constant drive for intercourse, and sexual arousal with unrelated stimuli such as urination. Potential neurochemical mechanisms have been elucidated for this symptomatology. Paliperidone palmitate has broad neuropharmacological effects, which might have contributed to the development of this rare clinical condition. (PsycINFO Database Record

Effect of familial Mediterranean fever on sexual and reproductive health in women.

BACKGROUND/AIM: The aim of this study was to investigate the relationship between familial Mediterranean fever and female sexual dysfunction and premenstrual syndrome. MATERIALS AND METHODS: This study included 36 patients with familial Mediterranean fever and 33 healthy volunteers. Familial Mediterranean fever was diagnosed according to the Tel Hashomer criteria and familial Mediterranean fever mutations were identified in all of the patients. The patients and healthy volunteers were compared in terms of anxiety, depression, sexual dysfunction, and premenstrual syndrome, and a model was created that describes the relationships among these variables. RESULTS: We found statistically significant differences between the groups in terms of anxiety, premenstrual syndrome, and Golombok Rust Inventory of Sexual Satisfaction frequency and vaginismus subscale scores. There was no difference in depression scores between the groups. CONCLUSION: Familial Mediterranean fever is a rheumatic disease that predisposes patients to sexual dysfunction and premenstrual syndrome, which emerges as direct and indirect psychological factors.

Perisylvian GABA levels in schizophrenia and bipolar disorder.

The aim of this study is to measure GABA levels of perisylvian cortices in schizophrenia and bipolar disorder patients, using proton magnetic resonance spectroscopy (1H-MRS). Patients with schizophrenia (n=25), bipolar I disorder (BD-I; n=28) and bipolar II disorder (BD-II; n=20) were compared with healthy controls (n=30). 1H-MRS data was acquired using a Siemens 3T whole body scanner to quantify right and left perisylvian structures' (including superior temporal lobes) GABA levels. Right perisylvian GABA values differed significantly between groups [χ2=9.62, df: 3, p=0.022]. GABA levels were significantly higher in the schizophrenia group compared with the healthy control group (p=0.002). Furthermore, Chlorpromazine equivalent doses of antipsychotics correlated with right hemisphere GABA levels (r2=0.68, p=0.006, n=33). GABA levels are elevated in the right hemisphere in patients with schizophrenia in comparison to bipolar disorder and healthy controls. The balance between excitatory and inhibitory controls over the cortical circuits may have direct relationship with GABAergic functions in auditory cortices. In addition, GABA levels may be altered by brain regions of interest, psychotropic medications, and clinical stage in schizophrenia and bipolar disorder.

Explanatory Models of Illness, Help Seeking Behaviours and Related Factors in Patients with Schizophrenia: A Comparative Study from Two Different Provinces of Turkey.

This study aims to identify the help seeking behaviours of patients from two geographically distinct provinces of Turkey. A questionnaire about sociodemographic characteristics and help seeking ways was applied to 49 schizophrenia patients from Van, 99 from Ankara. The ratio of patients seeking psychiatric help at the beginning of their illness was 76% in Ankara, the capital city, in contrast to 54% in Van (p = 0.01). Twenty-two percent of patients from Ankara and 69% from Van reported that non-psychiatric help seeking was the choice of their families (p < 0.001). Thirty-five percent of all patients sought religious support when their symptoms started. Patients with lower education levels sought more religious help (p = 0.002). Help seeking behaviours show regional variations. Religious help seeking behaviour is a major way of dealing with the illness. Psychoeducation is a crucial need both for patients and families.