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.

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.

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.

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

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.

The factors contributing to death anxiety in cancer patients.

Suffering comes in many ways for patients confronting cancer. One of these is an unspecifiable fear about death, which is an existential issue. The aim of this study was to investigate the relationship between death anxiety and its correlates in cancer patients. Seventy cancer patients were assessed using SCID-I, Templer's Death Anxiety Scale, the Hospital Anxiety (A) and Depression (D) Scale, the Distress Thermometer, the Visual Analogue Scale for pain (VAS), the Global Assessment of Functioning, and Glock and Stark's Dimensions of Religious Commitment scales, and these assessments were compared between cancer patients with and without death anxiety. Multiple regression analysis was conducted after correlation analysis between death anxiety and sociodemographic and clinical variables. Axis I psychiatric diagnosis, pain scores, and negative believes about what will happen after death were found to be higher in patients having death anxiety than patients not having death anxiety. Also life expectancy was perceived as shortened in patients with death anxiety. Death anxiety was associated with anxiety, depressive symptoms, and beliefs about what will happen after death. In conclusion, death anxiety could not be regarded as a natural consequence of having cancer; it is associated with the unresolved psychological and physical distress.

Perceptions of Turkish psychiatric inpatients about therapeutic factors of group psychotherapy.

Many studies on therapeutic factors in group psychotherapy were done during the 1970s and 1980s, primarily with Western samples, The present study was carried out in a psychiatric inpatient clinic in Turkey. Using Yalom's (1975) therapeutic factor questionnaire administered at discharge, patients rated existential factor, instillation of hope and self-understanding as the most helpful factors and identification as the least helpful. There were significant differences among patients with regard to gender, age, education, comorbid personality disorder, but not with Axis I diagnosis or number of attended sessions. Patients' and psychiatrist's rating showed significant differences. Differences between this Turkish sample and those reported in common Western literature are discussed under the light of relatedness psychology, which is an important concept of cross-cultural psychology.

Topiramate-induced psychotic exacerbation: case report and review of literature.

Background. Topiramate (TPM) is a new antiepileptic drug that is used mainly in the treatment of refractory partial epileptic seizures. There are some studies reporting TPM's effectiveness in the treatment and maintenance of some psychiatric illnesses such as acute mania, some other affective disorders, post-traumatic stress disorder and binge-eating disorder. On the other hand, it has been shown that TPM may cause mild to moderate cognitive impairment and is thought to be responsible for a series of neuro-psychiatric signs and symptoms. Some of the available articles that have mentioned the relationship of psychotic symptoms and topiramate usage are discussed. Objective. The present paper aims to discuss a case of psychotic exacerbation purported to occur after TPM administration and to review specifically the literature on TPM's potential for inducing psychotic symptoms. The patient presented here is thought to be an undiagnosed schizophrenia patient until his admission to our clinic (Department of Psychiatry, Gazi University Medical School) with TPM-exacerbated psychotic symptoms. Conclusions. The current findings are still subject to controversy because of the presence of both individual case reports and case series on the association between appearance of psychotic symptoms and TPM usage.