Social Cognition and Functioning in Patients With Social Anxiety Disorder and/or Attention-Deficit/Hyperactivity Disorder.

ABSTRACT: In recent years, social cognition and one of its dimensions, the theory of mind, have been more commonly investigated in patients with social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD). In this study, SAD, ADHD, comorbid SAD-ADHD, and healthy control (HC) groups, each consisting of 30 participants, were included and compared in terms of social cognition and functionality. Mean global functioning assessment scores were found to be significantly higher in the HC group compared with the other three groups and in the ADHD group compared with the SAD and SAD-ADHD groups. Mean Dokuz Eylül Theory of Mind Index total scores were found to be significantly higher in the HC group compared with the other three groups and in the SAD and SAD-ADHD groups compared with the ADHD group. These findings suggest that SAD patients with or without ADHD show better social cognition but worse functioning compared with pure ADHD patients.

The effects of the COVID-19 pandemic on patients with obsessive-compulsive disorder.

OBJECTIVE: Little is known about the impact of the COVID-19 pandemic on obsessive-compulsive disorder (OCD). The main aim of this study was to investigate how the pandemic has affected OCD patients and the relationship between the clinical features and the fear and obsession with COVID-19. METHODS: A total of 30 consecutive patients with OCD and 30 age-and sex-matched healthy controls were included in this cross-sectional study. Based on retrospective information provided by the patients, we evaluated changes in the severity of their OCD during the pandemic compared to the pre-pandemic period. We compared patients with OCD and healthy subjects using scores obtained from various scales. RESULTS: We found that symptom severity worsened in 60% of OCD patients during the pandemic compared to the pre-pandemic period, remained unchanged in 30%, and improved in 10%. The levels of obsession with COVID-19 were found to be higher in OCD patients than in healthy control subjects. The levels of fear of and obsession with COVID-19 both correlated with the anxiety levels of patients with OCD and healthy controls. CONCLUSIONS: Our results suggest that the levels of COVID-19 related fear and obsession are not linked to the severity of OCD, but to anxiety levels. Key pointsObsessive-compulsive symptom severity worsened in 60% of OCD patients in the pandemic.COVID-19 obsession levels were higher in OCD patients than healthy controls.COVID-19 fear levels did not differ between the OCD and healthy control groups.COVID-19 obsession levels were correlated with anxiety severity in OCD and healthy control groups.

Social Support Promotes Mental Health During the COVID-19 Outbreak: A Cross-Sectional Study from Turkey.

BACKGROUND: Coronavirus-19 (COVID-19) has several negative effects on mental health, given its rapid transmission, hygiene and isolation measures and associated social and financial difficulties. In this study, we aimed to investigate the mental health burden of the Turkish population and vulnerable groups during the COVID-19 outbreak, especially exploring the effects of social support. SUBJECTS AND METHODS: We assessed depression, anxiety, stress symptoms and perceived social support among 894 people all over Turkey, using the Depression Anxiety Stress Scales (DASS-21) and Multidimensional Scale of Perceived Social Support (MSPSS) two months after the declaration of the first COVID-19 case in Turkey. RESULTS: According to DASS-21 subscale scores, the findings showed that the prevalence of moderate to severe depression, anxiety and stress-related symptoms was 24.8%, 21.9% and 12.6%, respectively. Female gender, being single, having a lifetime psychiatric disorder, lower education level and financial concerns were significantly associated with higher DASS-21 scores. Also, there was a negative correlation between all subgroups of perceived social support, especially from the family, and the total DASS-21 score. CONCLUSIONS: Vulnerable groups should be identified and protected to reduce adverse psychiatric outcomes of COVID-19. Besides, further strategies should be provided to maintain protective factors, such as social support, under stressful conditions.

Proton Magnetic Resonance Spectroscopy in Social Anxiety Disorder.

In the present study, 24 nonmedicated patients with social anxiety disorder (SAD) were compared with 24 healthy control subjects to assess metabolite levels in the anterior cingulate, insula, caudate, and putamen using proton magnetic resonance spectroscopy. The ratio of N-acetylaspartate (NAA)/creatine (Cr) was significantly higher in patients with SAD than in healthy control subjects in the anterior cingulate and insula. NAA/Cr ratios in the insula correlated positively with the Liebowitz Social Anxiety Scale total scores in patients with SAD. Our results support the significance and biochemical involvement of the anterior cingulate and insula in the pathophysiology of SAD.

Predictors of early or late treatment seeking in patients with social anxiety disorder.

BACKGROUND: Social anxiety disorder (SAD) is common in the general population and usually begins at an early age. It is well established that patients with SAD rarely seek treatment, and their first treatment contact usually takes many years after onset. The aim of this study was to determine the predictors of early and late treatment seeking in patients with SAD. METHODS: This study enrolled 180 patients with generalized SAD. The mean and median durations between the emergence of SAD and first treatment contact were 15 and 14 years, respectively. Multiple linear regression with the backward elimination method was applied to assess the factors that affect the amount of time between occurrence of the disorder and first treatment contact. RESULTS: Older age, earlier onset of SAD, and lower level of education were associated with late treatment seeking, whereas earlier onset of comorbid major depressive episodes and lifetime history of comorbid obsessive-compulsive disorder were associated with earlier treatment seeking. CONCLUSIONS: Age of onset, comorbid psychiatric conditions, and level of education are associated with the timing of treatment seeking in patients with SAD. It is important to try to change the common perception that SAD is a personality trait rather than a psychiatric disorder.

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.

1H-magnetic resonance spectroscopy in obsessive-compulsive disorder: effects of 12 weeks of sertraline treatment on brain metabolites.

Several neuroimaging studies have investigated brain metabolite abnormalities in patients with obsessive-compulsive disorder (OCD) and also explored metabolic changes after OCD treatments using proton magnetic resonance spectroscopy ((1)H-MRS). The main objective of this study was to investigate the effects of a selective serotonin re-uptake inhibitor (SSRI) treatment on the neurochemical levels in patients with OCD. In the present study, levels of N-acetylaspartate (NAA), choline, and myo-Inositol were measured in terms of their ratios with creatine (Cr) using (1)H-MRS. The ratios of metabolite levels in the three brain regions for 19 unmedicated patients with OCD, including 10 who were drug-naïve, at baseline and following 12 weeks of sertraline treatment and for 19 healthy control subjects were compared with ANOVA. In post hoc analysis, the NAA/Cr levels were significantly lower in patients with OCD at baseline than in healthy controls in the anterior cingulate and in the caudate. On the other hand, no significant differences were detected in terms of the NAA/Cr in the anterior cingulate, caudate, and putamen between the patients with OCD after 12 weeks of sertraline treatment and healthy controls. The paired t test revealed that NAA/Cr levels were significantly higher in patients with OCD after 12 weeks of sertraline treatment compared with those at baseline in the anterior cingulate and in the caudate. Our results suggest that reductions in NAA can be reversed with SSRI treatment, which may indicate an improvement in neuronal integrity.

N2 and P3 potentials in early-onset and late-onset patients with obsessive-compulsive disorder.

BACKGROUND: Impaired cognitive control processes may be central in the pathogenesis of obsessive-compulsive disorder (OCD). Our objective was to evaluate cognitive control processes with event-related potentials in early-onset OCD (EO) and late-onset OCD (LO), which are suggested to have distinct characteristics. METHODS: Participants were unmedicated EO (n = 26) and LO patients (n = 33) without comorbid psychopathology and healthy controls (n = 54). Go/No-go tasks with 50 and 80% Go trial probabilities were implemented to manipulate the strength of response conflict and inhibitory demands. RESULTS: LO patients had shorter N2 latencies than controls and did not show the N2 amplitude increase seen in controls with the increase in Go trial probability as suggestive of abnormal conflict monitoring processes. Both EO and LO patients showed smaller P3 increase than controls with the increase in Go trial probability, suggesting problems in modifying attentional control with changes in task demands. P3 was more anteriorly distributed in LO patients than controls. Additionally, P3 increase, with the increase in Go trial probability, was larger in frontal and central sites than in parietal sites in controls, whereas in EO patients it was almost homogenous across anteroposterior sites. CONCLUSIONS: N2 processes were affected only in LO, whereas P3 processes were affected in both EO and LO, although, somewhat differently. P3 distributions suggest that EO and LO patients have differences concerning the contributions of frontal and parietal components of attentional networks to the execution of Go/No-go tasks. Our results imply that EO and LO are distinct subtypes affecting the cognitive control systems differently.

The clinical impact of mood disorder comorbidity on social anxiety disorder.

BACKGROUND: High comorbidity rates of mood disorders have been reported in patients with social anxiety disorder (SAD). Our study aims to identify the frequency of comorbid Axis I disorders in patients with SAD and to investigate the impact of psychiatric comorbidity on SAD. METHODS: The study included 247 patients with SAD. Thirty eight patients with bipolar depression (SAD-BD), 150 patients with major depressive disorder (SAD-MDD) and 25 patients who do not have any mood disorder comorbidity (SAD-NOMD) were compared. RESULTS: Around 90% of SAD patients had at least one comorbid disorder. Comorbidity rates of lifetime MDD and BD were 74.5% and 15.4%, respectively. There was no comorbidity in the SAD-NOMD group. Atypical depression, total number of depressive episodes and rate of PTSD comorbidity were higher in SAD-BD than in SAD-MDD. Additionally, OCD comorbidity was higher in SAD-BD than in SAD-NOMD. SAD-MDD group had higher social anxiety severity than SAD-NOMD. CONCLUSIONS: Mood disorder comorbidity might be associated with increased severity and decreased functionality in patients with SAD.

Treatment of insomnia with hypnotics resulting in improved sexual functioning in post-menopausal women.

BACKGROUND: This study sought to determine whether trazodone used in hypnotic doses, compared to the hypnotic agent zopiclone, had any specific positive effect on sexual function in non-depressive post-menopausal women with insomnia. SUBJECTS AND METHODS: Fifty (50) subjects participated in the study. Insomnia and sexual performance were evaluated before and after 4 weeks of hypnotic treatment. RESULTS: At week four, both treatments improved sleep quality to a similar degree. Sexual function also improved significantly with both treatments, with no significant difference between the groups. CONCLUSIONS: In post-menopausal women, sexual problems and sleep problems may be related and solving sleep problems may help sexual functioning, independently of depression.

COMT Val158Met polymorphism and executive functions in obsessive-compulsive disorder.

This study investigated the association between the catechol-O-methyl transferase (COMT) Val158Met polymorphism and executive functions in 101 patients with obsessive-compulsive disorder (OCD) and 100 healthy-control subjects (HS). Results showed that there was no significant difference for the genotype distributions between the OCD and HS groups. OCD-Met carrier subgroup's TMT B-A difference and lexical fluency scores were found to be significantly poorer than both HS subgroups. These findings suggest that lower activity of COMT associated with the Met allele, leading to higher levels of dopamine in the prefrontal cortex, lead to poorer executive function in OCD.

Neuropsychological function in obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a chronic disease characterized by repetitive, unwanted intrusive thoughts and ritualistic behaviors. Studies of neuropsychological functions in OCD have documented deficits in several cognitive domains, particularly with regard to visuospatial abilities, executive functioning, and motor speed. The objective of the present study was to investigate systematically the cognitive functioning of OCD patients who were free of medication and comorbid psychiatric disorders. In the present study, 72 OCD patients were compared with 54 healthy controls on their performance in a comprehensive neuropsychological battery. The Yale-Brown Obsessive Compulsive Scale and the Hamilton Depression Rating Scale were administered to the patients, and a semistructured interview form was used to evaluate the demographic features of the patients and control subjects. Overall, widespread statistically significant differences were found in tests related to verbal memory, global attention and psychomotor speed, and visuospatial and executive functions indicating a poorer performance of the OCD group. A closer scrutiny of these results suggests that the OCD group has difficulty in using an effective learning strategy that might be partly explained by their insufficient mental flexibility and somewhat poor planning abilities.

Brain-derived neurotrophic factor gene Val66Met polymorphism and cognitive function in obsessive-compulsive disorder.

In the present study, we have tested the hypothesis that brain-derived neurotrophic factor (BDNF) gene Val66Met polymorphism is associated with obsessive-compulsive disorder (OCD) and also investigated the association between the BDNF Val66Met polymorphism and the performance on tests measuring executive functions in a sample of patients with OCD. A total of 100 patients diagnosed with OCD according to DSM-IV criteria and 110 control subjects were included in this study. Single nucleotide polymorphism (G/A) leading to Val to Met substitution at codon 66 in BDNF was screened in the DNA samples of all participants. The genotype frequencies of BDNF Val66Met polymorphism were compared in OCD patients and healthy controls. The four subgroups of OCD and healthy control subjects, determined according to being Val homozygous or carrying a Met allele, were also compared according to their performance in a battery of neuropsychological tests of executive functions and verbal memory. There was no significant difference for the allele and genotype distributions of BDNF Val66Met polymorphism between the OCD and healthy control groups. Compared to the other three subgroups, OCD-Met carriers were slower on Trail-Making Test part A (TMT A), part B (TMT B) score and its speed-corrected score (TMT B-A). OCD-Met carriers had also poor performance on verbal fluency tasks and several CVLT measures compared only to the healthy control-Met carriers. These results demonstrate that the BDNF Val66Met polymorphism does not appear to be a risk factor for OCD. However, the presence of a BDNF Met allele, which is a known attenuator of BDNF activity, may be associated with a poorer executive functioning in OCD.

Psychological Reactions of Turkish Healthcare Workers During Covid-19 Outbreak: The Impact of Stigmatization.

Introduction: The Coronavirus Disease 2019 (COVID-19) outbreak has resulted in huge psychological distress, especially for people working under risky conditions, such as healthcare workers. We aimed to investigate the psychological challenges of Turkish healthcare workers during the outbreak and discuss the factors that increase their burden, including stigmatization. Methods: A cross-sectional online survey composed of sociodemographic data, questions about perceived stigma, and concerns about working conditions was completed. Depression Anxiety and Stress Scale-21 (DASS-21) was also used. Results: 634 participants completed the survey and the prevalence of moderate to severe depression, anxiety, and stress-related symptoms were 36%, 35%, and 22%, respectively. Being female, working with close contact with patients with COVID-19 and having a psychiatric disorder history were risk factors for psychological distress. The healthcare workers with significantly higher depression, anxiety, and stress scores described having less amount of personal protective equipment, lower support from their supervisors, and more unsafe working conditions. Additionally, 7% of the participants stated that they perceived stigmatization by their families and close friends, 14% perceived stigmatization by their neighbours, relatives, and less intimate friends; and 7% perceived stigmatization by unfamiliar people. Healthcare workers who perceived other people as more dismissive had significantly higher depression and anxiety scores. Conclusion: Our study shows that healthcare workers are at risk of developing psychological disturbances during infectious outbreaks. To minimize the psychological impact, additional risk factors such as having a previous psychiatric disorder, working under unsafe conditions, and stigmatization should be taken into account and a more supportive and safer environment should be provided.

Comparing retinal changes measured by optical coherence tomography in patients with schizophrenia and their siblings with healthy controls: Are retinal findings potential endophenotype candidates?

AIM: The aim of our study is to examine whether differences in retinal structure may reflect endophenotypes for schizophrenia by comparing thicknesses of retinal layers between patients with schizophrenia, their unaffected siblings, and healthy control groups and investigating the relationship between OCT findings and disease parameters. MATERIAL AND METHODS: 46 patients with schizophrenia, their 46 healthy siblings, and 46 age and gender-matched healthy controls were enrolled in the study and underwent spectral domain OCT (examinations to assess differences in peripapillary retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL)+ inner plexiform layer (IPL) thicknesses and macular volumes (MV) in both eyes). Clinical variables were also recorded in the patient group. RESULTS: There was no difference between the groups in terms of RNFL thicknesses. The GCL+IPL thicknesses of the siblings are between the patients and controls but according to post hoc comparisons the GCL+IPLs of the patients were only thinner than controls. Additionally, MVs were significantly lower in the patient group compared to the sibling group. There was no correlation between any clinical parameters and the GCL+IPLs of all groups, however there were some correlations between RNFL and clinical features especially in the patients group. CONCLUSION: GCL+IPL values do not seem to be affected by the disease parameters or the factors like body mass index or nicotine use. On the other hand, further studies are needed to determine whether GCL+IPL could be an endophenotype candidate.

Is Olfactory Reference Syndrome a Diagnostic Entity Under Obsessive-Compulsive and Related Disorders?: A Case Report. / Olfaktör Referans Sendromu Obsesif Kompulsif ve Iliskili Bozukluklar Basligi Altinda Degerlendirilebilir mi? Bir Olgu Sunumu.

Olfactory reference syndrome (ORS) is a rare psychiatric condition involving embarrassment and distress due to persistent mental preoccupation with the idea of emitting body odours foul and offensive enough to disturb others. This disorder is often accompanied by shame, embarrassment, significant distress, avoidance behavior, social phobia and social isolation. The patients may worry that they spread odours originating from their mouth, sweat, genital areas or the gut. This belief may lead the patients to misinterpret the behaviours of others, they may frequently smell themselves, shower and change clothing during the day. There are differences of opinion whether ORS should be considered as a delusional disorder or appear in under the rubric of obsessive-compulsive related disorders. One of the reasons that create this uncertainty is the variation in the response to different treatments. The treatment strategies generally include the use of antipsychotics, the antidepressants, they are preferentially used in combination. In this report we aimed to discuss the case of a 33-year old male patient whose first complaints had been diagnosed 14 years prior, with a diagnosis of OCD with low insight. Shortly after improvement of the OCD symptoms he developed ORS symptoms. We aimed here to discuss the place of ORS in the diagnostic systems with reference to this case.

Clinical profile of delusional disorder and its subtypes: a descriptive study from Turkey.

The fact that delusional disorder (DD) received minimal research attention indicates the need for descriptive studies that will better delineate the clinical and socio-demographic characteristics of DD. We conducted a chart review descriptive study in a tertiary hospital from Turkey. A total of 99 cases of DD were identified through hospital registry system. 57 were male (57.6%), and mean age at first admission was 49.34±13.49. The most common type of DD was persecutory (36.4%), followed by jealous type (28.3%), mixed type (18.2%), and somatic type (16.2%). Jealous type DD patients were more likely to be married, and mixed type DD patients were more likely to be divorced. The presence of hallucinations was significantly associated with history of hospitalization. About one-tenth of the patients had a family history of psychotic spectrum disorder. Comorbid depressive disorder was present in 42.9% of the patients, whereas only 9.2% had comorbid anxiety disorder. Depressive disorder comorbidity in DD seems to be associated with continued treatment for longer periods of time in psychiatry services. While most of our data were comparable with the literature on DD, our divergent findings like higher rates of male patients and jealous type of the disorder might be attributed to the cultural and geographical factors. This situation points out that future research with larger populations and from different regions would contribute to better understanding of clinical and socio-demographical characteristics of delusional disorder.

The Features of Comorbidity of Childhood ADHD in Patients With Obsessive Compulsive Disorder.

Objective: Our aim is to investigate the impact of childhood ADHD comorbidity on the clinical features of obsessive compulsive disorder (OCD). Method: Ninety-five adult outpatients with a diagnosis of OCD were assessed by using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version, ADHD module, and the Yale-Brown Obsessive Compulsive Scale. Patients with or without childhood ADHD were compared in terms of the sociodemographic and clinical features, psychiatric comorbidities, and rating scales. Results: The rate of episodic course of OCD (p < .001), religious and sexual obsessions (p = .009, p = .020, respectively), lifetime comorbidity of bipolar disorder (BD), social anxiety disorder (SAD; p = .001, p = .009, respectively), and tic disorder (TD) comorbidity (p < .001) were higher in the OCD + ADHD group than in the OCD without ADHD group. Conclusion: Childhood ADHD may be associated with higher rates of BD, SAD, and TD comorbidity and episodic course of OCD as well as higher frequency of certain types of obsessions.

A comparative study of obsessive-compulsive disorder and other psychiatric comorbidities in patients with temporal lobe epilepsy and idiopathic generalized epilepsy.

Our aim was to assess the associations of temporal lobe epilepsy (TLE) and idiopathic generalized epilepsy (IGE) with comorbid psychiatric conditions, especially obsessive-compulsive disorder (OCD), in a comparative design. We evaluated 29 patients with TLE, 27 patients with IGE, and 30 healthy controls. The Structured Clinical Interview for DSM-IV (SCID), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist, and Beck Depression Inventory (BDI) were administered. Among patients with TLE, 75.9%, and among patients with IGE, 48.1% had at least one Axis I psychiatric disorder. Clinically meaningful obsessive-compulsive symptoms (CM-OCS) were noted in 10 patients with TLE and in 3 patients with IGE, and this difference was statistically significant (P<0.05). CM-OCS were present in 9 of 18 patients with left-sided TLE, but in only 1 of 11 patients with right-sided TLE. Higher comorbidity in TLE suggests that involvement of the temporal lobe may play a role in the development of specific psychopathological syndromes.

Is there a prodrom period in patients with social anxiety disorder? A discussion on the hypothesis of social anxiety disorder development secondary to attention-deficit/hyperactivity disorder.

The association between social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD) is poorly established. In fact, increasing and converging evidences suggest that there is a close relationship between the two disorders. High comorbidity rate between these two disorders, follow-up studies showing high rates of later development of SAD in ADHD and treatment studies in which ADHD medications have been helpful for both conditions all indicate this relationship. Recently, we have published a hypothesis regarding the development of SAD secondary to ADHD. In this hypothesis, we recognized that patients with SAD seem to go through a prodromal period that we labeled as "pre-social anxiety." Detecting patients in this period before meeting full-blown SAD criteria provides early intervention and prevention of SAD. New, comprehensive follow-up studies which will investigate whether ADHD causes later SAD secondarily are needed. In the current review, taken into account our developmental hypothesis, we will discuss whether high comorbidity of SAD and ADHD is a chance finding (i.e., the two disorders are found in cases with no causal relationship between them) or can SAD develop secondarily due to childhood ADHD. Is there a prodrom period in patients with SAD as in cancer or psychosis patients? We are going to summarize the overlapping features of SAD and ADHD in terms of child/parents interaction and family issues, aversive childhood experiences, social skill deficits, and development of cognitive distortions.