Temperament traits and psychopathy in a group of patients with antisocial personality disorder.

OBJECTIVE: The Psychopathy Checklist Revised (PCL-R) and Temperament and Character Inventory (TCI) have been used extensively in research of personality disorders; however, no previous study has investigated the relation between psychopathy factors and temperament and character traits in patients with antisocial personality disorder (ASPD). Our aim was to fill this gap in the literature. METHODS: The PCL-R Factor scores and the TCI temperament and character scores were evaluated in 68 men with ASPD and 65 healthy male controls. RESULTS: The ASPD cases had significantly higher PCL-R Factor 1, Factor 2, and Total scores, as well as significantly higher TCI Novelty Seeking and Harm Avoidance scores, whereas the control group had higher TCI Reward Dependence, Persistence, Self-Directedness, and Cooperativeness scores. Correlation analysis revealed that, in the whole study group, PCL-R Factor 1, Factor 2, and Total scores were positively correlated with Novelty Seeking and Harm Avoidance scores and negatively correlated with Reward Dependence, Persistence, Self-Directedness, and Cooperativeness scores. When each group was analyzed separately, the correlations were not significant. Regression analysis supported the main findings. CONCLUSION: Our results showed that both PCL-R Factor 1 score, which is claimed to reflect "core psychopathy," and PCL-R Factor 2 score, which reflects criminal behaviors, were positively correlated with Novelty Seeking and Harm Avoidance and were negatively correlated with Reward Dependence in the whole sample. The reduced variance of PCL-R in each group might lead to nonsignificant associations within groups. Without the subjects with severe psychopathy in the present study, it might not be possible to show the association.

Synaptosomal-associated protein 25 gene polymorphisms and antisocial personality disorder: association with temperament and psychopathy.

OBJECTIVE: The molecular genetic of personality disorders has been investigated in several studies; however, the association of antisocial behaviours with synaptosomal-associated protein 25 (SNAP25) gene polymorphisms has not. This association is of interest as SNAP25 gene polymorphism has been associated with attention-deficit hyperactivity disorder and personality. METHODS: We compared the distribution of DdeI and MnII polymorphisms in 91 young male offenders and in 38 sex-matched healthy control subjects. We also investigated the association of SNAP25 gene polymorphisms with severity of psychopathy and with temperament traits: novelty seeking, harm avoidance, and reward dependence. RESULTS: The MnII T/T and DdeI T/T genotypes were more frequently present in male subjects with antisocial personality disorder (APD) than in sex-matched healthy control subjects. The association was stronger when the frequency of both DdeI and MnII T/T were taken into account. In the APD group, the genotype was not significantly associated with the Psychopathy Checklist-Revised scores, measuring the severity of psychopathy. However, the APD subjects with the MnII T/T genotype had higher novelty seeking scores; whereas, subjects with the DdeI T/T genotype had lower reward dependence scores. Again, the association between genotype and novelty seeking was stronger when both DdeI and MnII genotypes were taken into account. CONCLUSION: DdeI and MnII T/T genotypes may be a risk factor for antisocial behaviours. The association of the SNAP25 DdeI T/T and MnII T/T genotypes with lower reward dependence and higher novelty seeking suggested that SNAP25 genotype might influence other personality disorders, as well.

Lack of association between DRD3 gene polymorphism and response to clozapine in Turkish schizoprenia patients.

It is hypothesized that molecular components of dopaminergic system, especially the dopamine D3 receptor gene (DRD3), may play a crucial role in the pathophysiology of schizophrenia, because it is abundant in the limbic system of the brain and it binds antipsychotic drugs. Several groups attempted to find an association between a serine-to-glycine polymorphism of the DRD3 gene (Ser9Gly) and schizophrenia; however, the results were inconsistent. In this study, we aimed to investigate the relationship of the Serine/Glycine polymorphism of the DRD3 gene with therapeutic response to clozapine treatment between Turkish schizophrenia patients (N = 92) and healthy controls (N = 100). Genotype groups were comparable in BPRS, SAPS, SANS analysis of response to clozapine. Our results suggest that an association between the Ser/Gly polymorphism of DRD3 gene and response to clozapine in Turkish schizophrenia patients is unlikely to exist.

Accompaniment of Tourette syndrome and neuropsychiatric symptoms.

Tourette syndrome (TS) is a neuropsychiatric disorder characterized by multiple motor tics and one or more vocal tics. Attention deficit, obsessive-compulsive disorder, personality problems, and impulsivity may be associated with TS. Functional neuro-imaging studies indicate that the ventral striatum is the most affected brain area in TS. We report a case with TS who had cerebellar atrophy, cerebellar arachnoid cyst, bilateral congenital triangular alopecia, bilateral strabismus, and oxycephaly. The association among these symptoms and TS is rare, and the possible relationship of these symptoms should be investigated with further studies.

Effects of diagnostic comorbidity and dimensional symptoms of attention-deficit-hyperactivity disorder in men with antisocial personality disorder.

OBJECTIVE: Although children with attention deficit hyperactivity disorder (ADHD) are at increased risk for later onset of antisocial personality disorder (APD) as adults, the utility of ADHD as either a comorbid diagnosis (ADHD(c)) or dimensional symptoms (ADHD(d)) in predicting behaviour and substance use problems in APD subjects has not been examined. METHOD: A total of 105 adult male offenders with Structured Clinical Interview for Axis II Disorders (SCID-II)-based DSM-III-R APD were studied in terms of: (i) psychopathy scores on the Hare Psychopathy Checklist-Revised (PCL-R); (ii) ADHD(c) diagnostic comorbidity on clinically administered DSM-IV questionnaire; and (iii) ADHD(d) dimensional symptoms by means of Wender Utah Rating Scale (WURS) and Conners Adult ADHD Rating Scale (CAARS) during a 12 month study period (May 2005-May 2006). RESULTS: Sixty five per cent of APD subjects met criteria for ADHD(c) diagnostic comorbidity with significantly increased rates of childhood neglect, parental divorce and suicide attempt, but not of psychopathy. APD subjects with ADHD(d) symptoms were noted to have earlier onset and increased rate of self-injurious behaviour (SIB), suicide attempt, and psychopathy. The psychopathy scores, in turn, were predictive of earlier onset of SIB and behavioural problems. CONCLUSION: Both ADHD(c) diagnostic comorbidity and ADHD(d) symptoms need to be assessed in APD subjects and the dimensional measures may be better in detecting earlier onset SIB, suicide attempt and other behavioural problems.

Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder.

AIMS: The aims of the present study were to examine the rate of nightmare disorder (ND) and to determine the levels of dream anxiety and subjective sleep quality in patients with borderline personality disorder (BPD). Another aim was to determine whether dream anxiety was associated with childhood trauma, dissociative experiences, and subjective sleep disturbance in BPD patients. Finally, the hypothesis as to whether BPD patients with ND exhibited a more severe clinical profile than those without ND, was also tested. METHODS: A total of 88 borderline patients and 100 age- and sex-matched healthy control subjects were assessed using the Structured Clinical Interview for DSM-III-R Personality Disorders, Structured Clinical Interview for DSM-IV Axis I Disorders, Van Dream Anxiety Scale, Pittsburgh Sleep Quality Index, Dissociative Experiences Scale, and Traumatic Experiences Checklist. Subjects with codiagnoses that could affect sleep were not included. RESULTS: BPD patients suffered a significantly greater rate of nightmares, elevated levels of dream anxiety, and disturbed sleep quality than did controls. In the borderline group, heightened dream anxiety was correlated with higher rates of early traumatic experiences and dissociative symptoms, and impaired sleep quality. Furthermore, borderline patients with ND exhibited greater psychopathology as compared to those without ND in terms of several clinical characteristics. CONCLUSIONS: The present study provides support for a strong association between BPD, distressing nightmares, and subjective sleep quality. Recognition and management of dream and sleep disturbances in BPD patients might lead to improvements in their global clinical picture.

Self-mutilating behavior in patients with dissociative disorders: the role of innate hypnotic capacity.

BACKGROUND: Despite the fact that the assumption of a relationship between self-mutilation and dissociative disorders (DD) has a long history, there is little empirical evidence to support this premise. The present study examined this relationship and investigated whether this commonality is associated with innate hypnotic capacity. METHODS: Fifty patients diagnosed with DD and 50 control subjects with major depression were assessed by using a self-mutilation questionnaire, Dissociative Experiences Scale, Traumatic Experiences Checklist, and the Eye-Roll Sign for their self-mutilating behaviors, dissociative symptoms, early trauma, and innate hypnotic capacity, respectively. RESULTS: We have found that 82% of the present sample of patients with DD injured themselves. They had higher scores on trauma, dissociation and eye-roll measurements than controls. In addition, DD patients with self-mutilation were more likely to have high scores of trauma, dissociation and eye-roll than those without self-mutilation. Innate hypnotic capacity was a strong predictor of self-mutilating behavior in DD patients. CONCLUSIONS: This study strongly supports the assumption that patients with DD are at high risk for self-mutilating behavior and points to the necessity of routine screening for self-mutilating behavior as well as the hypnotic capacity which may constitute a high risk for self-injury in this patient group.

[The relationship between subjective sleep quality and aggression in male subjects with antisocial personality disorder]. / Antisosyal kisilik bozuklugu olan erkek bireylerde subjektif uyku kalitesinin saldirganlik ile iliskisi.

OBJECTIVE: The aim of this study was to evaluate subjective sleep quality and to determine its relationship to aggression in male subjects diagnosed with antisocial personality disorder (APD). METHODS: The study included 125 male soldiers with APD that consecutively presented to the outpatient psychiatric unit of GATA Haydarpasa Training Hospital. A control group of 125 normal volunteers with no known medical or psychiatric disorders were selected from among male military personnel. The subjects were evaluated with an assessment battery, which included the Pittsburgh Sleep Quality Index and Aggression Questionnaire, during a semi-structured interview. RESULTS: The main finding was that more of the APD patients suffered from disturbed sleep quality than did the controls. Compared to the matched controls the APD patients had lower subjective sleep quality, longer sleep latency, shorter duration of sleep, less habitual sleep efficiency, more sleep disturbances, more use of sleeping medication, and a higher level of daytime dysfunction. In the APD group, elevated levels of aggression were also significantly correlated with impaired sleep quality. CONCLUSIONS: The present study provides support for a strong link between subjective sleep quality and aggression in APD. Recognition of sleep disturbances in APD patients is also relevant to the management of APD because effective strategies to improve sleep in this patient group might also lead to vast reductions in their aggressive behaviors.

Clinical predictors of therapeutic response to clozapine in a sample of Turkish patients with treatment-resistant schizophrenia.

BACKGROUND: Several lines of evidence suggest that clozapine is more effective than both first- and second-generation antipsychotic drugs in treatment-resistant schizophrenia (TRS). However, clinicians appear to be hesitant to prescribe this drug. It would therefore be extremely valuable if predictors of response to clozapine could be identified. The aim of this study was to evaluate the predictive factors of clinical responses to clozapine in a group of Turkish patients with TRS. METHODS: This was a 16-week uncontrolled open study carried out among 97 TRS patients (80 males and 17 females; DSM-IV diagnosis). All patients fulfilled the criteria for refractory schizophrenia according to the UK guidelines for the National Institute of Clinical Excellence (NICE). After all previous antipsychotic medications had run their course, the patients were started on clozapine according to a standardized titration and dosage schedule. Psychopathology was evaluated before the initiation of clozapine therapy and once every 4 weeks using the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment for Positive Symptoms, and the Scale for the Assessment of Negative Symptoms. RESULTS: Of the TRS patients on clozapine, 55.7% achieved a clinical response, defined as at least a 20% decrease in BPRS. We observed a favorable effect of clozapine on both positive and negative symptoms. Logistic regression analysis showed that a good clozapine response was more likely when schizophrenia began at a later age, when negative symptoms were severe, and when patients had an early response at 4 weeks. CONCLUSION: A combination of demographic, baseline clinical, and acute treatment response variables may accurately predict response to clozapine in TRS. Priority should be given to initiating clozapine at the earliest phase of TRS, especially for patients with evident negative symptoms.

[Comparison of right thalamus and temporal cortex metabolite levels of drug-naive first-episode psychotic and chronic schizophrenia in patients]. / Ilaç Kullanmamis Ilk Psikotik Atak Hastalari ile Kronik Sizofreni Hastalarinda Sag Talamus ve Temporal Korteks Metabolit Seviyelerinin MRS ile Karsilastirilmasi.

OBJECTIVE: The aim of this study was to use Magnetic Resonance Spectroscopy (MRS) to investigate whether patients with chronic schizophrenia have different brain metabolite levels in the temporal cortex and thalamus than drug-naive first-episode patients. METHOD: We compared right-handed male first-episode patients (n=13) and chronic schizophrenic cases (n=15) with gender- and handedness-matched controls (n=10). Right temporal and right thalamic N-Acetylaspartate (NAA)/Creatine (Cre), NAA/Choline (Cho), and Cho/Cre ratios were obtained with MRS. RESULTS: Right temporal NAA/Cre, NAA/Cho, and right thalamus NAA/Cre ratios were significantly lower both in the chronic and first-episode patient groups when compared to normal controls (p<. 001), suggesting decreased neuronal integrity in both patient groups. There were no significant correlations between symptom severity and functional status with MRS variables (p=.027). These results suggested that both patient groups had neural integrity problems. Duration of illness (days) in the first-episode patients was significantly correlated with right temporal NAA/Cre and NAA/Cho. CONCLUSIONS: These results suggested that first-episode and chronic patients had significantly impaired neural integrity, particularly in the temporal cortex. It seems that in the acute phase of the first-episode, neural integrity impairment increased along with days elapsed without treatment.

Smoking and substance abuse in outpatients with schizophrenia: a 2-year follow-up study in Turkey.

BACKGROUND: This study aimed to determine the prevalence of smoking and substance abuse in outpatients with schizophrenia, and to determine the relationship between smoking status and sociodemographic/clinical characteristics of schizophrenia. METHODS: One hundred and thirty-six schizophrenic outpatients were assessed by the structured clinical interview for DSM-IV (SCID) and brief psychiatric rating scale (BPRS). Demographic and treatment variables were obtained from case records and interviews with patients and their family members. RESULTS: The frequency of smoking among schizophrenic patients was 50%. However, the rate of substance abuse was 5.2%. We found no statistically significant differences between the smoker and the non-smoker patients on the demographic variables of age, sex, marital status, and employment status. There was no significant difference between the groups on BPRS scores. However, smokers were receiving a higher daily dose of neuroleptic than non-smokers. CONCLUSION: The prevalence of smoking among schizophrenic patients was similar to the rates found in Western cultures. However, the prevalence of substance abuse was lower in Turkish patients as compared with patients in the Western population.

[Factors affecting the satisfaction of recruits with the military environment]. / Acemi erlerin yasam kosullarindan memnuniyetini belirleyen faktörlerin incelenmesi.

OBJECTIVE: Life satisfaction is one of the global indicators of adjustment. The purpose of this study was to investigate the roles of individual and familial characteristics, and attitudes towards military service of new recruits in terms of their satisfaction with the fundamental principles of military service and daily military lifestyle and environment. METHODS: The study was conducted among 214 soldiers recruited one month previously in an orientation camp for privates located in an Istanbul military center. All subjects were administered a questionnaire concerning individual and familial sociodemographic features and their feelings about the fundamental principles of military service and daily military lifestyle and environment. RESULTS: Variables included in the questionnaire such as "prior concern about military service", "unexpected timing of military service", "disappointment with military service", "older age at onset of military service" and "higher education level of the subject himself or his mother", were found to be negatively correlated with the satisfaction levels of soldiers. All these items, excluding the education level of the mother, were determined to predict a low level of satisfaction in recruits. CONCLUSIONS: Satisfaction with the fundamental principles of military service and daily military life and environment of recruits, which is a good indicator of adjustment, is concluded to have been affected by the attitudes of individuals towards military service and expectations from this position, the educational level of soldiers and the age of the soldier at the start of military service.

Attention-deficit hyperactivity disorder in patients with premature ejaculation: a pilot study.

PURPOSE: The etiology of both adult-type ADHD and PE is not completely understood, but the studies revealing common etiologic factors for both conditions suggest a high likelihood of coexistence. We aimed to find out the prevalence of ADHD among adult males with lifetime PE. METHODS: The patients with lifetime PE were included in the study. Both patients and controls were evaluated with the 10-item premature ejaculation index of Althof and Rosen for premature ejaculation, Wender Utah rating scale (WURS) and Conner's adult ADHD rating scales (CAARS) for determining the presence of attention-deficit hyperactivity disorder syndrome. RESULTS: A total of 38 patients and 27 controls were included in the study. Patient and control groups were similar in terms of age and (p < 0.878), but different IELT (p < 0.001). ADHD was detected in 16 (42.1 %) of patients with PE, while ADHD symptoms were detected in only 1 (3.7 %) of control patients. Distribution of patients in the study group according to ADHD types was as follows: Type 1, Type 2, Type 3 in 2 (5.3 %), 4 (10.5 %), and 10 (26.3 %) patients, respectively. CONCLUSIONS: ADHD is significantly more frequent among patients with PE than controls. The close relationships between these two diseases must be examined by prospective studies.

Association between dopamine beta hydroxylase gene polymorphism and age at onset in male schizophrenia.

OBJECTIVES: The heterogeneity of schizophrenia mainly results from variations in clinical expressions of the disease, such as age at onset, gender differences in onset of illness, symptoms and response to antipsychotic treatment. Enhanced sensitisation of dopamine pathways in males, having consistently an earlier onset, might be implicated as disease modifiers for schizophrenia in males. METHODS: In this study, we performed a case (n = 87)-control (n = 100) association study between the DBH5'-ins/del and DBH-444g/a polymorphisms of the DBH gene and also compared the level of psychotic symptoms between patients with different DBH genotypes/haplotypes with respect to antipsychotic therapeutic response and gender difference. RESULTS: No significant differences between allele and genotype and haplotype frequencies at either groups (p < 0.05). When the age is considered in patient group, a significant difference was observed between patients with ID genotype and with II genotype (p = 0.018). Patients with ID genotype have been diagnosed as schizophrenics in early ages when compared to II genotype carriers. We also found a significant difference between II and ID genotype (p = 0.007) when the gender had taken into account, showing that the ID genotype carriers had an early onset to schizophrenia. CONCLUSIONS: This association was more significant in male schizophrenia patients than females. Thus, this finding may constitute a novel biological support for the prior finding that onset of schizophrenia varies with gender. The results also showed that critical genetic vulnerability may be associated with the presence or absence of the ID genotype of DBH5'-ins/del.

Clinical characteristics of self-mutilating behavior in Turkish male subjects with antisocial personality disorder: relationship to psychopathy.

AIMS: The aims of this study were to determine the characteristics of self-mutilation (SM) and examine the relationship between SM and psychopathy in male subjects with antisocial personality disorder (APD). METHODS: APD diagnosis was established by the Structured Clinical Interview for DSM-III-R Axis II Disorders. Subjects (N = 116) were assessed using the Psychopathy Checklist-Revised and a semi-structured self-mutilation questionnaire form. RESULTS: In males with APD, the percentages of psychopathy and SM were 48.3% (N =56) and 96.6% (N = 112), respectively. There were positive correlations between severity of psychopathy and severity, number, and frequency of SM. CONCLUSION: Considerably high rates of SM and psychopathy were found in Turkish males with APD. The features of SM were associated with comorbidity of psychopathy. These results showed the importance of exploring the self-injurious behavior and psychopathy when diagnosed with APD.

Plasma orexin A, ghrelin, cholecystokinin, visfatin, leptin and agouti-related protein levels during 6-week olanzapine treatment in first-episode male patients with psychosis.

The objective of the study was to investigate the change of body mass index (BMI), waist circumference, lipid profile, leptin, ghrelin, orexin, visfatin, agouti-related protein, and cholecystokinin levels during 6 weeks of olanzapine treatment in newly diagnosed first-episode drug naive, young adult, nonobese male patients with psychosis. Twenty male participants who were all first-episode drug naive psychotic patients without prominent affective signs and symptoms and 22 healthy male controls of similar age were included. BMI, waist circumference, fasting glucose, and lipid profiles were measured, and Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores were obtained at baseline, during the second and sixth week of treatment, and the aforementioned neuropeptide levels were measured at baseline and during the sixth week of treatment. Treatment was associated with significant increases in BMI, waist circumference, serum triglyceride, and low-density lipoprotein levels. BMI levels increased more than 7% in over 75% of the patients. Leptin increased, and ghrelin and orexin decreased significantly with olanzapine treatment, whereas cholecystokinin, visfatin, and agouti-related protein levels did not change significantly. In conclusion, consistent with previous studies, we found increased BMI, leptin and lipids during olanzapine treatment. Association of neuropeptide level changes with symptom improvement might be mediated by the dopaminergic and serotonergic systems.

Evaluation of general psychopathology, subjective sleep quality, and health-related quality of life in patients with obesity.

OBJECTIVE: Recently, the increasing rate of obesity has been elucidated as a major public health problem. The aim of this study was to examine the psychological distress, subjective sleep quality, and health-related quality of life (HRQOL) in a group of patients diagnosed with obesity. METHODS: A total of 124 obese patients (32 of them Class I obesity (BMI: 30-34.9 kg/m2), 92 Class II obesity (BMI: > or = 35kg/m2)) and 106 healthy control subjects were involved in the study. Subjects were evaluated with self-administered questionnaires including the Symptoms Checklist-90-Revised (SCL-90-R), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Short Form 36 (SF-36). Several clinical and socio-demographic data were also recorded. RESULTS: Class II obesity group had a significantly worse psychological status, quality of life, and sleep quality than control group, Although Class I obesity group did not differ from Class II and control groups according to sleep quality and psychological status, they had worse HRQOL than the control group. BMI scores positively correlated with the majority of subscales of psychological distress (SCL-90-R) and sleep quality (PSQI, ESS) and negatively correlated with all dimensions of HRQOL (SF-36). CONCLUSIONS: Obesity is associated with psychological distress, poor sleep quality, and reduced quality of life. Thus, obesity should be evaluated in a biopsychosocial manner, including management of patients' psychopathology.

Reduced urinary excretion of homocysteine could be the reason of elevated plasma homocysteine in patients with psychiatric illnesses.

OBJECTIVES: Although increased plasma total homocysteine (tHcy) concentrations were reported in psychiatric diseases, currently the reasons of elevated tHcy levels were not clearly understood. In this study we aimed to investigate the contribution of renal clearance of homocysteine on plasma tHcy load in patients with depression and first episode psychosis. DESIGN AND METHODS: Thirty depression, 14 first episode psychosis patients and 34 healthy individuals (control group) were involved in the study. In patients and control groups, plasma and urine tHcy levels, urine methylmalonic acid (uMMA), serum vitamin B12 and folate concentrations were measured. RESULTS: Although there was not any difference between depression, psychosis and control groups with respect to mean (SD) values of vitamin B12 (289(131), 230 (72) and 249(79) pg/mL, respectively) and folate (6.4(4.0), 5.3(2.3) and 5.7(2.3) ng/mL, respectively), plasma tHcy levels of depression and psychosis group were higher than the control values (16.3(6.2), 15.5(4.3) and 9.9(2.1) micromol/L, respectively). Urine tHcy values of patient groups were significantly lower than those in the control group (14.5(7.6), 15.8(6.8) and 29.6(16.9) micromol/g creatinine, respectively). There were elevated uMMA levels in depression and psychosis groups compared with control group (4.9(2.4), 6.6(3.2) and 2.8(1.2) mmol/mol creatinine, respectively). There were a significant and negative correlation between urinary tHcy and plasma tHcy levels (r=-0.258 and p=0.011). CONCLUSION: In conclusion, reduced urinary tHcy levels in psychiatric patients could be one of the reasons of plasma tHcy elevations with normal folate and vitamin B12 levels. Altered renal handling mechanisms of homocysteine may lead to elevated plasma tHcy levels by reduced clearance of homocysteine via glomerular filtration.