Anxiety, depression, sleep disorders and quality of life in parents of children with first unprovoked seizure and epilepsy.

BACKGROUND: Parents of a child with neurological problems such as seizures and epilepsy experience significant mental distress. Little is known about the mental state of parents in such a stressful situation. This study aims to determine the prevalence of self-reported depression, anxiety, sleep disorders, and quality of life in parents of children with epilepsy and first unprovoked seizure. METHODS: This cross-sectional study was conducted among the parents of children diagnosed with first unprovoked seizure and epilepsy admitted to the Pediatric Neurology Department, Outpatient Unit of Inönü University Medical Faculty Hospital. Participants filled out a questionnaire investigating demographic variables, Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Pittsburgh Sleep Quality Index (PSQI), and 36- Item Short-Form Health Survey (SF-36). RESULTS: 113 parents participated in the study. Depression was found in 7%, anxiety in 14%, and sleep quality disorder in 33.3% of parents of children diagnosed with epilepsy on the basis of moderate or higher severity, while depression was found in 8.9%, anxiety in 14.3%, and sleep disorder in 21.4% of parents of children diagnosed with first unprovoked seizure. There was no statistically significant difference between the groups. Mothers were at higher risk for loss of physical function and social functionality. There was a positive correlation between BAI, BDI, and PSQI scores. Quality of life sub-dimension measured by SF-36 was associated with different levels of depression, anxiety, and sleep quality. CONCLUSION: Addressing parental psychiatric problems by professionals involved in the treatment of children with a history of seizures may have the potential to provide further support for the family and the care of patients.

A NEW ARTIFICIAL INTELLIGENCE-BASED CLINICAL DECISION SUPPORT SYSTEM FOR DIAGNOSIS OF MAJOR PSYCHIATRIC DISEASES BASED ON VOICE ANALYSIS.

BACKGROUND: Speech features are essential components of psychiatric examinations, serving as important markers in the recognition and monitoring of mental illnesses. This study aims to develop a new clinical decision support system based on artificial intelligence, utilizing speech signals to distinguish between bipolar, depressive, anxiety and schizophrenia spectrum disorders. SUBJECTS AND METHODS: A total of 79 patients, who were admitted to the psychiatry clinic between 2020-2021, including 15 with schizophrenia spectrum disorders, 24 with anxiety disorders, 25 with depressive disorders, and 15 with bipolar affective disorder, alongside with 25 healthy individuals were included in the study. The speech signal dataset was created by recording participants' readings of two texts determined by the Russell emotion model. The number of speech samples was increased by using random sampling in speech signals. The sample audio signals were decomposed into time-frequency coefficients using Wavelet Packet Transform (WPT). Feature extraction was performed using each coefficient obtained from both Mel-Frequency Cepstral Coefficients (MFCC) and Gammatone Cepstral Coefficient (GTCC) methods. The disorder classification was carried out using k-Nearest Neighbor (kNN) and Support Vector Machine (SVM) classifiers. RESULTS: The success rate of the developed model in distinguishing the disorders was 96.943%. While the kNN model exhibited the highest performance in diagnosing bipolar disorder, it performed the least effectively in detecting depressive disorders. Whereas, the SVM model demonstrated close and high performance in detecting anxiety and psychosis, but its performance was low in identifying bipolar disorder. The findings support the utilization of speech analysis for distinguishing major psychiatric disorders. In this regard, the future development of artificial intelligence-based systems has the potential to enhance the psychiatric diagnosis process.

Interpretable Estimation of Suicide Risk and Severity from Complete Blood Count Parameters with Explainable Artificial Intelligence Methods.

BACKGROUND: The peripheral inflammatory markers are important in the pathophysiology of suicidal behavior. However, methods for practical uses haven't been developed enough yet. This study developed predictive models based on explainable artificial intelligence (xAI) that use the relationship between complete blood count (CBC) values and suicide risk and severity of suicide attempt. SUBJECTS AND METHODS: 544 patients who attempted an incomplete suicide between 2010-2020 and 458 healthy individuals were selected. The data were obtained from the electronic registration systems. To develop prediction models using CBC values, the data were grouped in two different ways as suicidal/healthy and attempted/non-attempted violent suicide. The data sets were balanced for the reliability of the results of the machine learning (ML) models. Then, the data was divided into two; 80% of as the training set and 20% as the test set. For suicide prediction, models were created with Random Forest, Logistic Regression, Support vector machines and XGBoost algorithms. SHAP, was used to explain the optimal model. RESULTS: Of the four ML methods applied to CBC data, the best-performing model for predicting both suicide risk and suicide severity was the XGBoost model. This model predicted suicidal behavior with an accuracy of 0.83 (0.78-0.88) and the severity of suicide attempt with an accuracy of 0.943 (0.91-0.976). Lower levels of NEU, WBC, MO, NLR, MLR and, age higher levels of HCT, PLR, PLT, HGB, RBC, EO, MPV and, BA contributed positively to the predictive created model for suicide risk, while lower PLT, BA, PLR and RBC levels and higher MO, EO, HCT, LY, MLR, NEU, NLR, WBC, HGB and, age levels have a positive contribution to the predictive created model for violent suicide attempt. CONCLUSION: Our study suggests that the xAI model developed using CBC values may be useful in detecting the risk and severity of suicide in the clinic.

The role of childhood trauma in patients with chronic urticaria.

OBJECTIVE: Chronic urticaria (CU) is a common skin disease in which the etiology involves immunological and psychological factors. Childhood traumas may disrupt the development of the neuro-immuno-cutaneous-endocrine system and start a complex pathophysiological process with inflammatory abnormalities, potentially leading to the development of skin disease. In light of this information, we believe that childhood trauma may play a role in the onset and severity of disease in CU patients. Our study aimed to discover a potential relationship between CU and childhood traumatic experiences. METHODS: This study was conducted with 53 controls and 50 CU patients. The participants were given a questionnaire form that included sociodemographic information, Beck Anxiety Scale, Beck Depression Scale, and Childhood Trauma Questionnaire (CTQ-28). RESULTS: The rates of childhood trauma were found to be 68% in the patient group, and 54.7% in the control group. The patient group demonstrated higher scores for moderate to severe anxiety and depression. The mean emotional abuse score was significantly higher in early onset (<35 ages) urticaria patients in comparison to late onset urticarial (≥35 ages) and the control group. It was found that depression scores were positively correlated with all abuse sub-types, excluding sexual abuse, and total CTQ-28 scores. Anxiety scores were positively correlated with emotional abuse, physical neglect, emotional neglect, and total CTQ-28 scores. CONCLUSION: Childhood traumas are associated with the early onset and severity of disease in CU patients as well as the accompanying depression and anxiety.

Burnout, mental health symptoms, and empathy in healthcare workers who care for children treated in a liver transplant center.

OBJECTIVE: The healthcare workers in pediatric liver transplantation units are exposed to various stresses; however, their burnout has not been clarified yet. This study aimed to determine burnout, psychological symptoms and empathy levels in healthcare workers, to examine the relationship between these variables and to investigate the predictors of burnout. METHOD: This cross-sectional study was conducted on healthcare workers in Turgut Özal Medical Center Pediatric Liver Transplant Institute. The participants filled out a questionnaire that investigating demographic and occupational characteristics, and including questions from Toronto Empathy Questionnaire, Maslach Burnout Inventory, and Brief Symptom Inventory. RESULTS: Fifty healthcare workers participated in the study. Based on moderate and higher severity scores, 48% of the participants were emotionally exhausted, 22% of them were depersonalized. All of them had a high perception of personal accomplishment. There was a correlation between psychological symptoms level and emotional exhaustion and personal accomplishment as well as empathy and personal accomplishment. Not choosing the profession and the department willingly, age, education level, marital status, duration of profession, unit, not receiving in-service training, empathy, depressive symptoms and hostility scores predicted different aspects of burnout. CONCLUSION: Considering that burnout and psychological stress lead to reduced professional abilities and the development of serious complications, the results obtained can guide managers on the measures to be taken.

Assessment of Psychological Responses and Related Factors of Discharged Patients Who Have Been Hospitalized with COVID-19.

BACKGROUND: COVID-19 is the biggest pandemic of the last century. While a large number of cases and mortality rates direct the research to the clinic and prognosis of the disease, the mental health of these patients has recently become a matter of concern. This study aims to predict psychiatric morbidity and possible associated markers in COVID-19 survivors. SUBJECTS AND METHODS: A total of 102 survivors with COVID-19 infection participated in this study. A questionnaire was applied to the participants to evaluate demographic variables, history of comorbid diseases, smoking, loss of a relative due to COVID-19, and environmental attitudes after the discharge. Length of hospitalization, lung findings, intensive care history and treatments were recorded. Psychiatric morbidities were evaluated with General Anxiety Disorder-7, Patient Health Questionnaire-9 and The National Stressful Events Survey PTSD Short Scale. RESULTS: Anxiety was found in 20.6%, depression in 13.7% based on moderate and above levels, 21.6% had significant PTSD. Female gender, history of psychiatric and comorbid diseases, smoking, perceived discrimination, and lack of long-lasting immunity posed a risk in terms of psychological response. There was a negative correlation between age and depression scores. No relation was found between the duration of hospitalization, presence of lung involvement, receiving intensive care treatment, losing a relative due to COVID-19 and psychological response. CONCLUSIONS: On patients treated for COVID-19 infection, psychological response continue after discharge. Mental health support and efforts to reduce stigma among infected subjects can reduce the psychological impact caused by the pandemic.

Can Temperament and Character Traits Be Used in the Diagnostic Differentiation of Children With ADHD?

ABSTRACT: In this study, it was aimed to determine the contributions of temperament and character traits to the diagnosis of attention deficit hyperactivity disorder (ADHD) in children. Thirty-six patients between the ages of 9 and 14 with a diagnosis of combined type ADHD and 39 healthy children were included in the study. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-Turkish Version and the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale parent form were used to assess hyperactivity/impulsivity and inattentiveness, and comorbid disorders. The Junior Temperament and Character Inventory-Revised form was used to evaluate temperament-character traits. The classification-based association rules (CBARs) method was used for finding rules predicting ADHD accurately. Low persistence and self-directedness scores, and higher disorderliness and fatigability subgroup scores were found in the ADHD group. In CBARs, the separation of children with ADHD from healthy controls could be made with 0.83 accuracy, 0.80 sensitivity, and 0.86 specificity. The results of our study support the view that temperament-character traits can help clinical diagnosis of ADHD.

Factors Affecting Patient Satisfaction in Breast Reduction Surgeries: A Retrospective Clinical Study.

BACKGROUND: Breast reduction surgeries increase the individual's comfort of life by eliminating the problems caused by breast hypertrophy. We aimed to evaluate the effects of patients' demographic and operational data on satisfaction by using Breast-Q Questionnaire. METHODS: Breast-Q Questionnaire breast reduction module was applied to patients who had undergone breast reduction surgery by a single surgeon between 2016 and 2020 and who agreed to participate in the study. Demographic and operational data and Questionnaire results were analyzed with the help of SPSS Statistics V21.0 program by considering p < 0.05 as significant. RESULTS: Of the 94 patients who had undergone surgery, 52 who agreed to fill in the questionnaire were included in the study. Mean age was 39 and mean body mass index was (BMI) 28.6 kg/m2. Forty eight (92.3%) patients had undergone surgery for noncosmetic reasons. Significant differences were found between the physical well-being scores of the participants whose BMI was <25 and those whose BMI was >30. It was found that physical well-being (p= 0.001) and the amount of tissue removed increased with the increase in BMI (p = 0.018). No association was found between the tissue removed, the change in bra sizes and satisfaction. Satisfaction with outcome of surgery was found as 84.51% ± 24.28. Linear association was found between pre-information given and Breast-Q scores (p < 0.001). CONCLUSIONS: In our study, it was found that the tissue removed, breast size and the change in bra size had no effect on patient satisfaction. Being informed was found to be directly related to satisfaction. Providing sufficient information, understanding the expectations and obtaining the desired cosmetic results is important. Although physical complaints are at the forefront in the decision of surgery, aesthetic appearance is more effective in being satisfied with the surgery. A breast the weight of which is reduced through breast reduction and which looks aesthetically beautiful can only please the patient. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Prevalence and predictors of psychological response during immediate COVID-19 pandemic.

AIM: COVID-19 pandemic has created a serious psychological impact worldwide since it has been declared. This study aims to investigate the level of psychological impacts of the COVID-19 pandemic on the Turkish population and to determine related factors. METHODS: The study was carried out by an online questionnaire using the virtual snowball sampling method. The sociodemographic data were collected on the following subjects: participants' experience on any signs of infection within the last month, the history of COVID-19 contact-treatment-quarantine, level of compliance with precautionary measures, the sources of information and level of knowledge about the pandemic process and their belief levels on the knowledge they acquire. Besides, the questions that take place in the Depression, Anxiety and Stress Scale-21 (DASS-21), and Impact of Events Scale-Revised (IES-R) were asked to participants. RESULTS: Of the 3549 participants, anxiety was found in 15.8%, depression in 22.6%, stress in 12.9%, and psychological trauma in 20.29% based on moderate and above levels. Female gender, young age, higher education level, being single, high monthly income, presence of psychiatric illness, a large number of people living together, having any signs of infection, and contact history with COVID-19 infected person or contaminated object are identified as risk factors that may increase psychological impact. Compliance with the rules was found to reduce the risk of psychological response. CONCLUSIONS: The risk factors for the psychological impact of the COVID-19 pandemic, and acknowledging these factors can help to formulate the interventions to reduce the stress levels of the population.

The role of physical activity on mental health and quality of life during COVID-19 outbreak: A cross-sectional study.

INTRODUCTION: The COVID-19 pandemic has placed restrictions on people's physical activities. The aim of this study was to evaluate the physical activity levels of individuals and assess the effects of physical activity on quality of life, depression and anxiety levels during the COVID-19 outbreak. METHODS: This cross-sectional study were included 2301 participants aged 20-75 years. The data were collected through the Google Forms web survey platform by the virtual snowball sampling method. In the multivariate analysis, the independent predictors were analyzed using possible factors identified in previous analyses by multinomial logistic regression analysis. Hosmer-Lemeshow and Omnibus tests were used to evaluate the logistic regression model and coefficients. RESULTS: The mean weekly energy consumption of the participants was 875±1588 MET-min, and only 6.9% were physically active enough to maintain their health. There was a weak positive relationship between physical activity levels and quality of life, while there was a weak negative relationship between physical activity levels, depression and anxiety (p<0.05). In the multinomial logistic regression model established for comparison of physically active and inactive participants, general health status and physical health status variables were statistically significant (p<0.05). However, relationships between psychological status, social relationships and environment scores, Beck Depression and Beck Anxiety Inventory scores were not statistically significant (p>0.05). CONCLUSIONS: Results showed that physical activity programs should be included in guidelines as an integrative approach to pandemic management. During COVID-19 outbreak, community-based rehabilitation programs are needed, and these programs should be carried out in cooperation with community stakeholders.

Evaluation of temperament and character traits of patients with severe acne.

BACKGROUND: Acne vulgaris (AV) is an inflammatory disease of the pilosebaceous unit. The relationship between personality and acne development has not been fully explained, and to the best of our knowledge, there are a limited number of studies in the literature evaluating temperament and character traits of individuals with acne. AIM: The aim of this study is to evaluate temperament-character traits of individuals with severe acne and to compare them with healthy controls. PATIENTS/METHODS: This study was conducted on 51 patients who admitted to the dermatology outpatient clinic with complaint of acne and were diagnosed with severe AV and 47 healthy individuals, as a control group. All individuals included in the study participated voluntarily. The forms including sociodemographic data, clinical information, and Temperament and Character Inventory (TCI) scores were applied to the patient and control groups. RESULTS: The scores of scales/subscales of exploration (NS1), persistence (P), responsibility (S1), purposefulness (S2), resourcefulness (S3), self-acceptance (S4), enlightened 2nd nature (S5), self-directedness (S), integrated conscience (C5), and cooperativeness (C) were statistically significantly lower, and the scores of scales/subscales of worry and pessimism (HA1), fear of uncertainty (HA2), shyness (HA3), fatiguability (HA4), and harm avoidance (HA) were statistically significantly higher in the patient group, in comparison with the control group. CONCLUSIONS: When we evaluated the patients with severe acne in terms of temperament and character features, we concluded that individuals' feeling of discomfort about their appearance may cause them to be less sociable, more anxious, and to have low resourcefulness and virtues.

Different manifestations of nervous system involvement by neurobrucellosis.

OBJECTIVES: To assess the clinical categories, laboratory, radiological findings, and treatment outcomes of patients with neurobrucellosis. METHODS: This retrospective study was designed at the Infectious Diseases and Clinical Microbiology Department, Faculty of Medicine of Gaziantep University, Gaziantep, Turkey between 2003 and 2006. In this period, 300 patients with brucellosis were diagnosed, and 13 patients with neurobrucellosis are described. Diagnosis of neurobrucellosis was based on the isolation of Brucella spp. from CSF and/or CSF standard tube agglutination (STA) ≥ 1/40, lymphocytic pleocytosis, increased protein in CSF and STA ≥ 1/320 in blood. The mean adenosine deaminase level was 12.15 u/L in CSF. The duration of antimicrobial treatment varied with the clinical response of the patient. RESULTS: We divided the 13 patients with neurobrucellosis into 4 different groups according to clinical presentation: meningoencephalitis in 8 patients, cerebral demyelination in one patient, myelitis in one patient, and neuropsychiatric disorder in 3 patients. The most common clinical form of neurobrucellosis was meningoencephalitis. There was no mortality in any of the cases. CONCLUSION: Applying these diagnostic criteria can help both early diagnosis of neurobrucellosis and differentiation from other CNS involvement in endemic regions.

The effects of electroconvulsive therapy on ghrelin, leptin and cholesterol levels in patients with mood disorders.

The effects of electroconvulsive therapy (ECT), which is a widely used treatment for psychiatric disorders, have not yet been established. Therefore, we aimed to explore whether the patients' serum ghrelin and leptin levels are associated with the action of ECT treatment. In the case of the mood disorders, which occurred in 16 patients with major depressive episode (MDE) and 12 patients with bipolar disorder-manic episode (BD-me) and 25 healthy controls, we have determined the serum levels of ghrelin, leptin and cholesterol before ECT and 2 days after ECT. The BMI was also calculated in all subjects. Although ECT treatment did not change mean the BMI and serum leptin level, the mean serum ghrelin level decreased and the total cholesterol level increased after ECT compared with before ECT. While the leptin levels in the patient group were significantly lower than the controls before and after ECT, the mean serum ghrelin and total cholesterol levels differed statistically only before ECT, but not after ECT than those in controls. The ghrelin levels have decreased significantly after ECT in both sub-groups MDE and BB-me. However, the mean serum total cholesterol level increased statistically after ECT only in the MDE sub-group, and the leptin levels did not differ in both sub-groups after ECT compared with before ECT. In conclusion, ECT treatment seems to be associated with decreased ghrelin levels and increased cholesterol levels but not leptin levels. However, more comprehensive and detailed studies are needed to decipher the exact role of ECT on ghrelin, leptin and total cholesterol in mood disorders.

Neuroleptic malignant syndrome induced by ziprasidone on the second day of treatment.

Neuroleptic malignant syndrome (NMS) is the rarest and most serious of the neuroleptic-induced movement disorders. We describe a case of neuroleptic malignant syndrome (NMS) associated with the use of ziprasidone. Although conventional neuroleptics are more frequently associated with NMS, atypical antipsychotic drugs like ziprasidone may also be a cause. The patient is a 24-year-old male with a history of schizophrenia who developed signs and symptoms of NMS after 2 days of treatment with an 80-mg/day dose of orally administrated ziprasidone. This case is the earliest (second day of treatment) NMS due to ziprasidone reported in the literature.