Oxidative Stress and Inflammatory Biomarkers in People with Methamphetamine Use Disorder.

Objective: This study aimed to investigate the blood serum levels of biomarkers specifying oxidative stress status and systemic inflammation between people using methamphetamine (METH) and the control group (CG). Serum thiol/disulfide balance and ischemia-modified albumin levels were studied to determine oxidative stress, and serum interleukin-6 (IL-6) levels and complete blood count (CBC) were to assess inflammation. Methods: Fifty patients with METH use disorder (MUD) and 36 CG participants were included in the study. Two tubes of venous blood samples were taken to measure oxidative stress, serum thiol/disulfide balance, ischemia-modified albumin, and IL-6 levels between groups. The correlation of parameters measuring oxidative stress and inflammation between groups with sociodemographic data was investigated. Results: In this study, serum total thiol, free thiol levels, disulfide/native thiol percentage ratios, and serum ischemia- modified albumin levels of the patients were statistically significantly higher than the healthy controls. No difference was observed between the groups in serum disulfide levels and serum IL-6 levels. Considering the regression analysis, only the duration of substance use was a statistically significant factor in explaining serum IL-6 levels. The parameters showing inflammation in the CBC were significantly higher in the patients than in the CG. Conclusion: CBC can be used to evaluate systemic inflammation in patients with MUD. Parameters measuring thiol/disulfide homeostasis and ischemia-modified albumin can be, also, used to assess oxidative stress.

Associations of dysfunctional attitudes, ruminations and metacognitive beliefs about rumination with pharmacological treatment response in patients with first episode of major depression.

INTRODUCTION: The aim of this study is to investigate whether treatment with selective serotonin reuptake inhibitors (SSRI) has an effect on the ruminative response, ruminative beliefs and dysfunctional attitudes (DA), and to evaluate the effects of pre-treatment dysfunctional attitudes and rumination levels on treatment response in individuals diagnosed with the first episode of major depression (MD). METHODS: 110 patients with MD participated in this study. Participants were evaluated with the Hamilton Depression Rating Scale (HDRS), the Clinical Global Impression Scale (CGI), the Short Version of Ruminative Response Scale (RRS), the Positive Beliefs about Rumination Scale (PBRS), the Negative Beliefs about Rumination Scale (NBRS), and the Dysfunctional Attitude Scale form A (DAS-A) before receiving SSRI treatment and 2 months after the onset of treatment. RESULTS: After two months of SSRI treatment, patients were divided into two groups, remission and non-remission groups. The decrease in RRS subscales and total scores, NBRS uncontrollability and danger of ruminations score, PBRS total score and DAS-A autonomous attitude scores were significantly higher in the remission group. RRS and DAS-A scores were found to be predictors of remission. CONCLUSIONS: DA and ruminations may be associated with poor response to SSRI treatment in depression. KEY POINTSAfter treatment with selective serotonin reuptake inhibitors, ruminations, dysfunctional attitudes, and positive and negative metacognitions on ruminations significantly decreased in patients with a first episode of major depression.The decrease in ruminations, autonomous attitudes, the metacognitions on the uncontrollability and danger of ruminations, and positive metacognitions on ruminations was higher in remission group compared to the non-remission group.Ruminations and dysfunctional attitudes significantly predicted remission in first episode of major depression.

Risk of Relapse Assessment Scale for Metamphetamine Abusers: Reliability and Validity Study of the Turkish Version.

Background: This study aims to investigate the validity and reliability of the Turkish adaptation of the 16-item Risk of Relapse Assessment Scale (RRAS) for methamphetamine abusers. Methods: A total of 160 patients diagnosed with methamphetamine use disorder were included in this study to evaluate the validity and reliability of the scale. The comparison of the relationship between the Risk of Relapse Assessment Scale, the Substance Craving Scale, and the Relapse Prediction Scale was also carried out. The validity of the Risk of Relapse Assessment Scale was examined in the first step by exploratory factor analysis. The suitability of the data for exploratory factor analysis was evaluated by Kaiser-Meyer-Olkin test and Barlett's test. Cronbach's α coefficient and corrected item-total correlation value were used to test the reliability of the scale. The validity results of Risk of Relapse Assessment Scale were tested by confirmatory factor analysis. The significance level was set at P < .05 for all analyses. Results: Considering the examination of the internal consistency values of the Risk of Relapse Assessment Scale, Cronbach's α value was detected to be 0.90, and Cronbach's α value of the subscales ranged from 0.72 to 0.90. The study determined that the goodness of fit values for RRAS were χ 2/df =2.13, P < .001, goodness of fit index = 0.88, comparative fit index = 0.92, normed fit index = 0.86, Trucker-Lewis index = 0.90, root mean square error of approximation = 0.08, and standardized root mean squared residual = 0.06. Conclusion: Our findings demonstrate that Risk of Relapse Assessment Scale is a valid and reliable measurement tool for assessing the risk of methamphetamine relapse in Turkish.

Investigation of the Metacognitive Model of Depression in a Turkish Sample of Major Depressive. / Depresyonun Üstbilissel Modelinin Türkiye'deki Bir Majör Depresif Bozukluk Örneklemi Üzerinde Incelenmesi.

OBJECTIVE: The aim of this study was to test the metacognitive model of depression in individuals diagnosed with major depressive disorder (MDD) and to investigate the relative contributions of cognitions and metacognitions about rumination to the explanation of depressive symptoms. METHOD: The participants of the study consisted of 180 MDD patients not meeting the diagnostic criteria for other psychiatric disorders. The obtained data were analyzed through structural equation modelling (SEM) and hierarchical regression analyses. RESULTS: SEM results showed that positive beliefs about rumination increased the rumination level, and the higher levels of rumination significantly predicted the increase in depressive symptoms partly through the mediating effect of negative metacognitive beliefs about rumination regarding interpersonal and social consequences. However, negative metacognitive beliefs about the uncontrollability and danger of rumination were not found to be associated with symptoms of depression in the participants of this study. The power of dysfunctional attitudes for predicting depression was lost when hierarchical regression analysis was carried out by controlling the metacognitions about negative interpersonal and social consequences of rumination. CONCLUSION: The results are consistent with the metacognitive model of depression, which was originally developed for better understanding of MDD, and point to the usefulness of considering positive and negative metacognitions about rumination in the processes of clinical evaluation and intervention for MDD.

Resilience and Associated Factors in Schizophrenia. / Sizofrenide Dayaniklilik ve Iliskili Etmenler.

OBJECTIVE: Resilience in schizophrenia has been associated with multiple clinical variables that, to the best of our knowledge, do not include impulsiveness, aggression and also personality and insight with possible influences, which remain as poorly investigated topics. This study investigated the relationships of resilience with depression, aggression, impulsivity, personality and insight in order to assess the factors that explain resilience in schizophrenia. METHOD: The study included 139 individuals with clinically stable schizophrenia. Data were acquired by means of the Resilience Scale for Adults (RSA), the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), the Schedule for Assessment of Insight (SAI), the Eysenck Personality Questionnaire Revised-Abbreviated (EPQR-A), the Barratt Impulsiveness Scale, 11th version (BIS-11) and the Buss-Perry Aggression Questionnaire (BPAQ). Correlations of the scores of the RSA with the scores of the other psychometric scales and the demographic and clinical data were evaluated. Linear regression analysis was used to determine the factors predicting resilience. RESULTS: The PANSS total and general psychopathology scores and scale scores on depression, impulsiveness and aggression were negatively correlated with resilience scores. Attentional impulsiveness, neuroticism and depression predicted low levels of resilience. There were no significant correlations between insight and the total or subdimension scores of resilience except for the subdimension structural style. CONCLUSION: Treatments focusing only on clinical remission in schizophrenia are not sufficiently effective. Interventions for enhancing resilience in schizophrenia should consider depressive symptoms, attentional impulsivity and personality traits such as neuroticism.

Prodynorphin (PDYN) gene polymorphisms in Turkish patients with methamphetamine use disorder, changes in PDYN serum levels in withdrawal and the relationship between PDYN, temperament and depression.

Aim of the study is to compare prodynorphin (PDYN) rs1997794, rs1022563, rs6045819, rs2235749 polymorphisms in individuals with methamphetamine use disorder (MD) to that of healthy controls (HC), and to investigate the differences in serum PDYN levels in methamphetamine withdrawal. It is also aimed to explore the temperament characteristics and depression and their relationship with PDYN polymorphisms and PDYN serum levels in MD group. PDYN gene and serum levels were studied in 134 patients with MD and 97 HC. Patients with MD were administered Beck Depression Inventory (BDI) and Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A). For rs1022563 polymorphism, TT and CT genotype frequency and T allele frequency were significantly higher in the MD group than the frequencies in HC. It was found that rs2235749 polymorphism AA genotype was associated with increased risk of MD. PDYN rs1997794 CT genotypes had significantly higher scores of TEMPS-A irritable than CC genotypes and PDYN rs1022563 CC genotypes had significantly higher scores of TEMPS-A irritable than TT genotypes. PDYN levels among persons with MD were significantly higher than among the HC group when the withdrawal level increased and withdrawal symptoms improved. During the period in which the withdrawal level increased, there was a negative correlation between PDYN level and BDI and a positive relationship between PDYN level and TEMPS-A hyperthymic. It may be beneficial to screen temperament characteristics associated with increased risk of addiction in patients with MD and develop interventions based on temperament characteristics and the effects of PDYN.

Perinatal Grief and Related Factors After Termination of Pregnancy for Fetal Anomaly: One-Year Follow-up Study.

INTRODUCTION: Many people grieve in a resilient manner, often having a sense of equilibrium restored within six months. The most devastating type of loss is usually considered to be the death of the child. For such a loss, bereavement may take a period of distressing years with signs and symptoms that are related to grief. There have been different phases identified in the grieving process, and this process encompasses various difficulties with different levels of psychological effects. Women with perinatal losses can suffer long periods of grief. The purpose of this study was to monitor the grief in women who had undergone a termination of pregnancy due to fetal anomaly. METHODS: Forty-six women who applied to the Gynaecology Clinic of Istanbul University Cerrahpasa Faculty of Medicine and who decided to terminate their pregnancy due to fetal anomaly were included in the study. The Perinatal Grief Scale (PGS), the Impact of Event Scale-Revised (IES-R), Beck Anxiety Inventory (BAI), the Edinburgh Postnatal Depression Scale (EPDS), the Multidimensional Relationship Questionnaire (MRQ) and the Adult Attachment Scale (AAS) were administered to the participants six weeks after termination. Participants' grief signs were re-evaluated with the PGS at the sixth and 12th months. RESULTS: There was no relationship between severity of grief symptoms and socio-demographic and clinical characteristics of the patients. The perinatal grief symptoms can decrease gradually from termination of pregnancy to six months and can persist for a period of six months up to a year. There was positive correlation between the scores of PGS and BAI, IES-R hyper-arousal. The mean score of PGS changed significantly from sixth week to sixth month and from sixth week to 12th months. IES-R hyper-arousal and MRQ relational satisfaction were found to be the predictors for PGS total score at the first year. CONCLUSION: The diagnosis of fetal anomaly and especially the termination of pregnancy itself may be traumatic and disruptive. In women with perinatal loss, grief may become persistent after the first six months. It would be helpful to examine how the women resolve this experience. Especially the anxiety and the hyper-arousal signs following the termination should not be ignored. Perinatal grief is a unique bereavement experience; specific interventions should be performed for detecting and treating severe perinatal grief.

Effects of Exercise on Resilience, Insight and Functionality in Patients with Chronic Schizophrenia in a Psychiatric Nursing Home Setting: A Randomized Controlled Trial.

To our knowledge, there are no studies on the effects of exercise in patients with severe schizophrenia-related disability or in nursing home settings. Again, the literature search on the influence of exercise on insight and resilience gives no results except mind-body exercises. The aim of this study was to investigate the effects of exercise on psychotic symptoms, depression, functionality, insight and resilience in patients with severe schizophrenia-related disability living in nursing home setting. Thirty-nine patients with schizophrenia were recruited. Exercise group with 20 patients who continued resistance exercise for 60 min, 2 days a week, for 3 months; and treatment as usual (TAU) group with 19 patients. All patients were administered Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms (SANS), Calgary Depression Scale for Schizophrenia (CDSS), Schedule for Assessment of Insight (SAI), Functional Remission of General Schizophrenia Scale (FROGS), Resilience Scale for Adults (RSA) at baseline and 3 months after. There were no significant differences between the groups for baseline and third month scores. In both groups significant decrease in SANS scores, significant increase in scores of FROGS total and social functioning, daily life skills subscale and RSA perception of the self were observed. In exercise group, significant decrease in CDSS scores, and significant increase in SAI awareness of illness, FROGS health and treatment, occupational functioning scores were found. Exercise combined with TAU may be effective in increasing awareness of illness and alleviating depression in chronic schizophrenia.

Resilience and insight in euthymic patients with bipolar disorder.

BACKGROUND: The relationship between resilience and insight may be of potential importance for coping with stress in bipolar disorder (BD). The aim of this study was to investigate if there was a relation between insight and resilience in euthymic patients with BD and also to analyze the associations between resilience, impulsivity, aggression, alcohol use and affective temperament. METHODS: 142 patients with BD type I in remission period were involved. Resilience Scale for Adults-Turkish version, Schedule for Assessment of Insight, Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, Barratt Impulsiveness Scale, Buss-Perry Aggression Questionnaire, Michigan Alcoholism Screening Test were used. RESULTS: Total insight scores were negatively correlated with the scores of perception of future. As distinct from other subscales of resilience, family cohesion had independent significant associations with insight in relabelling of psychotic experiences and attention impulsivity. There was no relationship between total insight and total resilience scores. Resilience scores were negatively correlated with number of depressive episodes and number of suicide attempts. Degree of aggression, degree of impulsivity, scores of depressive and hyperthymic temperament significantly predicted resilience. LIMITATIONS: Recruitment of patients from a tertiary centre limits the generalizability of the findings. CONCLUSIONS: Better insight was related to negative perception of the future and did not have significant associations with total resilience. Number of depressive episodes, number of past suicide attempts correlated with resilience, emphasizing the importance of interventions to increase resilience in BD.

Sex difference in the progression of manic symptoms during acute hospitalization: A prospective pilot study.

OBJECTIVES: Acute mania is a serious medical condition that impacts men and women equally. Longtime presentation of manic symptoms is sex-dependent; however, little is known about acute symptoms of mania. The objective of this study is to track and compare acute manic symptoms for sex differences during inpatient hospitalization. METHODS: All patients with bipolar mania admitted to a large university hospital between January and October 2017 were invited to participate in this longitudinal naturalistic follow-up study. Manic (YMRS), depressive (MADRS), and psychotic (PAS) symptoms were tracked daily from admission to discharge. RESULTS: The total YMRS scores decreased significantly overtime (p < .0001) in both male (n = 34) and female (n = 23) patients (p = .7). However, male patients scored significantly higher in sexual interest (p = .01), disruptive and aggressive behavior (p = .01), and appearance (p < .001) while females had better insight into their illness (p = .01). Males and females received similar doses of lithium (p = .1), but males received significantly higher doses of valproic acid (VPA) in comparison with females (p = .003). However, plasma lithium and VPA concentrations at discharge were not significantly different between sexes. CONCLUSION: Our results show sex differences in the progression of certain domains of manic symptoms in a cohort of 23 female and 34 male patients admitted to a large academic center in Turkey. Males, in this sample, exhibited more sexual interest, disruptive and aggressive behaviors, better grooming, and less insight compared to females. While these results are concordant with our preclinical findings and with anecdotal clinical observations, replication in larger samples is needed.

The mediator role of ruminative thinking style in the relationship between dysfunctional attitudes and depression.

BACKGROUND: The main aim of the present study was to examine whether ruminative thinking styles (brooding and reflection) mediate the effects of dysfunctional attitudes on depressive symptoms. METHODS: 120 psychotropic drug-naive first episode depression patients recruited from Bulent Ecevit University School of Medicine psychiatry department and Zonguldak State Hospital psychiatry department outpatient clinics were involved in the study. Participants completed the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Beck Depression Inventory (BDI), Dysfunctional Attitude Scale (DAS) and Ruminative Responses Scale (RRS-short version). Regression analyses together with the Sobel tests were performed for testing the mediator hypothesis. RESULTS: According to the path model, the level of brooding fully mediated the relationship between dysfunctional attitudes and depressive symptomatology but reflection did not play a mediator role in the relationship between dysfunctional attitudes and depressive symptoms. CONCLUSIONS: Assessment of brooding with both mental status examination and specific measurements and focusing on brooding as an intervention strategy would be beneficial components for an effective treatment of depression.

Relationship of Internet addiction with cognitive style, personality, and depression in university students.

BACKGROUND: The aim of the study was to investigate the relationship of dysfunctional attitudes, self-esteem, personality, and depression with Internet addiction in university students. METHODS: A total of 720 university students participated in the study in Bülent Ecevit University English Preparatory School which offers intensive English courses. Students were evaluated with a sociodemographic data form, Beck Depression Inventory (BDI), Dysfunctional Attitudes Scale form A (DAS-A), Internet Addiction Scale (IAS), Rosenberg Self-Esteem Scale (RSES), and Eysenck Personality Questionnaire Revised/Abbreviated Form (EPQR-A). RESULTS: The results indicated that 52 (7.2%) of the students had Internet addiction. There were 37 (71.2%) men, 15 (28.8%) women in the addicted group. While the addicted groups' BDI, DAS-A perfectionistic attitude, need for approval, RSES, EPQR-A neuroticism, and psychoticism scores were significantly higher, EPQR-A lie scores were significantly lower than those of the non addicted group. According to the multiple binary logistic regression analysis, being male, duration of Internet usage, depression, and perfectionistic attitude have been found as predictors for Internet addiction. It has been found that perfectionistic attitude is a predictor for Internet addiction even when depression, sex, duration of Internet were controlled. CONCLUSIONS: To the knowledge of the researchers, this study is the first study to show the dysfunctional attitudes in Internet addiction. It can be important to evaluate dysfunctional attitudes, personality, self-esteem and depression in people with Internet addiction. These variables should be targeted for effective treatment of people with Internet addiction in cognitive behavioral therapy.

Depression, loneliness, anger behaviours and interpersonal relationship styles in male patients admitted to internet addiction outpatient clinic in Turkey.

BACKGROUND: 'Internet addiction' is excessive computer use that interferes with daily life of a person. We designed this study in order to evaluate the predictor effect of depression, loneliness, anger and interpersonal relationship styles for internet addiction as well as develop a model. SUBJECTS AND METHODS: Forty (40) male internet addicted patients were selected from our hospital's internet Addiction Outpatient Clinic. During the study, the Internet Addiction Test (IAT), the Beck Depression Inventory (BDI), the State Trait Anger Expression Scale (STAXI), the UCLA-Loneliness Scale (UCLA-LS), and the Interpersonal Relationship Styles Scale (IRSS) were used for the evaluation of the patients. RESULTS: The results of this study showed that the 'duration of internet use' (B=2.353, p=0.01) and STAXI 'anger in' subscale (B=1.487, p=0.01) were the predictors of internet addiction. CONCLUSION: When the clinicians suspect for the internet overuse, regulation of internet usage might be helpful. Psychiatric treatments for expressing anger and therapies that focus on validation of the feelings may be useful.

Attachment and family functioning in patients with internet addiction.

OBJECTIVE: Although the Internet is used effectively in many areas of life, some users experience problems because of over-use due to a lack of control. The diagnostic criteria for Internet addiction include disruptions in family relationships, but adequate data on the attachment styles and family functioning associated with this condition are limited. This study aimed to investigate the attachment styles and family functioning of patients with Internet addiction. METHOD: The sample included 30 male patients consecutively admitted to the Bakirköy Mental Health and Research Hospital Internet Addiction Outpatient Clinic, who were diagnosed in clinical interviews as having Internet addiction according to Young's (1998) criteria. Thirty healthy males who were matched with the experimental group in terms of sociodemographic characteristics were included as control subjects. Both groups provided sociodemographic data and completed the Beck Depression Inventory (BDI), the Experiences in Close Relationships Questionnaire-r (ECR-r) and the Family Assessment Device (FAD). RESULTS: Patients with Internet addiction had higher BDI scores (P<.001) and higher attachment anxiety subscores on ECR-r (P<.001) compared with those in the control group. Patients with Internet addiction evaluated their family functioning as more negative and reported problems in every aspect addressed by the FAD. Scores on the FAD behaviour control, affective responsiveness, and problem-solving subscales (P<.05) and on the FAD communication, roles, and general functioning subscales (P<.001) were significantly higher in the patient compared with the control group. CONCLUSION: Patients with Internet addiction have more anxious attachment styles as well as prominent disruptions in family functioning. Thus, it may be important to evaluate the attachment styles and family functioning of patients with Internet addiction. Indeed, comprehensive treatment approaches including other family members may make important contributions to treatment success.

Two Cases of Excessive Internet Use with Comorbid Family Relationship Problems.

Although the internet is used effectively and beneficially in every aspect of life, several users have been experiencing some problems due to excessive and uncontrolled use. While the term "internet addiction" still remains controversial, disturbed family relationships are considered to be a diagnostic criterion. The use of the internet, even in non-excessive levels, is associated with disturbance in family and social life. As considering from systemic point of view; while family relationships may be disturbed with internet addiction, people who have problems with their family relationships also may use internet excessively. This case report is composed of both the cases with excessive internet usage and those who had problems in complying with the changes in their family systems following the decrease in duration of internet usage during the treatment process.