Exploring the "Insight Paradox" in Treatment-Resistant Schizophrenia: Correlations Between Dimensions of Insight and Depressive Symptoms in Patients Receiving Clozapine.

Objective: There remains a lack of clarity as to the possible cross talk of insight into illness and depressive symptoms in treatment-resistant schizophrenia. We therefore set our primary aim to evaluate relationship between insight dimensions and depressive symptoms in patients with treatment-resistant schizophrenia receiving clozapine. Methods: This was a cross-sectional, non-interventional study, conducted in daily clinical practice conditions. Patients in outpatient clinics between March 2020 and May 2020 with treatment-resistant schizophrenia (based on Treatment Response and Resistance in Psychosis), with no comorbid psychiatric disorder, and with no body mass index greater than 40.0 kg/m2 were included. We collected sociodemographic variables, scores of insight dimensions (treatment compliance, illness recognition, and symptom relabeling with the Schedule for Assessment of Insight), and depressive symptoms with Calgary Depression Score for Schizophrenia. Linear regression models were used to investigate variables associated with depressive symptoms as the outcome of interest. Results: The final analysis sample comprised 55 patients with treatment-resistant schizophrenia, with a mean age of 42.48 (SD = 9.18) years and a predominance of the male sex (n = 42, 76.9%). Model 1 [Calgary Depression Score for Schizophrenia ~ (Schedule for Assessment of Insight + Positive and Negative Syndrome Scale)] displayed that 48% of the variation in the Calgary Depression Score for Schizophrenia can be explained by Schedule for Assessment of Insight-composite and Positive and Negative Syndrome Scale-composite (P < .001). More effectively, model 2 [Calgary Depression Score for Schizophrenia ~ (Schedule for Assessment of Insight-illness recognition + Positive and Negative Syndrome Scale-general psychopathology)] revealed that 51% of the variation in the Calgary Depression Score for Schizophrenia can be explained by the sub-scales (P < .001). We further designed a new model in which Global Assessment of Functioning scores were the response variable to explore the link between awareness into illness and functionality (Global Assessment of Functioning ~ Schedule for Assessment of Insight-illness recognition). In this model, awareness of illness did not explain a significant proportion of variance in functionality scores (R 2 = 0.045, F(1,52) = 2.48, P = 0.121). Conclusion: The treatment compliance part of insight was not one of the significant explanatory variables of depressive symptoms, but it explained the variance in functioning, in contrast to the illness recognition dimension of insight. If our findings were replicated in treatment-resistant schizophrenia, they would suggest that promoting treatment compliance dimension of insight instead of recognition of illness could not increase depressive symptoms.

Bupropion Use Disorder by Chewing.

INTRODUCTION: Bupropion is a widely used antidepressant that plays an essential role in treating mental disorders. Due to its structural similarities with psychostimulants, bupropion is suggested to have addictive potential. Several case reports have been published addressing its misuse in recent years, mainly through nasal insufflation and intravenous administration. Most of the reported cases cited a history of substance use disorder. METHODS: Written informed consent was obtained from the patient to write this case report. CASE PRESENTATION: We present a case with alcohol use disorder and attention deficit hyperactivity disorder, who developed a substance use disorder to bupropion while chewing it in doses up to 2250 mg, in an attempt to get "high" with no history of seizures. DISCUSSION: Our case suggests that bupropion can also be misused by chewing even at high doses and that it can lead to a substance use disorder. Its use in various indications in treating mental disorders and its over-the-counter accessibility, along with a lower risk of stigmatization, could increase the prevalence of bupropion misuse. It is essential to know the medical consequences of bupropion misuse as there is increasing data on its addictive potential. More information is needed to clarify the impact of the route of administration on drug metabolism and adverse effects.

The Silent Cry of Healthcare Workers: A Cross-Sectional Study on Levels and Determinants of Burnout among Healthcare Workers after First Year of the Pandemic in Turkey.

Background: Although the acute phase of the pandemic is over, healthcare workers continue to face challenges. The aim of this study was to determine burnout levels and possible related psychological processes such as psychological flexibility, moral injury, and values among healthcare workers after the first year of coronavirus disease 2019 (COVID-19) pandemic. Methods: A cross-sectional study was performed using an online survey distributed through social networks. A sample of 124 front line healthcare workers working during the pandemic, between January and April 2021, were included in the study. Multiple linear regression was used to identify predictors of all 3 burnout dimensions (emotional exhaustion, depersonalization, and lack of personal accomplishment). Results: While 51.6% of healthcare workers experienced high levels of emotional exhaustion, 75.8% of them were found to have experienced high levels of lack of personal accomplishment. On the contrary, 81.5% of the participants reported low levels of depersonalization. Emotional exhaustion was predicted by total Depression Anxiety Stress Scale score (P = .004) and total Moral Injury Events Scale score was the only predictor of depersonalization (P = .051). Predictors of lack of personal accomplishment were the number of days worked in COVID-19 (P = .001), total Moral Injury Events Scale (P=0.004), Valuing Questionnaire (VQ)-Obstruction (P = .009), and total Depression Anxiety Stress Scale score (P = .002). On the other hand, psychological flexibility did not predict any sub-dimension of burnout. Conclusion: Healthcare workers had high levels of burnout after 1 year with the pandemic. Our findings highlight the importance of factors such as moral injury, values, and emotional distress which need to be taken into consideration to develop future interventions to treat and prevent burnout in healthcare workers.

Burned out and Avoided: Stigmatizing Processes among Psychiarists.

BACKGROUND: The stigma of mental illness has been reported as a serious barrier in lives of people with mental illness. Besides blocking admission to mental health services, it was found associated with terminating appropriate treatment. As well as relatives, neighbours or friends, it is shown that patients face stigma from psychiatrists. The aim of this study is to evaluate stigmatizing attitudes of psychiatrists and to find out its relationship with burnout and psychological flexibility. SUBJECTS AND METHODS: 256 psychiatrists all along Turkey were participated and age, gender, duration that spent as a clinician and psychotherapy training have been recorded. Acceptance and Action Questionnaire-II, Maslach Burnout Inventory and Mental Illness: Clinicians' Attitudes (MICA) Scale were used to evaluate participants' psychological flexibility, burnout level and stigmatizing attitudes respectively. Structural Equation Modelling (SEM) was used to assess direct and indirect influences on stigma. RESULTS: There were statistically significant differences between residents and senior psychiatrists in all three scales. Psychotherapy training was found significantly associated with lower levels of stigma. Stigma was found to be predicted by duration, age, and burnout levels. In SEM analyses psychological flexibility was found to predict stigma indirectly via burnout. CONCLUSION: Increasing contact with the stigmatized and education are two widely used methods against stigma. In years their effects were found limited and temporary. Burnout in clinicians is an important parameter in many aspects as well as its relation with stigma. There are limited data to decrease burnout in psychiatrists. There are some evidence that shows Acceptance and Commitment Therapy is effective to decrease burnout and stigma in clinicians. In the means of additional ways when dealing with stigma, Acceptance and Commitment Therapy can be a powerful tool while it targets to increase psychological flexibility.

Reliability and Validity Study of the Turkish Version of Bipolar Spectrum Diagnostic Scale. / Bipolar Spektrumu Tani Ölçegi Türkçe Formu’nun Güvenilirlik ve Geçerlilik Çalismasi.

OBJECTIVE: The purpose of this study is to evaluate the reliability and validity of the Turkish Version of the Bipolar Spectrum Diagnostic Scale (BSDS). METHOD: The study was carried out with 130 patients diagnosed with bipolar I disorder, 15 patients diagnosed with bipolar II disorder, and 38 patients diagnosed with major depressive disorder attending the outpatient psychiatry departments of the Bakirköy Prof. Dr. Mazhar Osman Training and Research Hospital for Mental Health and Neurological Diseases. The Mood Disorder Questionnaire (MDQ) was used for convergent validity. The internal consistency coefficient, itemtotal score correlation coefficients, test-retest correlation coefficient, confirmatory factor analysis, correlation with concurrent scale, and ROC curve were statistically calculated. RESULTS: Confirmatory factor analysis indicated that the 20-item version did not show adequate goodness-of-fit. The item 4 with a relatively low regression weight was removed from the model. For the 19-item revised and corrected model, the observed goodness-of-fit indexes were RMSEA = 0.040, CFI = 0.900, GFI = 0.890, IFI = 0.900 and χ2/df = 1.230. The internal consistency Cronbach's alpha coefficient was 0.831. The correlation coefficient between the Turkish version of the BSDS and the MDQ was 0.54. The cutoff point of the scale calculated by the ROC analysis was 12 with a sensitivity of 78.6% and a specificity of 86.8%. CONCLUSION: The Turkish Version of the BSDS, has been shown to be reliable and valid tool for screening bipolar disorder after removal of the item 4 of the original version of the scale.

Experiential avoidance, empathy, and anger-related attitudesin antisocial personality disorder.

BACKGROUND/AIM: In prevailing opinion, a strong relation exists between lack of empathy and antisocial personality disorder (ASPD). However, recent data fail to wholly clarify this relation, especially in consideration of empathy dimensions. In this study our aim was to address ASPD and social functionality from a contextual behavioral science viewpoint. MATERIALS AND METHODS: The present study was conducted with a sample of 34 individuals with ASPD and 32 healthy individuals as the control group. The participants were assessed with a sociodemographic form, Structured Clinical Interviews for DSM I and II (SCID-I and SCID-II), Social Functioning Scale (SFS), Acceptance and Action Questionnaire-II for measuring experiential avoidance, Interpersonal Reactivity Index for measuring empathy dimensions, and the State-Trait Anger Scale for anger-related attitudes. RESULTS: Experiential avoidance, dysfunctional anger regulation patterns, and lack of perspective-taking levels were higher in the ASPD group than in the control group. Experiential avoidance and perspective-taking processes were related with social functioning in ASPD. CONCLUSION: These findings may provide initial data for understanding ASPD clinical features and related social interaction problems. Further relations between scales and social functionality also analyzed and discussed.

Metacognitive and Meta-Emotional Styles in Patients With Alcohol and the Other Substance Dependence.

BACKGROUND: Both alcohol and other substances are utilized for emotional and cognitive regulation. OBJECTIVES: The purpose of the present study was to compare metacognitive styles and distress intolerance in patients with alcohol and other substance dependence. PATIENTS AND METHODS: According to DSM-IV TR criteria, 45 patients with alcohol dependence (AD), 44 patients with substance dependence (SD), and 43 volunteers without AD or SD (control group) were enrolled. Socio-demographic information form, Distress Tolerance Scale (DTS), and metacognitive questionaire-30 (MCQ-30) were used to evaluate the participants. RESULTS: Patients with AD had significantly lower "tolerance" subscale and total DTS scores than those with SD and control group (P = 0.008 for SD sample and P = 0.004 for control group). Patients with SD had significantly higher scores in "appraisal" subscale DTS than control group (P = 0.005). Patients of both AD and SD groups had significantly higher scores in "positive beliefs" subscale of MCQ-30 than control group (P = 0.012 for AD group and P = 0. 001 for SD group). There was no significant difference between AD and SD groups in any MCQ-30 subscale and total scores (P = 0.440). CONCLUSIONS: Metacognitive regulation strategies are more considerable prediction than emotional regulation strategies in SD group than in AD group. Individuals with AD use alcohol as a means of both cognitive and emotional regulation strategy.