Functional Somatic Symptoms and Their Predictors in Patients with Major Depressive Disorder and Fibromyalgia Syndrome.

Introduction: Despite being different medical conditions, functional somatic symptoms (FSSs) are common in patients with major depressive disorder (MDD) and fibromyalgia syndrome (FMS). Higher levels of depression, anxiety, somatosensory amplification, hypochondriacal worry and alexithymia may be related to the severity of somatization in patients with MDD and FMS. We aimed to investigate the typology and severity of FSSs and the association between FSSs and these psychiatric symptoms in patients with MDD and FMS. Method: 56 MDD, 33 FMS, 21 CoMF (Comorbidity of MDD and FMS) patients, and 50 healthy participants were included in the study, respectively. Diagnosis of MDD and FMS was established according to DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Revised Text), and ACR (American College of Rheumatology) 2010 diagnostic criteria. All participants were evaluated with self-report questionnaires including Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Somatosensory Amplification Scale (SSAS), Toronto Alexithymia Scale-20 (TAS-20), Whiteley Index-7 (WI-7), The Symptom Checklist-90-R (SCL-90-R) somatization subscale and Bradford Somatic Inventory-44 (BSI-44). Results: The severity of somatization was statistically significantly highest in the CoMF group, and similar in the FMS and MDD groups, and lowest in the control group according to the BSI-44 and SCL-90-R results. The typology of FSSs was quite similar in patients with MDD and FMS, and weakness, tiredness and neck pain were the most common FSSs in both groups. Independent predictors of FSSs were age, the severity of anxiety and alexithymia in the MDD group, however, it was only the severity of anxiety in the FMS group. Conclusions: Our results show that the typology and severity of FSSs are similar in MDD and FMS patients. Moreover, somatization appears to be more associated with anxiety in patients with MDD and FMS.

Impact of expectant mother's knowledge level about fetal anomaly scan on their state anxiety prior to antenatal ultrasound screening.

OBJECTIVE: We aimed to investigate the role of expectant mothers' background antenatal ultrasound knowledge on their state anxiety when they apply for the ultrasound examination. MATERIALS AND METHODS: A cross-sectional study was conducted in perinatology outpatient clinic of a university hospital. Expectant mothers who applied for the first trimester ultrasound scan and second trimester anomaly scan were recruited to the study. A self-report form was applied to participants to assess the sociodemographic characteristics, obstetric history, knowledge and attitudes toward antenatal ultrasound. Expectant mothers' state anxiety prior to ultrasound scan was measured with the state sub-scale of State-Trait Anxiety Inventory. RESULTS: A total of 500 expectant mothers (220 in the first trimester and 280 in the second trimester) were included to the study. We found a negative correlation between the participants' age and state anxiety level (r = -0.118, p < .01). Also, participants' education level had a significant effect on their state anxiety level (F (2, 497)=5.91, p < .01). Participant's age significantly predicted lower state anxiety level (ß = -0.10, t = -2.09, p < .05). We did not find any significant relationship between the mean knowledge level of mothers and state anxiety levels of mothers (r = -0.07, p > .05). CONCLUSION: Age was the only affecting factor on anxiety levels before ultrasound scan in pregnant participants. There was no significant effect of background knowledge on state anxiety.

Evaluation of depression, anxiety and quality of life in hepatitis C patients who treated with direct acting antiviral agents.

BACKGROUND/AIMS: Hepatitis C virus (HCV) infection is known to impair the quality of life (QoL). Increased levels of anxiety and depression have been found in HCV infection with a prevalence of 28% and 33%, respectively. Our aim was to investigate depression, anxiety, and QoL of chronic hepatitis C (CHC) patients before and after treatment with a direct-acting antiviral agent (DAAA). MATERIALS AND METHODS: In this study, enrolled CHC patients who had undergone DAAA treatment in our out-patient clinic. We administered the Hospital Anxiety and Depression (HAD) questionnaire to measure the severity of the anxiety and depression symptoms and the Short Form-36 (SF-36) questionnaire to measure the QoL at the beginning and at the end of the treatment. RESULTS: Pretreatment anxiety and depression scores showed a statistically significant difference from the post treatment scores (p=0.000 and p=0.029 respectively). When we compared the SF-36 subitems before and after the treatment, a statistical significance was found in physical functioning (p=0.026), physical role limitation (p=0.009), bodily pain (p=0.011), general health (p=0.017), social functioning (p=0.006), and emotional role limitation (p=0.007). Also, an improvement was seen in the vitality (p=0.488) and mental health (p=0.714), which was not statistically significant. CONCLUSION: Depression got minimally worse in the male group despite an improvement in CHC. Anxiety scores were improved with treatment in the cirrhotic and non-cirrhotic groups significantly. A decrease in anticipatory anxiety may be related to the high treatment success with DAAA. Nearly all the subitems of the QoL scores were improved after treatment and these were more common in the female group. Elimination of HCV may itself decrease the number of patients who need psychiatric treatment.

Increased arterial stiffness parameters in panic disorder patients in long term treatment period.

BACKGROUND: The relationship between mental stress and cardiovascular disease has been shown in several studies. Panic disorder (PD) is also associated with cardiovascular disease due to increased risk of myocardial infarction. The aim of this study is to evaluate the association between arterial stiffness parameters and depression/anxiety scores in patients with PD. METHODS: The study population consisted of 25 patients with PD and 25 age-sex-matched healthy controls. Depression and anxiety levels were evaluated by Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI), respectively. Determination of arterial stiffness parameters was conducted using a Mobil-O-Graph arteriograph system that detected signals from the brachial artery. RESULTS: While baseline characteristics were similar between two groups, BDI and BAI scores were significantly higher in patients with PD (p < 0.005). The pulse wave velocity (PWV) and Augmentation Index (AIx) were also significantly higher in patients with PD (p = 0.001, p = 0.006). There was a moderate correlation between PWV and AIx with BAI scores (r = 0.442, p = 0.001, r = 0.441, p = 0.001). AIx was also positively correlated with BDI scores (r = 0.415, p = 0.03). CONCLUSION: We demonstrated a significant relationship between arterial stiffness parameters and anxiety/depression scores in patients with PD who receive antidepressant treatment.

Increased Neutrophil/Lymphocyte Ratio in Patients with Depression is Correlated with the Severity of Depression and Cardiovascular Risk Factors.

OBJECTIVE: Chronic inflammation is associated with cardiovascular (CV) risk factors and psychiatric disorders. The neutrophil to lymphocyte ratio (NLR) has been investigated as a new biomarker for systemic inflammatory response. The aim of the study is to investigate the relation of NLR with severity of depression and CV risk factors. METHODS: The study population consisted of 256 patients with depressive disorder. Patients were evaluated with the Hamilton Rating Scale for Depression (HAM-D). Patients were classified into four groups according to their HAM-D score such as mild, moderate, severe, and very severe depression. Patients were also evaluated in terms of CV risk factors. RESULTS: Patients with higher HAM-D score had significantly higher NLR levels compared to patients with lower HAM-D score. Correlation analysis revealed that severity of depression was associated with NLR in depressive patients (r=0.333, p<0.001). Patients with one or more CV risk factors have significantly higher NLR levels. Correlation analysis revealed that CV risk factors were associated with NLR in depressive patients (r=0.132, p=0.034). In logistic regression analyses, NLR levels were an independent predictor of severe or very severe depression (odds ratio: 3.02, 95% confidence interval: 1.867-4.884, p<0.001). A NLR of 1.57 or higher predicted severe or very severe depression with a sensitivity of 61.4% and specificity of 61.2%. CONCLUSION: Higher HAM-D scores are associated with higher NLR levels in depressive patients. NLR more than 1.57 was an independent predictor of severe or very severe depression. A simple, cheap white blood cell count may give an idea about the severity of depression.

Neuroprotective effect of ebselen against intracerebroventricular streptozotocin-induced neuronal apoptosis and oxidative stress in rats.

The goal of this study was to examine the neuroprotective effect of ebselen against intracerebroventricular streptozotocin (ICV-STZ)-induced oxidative stress and neuronal apoptosis in rat brain. A total of 30 adult male Sprague-Dawley rats were randomly divided into 3 groups of 10 animals each: control, ICV-STZ, and ICV-STZ treated with ebselen. The ICV-STZ group rats were injected bilaterally with ICV-STZ (3 mg/kg) on days 1 and 3, and ebselen (10 mg/kg/day) was administered for 14 days starting from 1st day of ICV-STZ injection to day 14. Rats were killed at the end of the study and brain tissues were removed for biochemical and histopathological investigation. Our results demonstrated, for the first time, the neuroprotective effect of ebselen on Alzheimer's disease (AD) model in rats. Our present study, in ICV-STZ group, showed significant increase in tissue malondialdehyde levels and significant decrease in enzymatic antioxidants superoxide dismutase and glutathione peroxidase in the frontal cortex tissue. The histopathological studies in the brain of rats also supported that ebselen markedly reduced the ICV-STZ-induced histopathological changes and well preserved the normal histological architecture of the frontal cortex tissue. The number of apoptotic neurons was increased in frontal cortex tissue after ICV-STZ administration. Treatment of ebselen markedly reduced the number of degenerating apoptotic neurons. The study demonstrates the effectiveness of ebselen, as a powerful antioxidant, in preventing the oxidative damage and morphological changes caused by ICV-STZ in rats. Thus, ebselen may have a therapeutic value for the treatment of AD.

Clinical correlates of childhood trauma and dissociative phenomena in patients with severe psychiatric disorders.

In this present study, we aim to investigate the possibility of a link between psychotic disorders and traumatic experiences in a group of female patients diagnosed with psychotic disorders by comparing childhood trauma exposure with a group of non-psychotic psychiatric disorder attending the same pschiatric clinic. Secondary purpose of this study is to examine the clinical correlates of trauma exposure, dissociative phenomena and psychiatric symptomatology between these two group of patients. Two psychiatric sample groups, those with psychotic disorders-mostly schizophrenic-(n = 54), and those with a non-psychotic severe psychiatric disorders (n = 24), were recruited. Data were collected for demographic, psychiatric and trauma histories and psychiatric symptomatology for all patients. In this study, high prevalance rates of childhood traumatic experiences and dissociative phenomena were found in both groups. Total scores of childhood trauma questionnaire in favor of the non-psychotic group were found to be close to significance (p = 0.052). DES scores of non-psychotic group were also higher although not statistically significant. 54.2 % of nonpsychotic cases had DES scores >20 on the other hand, that percentage of psychotic cases were found to be as 38.9 %. Furthermore, psychiatric patients who have suffered childhood traumatic experiences are far more likely to try to kill themselves than psychiatric patients who have not experienced such abuse. The high rates of childhood traumatic events in our present samples of both schizophrenia-spectrum patients and nonpsychotic patients confirm the need for clinicans to take trauma histories routinely.

An outpatient clinical study of dissociative disorder not otherwise specified.

The relatively high prevalence of the diagnosis of dissociative disorder not otherwise specified is frequently considered to be disproportionate. The disproportionate rate of this diagnosis is thought to be related to nosologic and/or diagnostic issues in dissociative identity disorder. We sought to investigate and compare the symptom patterns of these two clinical entities. We conducted a cross-sectional study involving 1314 participants who were screened with the Dissociative Experience Scale (DES) and the Somatoform Dissociation Questionnaire (SDQ). Of the participants, 272 who scored above the cut-off points for the screening questionnaires (DES score>30 and/or SDQ score>40 points) were invited to complete a structured interview using the Dissociative Disorders Interview Schedule (DDIS); of this subsample, only 190 participants agreed to participate in the second phase of the study. The mean score for the DES was 18.55±17.23, and the mean score for the SDQ was 30.19±13.32. Of the 190 participants, 167 patients were diagnosed as having a dissociative disorder (87.8%). We found that DD-NOS was the most prevalent category of dissociative disorder. There was a significantly larger percentage of patients in the DID group than in the DD-NOS group according to secondary features of DID and Schneiderian symptoms. The secondary features of DID and Schneiderian symptoms appeared to be more specific for DID, while no differences were detected between DID and DD-NOS based on most of the items on the SCL 90R. Further longitudinal studies are needed to determine the features that are similar and dissimilar between DD-NOS and DID.

Low plasma adiponectin levels in panic disorder.

BACKGROUND: The present study was performed to evaluate plasma adiponectin levels in the patients with PD. METHOD: The study group included a total of 28 patients (17 females, 11 males) and 23 age- and sex-matched healthy comparison subjects (10 females and 13 males). The plasma fasting glucose, total cholesterol, triglyceride, low density lipoprotein (LDL), high density lipoprotein (HDL), and hemoglobin were measured. RESULTS: There were no differences in regard to plasma fasting glucose, total cholesterol, triglyceride, LDL, HDL, and hemoglobin levels between groups. However, the mean adiponectin levels were significantly lower in the patient group (26.96 ± 9.92 ng/ml) compared to controls (37.63 ± 23.17 ng/ml) (t=-2.21; p=0.032). As for the ANCOVA analyses, it revealed the main effect of diagnosis on adiponectin levels (F=5.78, p=0.020) after BMI (body mass index) and gender as covariates. CONCLUSIONS: Consequently, the findings of our study suggest that there may be an interaction between panic disorder and plasma adiponectin. Moreover, they led us to consider that these patients should be also followed as cardiac problems.