The relationship between insight and the level of expressed emotion in patients with obsessive-compulsive disorder.

AIM: The aim of this study is firstly to compare the obsessive-compulsive disorder (OCD) patients with good insight and OCD patients with poor insight in terms of socio-demographic and clinical features; to investigate the relation between insight and the level of the expressed emotion (EE) in the patients; and lastly to specify the factors that predict level of insight. METHODS: OCD patients with good insight and patients with poor insight were compared in terms of clinical features and the perceived EE level of the patients and the individuals that they live with in order to specify the factors that predict the insight level, and to investigate the relationship between insight level and EE. RESULTS: It was found that the total Expressed Emotion Scale, total Level of Expressed Emotion (LEE), LEE-Emotional Response and LEE-Tolerance/Expectation subscale scores of the group comprised of patients with poor insight are higher than the other group. The results also show that the duration of illness and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score predict insight level. CONCLUSIONS: This study shows that the level of EE perceived by the patients with poor insight and the person that he/she lives with, is higher than the group with good insight. The studies that investigate the relationship between the factors of insight level and EE level, which are indicated to determine the level of the illness severity and its chronicity, will enable the researchers to understand the importance of the role of the family on the treatment processes of OCD.

Are there differences in oxidative stress and inflammatory processes between the autogenous and reactive subtypes of obsessive-compulsive disorder? A controlled cross-sectional study.

OBJECTIVE: To date, no study has investigated whether autogenous and reactive obsessive-compulsive disorder (OCD) types are different entities in terms of oxidative stress and inflammatory processes. The aim of this study is to compare them in terms of these features. METHODS: The study was conducted in subjects with reactive OCD (n=19), autogenous OCD (n=14), and a control group (n=17). All participants were non-smokers. Sociodemographic data were collected and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Obsessive Beliefs Questionnaire (OBQ), and Overvalued Ideas Scale (OVIS) were administered. High-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), paraoxonase (PON1), total oxidant status (TOS), and total antioxidant status (TAS) were measured. RESULTS: There were no significant differences in TAS, TOS, or oxidative stress index (OSI) between the OCD and control groups. PON1 and hs-CRP levels were higher in the OCD group, whereas IL-6 and IL-10 levels were lower. Comparison across the three groups revealed no differences in TAS, TOS, OSI, or PON1 levels; however, hs-CRP was significantly higher while IL-6 and IL-10 were significantly lower in the reactive group compared to controls. CONCLUSION: Our results show that, although inflammatory processes may play a role in OCD, the autogenous and reactive subtypes do not differ from each other in these respects. The classification of OCD into autogenous and reactive subtypes should be reevaluated.

Single nucleotide polymorphisms in 5-HT receptors in the etiology of premature ejaculation.

INTRODUCTION AND OBJECTIVES: Premature ejaculation (PE) is characterized by shorter intravaginal ejaculation latency time than it is acceptable for the patient or partner. It is thought that lifelong PE is a neurobiological dysfunction associated with genetic predisposition and with central serotonin neurotransmission dysfunction in receptors. To contribute to the understanding the genetic etiology of lifelong PE, it was planned to compare the 5-HT2C receptor gene rs3813929, rs518147, 5-HT1A receptor gene rs6295, 5-HT1B receptor gene rs11568817 of lifelong PE patients to healthy controls. MATERIALS AND METHODS: For this purpose, 100 patients with premature ejaculation and 100 healthy controls were included in the study. Blood samples for DNA extraction were obtained. Appropriate procedures were applied to the probes (rs3813929, rs518147, rs6295, rs11568817) suitable for the DNA studied. RESULTS: A statistically significant relationship was found between the rs11568817 polymorphism (p=0.019) in the 5-HT1B receptor gene and the rs518147 polymorphism (p=0.016) in the 5-HT2C receptor gene. Also, no statistically significant relationship was found between 5-HT1A receptor gene rs6295 polymorphism and 5-HT2C receptor gene rs3813929 polymorphism and lifelong PE. CONCLUSIONS: The relationship between rs3813929 and rs11568817 polymorphisms with lifelong PE was confirmed. Repeating the study in larger sample groups could be useful in determining the genetic etiology of PE.

Association of Nicotine Use Disorder with Neurexin 3 Gene Polymorphisms. / Nikotin Kullanim Bozuklugunun Neurexin 3 Gen Polimorfizmi ile Iliskisi.

OBJECTIVE: In this study, we aimed to investigate the Neurexin 3 gene (NRXN3) polymorphisms in the rs 221473, rs 221497, rs1004212 and rs11624704 regions in relation to nicotine use disorder (NUD) in the Turkish population. METHOD: Power analysis indicated that the NUD group and the control group of this study should each comprise 200 participants in the 18-65 year age range. The NUD group consisted of individuals without a psychiatric first axis disorder except for NUD, mental retardation, past head trauma or a neurological disorder, who had smoked minimally10 cigarettes per day for at least 1 year. The control group included individuals without a serious chronic physical illness, a previous psychiatric disorder or mental retardation and who responded "no" to the question "have you ever smoked?" A sociodemographic questionnaire and the Fageström nicotine dependence scale (FNDS) for the NUD group were utilized. Venous blood samples of all participants were taken into tubes containing EDTA (ethylene daimine tetra acetic acid) for DNA extraction. Duplex fluorescence melting curve analysis was used for genotype detection and differentiation. RESULTS: The individuals carrying the AC allele and the AG allele at the rs11624704 and the rs1004212 regions respectively had a high risk of being addicted to cigarettes. CONCLUSION: This is first study investigating the relationship of the NRXN3 gene and nicotine addiction in the Turkish population. It was observed that the risk of NUD in the Turkish population may be related to the Neurexin gene.

Association of Nicotine Use Disorder with Neurexin 3 Gene Polymorphisms. / Nikotin Kullanim Bozuklugunun Neurexin 3 Gen Polimorfizmi ile Iliskisi.

OBJECTIVE: In this study, we aimed to investigate the Neurexin 3 gene (NRXN3) polymorphisms in the rs 221473, rs 221497, rs1004212 and rs11624704 regions in relation to nicotine use disorder (NUD) in the Turkish population. METHOD: Power analysis indicated that the NUD group and the control group of this study should each comprise 200 participants in the 18-65 year age range. The NUD group consisted of individuals without a psychiatric first axis disorder except for NUD, mental retardation, past head trauma or a neurological disorder, who had smoked minimally10 cigarettes per day for at least 1 year. The control group included individuals without a serious chronic physical illness, a previous psychiatric disorder or mental retardation and who responded "no" to the question "have you ever smoked?" A sociodemographic questionnaire and the Fageström nicotine dependence scale (FNDS) for the NUD group were utilized. Venous blood samples of all participants were taken into tubes containing EDTA (ethylene daimine tetra acetic acid) for DNA extraction. Duplex fluorescence melting curve analysis was used for genotype detection and differentiation. RESULTS: The individuals carrying the AC allele and the AG allele at the rs11624704 and the rs1004212 regions respectively had a high risk of being addicted to cigarettes. CONCLUSION: This is first study investigating the relationship of the NRXN3 gene and nicotine addiction in the Turkish population. It was observed that the risk of NUD in the Turkish population may be related to the Neurexin gene.

Inflammation and Oxidative Stress in Deficit Schizophrenia.

INTRODUCTION: Differences in parameters related to inflammatory and oxidative stress in deficit (DS) and nondeficit schizophrenia (non-DS) may support the DS/non-DS categorization of schizophrenia. For DS patients, non-DS patients, and for healthy controls, this study aims to evaluate the serum levels of: proinflammatory cytokines of interleukin (IL) 1ß, tumor necrosis factor (TNF) α, Interferon (IFN) γ, IL-12, and IL-17; anti-inflammatory cytokines of IL-10, IFN-α, and transforming growth factor (TGF) ß; and antioxidant biomarkers of paraoxonase1 (PON1) and Total Antioxidant Capacity (TAOC). METHOD: Serum IL-1ß, TNF-α, IFN-γ, IL-12, IL-17, IL-10, IFN-α, TGF-ß, PON1 and TAOC levels were measured and performed in DS (n=26), non-DS (n=28), and healthy control (n=28) groups. RESULTS: Patients in the DS group had higher IL-17 levels than the non-DS group did. TGF-ß values for both patient groups were significantly higher than those of the controls. PON1 and TAOC values for both patient groups were significantly lower than those of the controls. CONCLUSION: Our findings may be evidence for the consideration that DS reflects a coherent entity within schizophrenia. Increased levels of IL-17 from pro-inflammatory cytokines may be related with DS.

[Comparison of patients with schizophrenia, obsessive-compulsive disorder, and schizophrenia with accompanying obsessive-compulsive symptoms]. / Obsesif kompulsif belirtileri olan sizofreni hastalarinin sizofreni ve obsesif kompulsif bozukluk hastalari ile karsilastirilmasi.

OBJECTIVE: The present study aimed to determine if schizophrenic patients with OC-symptoms represent a subtype of schizophrenia and to evaluate the differences between schizophrenic patients with OC symptoms and OCD patients. METHODS: The study included 20 patients diagnosed with OCD, 40 schizophrenic patients, and 20 schizophrenic patients with OC symptoms. While the distribution and the severity of psychotic symptoms in the OC-schizophrenia group were compared to those of the schizophrenic patients, and while the distribution and severity of obsessive-compulsive symptoms of the OC-schizophrenia group were compared to OCD patients, all 3 groups were compared to each other in terms of demographic data and other clinical characteristics. RESULTS: There were no differences in the distribution and severity of psychotic symptoms between the OC-schizophrenia group and the schizophrenia group. Moreover, the distribution and severity of OC symptoms in the OC-schizophrenia group were no different than those in the OCD group. Brief Disability Questionnaire scores were significantly higher in the OC-schizophrenia group than in the other 2 groups. Hamilton Depression Scale and Hamilton Anxiety Scale mean scores were significantly higher in the OCD and OC-schizophrenia groups than in the schizophrenia group. Moreover, Yale-Brown Obsessive-Compulsive Scale total scores were not correlated to the Scale for the Assessment of Negative Symptoms or the Scale for the Assessment of Positive Symptoms scores in the OC-schizophrenia group. CONCLUSION: According to our results OC-schizophrenia might be a sub-type of schizophrenia, which doesn't have more severe psychotic symptoms, but more severe depression and anxiety, which are related to greater disability.

[The Effect of Chronic Cigarette Use on Cognitive Function]. / Kronik Sigara Kullaniminin Bilissel Islevler Üzerine Etkisi.

OBJECTIVE: In this study, we aimed to investigate the effect of chronic cigarette smoking on the cognitive function in people who have no other mental or physical illness other than tobacco use disorder. METHOD: The study was carried out on three groups: smokers (n = 71), former smokers (n = 39), and non-smokers (n = 49). The Wisconsin Card Sorting Test (WCST), Stroop Color and Word Test (ST), Trail Making Test (TMT), Auditory Verbal Learning Test (AVLT), and Serial Digit Learning Test (SDLT) were applied to the 3 groups participating in the study. Groups were compared with the Three-Factor Covariance Analysis. RESULTS: Stroop test 4th card time score which determined the basic level of color discourse in the smoker group was significantly higher than the non-smoker group. The Trail Making Test-B time scores were significantly higher in the smoker group than the non-smoker group. And Trail Making Test-B time points were significantly higher in the former smoker group than nonsmoker group. Auditory Verbal Learning Test - verbal learning scores were lower in the smoker group than the non-smoker and former smoker group. There was no significant difference in verbal learning scores between the non-smoking and former smoker groups. The neurocognitive deficits in smokers appear to be related to dose and duration. CONCLUSION: This study suggests that auditory verbal memory, visualspatial processing, and attention areas may be a selective area of disability in smokers. A major limitation is the fact that general cognitive performance levels of participants was not assessed by a general criteria such as Wechsler Adult Intelligence Scale (WAIS).

Theory of Mind and Selective Attention, Response Inhibition, Cognitive Flexibility in Patients with Schizophrenia.

INTRODUCTION: The aims of the current study are to investigate the relationship between selective attention, response inhibition, and cognitive flexibility that are among executive functions and sociocognitive and socioperceptual theory of mind (ToM) functions and also to investigate whether selective attention, response inhibition, and cognitive flexibility are predictive factors for ToM functions in patients with schizophrenia. METHODS: Forty-seven patients diagnosed with schizophrenia and a control group consisting of 42 individuals were administered demographic information form, Wisconsin card sorting test (WCST), Stroop test, Eye test, Hinting test. Positive and negative syndrome scale was applied to the schizophrenia group. RESULTS: In comparison to the control group, the schizophrenia group performed significantly worse on Eyes test and Hinting test. Eyes Test score and age, WCST perseverative error scores were significantly negatively correlated; education and WCST categories achieved scores were significantly positively correlated in patients with schizophrenia. Age and cognitive flexibility were found to predict the Eyes test score in patients with schizophrenia. CONCLUSIONS: ToM functions that are important in maintaining socioperceptual functioning are closely related with cognitive flexibility, and impairment in cognitive flexibility may predict the ToM functions in patients with schizophrenia.

Anxiety, depression and coping behaviors with pain in cancer patients who are aware or unaware of their cancer.

OBJECTIVES: This study aimed to investigate whether there are differences in depression, anxiety, pain and styles of coping with pain between cancer patients with and without awareness of their cancer diagnosis. METHODS: In this study, 30 cancer patients aware of their diagnosis and 30 cancer patients unaware of their diagnosis, all of whom visited a clinic for pain treatment, were enrolled in this study. A sociodemographic information form, a questionnaire comprising questions about pain severity and related variables, Hospital Anxiety Depression Scale, and the Pain Coping Questionnaire were administered to the patients. RESULTS: No significant association was observed between the patients with awareness or unawareness of cancer with respect to anxiety, depression, pain severity, or coping with pain. Pain intensity was significantly associated with depression in both the patient groups. CONCLUSION: The study enrolled patients who were admitted for pain treatment, and the sampling group was small. However, this is the first study to investigate the effects of the awareness of cancer diagnosis on pain and its management.

Are there differences in oxidative stress and inflammatory processes between the autogenous and reactive subtypes of obsessive-compulsive disorder? A controlled cross-sectional study

Objective: To date, no study has investigated whether autogenous and reactive obsessive-compulsive disorder (OCD) types are different entities in terms of oxidative stress and inflammatory processes. The aim of this study is to compare them in terms of these features. Methods: The study was conducted in subjects with reactive OCD (n=19), autogenous OCD (n=14), and a control group (n=17). All participants were non-smokers. Sociodemographic data were collected and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Obsessive Beliefs Questionnaire (OBQ), and Overvalued Ideas Scale (OVIS) were administered. High-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), interleukin-10 (IL-10), paraoxonase (PON1), total oxidant status (TOS), and total antioxidant status (TAS) were measured. Results: There were no significant differences in TAS, TOS, or oxidative stress index (OSI) between the OCD and control groups. PON1 and hs-CRP levels were higher in the OCD group, whereas IL-6 and IL-10 levels were lower. Comparison across the three groups revealed no differences in TAS, TOS, OSI, or PON1 levels; however, hs-CRP was significantly higher while IL-6 and IL-10 were significantly lower in the reactive group compared to controls. Conclusion: Our results show that, although inflammatory processes may play a role in OCD, the autogenous and reactive subtypes do not differ from each other in these respects. The classification of OCD into autogenous and reactive subtypes should be reevaluated.

[Pain and pain behavior]. / Agri ve agri davranisi.

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Behavioral manifestation of pain, distress, and suffering have been characterized as pain behaviors. Pain behavior is the way individuals think, feel, and act in relation to their pain status. Pain behaviors are either adaptive or pathological, as when the pain behavior is disproportionate to the objective pathology. It's reported that when pain behavior exists in patients with pain, a psychiatric disorder might to increase pain. The relation between psychological factors and pain behavior is investigated in several studies.

Prevalence of Substance Use in Patients Diagnosed with Schizophrenia.

INTRODUCTION: Substance abuse among schizophrenic patients is a growing clinical concern. Substance use disorders and their effects on the course of schizophrenia have made the identification and treatment of schizophrenic patients a high priority. This study aimed to investigate the prevalence of substance use, preferred types of substances, sociodemographic characteristics and clinical features of schizophrenia, and substance use impact in schizophrenic patients. METHODS: Hundred patients who were consecutively admitted to the psychiatry clinic and were diagnosed with schizophrenia according to the DSM-IV criteria were enrolled in this study. Individual interviews were conducted during the patients. In order to evaluate substance abuse disorder (SAD) as per DSM-IV criteria, the substance use disorder section of the structured clinical interview for DSM disorders-II (SCID-II) form was used. In addition, the following were applied to schizophren-ic patients: sociodemographic data form, medical history form, Brief Disability Questionnaire (BDQ), UKU Side Effect Rating Scale (UKUSERS), Insight Rating Scale (IRS), Alcohol Use Dis-orders Identification Test (AUDIT), Fagerstrom Nicotine Dependence Test (FNDT), Global As-sessment of Functioning Scale (GAF), Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), and Calgary Depression Scale (CDS). RESULTS: Schizophrenia and alcohol and drug use were more common in males, and younger age was found to have no association with substance use. Unemployment, low education levels, rural survival rates, age at disease onset, the doctor first age of the applicant, the first inpatient years, legal issues, harm caused by others and suicidal behavior, SAPS, SANS, CDS received from their scores significant difference was detected. Schizophrenic patients with substance use had higher side effects of drugs, disability, and psychopathology scores than schizophrenic patients without substance use. The functioning of schizophrenic patients with substance use was worse, and the total length of stay was longer. Nicotine, alcohol, biperiden, cannabis, and volatile substances were the preferred materials most commonly used by schizophrenic patients. CONCLUSION: In our country, limited research has been conducted on the prevalence of substance use in schizophrenic patients. Therefore, we believe that this study will contribute to the literature on the subject. More sample groups and first-episode patients as well as follow-up studies will contribute to a better understanding of the effect of substance use on the clinical course of schizophrenia.

Evaluation of Changes in Anxiety and Depression Symptoms, and Sexual Functions in Patients Receiving Antidepressants: 3 Months-Long Naturalistic Follow-Up Study. / Antidepresan Ilaç Tedavisi Baslanan Hastalarda Anksiyete ve Depresyon Belirtileri ile Cinsel Islevlerdeki Degisikliklerin Degerlendirilmesi: 3 Aylik Dogal Izlem Çalismasi.

OBJECTIVE: The aim of this study was to study the change in sexual functions within 3 months period following the initiation of antidepressant treatment in psychiatry outpatients, and its relationship with the change in anxiety and depression symptoms. MATERIAL AND METHOD: Eighty two patients, who consecutively applied to the psychiatry outpatient clinic and who were prescribed antidepressants, were included in the study. Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, General Assessment of Functioning Scale and Arizona Sexual Experience Questionnaire (ASEC) were administered to the patients at the first interview, then repeated on a monthly basis during 3 months. RESULTS: Fifty seven of the patients (69.50 %) has been diagnosed with sexual dysfunctions prior to the antidepressant treatment. During the third month after the antidepressant treatment, 24 patients in this group (42.11%) showed no impairment in ASEC scores, whereas 33 patients' (57.89%) scores were still at impairment level. Eight patients out of 25 (32%) who weren't diagnosed with sexual dysfunctions prior to the treatment were later diagnosed with sexual dysfunctions. Sexual dysfunctions correlated with patients' level of functioning, separately from anxiety and depression symptoms. RESULTS: Our study results show that the sexual dysfunction rate is quite high in psychiatric patients population. However, sexual dysfunctions rate which can be related to antidepressant treatment is 36%. It would be appropriate for clinicians to determine benefit-loss balance by considering patients' mental syndromes together with sexual functions.

[The Relationship between Violence and Clinical Features, Insight and Cognitive Functions in Patients with Schizophrenia]. / Sizofrenide Siddet Davranisinin Klinik Özellikler, Içgörü ve Bilissel Islevler ile Iliskisi.

OBJECTIVE: We aimed to investigate the predictive factors of violent behavior in schizophrenia and the relationship between violent behavior and insight and cognitive functions in this study. METHOD: 68 patients diagnosed with schizophrenia were separated into two groups; with a history of violent behavior (n = 30) and without (n = 38). Both group swere administered the Positiveand Negative Syndrome Scale (PANSS), Buss-Perry Aggression Questionnaire, Schedule for Assessing the Three Components of Insight, California Verbal Learning Test (CVLT), Trail Making Test, Wisconsin Card Sorting Test, and Stroop Test. RESULTS: Male gender, the number of hospitalizations, incompliance with the treatment, alcohol and substance abuse, the number of suicide attempts, the mean score of PANSS positive symptoms, PANSS general symptoms and PANSS total were significantly higher in patients with schizophrenia with a history of violent behavior, compared to non-violent group. Long delayed response subsection of CVLT mean score was lower in patients with violent behavior. Incompliance with the treatment (OR:5.927, p=0.041), alcohol and substance abuse (OR:21.089, p=0.000), and PANSS total score (OR:1.053, p=0.011)were identified as predictive factors of violent behavior in patients with schizophrenia. CONCLUSION: Lack of insight and executive function impairment are the core symptoms of schizophrenia and not seems to be associated with violent behavior in patients with schizophrenia. Impairment of memory may be associated with violent behavior in patients with schizophrenia. Incompliance with treatment, alcohol and substance abuse, and the severity of positive symptoms are important factors in predicting violence behavior in patients with schizophrenia.

The effects of infertility on sexual functions and dyadic adjustment in couples that present for infertility treatment.

OBJECTIVE: The aim of this study was to determine the effects of infertility on sexual functions and dyadic adjustment in infertile couples that seek infertility treatment. MATERIALS AND METHODS: The Beck Depression Inventory (BDI), Golombok-Rust Inventory of Sexual Satisfaction (GRISS), and Dyadic Adjustment Scale (DAS) were administered to the infertility group (n = 220) and control group (n = 110). None of the study participants had an Axis I psychiatric disorder. RESULTS: There wasn't a significant difference in BDI score between the 2 groups. None of the study participants had clinical depression. Men in both groups reported more problems according to GRISS total scale and subscale scores (except the avoidance subscale) than the women. Women in both groups reported more problems according to GRISS avoidance subscale score than did the men. Men in the control group reported more problems on the GRISS frequency subscale, as compared men in the infertile group. Women in the control group reported more problems based on GRISS total score, and GRISS frequency, satisfaction, touch, and avoidance subscale scores, as compared to the women in the infertile group. The men in the infertile group were more satisfied with dyadic adjustment than the women in the infertile group. The men and women in the control group had higher DAS total score, and DAS consensus and emotional expression subscale scores. CONCLUSION: The differences in sexual functions between the infertile and control groups were not significant. Both women and men in the infertility group reported more dyadic adjustment problems than those in the control group.

The first report of a patient with probable variant creutzfeldt-jakob disease in Turkey.

Variant Creutzfeldt-Jakob disease (vCJD) was first reported in the UK in 1996. Here, we report the first Turkish case of vCJD. A 47-year-old man, who has never lived outside of Turkey and had had no transfusion, was admitted to the University Hospital with speech disorder, cognitive decline and ataxia following depression, irritability, and personality change. The immunoassay of the 14-3-3 protein in the cerebrospinal fluid was negative. Brain magnetic resonance imaging revealed high-signal lesions involving the bilateral caudate and lentiform nucleus on T(2)- and diffusion-weighted imaging. The patient developed akinetic mutism 10 months after disease onset. The clinical presentation and neuroimaging findings were compatible with the vCJD cases reported since 1996 and met the World Health Organization's case definition for probable vCJD.