Temperament, Character, and Defense Mechanism Changes With Treatment in Depression: A 9-Month Naturalistic Follow-up.

The aim of this study was to evaluate the changes in temperament, character, and defense mechanisms with the treatment and remission in patients with major depressive disorder. The study was designed as a longitudinal observational follow-up study of patients with repeated measures at 0, 12, and 36 weeks. In baseline comparisons, the major depression group showed higher harm avoidance and novelty seeking scores and lower self-directness and mature defense styles scores compared with healthy controls. In the follow-up, temperament dimensions and neurotic defenses remained unchanged, mature defense styles and self-directness revealed significant increase, and immature defense styles revealed significant decrease. Although there was no significant difference in the defense styles, harm avoidance and novelty seeking scores remained higher in MDD patients compare with healthy controls in 36 weeks. Our findings regarding continuation of hierarchically upward improvement in defense mechanism after the remission may support importance of treatment after remission.

Predicting factors for non-suicidal self-injury in patients with schizophrenia spectrum disorders and the role of substance use.

Non-suicidal self-injury (NSSI) has been shown as a characteristic feature in many clinical populations in recent years and schizophrenia is one of the most common psychiatric disorders which is associated with NSSI. In this study, we aimed to investigate predictors of NSSI in patients with schizophrenia spectrum disorders (SSD) and the role of lifetime substance use disorder (SUD). A sample of 165 patients with a diagnosis of SSD who were in remission participated in the study. Lifetime NSSI was assessed using the Inventory of Statements About Self-injury (ISAS). Lifetime SUD were evaluated. Logistic regression analysis was conducted to predict NSSI. SUD was found to be related to NSSI in patients with SSD, and it was associated with an approximately fourfold increase in the risk of NSSI. The rates of lifetime SUD in our sample and in the NSSI (+) group were 38.2 % and 55.6 %, respectively. The most commonly abused substances among patients with NSSI were cannabis and synthetic cannabinoids. The prevalence of NSSI was 43.6 % in our sample. 'Self-cutting' was the most common type and 'affect regulation' was the most common function of NSSI. One of the most significant risk factors for NSSI was a previous history of suicide attempts. SUD appears to be a significant predictor of NSSI in patients with SSD. Further investigation of treatable risk factors such as SUD which are related to NSSI is needed. It is also essential to screen SSD patients for NSSI due to the probable relation to high risk of suicide.

[The factor analytic symptom structure of manic episode and its relationship with affective temperaments]. / Manik dönemin faktör analizine dayanan alt-tipleri ve mizaçla iliskisi.

OBJECTIVE: The aim of this study is to establish the factor analytic dimensions of manic episode, and to investigate relationship between established factors and underlying affective temperament. METHODS: Hundred patients who had been hospitalized in psychiatric clinics of Bakirköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology for DSM-IV bipolar disorder manic episode were assessed by Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS) and Positive And Negative Syndrome Scale (positive syndrome sub-scale) (PANSS) and followed by factor analysis. The relationship between factor scores and underlying affective temperaments has been investigated in 72 full remitted patients who had been re-assessed by Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) Turkish version. RESULTS: 7 factors model which accounted 67.48% of the total variance has been emerged by principal component factor analysis. Determined factors were dysphoria, psychomotor acceleration, psychosis, irritability, insight, grandiosity and sexual interest. It has been found linear correlation between hyperthymic temperament and psychomotor acceleration (r=0.255, p<0.05) and, inverse correlation between depressive temperament and sexual interest (r=-0.248, p<0.05). CONCLUSIONS: The results of our study has shown that clinical phenomenology of mania has been formed by independent dimensions of dysphoria, irritability and psychosis, also with relationship between hyperthymic temperament and psychomotor acceleration which is accepted core characteristic of mania.

The validity and Reliability of the Turkish Version of Drug Attitude Inventory-10.

INTRODUCTION: Compliance with drug treatment is an important issue in schizophrenia for which many scales have been devised. Turkish version of the Drug Attitude Inventory is frequently employed due to ease of use and high predictive value, although it is not as accurate as blood level testing.To determine the validity and reliability of the Turkish version of the Drug Attitude Inventory-10. METHODS: Eighty-two schizophrenia patients were included in the study. Subjects were evaluated using Drug Attitude Inventory-10, a Sociodemographic Data Form, Positive and Negative Symptom Scale PANNS, Social Functioning Scale, and Quality of Life Scale for schizophrenia patients. RESULTS: Reliability analysis revealed Cronbach's α coefficient for internal consistency to be 0.798 and item-total item correlation coefficients to be between 0.420 and 0.647. Test-retest correlation coefficient (r) was 0.809. Construct validity analysis revealed a tri-factorial construct which accounts for 62.68% of variance. Good conformity to single factor construct was found with confirmatory factor analysis. CONCLUSION: Turkish version of the Drug Attitude Inventory-10 is valid and reliable for evaluation of schizophrenia patients which makes it suitable for research and clinical settings.

Substance abuse amplifies the risk for violence in schizophrenia spectrum disorder.

The factors responsible for the association between schizophrenia and violence with or without co-occurring substance abuse have not been fully elucidated. The present study had two aims: (1) ascertain whether substance abuse augments the risk for violence in patients with schizophrenia; and, (2) determine whether violence is differentially related to positive and negative symptoms of schizophrenia. A sample of 133 adults were participated in this study. Patients with bizarre behavior and avolition-apathy symptoms were more likely to manifest violent behavior. In addition, patients with a history of criminal offenses and substance use disorder were more likely to exhibit violent behavior. Based on the results of this study, it is feasible to identify individual with schizophrenic spectrum disorder who are at high risk for violence.

Antisocial personality disorder in Turkish substance dependent patients and its relationship with anxiety, depression and a history of childhood abuse.

The prevalence of antisocial personality disorder (ASPD) in treatment-seeking Turkish substance dependent patients and the relationship of ASPD with clinical characteristics were studied. Participants were 132 inpatients with substance dependence according to the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. The clinician applied a semi-structured socio-demographic form, SCID-I, SCID-II, Childhood Abuse and Neglect Questionnaire (CANQ), Michigan Alcoholism Screening Test (MAST), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Among the 132 substance dependent patients, 31 (23.5%) had ASPD diagnosis and 56 (42.4%) had no personality disorder or personality traits. Rate of childhood physical abuse, childhood verbal abuse, childhood neglect, suicide attempt history, self-destructive behavior and lifetime major depression were higher among patients with ASPD. Also mean scores of BDI, BAI and MAST were higher among patients with ASPD. The high rate of ASPD found among Turkish substance dependent patients suggests that special attention must be paid to identify ASPD in this group. Findings in this study showed that there is an association between ASPD and childhood abuse, lifetime major depression and severity of substance use.

Substance use is a risk factor for violent behavior in male patients with bipolar disorder.

BACKGROUND: To determine the factors involved in violent behavior in patients with bipolar disorder (BD) and to investigate the relationship between violence and substance use disorder (SUD). METHODS: A sample of 100 male inpatients diagnosed with BD type I who were experiencing a current mood episode participated in the study. Violent behavior was defined as physical aggression against others. All patients were evaluated using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Positive and Negative Syndrome Scale-positive subscale (PANSS-p), Barratt Impulsivity Scale-11 (BIS-11), Buss-Perry Aggression Questionnaire (BPAQ) and Overt Aggression Scale (OAS). Lifetime SUD and current use of substances were evaluated. Logistic regression analysis was conducted to predict violent behavior. RESULTS: Current substance use (CSU) rather than lifetime SUD was found to be related to violent behavior in patients with BD, and CSU was associated with a threefold increase in the risk of violence. The rate of lifetime SUD in our sample was 59%, and the rate of CSU was 39%. The most commonly abused substances were cannabis and alcohol, followed by synthetic cannabinoids, in both groups of patients with lifetime SUD and CSU. Individuals abusing any substance were more likely to have a criminal record and history of incarceration than other patients. One of the most significant risk factors for violence was a previous history of violent behavior. LIMITATIONS: The sample was limited to male patients. Data on some participants' recent substance use from standard urine analysis was not obtained. The data on the use of synthetic cannabinoids was obtained from patients and their families owing to the lack of equipment for detecting synthetic cannabinoids using laboratory analysis. CONCLUSIONS: CSU appears to be a significant predictive factor in violent behavior in male patients. Further investigation of co-occurrence of violence with CSU and improvement in treatment strategies might reduce or prevent violence in patients with BD.

Dissociative disorders among inpatients with drug or alcohol dependency.

OBJECTIVE: To determine the prevalence of dissociative disorders among inpatients with alcohol or drug dependency. METHOD: The Dissociative Experiences Scale was used to screen 215 consecutive inpatients admitted to the dependency treatment center of a large mental hospital over a 1-year period (March 1, 2003, to March 31, 2004). Patients who had scores of 30.0 or above were compared with patients who scored below 10.0 on the scale. The patients in both groups were then evaluated using the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for DSM-IV Dissociative Disorders. The interviewers were blind to the Dissociative Experiences Scale scores. RESULTS: Of the patients, 36.7% had a Dissociative Experiences Scale score of 30.0 or above. The prevalence of DSM-IV dissociative disorders was 17.2% (N = 37). On average, 64.9% of these patients' dissociative experiences had started 3.6 years (SD = 2.9; range, 1.0-11.0 years) before onset of the substance use. Patients with dissociative disorders were younger, and the mean duration of their remission periods was shorter. Dissociative disorder patients tended to use more than 1 substance, and drugs were used more frequently than alcohol in this group. The frequency of borderline personality disorder, somatization disorder, history of suicide attempt, and childhood abuse and neglect occurred more frequently in the dissociative disorder group than in the nondissociative disorder group. History of suicide attempt (p = .005), female sex (p = .050), and childhood emotional abuse (p = .010) were significant predictors of a dissociative disorder diagnosis. Significantly more patients with dissociative disorders stopped their treatment prematurely (p < .001). CONCLUSION: Impact of dissociative disorders on development and treatment of substance dependency requires further study.

Phenomenological subtypes of mania and their relationships with substance use disorders.

OBJECTIVE: The aim of the present study was to determine the distinct clusters of subtypes among patients with bipolar disorder (BD) and the relationship between the clinical features of BD patients, particularly substance use disorders (SUDs) and the clusters. METHOD: The present study initially assessed 96 inpatients who were hospitalized in the psychiatric clinic of Bakirköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology, for a BD manic episode. All patients were evaluated during the initial 3 days of their admission using the Young Mania Rating Scale (YMRS), the Montgomery-Asberg Depression Rating Scale (MADRS),the Scale for the Assessment of Positive Symptoms (SAPS), the Michigan Alcoholism Screening Test (MAST) and a sociodemographic questionnaire. The factor structures of the psychopathological scale items were determined with factor analyses and based on the factor loadings, cluster analyses were performed. The relationships among the clusters and the clinical variables were then evaluated. RESULTS: The factor analyses generated three factors: increased psychomotor activity, dysphoria, and psychosis. A hierarchical cluster analysis was applied to the three factor loadings, and revealed that factor 1 (increased psychomotor activity) was high in cluster 1 and that the effects of factors 2 (dysphoria) and 3 (psychosis) were high in cluster 2. Within cluster 1 (Psychomotor elevation), 39% of patients were diagnosed with an alcohol use disorder while 31.6% of patients in the cluster 2 (dysphoric-psychotic) were diagnosed with both alcohol and cannabis use disorders. Within cluster 2 (dysphoric-psychotic), 47.4% of patients had one suicide attempt and 21.1% of patients had two or more attempts during their lifetime. CONCLUSION: There was a significant difference in the presence of SUDs between patients with psychomotor elevation and patients in dysphoric-psychotic cluster. This may be point out that pure manic patients with BD self-medicate using the sedative effects of alcohol and the causal relationship between cannabis and psychosis. Using a dimensional approach to study BD may enhance detection of the biological correlates of BD and improve the treatment and outcomes of the disorder.

The relationship between catechol-O-methyltransferase gene Val158Met (COMT) polymorphism and premorbid cannabis use in Turkish male patients with schizophrenia.

BACKGROUND/AIM: One of the risk factors for increasing psychotic disorders is the use of cannabis. It has been shown that the inactivation of dopamine and other catecholamines causes a common polymorphism generating substantial variations in COMT enzyme activity. We aimed to understand the role of cannabis in the etiology of schizophrenia with and without pre-morbid usage. PATIENTS AND METHODS: The study group consisted of 80 male patients and genotyping of COMT enzyme Val158Met gene polymorphisms were detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: It was found that the Val/Val genotype is significantly higher in patients with premorbid cannabis use (88.9%) compared to patients without pre-morbid cannabis use (68.4%). Also, the mean total positive and negative syndrome scale (PANSS) score seen in the Val/Val genotype group is significantly higher than the scores of the patients with the Met allele. CONCLUSION: The findings from this study confirm the association between COMT Val158 Met polymorphism and pre-morbid cannabis use in causing schizophrenia.

Substance abuse and associated psychosocial risk factors among Turkish male adolescents.

This study reports the validation of the Drug Use Screening Inventory (DUSI) in a sample of Turkish youth. Clinical cases (N=90) were recruited from the inpatient and outpatient addictions treatment facility at Bakirkoy State Hospital for Psychiatric and Neurological Diseases in Istanbul, Turkey. Nonclinical cases (N=68) were recruited from the community by direct invitation from the researchers and advertisement. Reliability, discriminative, and construct validity of the Turkish version of the DUSI were documented. A cut-off score of 35% severity on the overall problem density score correctly classified 83% of subjects with sensitivity of 80% and specificity of 87%. Furthermore, the DUSI overall problem density score predicted prior 30 days level of substance use involvement. Finally, a history of family substance use disorder predicted the overall problem density score in their children. These findings indicate that the Turkish version of the DUSI is an efficient method for multidimensional screening of youth who need treatment for substance abuse.

[Suicidal ideation in schizophrenia: relationship with positive and negative symptoms, depression and insight]. / Sizofrenili hastalarda ozkiyim düsüncesi: pozitif, negatif belirtiler, depresyon ve içgörüyle iliskisi.

OBJECTIVE: To estimate suicidal ideation among schizophrenic patients and compare sociodemographic and clinical properties. METHOD: Sixty patients schizophrenic according to DSM-IV criteria were included in the study. Half the patients were in the acute phase and were inpatients, while the other half were in the stable phase and were outpatients. A semistructured sociodemographic form, the Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS) and Schedule for Assessing the Three Components of Insight were used. RESULTS: Suicidal ideations were found in 12 (20%) patients. The proportion having relationship problems, having attempted suicide in the past, and in the acute phase was higher in the group with suicidal ideations than in the group without suicidal ideations. The mean number of suicide attempts was also higher in the group with suicide ideations. The depression score measured by CDSS was higher in the group with suicidal ideations, while there were no relationships between the scores of positive and negative symptoms, and the degree of insight and suicidal thoughts. CONCLUSION: The high rate of suicidal ideation in our sample suggests that, when planning treatment and follow-up for these patients, the risk of suicide has to be determined and protective measures have to be taken. It suggests that determining depression routinely with scales that can be used easily, like CDSS, can be useful for these patients.

[Phenomenological differences between adolescent and adult onset mania: a comparative study]. / Ergen ve eriskin baslangiçli maninin fenomenolojik farkliliklari: karsilastirmali bir calisma.

OBJECTIVE: The aim of this study is to determine the relationship between age of onset and phenomenology of bipolar affective disorder (mania). METHOD: The current and retrospective diagnoses of the patients were made according to DSM-IV Bipolar Affective Disorder (mania) criteria. Sociodemographic features, clinical features, type of episode, number and length of hospitalizations were investigated in three groups which were consisted of adolescent-onset adolescents (n=60), adolescent-onset adults (n=60) and adult-onset adults (n=60). The groups were determined according to age of onset and current age categories. All patients have been assessed by Structured Clinical Interview for DSM-IV-Clinical Version (SCID-I), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D) and Scale for the Assessment of Positive Symptoms (SAPS). RESULTS: The groups were consisted of equal numbers of women and men. Rate of single (%51.7) and divorced patients (%21.7), rate of unemployment status (%70) were higher in adolescent-onset patients than adult-onsets. Adolescent-onset adolescents and adolescent-onset adults were different from adult-onset patients with respect to mixt episodes (%26.7, %15) and mood congruent or incongruent psychotic features (%35/%50, %31.7/%66.7) and length of hospitalization (23.9+/-4.8, 23.8+/-3.9). CONCLUSION: Adolescent-onset of illness causes higher probability of mixt episodes, psychotic features such as mood congruent or incongruent hallucinations and delusions. This study supports the hypothesis that adolescent-onset mania may be a different subtype than adult-onset mania with respect to type of episode, phenomenology, and clinical features.

Optical coherence tomography findings in bipolar disorder: a preliminary receiver operating characteristic analysis on ganglion cell layer volume for diagnosis

Abstract Background Optical coherence tomography (OCT) has been recently used to investigate neuropsychiatric disorders. Objective The aim of this study was to compare the retinal nerve fiber layer thickness (RNFLT) and the ganglion cell layer (GCL) volume in patients with type 1 bipolar disorder (BPD1, diagnosed according to DSM 5) to the values in healthy controls. Methods Eighty consecutive outpatients with a diagnosis of euthymic BPD1 and 80 healthy controls were enrolled in the study. Following assessment with the Sociodemographic Data Form, Structured Clinical Interview for DSM-IV (SCID-I), Hamilton Depression Scale and Young Mania Evaluation Scale, both groups underwent Optical coherence tomography (OCT). Results The mean RNFL thickness and mean GCL volume were significantly lower in the BPD1 group than in the controls (p < 0.05). The GCL global value had a significant and independent effect in distinguishing the BPD1 patients from the controls. A cut-off value of 101 mm3 for global GCL volume was proposed to distinguish BPD1 patients from controls with a sensitivity of 87.5%. Discussion Lower values of GCL volume and RNFLT in patients suffering from BPD1 suggest that neurodegeneration may occur during the course of BPD and that this degeneration can be characterized in particular by a thinning of the GCL volume.

[Clinical correlates of social anxiety disorder comorbidity in schizophrenia]. / Sizofrenide Sosyal Bunalti Bozuklugu Estanisi; Sosyodemografik ve Klinik Özellikler ile Iliskisi.

OBJECTIVE: The aim of this study is to investigate the social anxiety disorder comorbidity and clinical features in schizophrenia. METHOD: 102 (23 women and 79 men) outpatients who had been followed in the Psychotic Disorders Unit in Bakirköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were diagnosed with schizophrenia according to DSM-IV criteria were included in the study. Schizophrenia and Social anxiety disorder were assessed by a structured clinical interview for DSM-IV. Patients were evaluated with a questionnaire which included demographics, clinical characteristics, Liebowitz social anxiety scale, Positive and Negative Syndrome Scale (PANSS), Calgary depression scale for schizophrenia (CDSS),The Scale of Unawareness of Mental Disorders (SUMD), Short form-36 health survey questionnaire and state-trait anxiety inventory. RESULTS: In remission, 22 patients (21.6%) had co-morbid social anxiety disorder. Patients with social anxiety disorder comorbidity, had higher levels of awareness. Their depression scores were higher and functional impairments were lower. These patients had been treated with typical and atypical antipsychotics and antidepressants. CONCLUSION: Social anxiety disorder comorbidity in schizophrenia adversely affects the quality of life and is not rare. Future studies should be planned with the assesment of social anxiety disorder treatment as well as schizophrenia treatment.

The relationship between insight and clinical features in bipolar disorder.

OBJECTIVE: The aim of this study is to examine the relationship between insight dimensions and clinical features in bipolar disorder. METHOD: One hundred and four inpatients with bipolar disorder( manic or mixed episodes) diagnosed according to DSM-IV criteria participated in the study. Patients were evaluated both during an acute episode and in remission, prior their discharge from the hospital by the Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), Positive and Negative Syndrome Scale (PANSS), The Scale of Unawareness of Mental Disorders (SUMD), and a questionnaire regarding demographic and clinical characteristics. RESULTS: In remission, 57 patients (54.8%) had insight of their illness while 14 (13.5%)did not have insight. Besides %6.7 of patients did not have the Insight into the effects of medication. We also found that 27.9% of patients were unaware of the social consequences of their illness. Patients with psychotic symptoms had a significantly low level of awareness to the effects of their medication as well as the severeness of their manic episode. We found an unawareness of delusion in these patients. In terms of all SUMD items, female patients had significantly poorer insight compared to men. No correlation was found between the number of hospitalizations, the number of episodes or the first episode type and insight dimensions. CONCLUSION: Lack of insight in bipolar disorder is not rare. The assesment of insight addresses different components of the illness and the treatment awareness. The severity of illness, aggressive impulse control difficulties, psychotic symptoms especially the presence of delusions, female sex may be important predictors of impaired insight.

Temperament and character model of personality profile of alcohol- and drug-dependent inpatients.

The aims of this study were to evaluate the differences in dimensions of temperament and character in Turkish alcohol- and drug-dependent inpatients, and to examine which dimensions would predict drug dependency. The subjects consisted of 111 alcohol-dependent and 93 drug-dependent inpatients according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Subjects were tested using Cloninger's Temperament and Character Inventory (TCI). Among the temperament dimensions, novelty seeking score was higher and reward dependency score was lower in drug-dependent patients than in alcohol-dependent patients. Among the character dimensions, self-directedness and cooperativeness scores were lower in drug-dependent patients. Low age and novelty seeking predicted drug dependency in forward logistic regression model. Subscales that predicted drug dependency other than young age were lower scores on compassion vs revengefulness (C4) and helpfulness (C3), and higher score on spiritual acceptance vs rational materialism (ST3). As in previous studies, which indicate an association between personality and substance choice, in the present study, TCI was shown to be an efficient tool in discriminating alcohol and drug dependents; thus, it seems to be important to consider TCI dimensions in planning the treatment of substance dependency.