Comparison of Social-Evaluative Anxiety and Theory of Mind Functions in Social Anxiety Disorder, Schizophrenia, and Healthy Controls.

INTRODUCTION: Despite the similarities in poor social competence and clinical manifestations of poor social behavior, no study has compared the theory of mind performance between social anxiety disorder (SAD) and schizophrenia, considering the effect of social-evaluative anxiety and neurocognitive functions. In our study, we aimed to compare the theory of mind functions and social-evaluative anxiety between patients with SAD and schizophrenia and healthy controls and to examine the relationship between the theory of mind, neurocognitive skills, and social-evaluative anxiety. METHODS: Thirty-four consecutive patients with schizophrenia, 29 patients with SAD, and 30 controls matched by age, education level, and sex were enrolled in the study. Structured Clinical Interview for DSM, Beck Depression Inventory, Liebowitz Social Anxiety Scale, Theory of Mind measures (Reading the Mind in the Eyes Test, Hinting Task, Faux Pas Test), Social Appearance Anxiety Scale, Fear of Positive Evaluation Scale, Fear of Negative Evaluation Scale-Short Form, and neuropsychological tests were administered to all participants. RESULTS: A greater significant deterioration in theory of mind and neurocognitive functions was found in patients with schizophrenia compared to those with SAD and healthy controls. Social evaluation anxiety was highest in patients with SAD. Although social-evaluative anxiety was associated with the theory of mind function in schizophrenia, only fear of positive evaluation was associated with SAD. In all groups, neither theory of mind nor neurocognitive ability measures were correlated with social anxiety levels and related symptoms. CONCLUSIONS: The impaired theory of mind functioning detected in our study is more prominent in the schizophrenia group and largely independent of anxiety in schizophrenia and SAD. Although social evaluation anxiety, as a transdiagnostic concept, seems to be independent of theory of mind function in general, fear of positive evaluation seems to be associated with hinting in both disorders.

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.

Hand functions in patients with schizophrenia: A clinical comparison with bipolar disorder and healthy subjects.

OBJECTIVE: Failure to achieve expected level of motor functioning may be a significant contributor to social withdrawal and further attenuation of life quality in patients with schizophrenia. Hand functioning is one of the most crucial entities in that manner. This study aimed to reveal this question by means of comparing patients with schizophrenia and bipolar disorder who are receiving similar antipsychotic psychopharmacological agents along with healthy control subjects. METHODS: 99 patients with schizophrenia were compared to 40 patients with bipolar disorder matched according to the received pharmacotherapy comprising similar antipsychotics and 81 medication-free socio-demographically matched healthy control subjects. The materials were Hand Functional Index (HFI), Duruoz Hand Index (DHI), Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS) along with clinical characteristics. RESULTS: Difference in total scores of DHI and HFI between schizophrenia, bipolar disorder and control groups were extremely significant (p < 0.001). Further post-hoc subgroup analysis revealed that patients with schizophrenia demonstrated higher scores of HFI indicating worse performance when compared to both bipolar disorder and control group. Significantly higher scores of DHI in patients with schizophrenia than healthy controls were noted. CONCLUSION: Independent from the impact of the medication use, impairment in hand functions was found to be more frequently seen in schizophrenia when compared to patients with bipolar disorder and healthy subjects. It is evident that hand function impairment is seen independent from psychopharmacological side effect, and is recommended to be assessed as a possible preventable and retractable manifestation of schizophrenia.

Relationship between impulsivity and obsession types in obsessive-compulsive disorder.

OBJECTIVE: Impulsivity is an important aspect of obsessive-compulsive disorder (OCD) which is classified under a new heading in DSM-5 with other impulsivity related disorders like trichotillomania. Due to its heterogeneous nature, different obsessions may be linked to varying impulsivity profiles. Aim of this study was to investigate the impulsivity traits and their relationship with obsession types by comparing OCD subjects who display sexual, religious and aggressive obsessions or other obsessions to healthy controls. METHODS: Outpatients with OCD (n = 146) and healthy controls (n = 80) were evaluated with Sociodemographic Data Form, SCID-I, SCID non-patient version, Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Barratt Impulsiveness Scale (BIS-11). RESULTS: BIS-11 attention scores of the OCD group were significantly higher than healthy subjects. In patients with sexual, aggressive, religious obsessions, BIS-11 attention scores were significantly higher than those who have other obsession types and that of controls. CONCLUSIONS: Higher levels of attentional impulsivity, particularly in patients suffering from sexual, aggressive or religious obsessions suggest a common diathesis for a dysfunction in neural correlates corresponding to these symptoms. The results of our study may promote further studies conducted with more advanced and objective neuropsychometric tests evaluating features of the clinical course, neurobiology and the response to OCD treatment.

The relationship between adulthood traumatic experiences and psychotic symptoms in female patients with schizophrenia.

BACKGROUND: Previously, research aiming to investigate the effects of interpersonal traumatic experiences on psychotic symptoms mainly focused on adverse experiences in childhood. As mentioned above, patients with schizophrenia, particularly women, are at high risk for physical and sexual abuse in adulthood. In this study we aimed to investigate the effects of adulthood trauma in a sample of patients with schizophrenia who did not report childhood trauma. METHODS: Seventy female patients with schizophrenia participated in the study. Assessment included Traumatic Experiences Checklist, Positive and Negative Syndrome Scale and Calgary Depression Scale for Schizophrenia. RESULTS: The rates of traumatic events were as follows: physical abuse (81.4%), emotional abuse (78.6%), emotional neglect (55.7%), sexual harassment (28.6%), and sexual abuse (24.3%). Positive and Negative Syndrome Scale hallucinations, blunted affect, emotional withdrawal hostility, anxiety and affective lability item scores were significantly higher for patients who reported a history of sexual harassment. Patients who were exposed to sexual assault as adults had significantly higher scores in the Positive and Negative Syndrome Scale, anxiety, anger and difficulty in delaying gratification items. CONCLUSION: We concluded that traumatic life events and exposure to violence were common among female patients with schizophrenia and sexual trauma in adulthood was associated with particular clinical symptoms.

Comparison of theory of mind and neurocognition in siblings and offspring of female schizophrenia patients.

This study aims to compare the Theory of Mind (ToM) functions in the siblings and offspring of female Schizophrenia patients in an evaluation of the association between neurocognitive functions and ToM. A battery of ToM tests (Reading the Mind in the Eyes Test, Hinting Test and Faux Pas Test) and neurocognitive tests (Digit Span Test, Corsi Block Test, Digit Symbol Substitution Test, Rey's Auditory Verbal Learning Test, Trail Making Test, The Stroop Test, Wisconsin Card Sorting Test) were used to assess 31 offspring, 29 siblings of female schizophrenia patients and 28 healthy controls (HC). When the ToM functions of the offspring, siblings and HC groups in the present study are compared, no significant difference is identified between the offspring and sibling groups in Hinting, Faux Pas and Eyes tests, while Hinting test performance of the sibling group was significantly lower than those of the HCs. Neurocognitive functions are more affected both in offspring and siblings than HC. Although it was determined that ToM deficits of the patients' relatives were not as prominent as their neurocognitive functions, ToM is an endophenotype candidate in schizophrenia.

Clinical Characteristics of Healthcare Workers Attended to a Mental Health Support Line in the Very Early Phase of COVID-19 Pandemic.

Introduction: This study aimed to analyze and report findings from the sessions conducted with healthcare workers during the early phase of COVID-19 pandemic. Method: The study sample consisted of 130 healthcare workers who have consecutively reached out to nationwide psychosocial support line within the first ten days of COVID-19 pandemic and had a 30-minute video session and received psychological first aid and were evaluated using a socio-demographic data form. Mental state severity and progress were assessed using CGI (clinical global impressions) at the first and follow-up interviews. Results: 90.4% of the applicants were female, 50.4% were nurses, 34.4% were doctors, 68.8% were frontline workers, whereas second-line healthcare workers had significantly higher rates of psychiatric illness history. Contracting the virus (n=83, 66.4%), infecting others (n=72, 57.6%) were the situations that caused the highest level of anxiety. Most common psychiatric complaints were anxiety (n=107, 85.6%), restlessness (n=80, 64%), fear (n=72, 64.0%) and insomnia (n=68, 57.6%). A second session was conducted with 36.8% (n=46) of the callers, and it was detected that 93.48% (n=43) of them were able to manage their stress and 33 of them reported that the severity of their complaints decreased. Conclusion: Our findings have shown that healthcare workers were significantly affected in the early stage of COVID-19 pandemic with a significant level of anxiety and insomnia symptoms. Healthcare workers with a history of psychiatric illness should be considered as a vulnerable group regardless of their position.

Preventive and Therapeutic Mental Health Care after the Earthquake- Expert Opinion from the Psychiatric Association of Turkey. / Deprem Sonrasi Erken Dönemde Koruyucu ve Tedavi Edici Ruh Sagligi Hizmeti-Türkiye Psikiyatri Dernegi Uzman Görüsü.

Two major earthquakes hit Turkey at the Kahramanmaras region on February 6th 2023. The earthquakes affected almost 15 million individuals, resulting in more than forty thousand deaths, thousands of wounded and the destruction of ancient cities of humankind. Immediately after the earthquakes, the Psychiatric Association of Turkey organized an educational event to address the needs for a guidance on how to approach a trauma of such a big scale. The experts in this educational event summarized their presentations and prepared this review to guide the mental health professionals serving victims of this disaster. The review summarizes the early symptoms of trauma, and puts a framework on the principles of psychological first aid, the approach at the initial stages of the disaster, principles of planning, triage, and psychosocial support systems and the proper use of medications. The text covers the evaluation of the impact of trauma, aligning psychiatric practice with psychosocial interventions, the improvement of counseling skills and methods to better understand the mind during the acute post trauma phase. A set of presentations highlight the challenges in child psychiatry, brings a systematic overview to the earthquake and discuss the symptomatology, first aid and intervention principles in children and adolescents. Last, the forensic psychiatric perspective is presented, followed by a piece on the essentials of delivering bad news and the review is concluded with the emphasis on burnout, a syndrome to avoid particularly for field professionals, and possible preventive measures. Keywords: Disaster, trauma, psychosocial support, psychological first aid, acute stress disorder, post traumatic stress disorder.

Persistent genital arousal disorder misdiagnosed because of Islamic religious bathing rituals: a report of three cases.

Persistent genital arousal disorder is not well known or adequately understood by physicians. The disorder is characterized by a persistent and highly unwanted state of genital arousal and orgasm-like feelings. Ghusl is an ablution in Islamic culture, which is an obligatory ritual wherein the body is washed thoroughly after exposure to religious contaminants such as sexual intercourse, menstruation, and childbirth. Muslim women suffering from the disorder may bathe frequently because of their religious beliefs. The authors summarize the case histories of 3 patients with persistent genital arousal disorder who were initially misdiagnosed with obsessive-compulsive disorder. All 3 patients presented with complaints of unwanted, persistent orgasms or orgasm-like arousals, and as a result, they performed ghusl several times a day. At previous interviews, the genital arousal was diagnosed as a sexual and somatic obsession, and repeatedly performing ghusl was considered a cleansing compulsion. Physicians' lack of awareness or knowledge of persistent genital arousal disorder, combined with the unwillingness of patients to discuss sexual problems, can lead to a focus on the repetitive bathing, and thus, a misdiagnosis of the problem as obsessive-compulsive disorder. These cases are presented to highlight the possible pitfalls in the diagnosis of persistent genital arousal disorder cases in Islamic countries where ghusl is common.

Reliability and Validity of Turkish Version of Sexual Coercion in Intimate Relationships Scale.

Introduction: In this study, we aimed to investigate the validity and reliability of the Sexual Coercion in Intimate Relationships Scale in the Turkish population. Methods: 353 women aged 18-65 were included in the study. In addition to the 34 questions in the original scale, 8 questions from other scales in the literature were added, which were not included in the scale. Sociodemographic Data Form, World Health Organisation Women's Violence Against Partner Questionnaire, The Severity of Violence Against Women Scale, Sexual Experiences Survey-Short Form Victimization, and Relationship Stability Scale were also applied to the participants. Results: 3 items were removed due to low factor load values in the analyzes performed with the Varimax rotation method. The values obtained as a result of exploratory factor analysis made over 39 items were 21.718%, 24.424%, and 12.901%, respectively. This explained 53.88% of the total variance. The value of the scale was determined in high-level reliability (Cronbach's alpha:0.96). Subdomains were similar to the original survey. Its correlation with other scales showed a significant and strong relationship. Conclusion: In our study, the necessary analyzes for the quality of the measurement tool were applied and this scale is found psychometrically reliable and valid. This scale can evaluate all partner sexual violence, such as subtle and physical force types and their frequency.

Double standard for traditional value of virginity and premarital sexuality in Turkey: a university students case.

This study investigates the prevalence of myths regarding virginity and the hymen and their associations with sexuality prior to marriage. This study was conducted with 534 single, heterosexual male and female students from various faculties of Dicle University in Turkey. The findings demonstrated that the rates of masturbation (11.1%) and premarital sexual intercourse (4.3%) were much lower in women than in men (87.7% and 44.2% respectively) who were traditionally expected to maintain their virginity until marriage. A higher degree of commitment to religious faith was associated with a lower rate of masturbation and sexual contact experience. Also, the myth that the hymen symbolized virginity was slightly more prevalent among male students (74.2% vs. 72.1%). Female virginity was significantly more important among male students (76.7%) than females (11.1%), and male students more frequently (30.1% vs. 11.1%) stated that "the blood-stained bed sheet" should be displayed to the family on the day of marriage. Although some myths about virginity were frequently reported by females, less significance was attributed to virginity by females than by males. In conclusion, the traditional social structure that incites sexual double standards still prevails over the sexual attitudes and behaviors of university students in Turkey.

The Relationship of Theory of Mind and Attachment Characteristics with Disease Severity in Social Anxiety Disorder.

INTRODUCTION: The aim of our study is to compare the attachment characteristics and the theory of mind abilities measured by the Eyes Test between social anxiety disorder (SAD) patients and healthy controls. Another aim of our study is to investigate the relationship between attachment characteristics, theory of mind abilities and disease severity in patients with SAD. METHOD: 47 consecutive patients with SAD and 50 healthy controls were recruited for the study. Sociodemographic data form, SCID-I Structured Clinical Interview form Patient Version, Beck Depression Inventory (BDI), Reading Mind in the Eyes Test (Eye Test), Liebowitz Social Anxiety Scale (LSAS), Experiences in Close Relationship Inventory (ECR) and State-Trait Anxiety Inventory (STAI) were administered to all participants. RESULTS: The BDI, LSAS anxiety and avoidence, ECR and anxiety and avoidance, STAI state and trait anxiety scores of the SAD group were higher than the controls, but the Eyes Test scores were lower. It was observed that the Eyes Test score difference between the two groups survived when controlled for BDI and STAI state and trait anxiety scores. In the SAD group, both ECR anxiety and avoidance scores were associated with LSAS anxiety and avoidance scores. Eyes Test scores were associated with LSAS anxiety and avoidance scores. In regression analysis, it was observed that the Eyes Test, ECR anxiety and avoidance scores effected both the LSAS anxiety and the LSAS avoidance scores. CONCLUSION: In SAD patients, the theory of mind functions was impaired when compared to healthy controls, and this difference has been found to be independent of anxiety or depression levels. Attachment anxiety and avoidance dimensions have negative effects on SAD disease severity. The fact that the theory of mind ability is inversely related with SAD severity suggests that interventions to improve social cognition might have a potential to decrease the severity of disease in SAD.

[Factors affecting the diagnosis of post-traumatic stress disorder after a terrorist attack]. / Bir Terörist Saldiri Sonrasinda Travma Sonrasi Stres Bozuklugu Gelisimini Etkileyen Risk Faktörleri.

OBJECTIVE: On 3 January 2008 explosives placed in an automobile on a thoroughfare in Diyarbakir, southeastern Turkey exploded in a terrorist attack. The aim of this study was to determine the risk factors for the diagnosis of and the rate of post-traumatic stress disorder (PTSD) among individuals who were eye- or earwitnesses to the explosion 1 and 3 months after the explosion. METHODS: Among the residents and workers in close proximity to the explosion site, 216 individuals who were eye- or earwitnesses to the explosion were included in the study. A sociodemographic data form and a traumatic stress symptom scale were administered to the participants 1 and 3 months following the explosion. RESULTS: In all, 12.5% of the participants were diagnosed with PTSD 1 month post-explosion versus 9.6% 3 months post-explosion. While history of psychiatric disorder and physical injury were risk factors for PTSD 1 month post-explosion, risk factors 3 months post-explosion was history of psychiatric disorder. CONCLUSIONS: PTSD occurs at high rates in individuals exposed to terrorist attacks. More studies following such events are required in Turkey. In light of these results it is advised that individuals at risk of PTSD receive therapeutic and preventive interventions provided by mental health professionals.

[Chronic manganese intoxication due to methcathinone (ephedron) abuse: a case report]. / Metkatinon (Efedron) Kötüye Kullanimina Bagli Kronik Manganez Entoksikasyonu: Bir Olgu Sunumu.

Known as an occupational disease, chronic manganese intoxication is recently being observed among abusers of psychoactive substances. Methcathinone hydrochloride is obtained by combining ephedrine/pseudoephedrine and potassium permanganate. Various neuropsychiatric symptoms have been reported among Efedron users. Our patient is a 29 year old male, who was referred to our hospital from a state general hospital with a diagnosis of Conversion Disorder. He was hospitalized and preliminary diagnoses of Facititous Disorder, Conversion Disorder, Psychiatric Disorder due to a General Medical Condition and Antisocial Personality Disorder. He was abstinent from any substance for five years upon referral to our hospital and had a history of methcathinone abuse for 4.5 years. The backache dated back to 6 years ago and a disturbance of gait was added to the clinical picture. A speech disturbance, falling while walking downhill and walking on tiptoe were added in the last 2-3 years. In the neurological examination, extrapyramidal system findings, gait disturbance and the report on use of manganese compunds were found. The setting was changed from psychiatric ward to neuorology ward and evaluated by consultant neurologist. The case was diagnosed as ?Manganese Intoxication'. The aim of this report is to demonstrate and emphasize the importance of questioning the presence of manganese compounds in case of history of substance abuse. Other areas of interest are the shortage of data on the intravenous use of manganese and the cases reported in the literature coming from the former Soviet Union.

[Prevalence of Depression and Anxiety Disorders and Their Relationship with Sexual Functions in Women Diagnosed with Lifelong Vaginismus]. / Yasam Boyu Vajinismus Tanisi Konulan Kadinlarda Depresyon ve Anksiyete Bozukluklarinin Yayginligi ve Cinsel Islevlerle Iliskisi.

OBJECTIVE: In patients with vaginismus, the Lack of knowledge on rates of depression and anxiety disorders is noteworthy. The aim of the present study was to investigate the prevalance of anxiety disorders and major depression and to examine the relationship of these  omorbidities with sexual functions in women diagnosed with lifelong vaginismus.  METHOD: One hundred and fourty-four women who were diagnosed with vaginismus were recruited for the study. Depression and anxiety disorders section of the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) were administered to the participants.  RESULTS: At least one comorbid anxiety disorder and/or depression was found in 79.86 % of the cases. The most common comorbid disorder was specific phobia (63.9%). This was followed by major depression (35.4%), social anxiety disorder (13%), panic disorder (10%), obsessive compulsive disorder (5%) and generalized anxiety disorder (2%). On GRISS, mean avoidance score was higher in patients with comorbid depression and non-communication score was higher in patients with comorbid panic disorder when compared to patients with no comorbidity.  CONCLUSION: The prevalence of depression and anxiety disorders, especially spesific phobia, was higher in patients with vaginismus than the general population. Both high comorbidity of these psychiatric disorders and disruption of functions in all domains of sexuality emphasize the importance of holistic approach in evaluation of these patients.

Clomipramine trial for treatment-resistant persistent genital arousal disorder: a case series.

INTRODUCTION: Treatment of persistent genital arousal disorder (PGAD), as a chronic and disabling condition, implicates substantial compelling complexities. METHODS: In this case series, seven women diagnosed with PGAD who were referred to the Sexual Dysfunction Unit of Psychotherapy Outpatient Clinic of Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey between 2006 and 2009 were included. All patients were previously resistant to other antidepressants, antipsychotics and antiepileptics. The additional details of PGAD onset, frequency, type and duration of arousal, previous pharmacological interventions, and maximum and maintenance doses of clomipramine were recorded. RESULTS: All patients achieved a substantial symptomatic improvement with clomipramine within the follow-up period of 2-9 years. DISCUSSION: Based on our study results, we recommend clomipramine in combination with psychotherapy as the treatment of choice in PGAD and to be used before any invasive procedure such as electroconvulsive therapy (ECT) or surgery.

Relationship of Suicidal Ideation and Behavior to Attachment Style in Patients with Major Depression.

INTRODUCTION: The attachment theory aims to understand close relationships in adulthood based on the relationship of a child with the caregiver. Attachment styles are classified as secure, preoccupied, fearful and dismissing, which are the subtypes of insecure attachment style. Insecure attachment is suggested to be related to depression and suicide. In this study, the relationship of suicidal ideation and behavior to attachment style is investigated in patients diagnosed with major depression. METHODS: Sixty-two patients diagnosed with major depressive disorder according to the DSM-IV-TR criteria were taken and divided into two groups, 31 patients with and 31 patients without a past suicide attempt. Sixty healthy volunteers matched with the patients for age, gender and education and comprised the control group. Sociodemographic and clinical data form, Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hamilton Depression Rating Scale (HDRS), Experiences in Close Relationships Scale (ECR), Scale of Suicidal Ideation and Suicidal Behavior Scale were applied to the groups. RESULTS: In the patients with depression, ECR anxiety and avoidance scores were found to be higher compared with those in the control group. There were no differences in the anxiety and avoidance scores between the patients with and without suicide attempt. The rate of participants who showed secure attachment style in the control group was higher than that of those with depression. In the patients with fearful attachment style, the suicide attempt rate was found to be higher than the other groups. A positively significant relationship was detected between ECR anxiety score and scores of HDRS suicide item, Scale of Suicidal Ideation and Suicidal Behavior Scale. CONCLUSION: Patients with depression were more anxious and more avoidant and showed more insecure attachment. In patients with depression with fearful attachment style, suicide attempts were more common.