Is there any relation between arterial stiffness and insomnia? A challenging question.

PURPOSE: Insomnia is a common sleep disorder which has high comorbidity with a number of cardiovascular diseases (CVD). As a possible risk factor for the CVDs, arterial stiffness may be assessed non-invasively by pulse wave velocity (PWV) and augmentation index (AI). The aim of this study was to evaluate any relation between insomnia and arterial stiffness. METHODS: Patients with insomnia were included in the study after the exclusion of other sleep disorders by polysomnography. Sleep quality and the degree of insomnia symptoms were evaluated by the Pittsburgh sleep quality index (PSQI) and insomnia severity index (ISI), respectively. PWV and AI were assessed by Mobil-O-Graph arteriograph system. RESULTS: Consecutive patients with insomnia (n = 72, 56 women, mean age 55.8 ± 9.1 years) were included. Patients were grouped as those with severe ISI scores (22-28) and those with mild to moderate ISI scores (8-21). Despite no significant difference in characteristics and clinical data, patients with severe ISI scores had significantly higher total PSQI scores and NREM-2 with significantly lower REM duration. They also had significantly higher systolic blood pressure, mean blood pressure, pulse pressure, PWV, and AI compared to patients with mild and moderate ISI scores. Correlation analysis revealed that PWV and AI were significantly correlated with the ISI score and PSQI score. CONCLUSION: There is a close relation between arterial stiffness and insomnia suggesting a risk for CVD in patients with insomnia.

The effect of attention deficit hyperactivity disorder comorbidity on cognitive functions and severity of addiction in opioid use disorder.

The aim of this study is to determine the changes in social cognition and other cognitive domains in ADHD comorbidity and to investigate the possible moderation role of these changes in OUD. A hundered inpatients with OUD were included in the study. Cognitive functions, severity of addiction and symptomatology of ADHD were evaluated. ASRS and API scores were in positive correlation and ASRS scores had a moderating effect on the relationship between craving score and emotion recognition. Our study shows that changes in social environment/cognition play an important role in the follow-up/treatment of patients.

Comparison of sleep structure in patients with fibromyalgia and healthy controls.

BACKGROUND: Sleep disturbances such as nonrestorative sleep and nighttime awakenings play a crucial role in fibromyalgia (FMS). Pain and sleep disturbances show a bidirectional relationship which affect outcomes in FMS. This study aims to compare sleep structures between patients with fibromyalgia and healthy controls. METHODS: We evaluated subjective and objective sleep structures of 33 patients with fibromyalgia and 34 healthy controls using the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and polysomnography. Student's T test, chi-square, discriminant analysis, the Kruskal-Wallis, and Mann-Whitney U test were used for statistical analysis. RESULTS: Patients with FMS reported poorer sleep quality than controls (p = 0.003). Polysomnography data showed patients with FMS exhibited a greater number of awakenings (p = 0.01), more arousals (p = 0.00), higher arousal index (p = 0.00), greater apnea hypopnea index (p = 0.03), and less N1 sleep (p = 0.02) than healthy controls. The discriminant analysis revealed that number of arousals, arousal index, and N1 sleep were able to distinguish patients with FMS from healthy controls with 78.5% accuracy. Twelve of the 33 patients with FMS were diagnosed with obstructive sleep apnea syndrome (OSAS). When we excluded patients with OSAS, a statistically significant difference was maintained. CONCLUSIONS: Our findings may explain the deterioration of subjective sleep, symptoms as unrefreshing sleep, fatigue, and pain in patients with FMS. Despite similar clinical manifestations, patients with FMS should be evaluated for OSAS due to treatment differences. The role of sleep alterations in the clinical manifestation and severity of FMS suggest that effective treatments to improve sleep quality may lead to more effective management of FMS.

Association between apolipoprotein E genotypes and panic disorder in Turkish population.

AIM: In this study, we aimed to investigate possible interactions among the apolipoprotein E (ApoE) and panic disorder (PD), taking into account serum cholesterol levels and subfractions. METHODS: ApoE genotyping was performed by real-time polymerase chain reaction in DNA samples of PD patient group (n = 45) and healthy control group (n = 50). The serum lipid levels, low-density lipoprotein (LDL), and high-density lipoprotein (HDL) subfraction analysis were examined. RESULTS: There was a significant difference of ApoE genotypes in patient and control groups. The E3/E3 genotypes lower whereas E4 allele carriers were significantly higher in PD group ApoE4allele carriers had 3.2-fold higher risk of PD. PD group had significantly lower LDL and HDL levels. In spite of the decreased levels of total LDL, antiatherogenic large LDL subgroup was significantly lower in a patient with PD. Antiatherogenic large HDL and Intermediate HDL levels were lower, while atherogenic small HDL subfraction was significantly higher in PD group. Furthermore, Apo E3/E3 genotype carriers had significantly higher large LDL, HDL, large HDL, intermediate HDL level, and also had highest HDL between all the groups. ApoE4 allele carriers while they had highest atherogenic small HDL level. CONCLUSION: E4 allele can be associated with PD as an eligible risk factor, the E3/E3 could be a risk-reducing factor for PD. Patients with PD not only had lower LDL and HDL levels but also they have higher atherogenic LDL and HDL subfractions. Also, E3/E3 genotype carriers had convenient but ApoE4 carriers had atherogenic plasma cholesterol levels and subfractions.

Neuronal nitric oxide synthase polymorphisms in obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a mental disease characterized by recurrent and intrusive thoughts and repetitive behaviours that negatively affect the quality-of-life of the patients. Recent studies have implicated the participation of neuronal nitric oxide in OCD pathogenesis as a neurotransmitter modulator. AIMS: To identify whether variations in neuronal nitric oxide synthase (nNOS) genes may render individuals susceptible to OCD development. METHODS: This study examined nNOS polymorphisms in 100 OCD patients and 121 unrelated healthy controls by polymerase chain reaction and restriction enzyme digestion methods. RESULTS: nNOS 276 C + genotype incidence was significantly higher in OCD patients than controls and conferred a 2-fold increased risk for OCD. No significant differences were observed in frequencies of nNOS 84 genotypes between patients and controls. CONCLUSION: This study shows an association between nNOS gene polymorphism and OCD. Exact mechanisms by which nNOS gene variants contribute to OCD pathogenesis need to be further investigated.

Do ictal EEG characteristics predict treatment outcomes in schizophrenic patients undergoing electroconvulsive therapy?

OBJECTIVE: The aim of this study is to investigate the relationship between features of electroencephalography (EEG), including seizure time, energy threshold level and post-ictal suppression time, and clinical variables, including treatment outcomes and side-effects, among schizophrenia inpatients undergoing electroconvulsive therapy (ECT). METHOD: This is a naturalistic follow-up study on schizophrenia patients, diagnosed using DSM-IV-TR criteria, treated by a psychosis inpatient service. All participants completed the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF) scale, the Frontal Assessment Battery (FAB) and a Data Collection Form. Assessments were made before treatment, during ECT and after treatment. FINDINGS: Statistically significant improvements in both clinical and cognitive outcome were noted after ECT in all patients. Predictors of improvement were sought by evaluating electrophysiological variables measured at three time points (after the third, fifth and seventh ECT sessions). Logistic regression analysis showed that clinical outcome/improvement did not differ by seizure duration, threshold energy level or post-ictal suppression time. DISCUSSION AND CONCLUSION: We found that ictal EEG parameters measured at several ECT sessions did not predict clinical recovery/outcomes. This may be because our centre defensively engages in "very specific patient selection" when ECT is contemplated. ECT does not cause short-term cognitive functional impairment and indeed improves cognition, because symptoms of the schizophrenic episode are alleviated.

Predictors of suicide in patients with conversion disorder.

OBJECTIVE: Previous studies have shown that the ratio of suicide attempts is between 19.6 and 34.2% in patients with conversion disorder (CD), yet few studies have addressed this issue. The present study compared demographic and clinical variables and predictors of suicide attempts in patients with CD. METHODS: A total of 100 consecutive patients were recruited and divided into groups according to their history of suicide attempts. Socio-demographic variables such as economic status, age, gender, educational level, marital status, clinical variables such as the presence of psychiatric disorder in family, substance abuse, risky alcohol use, age of onset, subtype of CD, number of hospitalization were recorded. Participants also completed the Childhood Trauma Questionnaire (CTQ-28), Temperament and Character Inventory (TCI), Toronto Alexithymia Scale (TAS-20), Dissociative Experiences Scale (DES), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI). RESULTS: Suicide attempters had a higher rate of risky alcohol use, more hospitalizations, and higher mean scores on the BAI, BDI, DES/DES-taxon, TAS-total and CTQ-total than did non-suicide attempters or healthy control (NHC). Patients with CD had a higher harm-avoidance and a lower self-directedness rather than NHC. Risky alcohol use, number of hospitalizations, and mean DES-taxon and emotional abuse scores were independent predictors of suicide attempts. CONCLUSION: Our findings indicate that clinicians should be aware of the prediction of suicide in patients with CD who show dissociation and risky alcohol use. Moreover, a history of childhood emotional abuse should be considered in the management of CD. The fact that clinical variables distinguished between suicide attempters and non-attempters suggests that a history of suicide attempts may be used to clarify the heterogeneous nature of CD.

Correction: Psychometric Properties of Questionnaire of Cognitive and Affective Empathy (QCAE): Reliability and Factor Analysis Study in Turkish Sample.

[This corrects the article on p. 228 in vol. 58, PMID: 34526847.].

Psychometric properties of the Turkish version of the Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms.

OBJECTIVE: In this study, we examined the psychometric properties of the Turkish version of the Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms (PHQ-SADS) developed by Kroenke, Spitzer, and Williams. METHOD: This study sample consisted of 200 outpatients admitted to Erenköy Mental Health Training and Research Hospital, Erenköy Physiotherapy and Rehabilitation Hospital, and Kartal Training and Research Hospital and 240 graduate students in Karadeniz Technical University. Participants were administered the 90-item Symptoms Checklist (SCL-90R) and the 7-item Whiteley Index, along with the PHQ-SADS. A month later, the PHQ-SADS was readministered to 60 of the students. To investigate the internal consistency of the scale and its subscales, corrected item-total correlations were examined to establish the effect on the Cronbach coefficients and internal consistency of each item of the subscales. Test-retest correlations were also analyzed for reliability. Factorial structure was investigated using principal component analysis. The validity of distinguishing congruent and specific groups was also investigated for validity. RESULTS: Total scores on the scale showed an adequate test-retest consistency (r = 0.54, 0.52, and 0.76, respectively). All items showed adequate correlations (r > 0.26) in the test-retest analysis. Cronbach α values were 0.86 (control), 0.93 (patient), and 0.92 (total) on the test of internal consistency. When the questions were analyzed individually, the item-total correlation for item 7 of the PHQ somatization subscale was found to be inadequate in the control group. Exploratory factorial analysis and varimax rotation results showed that the scale provided a 4-factor structure. In the validity analysis, a significant difference between the patient and the control group mean values was determined. The SCL-90R, 7-item Whiteley Index, and SCL-90R somatization subscales were found to be sufficiently related to the number of symptoms to establish criterion-related validity. CONCLUSION: Findings with respect to internal consistency, test-retest consistency, item-total correlation, factorial structure, distinguishing validity for specific groups, and criterion-related validity for the PHQ-SADS show that the scale is acceptable in terms of validity and reliability for the Turkish population.

Psychometric Properties of the Turkish Version of the Barratt Impulsiveness Scale-Brief in Adolescents.

Introduction: Barratt Impulsiveness Scale-Brief (BIS-Brief) is a self-report scale that can be used to measure impulsivity in adolescents. In this study, it was aimed to determine the psychometric properties of the Turkish version of the BIS-Brief in clinical and non-clinical adolescent samples. Methods: The study included two groups of 116 psychiatric outpatients and 175 middle and high school students. For the re-test study, a small subgroup of the patient group (n=21) was re-applied BIS-Brief three weeks later. Socio-demographic data of the participants were collected. Aggression subscale of Childhood Behavior Checklist (CBCL), hyperactivity/impulsivity and anger control problems subscales of Conners-Wells' Adolescents Self-Report Scale-Long (CASS-L), and hyperactivity subscale of Conner's Parent Rating Scale-Short Form (CPRS-S) were administered. Results: The mean ages of the patient and control groups were 15.22±1.58 years and 15.16±1.86 years, respectively. There were 77 (66.4%) males in the patient group and 107 (61.1%) males in the control group. Cronbach's alphas for internal consistency were 0.78 (patient group) and 0.70 (control group). Three weeks test-retest reliability was 0.64 (patient group). We found a two-dimensional structure for the Turkish BIS-Brief. The BIS-Brief scores had a significant correlation with the scores of CBCL's aggression subscale (r=0.48; p<0.01), CASS-L's hyperactivity/impulsivity (r=0.45; p<0.01) and anger control problems subscales (r=0.45; p<0.01) and CPRS-S' hyperactivity subscale (r=0.21; p<0.01). Conclusion: Our findings suggest that the Turkish version of the BIS-Brief is a reliable and valid measure for clinical and non-clinical adolescent samples. In addition, the results show that the BIS-Brief has a two-dimensional model in contrast to the unidimensional structure of the original scale.

Emotional Information Processing and Assessment of Cognitive Functions in Social Anxiety Disorder: An Event-Related Potential Study.

The aim of our study was to determine deficits in cognitive areas, including social cognition such as emotion recognition capacity, theory of mind, and electrophysiological alterations in patients with social anxiety disorder (SAD) and to identify their effects on clinical severity of SAD. Enrolled in our study were 26 patients diagnosed with SAD and 26 healthy volunteers. They were administered the Liebowitz Social Anxiety Scale (LSAS), Reading Mind in the Eyes Test (RMET), and Cambridge Neuropsychological Test Automated Battery. EEG monitoring was performed for electrophsiologic investigation. In the patient group, total reading the mind scores were lower (P = .027) while P300 latencies and emotion recognition latency during the Emotion Recognition Task (ERT) were longer (P = .038 and P = .012, respectively). The false alarm scores in the Rapid Visual Information Processing Task (RVP) were higher in the patient group (P = .038). In a model created using multivariate linear regression analysis, an effect of ERT and RVP scores on LSAS scores was found. Results of our study confirm that particularly impairment of cognitive functions such as sustained attention and emotion recognition may seriously affect the clinical presentation negatively. P300 latency in the parietal region may has the potential to be a biological marker that can be used in monitoring treatment.

Investigation of auditory P50 sensory gating with sexual visual stimuli in patients with vaginismus.

OBJECTIVES: The aim of the study was to investigate sensory information processing induced by visual sexual stimuli and to assess its relationship with sexual behaviors and symptoms in patients with vaginismus. METHODS: Twenty-one patients with vaginismus and 20 controls were included in the study. The sociodemographic information and sexual life history of the patients with vaginismus and controls were examined and electrophysiological measurements related to auditory P50 sensory gating were obtained using a double click paradigm during by sexual/horror visual stimulation, which was thought to be related to the pathophysiology of the disease. RESULTS: P50 suppression ratios during visual sexual stimuli were lower in vaginismus group compared to the control group. There was no difference in P50 suppression ratios during visual horror stimuli when the two groups were compared. The P50 suppression of the vaginismus group with visual sexual stimuli was found to be lower than P50 suppression with visual horror stimuli. A positive moderate correlation was found between the duration of foreplay and P50 suppression ratio during visual sexual stimuli in vaginismus group. CONCLUSION: Our study revealed that patients with vaginismus had sensory gating impairment during visual sexual stimuli. Increase in the duration of foreplay in vaginismus patients may improve sensory gating impairment by affecting sensory gating functions.

Psychometric Properties of Questionnaire of Cognitive and Affective Empathy (QCAE): Reliability and Factor Analysis Study in Turkish Sample.

INTRODUCTION: The Questionnaire Cognitive and Affective Empathy (QCAE) scale is a tool that is widely used because of its multi-dimensional assessment of ability for empathy and is currently available in many languages. The aim of the current study was to examine the psychometric properties of the Turkish version of QCAE, which evaluates cognitive and emotional empathy with its multi-dimensional structure, and to bring it into the Turkish. METHODS: The study was carried out in a Turkish population of 412 healthy volunteers. Internal consistency, confirmatory factor analyses and gender comparisons of the Turkish version of the scale were performed. RESULTS: The Turkish version of QCAE had good construct validity and reliability for the five-correlated factors model (i. e., Emotion Contagion, Proximal Responsivity, Peripheral Responsivity, Perspective Taking and Online Simulation). Temporal reliability was high with a two week test-retest intra-correlation coefficient range of 0.69-0.79. A total of 3 models were tested with confirmatory factor analyses, including the models of the original investigation. Cognitive-Affective distinction was not supported by the pattern of correlations between the factors. CONCLUSION: Our results support that it is appropriate to compute and interpret the 5 sub-dimensions of the Turkish version of QCAE separately and totally, but the limitations in its use in the Cognitive Empathy and Affective Empathy sub-dimensions should be heeded.

Effect of childhood trauma on disease severity in patients with fibromyalgia: The mediating role of psychological resilience.

Objectives: This study aims to investigate the effect of childhood traumas on the disease severity in fibromyalgia and evaluate the mediating role of psychological resilience in this effect. Patients and methods: Between June 2017 and January 2018, this study included a total of 80 female patients (mean age: 31.9±4.0 years; range, 20 to 40 years) with fibromyalgia according to the 2010 American College of Rheumatology fibromyalgia diagnostic criteria. All patients were evaluated using the sociodemographic data form, Resilience Scale for Adults (RSA), Childhood Trauma Questionnaire (CTQ), and Fibromyalgia Impact Questionnaire (FIQ). Results: A positive correlation was observed between the FIQ and CTQ total scores, emotional abuse, physical abuse, and physical neglect scores. The FIQ was negatively correlated with the RSA scores. Path analysis conducted to evaluate mediating effect of psychological resilience revealed that psychological resilience had a mediator role in the correlation between FIQ and emotional abuse, physical abuse, and physical neglect scores. Conclusion: The main finding of this study is the protective effect of psychological resilience -improvable capacity to cope with early life traumas- on fibromyalgia symptoms that leads to negative functioning of several aspects.

Suicidal behavior in treatment resistant major depressive disorder patients treated with transmagnetic stimulation(TMS) and its relationship with cognitive functions.

The aim of this study is to investigate the effects of rTMS treatment on suicidal thoughts/behaviors and to determine the cognitive mechanisms underlying the effects of rTMS treatment on suicidal thoughts/behaviors in treatment-resistant depression(TRD). Thirty patients with TRD received rTMS 5 sessions per week for 4-6 weeks. Montgomery-Asberg Depression Rating Scale(MADRS), Columbia Suicide Severity Rating Scale(C-SSRS), Suicidal Ideation Scale(SIS), Beck Hopelessness Scale(BHS) and Cambridge Neuropsychological Test Automated Battery(CANTAB) were administered before and after treatment. After rTMS treatment, there was a significant decrease in depressive complaints and suicidal thoughts and improvement in emotional recognition. However, there was no significant change in cognitive functions such as cognitive flexibility, motor response inhibition and decision making. Pre-treatment decision-making and flexible thinking skills were related to the change in suicidal ideation. In TRD patients, rTMS has a positive effect on depressive symptoms and suicidal thoughts/behaviors and emotion recognition abilities. Although there is no negative effect on other cognitive functions, the positive effect of rTMS on cognitive functions is limited. At this point, we think that the TRD would be treated more effectively with treatments targeting specific symptom clusters such as other cognitive functions and suicidal thoughts.

The association between neurocognitive functioning and clinical features of borderline personality disorder.

OBJECTIVE: To investigate the relationship between neurocognitive profiles and clinical manifestations of borderline personality disorder (BPD). METHODS: Forty-five patients diagnosed with BPD and 35 healthy volunteers were included in the study. The BPD group was evaluated with the Borderline Personality Inventory for dissociative, impulsivity and suicidal dimensions. The Verbal Memory Processes Test and the Cambridge Neurophysiological Assessment Battery were administered to both the BPD and healthy control groups. RESULTS: BPD patients differed from controls in sustained attention, facial emotion recognition, and deteriorated verbal memory function. A model consisting of the Dissociative Experiences Scale - Taxon (DES-T), motor impulsivity and Scale for Suicidal Behavior scores explained 52% of the variance in Borderline Personality Inventory scores. It was detected that motor impulsivity, decision-making and recognizing sadness may significantly predict DES-T scores, and response inhibition and facial emotion recognition scores may significantly predict impulsivity. CONCLUSION: Our findings demonstrate that the disassociation, impulsivity, and suicidality dimensions are sufficient to represent the clinical manifestations of BPD, that they are related to neurocognitive differences, and that they interact with clinical features.

Normative data and factorial structure of the Turkish version of the Temperament and Character Inventory.

Cloninger's dimensional psychobiological model of personality accounts for both normal and abnormal variation in 2 major personality components: temperament and character. Here, we examined the psychometric properties of the Turkish version of the Temperament and Character Inventory (TCI) in a healthy Turkish population, obtaining normative data for the Turkish TCI. The study was conducted in healthy volunteers at both Karadeniz Technical University School of Medicine and Atatürk University School of Medicine (n = 683). The Turkish sample had significantly lower mean scores on Novelty Seeking and Reward Dependence and higher mean scores on Harm Avoidance than the American sample. The Turkish sample had significantly lower scores on Self-Directedness, Cooperativeness, and Self-Transcendence. Self-Directedness and Harm Avoidance, Cooperativeness and Reward Dependence, and Cooperativeness and Self-Directedness were intercorrelated. The Cronbach coeficients were between 0.60 and 0.85 on temperament dimensions, and between 0.82 and 0.83 on character dimensions. The lowest Cronbach coefficients were found in Reward Dependence (0.60) and Persistence (0.62). A principal axis factor analysis with a 4-factor solution revealed the highest loadings on Novelty Seeking and Harm Avoidance and relatively weaker loadings on Reward Dependence and Persistence. A 3-factor solution for character subscales indicated the highest loadings on Cooperativeness and Self-Transcendence. The factorial structure was consistent with Cloninger's 7-factor model of personality, and test-retest indicated a good stability of scores over time. The reliability and factorial validity of the Turkish version of the TCI are therefore supported.

Are emotion recognition deficits in patients with schizophrenia states or traits? A 6-month follow-up study.

BACKGROUND: Patients with schizophrenia were found to be less successful at emotion recognition tasks (ERTs) than healthy individuals. There is a debate surrounding whether this deficit is permanent or temporary. The current study aims to assess how emotion recognition skills are affected by treatment processes and during the course of the disease and also to determine the relation of this change with clinical assessment scales, other cognitive functions, and quantitative electroencephalography (QEEG). MATERIALS AND METHODS: Twenty-four inpatients with treatment-resistant schizophrenia have been included in the study. Patients were assessed before beginning clozapine and 6 months later. During both assessments, clinical evaluation scales (Positive and Negative Syndrome Scale and Global Assessment of Functioning), Cambridge Neuropsychological Test Automated Battery (CANTAB) for schizophrenia which is used for assessment of cognitive functions were used. Electroencephalography (EEG) monitorings were performed only once before treatment. In this study, CANTAB ERT was used for emotion recognition. RESULTS: There was no statistically significant change in the emotion recognition when the first and final ERTs were compared. There was a moderately positive relationship between emotional recognition and functioning (r = 0.65, P < 0.05). Cognitive functions such as visual memory, attention, flexible thinking, and planning were found to be in correlation with emotion recognition. Furthermore, slow waves such as delta and theta activities obtained from frontal, temporoparietal, and occipital regions were associated with emotion recognition. CONCLUSION: The current study supports that emotion recognition deficits are long-term stable features of schizophrenia, slow-wave electrical activity in the frontal, temporoparietal, and occipital areas in QEEG, and cognitive functions such as visual memory, attention, flexible thinking, and planning are found to be correlated with emotion recognition.

Effects of personality functioning on the global functioning of patients with bipolar disorder I.

Due to the comorbidity of personality traits or disorders and BD, the present study investigated the extent to which the global functioning of patients with BD would be affected by personality functioning. This study included 100 subsequent patients who had been diagnosed with BD-I, and were in the remission phase. Global functioning was assessed with the Bipolar Disorder Functioning Questionnaire (BDFQ) and the Level of Personality Functioning Scale (LPFS) was conducted following psychodynamic-oriented semi-structured interviews to assess the level of personality functioning. Hierarchical linear regression models were conducted. After controlling other variables, the predictability of LPFS components on global functionality was assessed. Global functioning was negatively correlated with subsyndromal depressive symptoms, the presence of a psychiatric comorbidity, alcohol/substance use disorders, the side effects of medication, poor social support, and an impaired level of personality functioning. Finally, a decrease in the level of personality functioning predicted impaired global functioning. The present study demonstrated that the level of personality functioning had a significant impact on global functioning during the euthymic period of BD. Therefore, the assessment of the level of personality functioning in patients with BD will aid in better understanding this population and in the design of long-term treatment plans.

Objective measures of sleep in fibromyalgia syndrome: Relationship to clinical, psychiatric, and immunological variables.

We aimed to investigate the changes in the objective and subjective sleep variables during painful episodes of fibromyalgia and post-episode period, and to evaluate the impact of the sleep variables on the current clinical, psychological, and immunologic parameters. Thirty-one consecutive patients who were referred to the Erenköy Physical Therapy and Rehabilitation Polyclinic with a diagnosis of fibromyalgia were evaluated before and in the sixth week of the acute pain treatment. The sleep variables were measured by polysomnography, Pittsburgh Sleep Quality Index, and Epworth Sleepiness Scale. The clinical and psychiatric assessment of patients was performed by using Fibromyalgia Impact Questionnaire; Patient Health Questionnaire-Somatic, Anxiety, and Depressive Symptoms; and Visual Analog Scale. Serum pro-inflammatory molecules were measured to evaluate the immunological status. The pain treatment significantly affected subjective sleep variables, psychiatric variables, clinical variables, and IL-6 levels. The subjective sleep parameters, clinical and psychiatric variables, and IL-6 levels were improved with pain treatment in fibromyalgia. The objective sleep variables, IL-1 and TNF-alpha levels were not significantly improved with the pain treatment, and they were not related to clinical presentation of patients with fibromyalgia. Subjective variability of sleep contributes to the clinical presentation, suggesting that the objective structure is trait-specific with IL-1 and TNF-alpha.