Dietary patterns and eating behaviors on the border between healthy and pathological orthorexia.

PURPOSE: The obsession with healthy eating associated with restrictive behaviors is called Orthorexia Nervosa (OrNe). Nevertheless, some studies suggest that orthorexia can also be a non-pathological interest in healthy eating which is called Healthy Orthorexia (HeOr). First, one of the main objectives of this study is to compare HeOr, OrNe and eating behaviors in different dietary patterns (vegan, vegetarian and omnivore). Second is to reveal the relationship between HeOr, OrNe and eating behaviors (cognitive restraint, uncontrolled eating, and emotional eating). Lastly, to determine the potential predictors of HeOr and OrNe. METHODS: Participants (N = 426 with an omnivorous diet; N = 415 with a vegan diet, N = 324 with a vegetarian diet) completed a web-based descriptive survey, the Teruel Orthorexia Scale and the Three-Factor Eating Questionnaire-R 21. RESULTS: HeOr and OrNe were more common in individuals following both vegan and vegetarian diets. Individuals following a vegan or a vegetarian diet had lower body mass index and higher body image satisfaction than individuals following an omnivorous diet. Cognitive restraint and following a vegan or a vegetarian diet were the two main predictors of both HeOr and OrNe. Cognitive restraint was positively associated with both HeOr and OrNe (more strongly correlated with OrNe), whereas uncontrolled eating and emotional eating behaviors were positively related to OrNe and negatively related to HeOr. CONCLUSION: The present study contributes to a better understanding of the some similarities and differences between HeOr and OrNe. It also points to higher rates of orthorexia in individuals following a vegan or vegetarian diet and represents a further step towards developing prevention and intervention programs by identifying risk factors for OrNe. Level V Cross-sectional descriptive study.

Diagnostic Transitions from Primary Psychiatric Disorders to Underlying Medical Conditions: A 5-Year Retrospective Survey from a University Hospital Sample.

Background: Undiagnosed underlying medical conditions can cause many patients to be followed, for years, by a diagnosis of a primary psychiatric disorder and to receive inappropriate treatment. The aim of this study was to determine the prevalence of patients initially diagnosed with a primary psychiatric disorder but whose symptoms were later attributed to medical conditions. These patients' initial and final diagnoses were also examined. Methods: The records of 1843 patients hospitalized in Gazi University Faculty of Medicine Psychiatric Inpatient Clinic between 2015 and 2020 were examined in this retrospective and descriptive study. Thirteen patients were excluded from the study due to insufficient data. Descriptive statistics were performed on the data of 30 patients diagnosed with an underlying medical condition. Results: In follow-up, 49 patients' diagnoses changed. 19 patients had a diagnosis unrelated to an underlying medical condition, and 30 had a diagnosis related to an underlying medical condition. Five (16.7%) of the patients, previously known to have psychiatric disorders, were found to have Alzheimer's disease. Brain space-occupying lesions, frontotemporal dementia, epilepsy, Parkinson's disease, and Arnold-Chiari malformation followed Alzheimer's disease at 6.7% (n = 2). The mean time until the diagnosis of the patients was revised was 4.95 years (standard deviation [SD] = 7.78). It was observed that psychotropic medications (90%) were used more than non-psychotropic drugs until the diagnosis was revised. Conclusion: During the diagnostic process, we believe that clinicians should be aware of potential underlying medical conditions and that the multidisciplinary work of psychiatry and neurology is also crucial.

Effect of Structured Cognitive-Behavioral Group Therapy on Body Weight, Mental Status and the Quality of Life in Obese and Overweight Individuals: A 16-Week Follow Up Study. / Obez ve Asiri Kilolu Bireylerde Yapilandirilmis Bilissel Davranisçi Grup Terapisinin Vücut Agirligi, Ruhsal Durum ve Yasam Kalitesi Üzerine Etkisi: 16 Haftalik Bir Takip Çalismasi.

OBJECTIVE: It was aimed in this study to investigate the effects of group cognitive and behavioral therapy (CBT) on the body weight, depression, anxiety, quality of life, self-esteem, dietary cognitive distortions and eating behavior of obese and overweight people. METHOD: The study was carried out at the Department of Psychiatry, Gazi University Faculty of Medicine, between 01.07.2017 and 31.12.2017. The participants attended group CBT sessions once weekly for eight weeks. Reinforcement sessions took place at the 12th and 16th weeks. At the first, 8th, 12th and the 16th weeks, body weights were measured and the participants were asked to complete the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), the Obese Individuals Specific Quality of Life Scale (OISQLS), the Dutch Eating Behavior Questionnaire (DEBQ), the Rosenberg Self-Esteem Scale (RSES) and the Diet Related Dysfunctional Attitudes Scale (DRDAS). RESULTS: The group mean age was 41.71±4.46 years, 32 (91.4%) being female. Significant improvements were found in body weight and the scores on the BDI, BAI, DEBQ, OISQLS, DRDAS, and the RSES (p<0.001 for each). The average percent weight loss was 10.2%. The BDI score was the best predictor of the change in body mass index (BMI). CONCLUSION: CBT-based group treatments for obese and overweight people are effective in losing weight. Therapy participants with less depression symptoms benefit more from treatment and lose more weight. These results should be re-evaluated in randomized controlled trials.

Revisiting Jerusalem Syndrome: A Case Displaying Similar Symptoms to Jerusalem Syndrome During Mecca Visit. / Kudüs Sendromuna Tekrar Bakis: Mekke Ziyareti Sirasinda Kudüs Sendromuna Benzer Belirtilerle Basvuran Bir Olgu.

Jerusalem syndrome is a mental illness rarely seen in people who visit Jerusalem, manifests itself with obsessive religious thoughts, delusions, psychotic symptoms, and some characteristic features. In clinical practice, it's uncommon to encounter patients displaying symptoms of the Jerusalem syndrome. In this paper, we report a case of a middle-aged woman who manifested psychiatric symptoms similar to the Jerusalem syndrome after a Mecca visit without any previous psychiatric history. After careful examination, religious delusions, auditory and visual hallucinations, racing thoughts, disorganized speech, and confusion were denoted, therefore the patient was hospitalized. Brain imaging and laboratory examination was unremarkable. After nine days of antipsychotic treatment, the patient's symptoms completely dissolved, and she was discharged. Antipsychotic treatment was ceased entirely after two months. The patient and her family members reported that the patient was symptom-free for the following two years. Keywords: Brief reactive psychosis, religion, travel, differential diagnosis.

The Effect of the New Type Coronavirus Outbreak on Quality of Life and Suicidal Thoughts in Psychiatric Patients. / Yeni Tip Koronavirüs Salgininin Psikiyatrik Hastalarda Yasam Kalitesi ve Intihar Düsüncelerine Etkisi.

OBJECTIVE: The aim of this study is to investigate the effect of perceptions on the COVID-19 pandemic on the quality of life and suicidal ideation in both healthy controls and individuals with psychiatric disorders. METHOD: The study was conducted on 4 different groups with 83 depressive disorders, 90 anxiety disorders and 61 schizophrenia patients who have been followed in Gazi University Medical Faculty Hospital Mental Health and Diseases outpatient clinic since before the COVID-19 pandemic period and another group of 93 healthy volunteers. Participants were evaluated with Sociodemographic Data Form, Suicide Probability Scale (SPS), SF-36 Quality of Life Scale (SF- 36), Perception of COVID-19 Scale (P-COVID-19), and Perception of Causes of COVID-19 Scale (PCa-COVID-19). RESULTS: The perception on the danger and contaigiousness of P-COVID-19 scored lowest in the schizophrenia group, compared to other groups and PCa-COVID-19's Conspiracy and Belief subdimension scores were highest. In all groups, a significant negative correlation was found between the P-COVID-19's dangerousness subdimension score and the SF-36 scale's Mental Health sub-dimension. Again, in all groups, significant positive correlations were found between the Dangerousness sub-dimension score of P-COVID-19 and the anger/impulsivity, hopelessness/loneliness and suicidal thoughts sub-dimensions of the SPS. CONCLUSION: The negative effects of perceptions associated with COVID-19 on mental health were observed both in groups with a psychiatric disorder and in healthy controls. The higher number of participants and longitudinal research will provide a better understanding of the effects of perceptions associated with COVID-19 and will guide the necessary treatment interventions.

The Effect of Defense Mechanisms and Eating Awareness on the Probability of Suicide After Bariatric Surgery. / Bariatrik Cerrahi Sonrasi Intihar Olasiligi Üzerine Savunma Mekanizmalari ve Yeme Farkindaliginin Etkisi.

OBJECTIVE: This study aims to investigate the relationship between suicide possibilities, defense mechanisms, and eating awareness of patients who have undergone bariatric surgery. METHOD: The study sample consisted of 101 patients who had bariatric surgery in a private hospital. People who had at least six months from the date of surgery, who had no pregnancy, and who did not give birth after surgery were included in the study. The Mindful Eating Questionnaire, Suicide Probability Scale, and the Defense Style Questionnaire were applied to the participants. RESULTS: While the average age of the sample was 52.46±9.72, 54.5% (n=55) were male. Within one year after the operation, 33.7% of (n=34) patients had lost weight between 21-30 kg, while 21.8% (n=22) had lost weight between 11-20 kg. Suicide probability scale scores are predicted by emotional eating (ß=0.272, p=0.004), neurotic defense mechanism (ß=0.284, p=0.003) and current body mass index (ß=0.258, p=0.008). CONCLUSION: The possibility of suicide after bariatric surgery is closely related to emotional eating, neurotic defense mechanisms, and body mass index. The solution to the problem of emotional eating rather than decreasing the body mass index may be more effective in decreasing the suicide possibilities of the patients. Therefore, in patients undergoing bariatric surgery, emotional eating is one of the problems that should be handled both before and after surgery.

Readmission Rates and Causes Within The First Six Months After Discharge in Patients with Alcohol Addiction.

INTRODUCTION: Readmission rate is an important criterion that evaluates the quality of treatment and care. In this study, it was aimed to determine the rates of readmission and variables predicting readmission in patients with alcohol addiction. METHODS: The study sample consisted of 264 alcohol addiction patients with recurrent admissions between 2005-2017 at the Gazi University Hospital Alcohol and Drug Addiction Clinic. In the study, ICD-10 diagnostic classification was used. The differences between the medical comorbidity and psychiatric comorbidity of the patients during the first and second admissions were analyzed. RESULTS: The average age of the study sample was 51.45±12.04 and 89% (n=235) were male. In the second admission, the comorbid headaches (p=0.001), psychotic symptoms (p=0.013), anxiety disorder (p=0.003) and substance addiction (p=0.027) were significantly higher, and the length of hospital stay was shorter. In the first six months, 24.2% (n=64) of the sample was hospitalized again. While the comorbidity of anxiety disorder increased the risk of readmission within six months 2.2-fold (OR=2.240; p=0.031), the short duration of hospitalization (less than 35 days) increased the risk of readmission 2-fold (OR=0.492; p=0.026). DISCUSSION: Patients with a short hospital stay have an increased risk of readmission within the first 6 months after discharge. Policies that reduce the length of hospital stay in health services should be reviewed. However, it is noteworthy that in the second admission of patients with alcohol dependence, the diagnosis of drug addiction is added. To prevent this, issues related to substance abuse prevention should be addressed during the treatment stages of alcohol dependence.

Social Media Addiction in Young Adult Patients with Anxiety Disorders and Depression.

Objective: Although the relationship between social media addiction (SMA) and mental health is bidirectional, there have been very few attempts to investigate patients with depression or anxiety disorders in terms of SMA. The first aim of this study is to determine whether young adult patients diagnosed with depression or anxiety disorders have a tendency to become addicted to social media. The second aim of the study is to examine the effects of 6 DSM-based personality traits (dependent, histrionic, narcissistic, obsessive-compulsive, borderline, and paranoid) that commonly coexist with these disorders on SMA. Methods: This study was carried out with 276 participants between the ages of 18 and 35 in the Psychiatry Outpatient Clinic in Gazi University Hospital, Turkey. Seventy-three patients diagnosed with depression, 80 patients diagnosed with anxiety disorders, and 123 healthy controls were recruited for the study. The SMA Scale, Hospital Anxiety and Depression Scale, and the Personality Belief Questionnaire-Short Form were administered to the participants. Results: Patients with anxiety disorders (PAD) and patients with depression (PD) were more addicted to social media than healthy controls (HC) despite similar frequencies of social media use. Dependent, histrionic, narcissistic, obsessive-compulsive, borderline, and paranoid personality features in HC increased the susceptibility to SMA. Borderline and dependent personality features comorbid with PAD increased the susceptibility to SMA. None of the personality traits comorbid with PD had an effect on SMA. Conclusion: The present study will serve as a base for future studies which explore factors that can make PAD or PD more vulnerable to SMA.

Predictors of depression, anxiety and stress among remote workers during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has had a massive impact on work and home life, changing all daily routines of remote workers. It is extremely important to figure out some changes in home and work life that may affect the mental health of remote workers more. OBJECTIVES: The first aim of the study was to investigate the predictors of depression, anxiety, and stress among first-time remote workers during the COVID-19 pandemic. The second aim was to explore sex differences regarding work and home life during the COVID-19 pandemic. METHODS: The sample consisted of 459 participants who have been working from home for the first time during the COVID-19 pandemic. An online survey used included questions relating to sociodemographic characteristics, changes in work and home life, Depression Anxiety Stress Questionnaire-Short Form, Jenkins Sleep Scale, and Leisure-Time Exercise Questionnaire. RESULTS: The prevalence of depression, anxiety, and stress was 17.9%, 19.6%, and 19.6% of the participants, respectively. Poor sleep quality, trouble focusing at work, being female, workplace loneliness, low levels of control over working hours, and low levels of physical activity were predictors of depression. Poor sleep quality, increased workload, and being female were predictors of anxiety. Poor sleep quality, trouble focusing at work, being female, financial concern, and workplace loneliness were predictors of stress. It was observed a higher increase in both housework and working hours during the COVID-19 pandemic in women. CONCLUSION: Determining the variables that can affect the mental health of remote workers is highly important for timely psychological intervention.

The Effect of Education and Motivational Interviewing on COPD Management and Outcome Parameters in COPD Patients.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is an important health problem. The disease management consists of avoiding risk factors, therapy for maintenance of disease stability, and prevention and treatment of exacerbations. Patient education and motivational interviewing are thought to be effective approaches in disease management. This study aimed to investigate the effects of repeated education and motivational interviewing conducted by a multidisciplinary team, and the outcomes in COPD patients. MATERIAL AND METHODS: This was a randomized controlled study. The study included 40 COPD patients (21 cases and 19 controls) hospitalized for exacerbation of COPD between June 2015 and June 2017. The patients were randomized in a ratio of 1 : 1 based on age, gender, and socioeconomic status. After a baseline assessment for all patients, patients in the study group were subjected to a total of 3 educational sessions and 4 motivational interview sessions through intermittent invitations over a period of one year. At the end of the first year, baseline assessment tests, the technique of drug use, the number of moderate/severe COPD exacerbations, and mortality status were evaluated for all patients. RESULTS: There was no difference between the groups in terms of age, gender, and pulmonary function tests (FEV1%, FEV1/FVC) and partial oxygen and carbon dioxide pressures (pO2 and pCO2). At the end of the 12 months, there was a statistically significant difference between the groups in terms of the levels of theoretical knowledge of COPD and the Morisky scale scores. All patients in the study group survived, whereas 4 patients died in the control group, with a statistically significant difference between the 2 groups. CONCLUSION: One-to-one education and motivational interviews (MI) on COPD, which are based on a multidisciplinary approach, are proposed, because they increase the level of knowledge of the disease and adherence to treatment, and have positive effects on mortality rates.

A Case of Arachnoid Cyst Presenting with Cognitive Impairment and Hypomania Symptoms. / Bilissel Bozukluk ve Hipomani Belirtileriyle Basvuran Bir Araknoid Kist Olgusu.

Arachnoid cysts are benign congenital malformations of the arachnoid which account for approximately 1.4% of the intracranial lesions. Although it is usually asymptomatic, it may be accompanied by headache, hydrocephalus and seizure. Psychiatric disorders associated with arachnoid cysts are rare. In this article, we present a giant arachnoid cyst with hypomania symptoms and marked cognitive impairment. A 44-year-old female patient was admitted to our outpatient clinic with a 4-year history of headache, nervousness and attention problems. Magnetic resonance imaging revealed a giant arachnoid cyst with a size of 5.5x10.5x12.5 cm was found in the left hemisphere of the patient. Considering the patient's irritability, increase in the amount of speech, flight of ideas, sleep disturbance and attention disorders, the diagnosis of hypomania was made. The neuropsychological tests showed that the speed of information processing, mental flexibility and attention functions decreased, and executive functions were impaired. The patient was consulted to the neurosurgery department. But no surgical treatment was offered. Drug therapy for hypomanic symptoms and cognitive impairment was planned, but could not be started since the patient did not attend to the follow-up exams. Albeit the lack of followup constitutes a limitation for our report, we believe that the size of the cyst, significant impairment of cognitive functions and the presence of hypomania symptoms might contribute significantly to the literature. Other cases with arachnoid cyst displaying cognitive impairment were summarized in our article.

Lujan-Fryns Syndrome Phenotype with Autism-Like Behavior and Atypical Psychotic Symptoms: Case Report. / Otizm Benzeri Davranis ve Atipik Psikotik Belirtileri Olan Lujan-Fryns Sendromu Fenotipi: Olgu Sunumu.

Lujan-Fryns Syndrome (LFS) is defined as a set of symptoms including mild-moderate mental retardation, marfanoid appearance, hypotonia at birth, hypernasal speech, characteristic craniofacial appearance and normal testis size. The frequency of the syndrome is not known thus the information obtained is solely based on case reports. Hereby, we present a patient with LFS diagnosis. The 29-year old male patient had mental retardation, aggression, and persecutory delusions, characteristic craniofacial and marfanoid features. During his speech pronominal reversal was observed ('the hurt him, he is so upset' when talking abour himself). After examination and genetic analysis, fragile X, Klinefelter, Marfan and Down syndromes and homocystinuria were eliminated as causes of mental retardation. A preliminary diagnoses of LFS done. No mutation was detected in exon 22 of the MED12 gene; but. Whole Exome Sequencing (WES) is ongoing. The patient was started on risperidone (4 mg/day) for psychotic symptoms and carbamazepine (200 mg/day) for impulse control and as an antiepileptic. After a follow up of 8 months, impulse control, psychotic symptoms and aggression improved significantly. Since the specific gene mutation of LFS was not determined in our case, we solely had to depend on clinical evaluation and genetic analysis. Although it is not easy to fully define or classify these syndromes, we believe every reported case will be a step in overcoming these difficulties.

[Mania Associated with the Use of Bortezomib and Dexamethasone]. / Bortezomib ve Deksametazon Kullanimina Bagli Gelisen Mani Olgusu.

Bortezomib, an antineoplastic agent used in Multiple Myeloma, is a modified dipeptidyl boronic acid that is selectively and reversibly attached to the 26S proteasome. Bortezomib may be combined with corticosteroids in treatment-resistant multiple myeloma patients. Corticosteroids can cause many psychiatric disorders ncluding mania, depression, psychosis, delirium, suicide and aggression. To date only one case of mania associated with the use of bortezomib was reported in which the patient responded to the treatment with olanzapine and valproic acid. In this article, we present a 57-year-old female with multiple myeloma in whom mania developed after the use of bortezomib combined with dexamethasone.Psychiatric symptoms such as sleep deprivation, increased self-esteem and excessive speech appeared within the first week of bortezomib and dexamethasone treatment. Quetiapine was administered for the treatment of psychiatric symptoms. A gradual improvement was noted in manic symptoms after treatment. Bortezomib is a relatively new drug and there are only a few reports with respect to its psychiatric side effects. While using antineoplastic drugs such as bortezomib, caution should be exercised with regards to the psychiatric symptoms.