Treatment adherence in forensic patients with schizophrenia spectrum disorders discharged on long-acting injectable antipsychotics: a comparative 3-year mirror-image study.

In this retrospective 3-year mirror-image study, 81 patients with schizophrenia spectrum disorders (SSD) were categorized according to whether they were prescribed long-acting injectable antipsychotics (LAI) or not upon discharge from the inpatient forensic psychiatric unit. Antipsychotic adherence, which was staged based on the 'proportion of days covered' method, as well as other clinical outcomes was compared between pre- and post-index mirror periods. In both Oral-only (n = 46) and Oral + LAI (n = 35) groups, the number of hospitalizations, convictions and months spent in the hospital were significantly lower in the post-index period than the pre-index period. Differences in these three variables between pre- and post-index periods were NS between the two groups. A mixed effect ordinal logistic regression model with random intercept showed that the odds ratio of obtaining a higher treatment adherence score in the post-index period was more pronounced in the Oral + LAI group than in the Oral-only group, considering adherence at baseline and the length of stay during the index hospitalization as potential confounders. Discharge with LAIs in a forensic psychiatric cohort of SSD was associated with a greater mid- to long-term improvement in antipsychotic medication adherence compared to discharge with oral-only antipsychotics.

Profiling Homicides Based on Impulsive or Proactive Natures in Male Schizophrenia Patients.

The main aim of this study was to ascertain whether a relationship existed between the modus operandi and motivation of homicide, clinical characteristics, and psychopathic traits in schizophrenia. Forty-seven male homicide perpetrators with schizophrenia were included in the study. We classified types of homicide perpetrated by the patients as predominantly impulsive (n = 27) or proactive (n = 20) in nature. We also evaluated the psychotic motivation accompanying the homicide. Forty-four (93.6%) of the homicides were psychotically motivated. The victim was a stranger in only 8.5 percent of the homicides. Use of firearms as a killing method was significantly higher in predominantly proactive homicides (30%) compared with impulsive homicides (3.7%). Infidelity delusions were more frequent in proactive homicides than in impulsive homicides. According to regression models, a predominantly proactive homicide was significantly associated with being married, older age at illness onset, killing with firearms, infidelity delusions and a high PCL-R affective facet score in univariate analyses. Multivariate analyses showed a significant association with infidelity delusions and a high PCL-R affective facet score. Our results confirm that certain predispositions, as well as contextual factors, may be associated with the violent subtype of homicidal behavior in perpetrators with schizophrenia.

Comparison of the sociodemographic, clinical and offense-related data of delusional disorder patients with and without a criminal history.

This study investigates the relationship of delusional disorder and its subtypes to criminal and violent behavior by comparing the sociodemographic and clinical characteristics of patients with and without a criminal history and identifying predictors of crime. The records of 346 patients with a delusional disorder diagnosis were retrospectively evaluated using a sociodemographic data form, a crime violence rating scale and the Overt Aggression Scale (OAS). The results show that homicide and attempted homicide were committed more frequently by patients with jealous delusions, whereas verbal assault and crimes against the public were committed more frequently by patients with persecutory and other delusions. Patients with a criminal history had more hospital admissions and longer stays. Marital status, persecutory delusions, a high OAS score and older age were found to be associated with higher risk of crime. Clinical subtypes and sociodemographic characteristics seem to discriminate delusional disorder patients' risk of crime.

Psychopathy, temperament, and character dimensions of personality as risk determinants of criminal recidivism in schizophrenia patients.

There is considerable evidence on the role of personality traits in the risk of criminal recidivism among schizophrenia patients, besides conventional risk factors. We evaluated the effects of psychopathy and biopsychosocial personality model on general criminal recidivism in schizophrenia patients. Ninety-four male DSM-5 diagnosed schizophrenia patients were recruited and classified into three groups according to the number of offenses since diagnosis: reoffenders (n = 32), Initial offenders (n = 31), and nonoffenders (n = 31). All subjects were evaluated by the Turkish versions of Psychopathy Checklist-Revised (PCL-R) and Temperament and Character Inventory-Revised (TCI-R). In Reoffenders, all subscale scores of PCL-R and Novelty seeking were the highest, while Self-directedness and Cooperativeness were the lowest. PCL-R Total, Factor 1 and Factor 2 positively correlated with Novelty Seeking, and negatively correlated with Harm Avoidance, Self-directedness, and Cooperativeness in offender patients. For criminal recidivism in offender patients, high PCL-R Total and Novelty Seeking, low Harm Avoidance, Self-directedness, and Cooperativeness, being unmarried, presence of childhood adversity, and younger age at the first offense were found to be significant predictors in univariate analyses; multivariate regression models revealed PCL-R Total and Persistence as the only significant predictors. These results suggest that certain dimensional personality evaluations combined with potential historical, clinical, and forensic risk factors can be employed in forensic settings to screen offender schizophrenia patients at an increased risk of recidivism and to take necessary precautions against further criminal behavior.

[Clinical Characteristics of Malingering Among Arrested and Convicted Male Cases That are Sent for Treatment]. / Tedaviye Gönderilmis Tutuklu ve Hükümlü Erkek Olgularda Hekimi Yaniltici Davranisin Klinik Özellikleri.

OBJECTIVE: The study is done to investigate the predictive variables of malingering among arrested/convicted cases and the clinical characteristics of malingerers. METHOD: The study includes 70 arrested/convicted male cases internalized for their treatment. Aform to collect clinical or sociodemografic data, Structured Clinical Interview for DSM-IV Disorders (SCID I), Structured Clinical Interview for DSM-III-R (SCID II), Symptom Check-list (SCL-90-R) and Rey Memory Test (RMT) are applied. Two independent psychiatrists, without being part of the study diagnosed malingering. RESULTS: Arrested cases reported mostly psychotic like and convicted cases mostly depression like symptoms. RMT is helpful by malingering and SCL-90-R psychotic symptom and paranoid symptom subscale scores were both correlated negatively when compared to the RMT scores by malingerers. Axis-I or Axis-II diagnosis were found out to be more predictive than other clinical variables to determine malingering. CONCLUSION: This study indicate that clinicians have to take malingering into account especially by arrested and convicted cases applied for treatment and they have to be careful by doing the differential diagnosis. Large sample studies conducted with arrested and convicted cases and surveys by grouping cases according to the expertise and treatment services may provide additional data related to malingering.

[First Episode Psychosis: Relationship of Symptoms, Initial Treatment and Clinical Response]. / Ilk Psikoz Atagi: Belirtiler, Tedavi Baslangici ve Klinik Yanit Iliskisi.

OBJECTIVE: It was aimed to explore the relationship of clinical psychopathology and treatment response with "duration of untreated psychosis" (DUP) and "duration of untreated illness"(DUI) in 15-20 years old (mean age: 17,34 ± 1.69) inpatients in Turkey. METHOD: Mood disorders with psyhotic features were grouped as affective psychoses (18 patients, mean age: 17,28 ± 1,75); schizophrenia, schiozophreniform disorder and other psychotic disorders were grouped as non-affective psychoses (25 patients, mean age: 17,38 ± 1,68). 43 patiens (11 females, 32 males) were evaluated for acute treatment response with Positive and Negative Scale-PANSS and Clinical Global Impressions Scale-CGI. RESULTS: Mean DUP was determined as 6,5 ± 12,4 weeks, mean DUI was determined as 37,8 ± 49,8 weeks. For the affective psychosis (AP) group; mean DUP was 1,9 ± 1,2 weeks, mean DUI was 24,6 ± 37,1 weeks, for the non-affective psychosis (NAP) group; mean DUP was 9,8 ± 15,5 weeks, mean DUI was 47,3 ± 55,9 weeks. Treatment response was better for the non-affective psychosis group and for the patients who had earlier access to treatment. Shorter DUP and DUI was related with better PANSS negative symptom severity at the time of the discharge. CONCLUSION: Better treatment response related with shorter DUP and DUI reveals the significance of early treatment for the disease prognosis.

The Validity and Reliability of the Turkish Version of Miller Forensic Assessment of Symptoms Test (M-FAST).

INTRODUCTION: The aim of this study was to show the validity and reliability of the M-FAST Turkish Version. METHODS: Translation and back-translation of the M-FAST was done, then the M-FAST Turkish Version was created with linguistic equivalence. The study was performed with 97 detainees and convicts sent from penal institutions who were internalized at our hospital forensic psychiatry service. M-FAST Turkish Version was applied to evaluees and as a result of clinical interview according to DSM-IV-TR diagnostic criteria and various data explorations the evaluee was examined for malingering. To investigate the internal consistency of the scale, Cronbach's alpha and test-retest methods were used. In order to check the validity of the scale, in addition to the clinician's diagnosis, participants were requested to fill the Minnesota Multiphasic Personality Inventory (MMPI) F and K validity scales. RESULTS: The mean age of participants was 31.8±9.3 (SD) years. 47 evaluees (48.5%) were diagnosed as malingering. In the internal consistency analysis, Cronbach's alpha Coefficient was found to be .93. Test-retest relationship that was applied to 22 evaluees was found to be highly significant and strong (r=.89, p<.001). M-FAST scores were significantly high at the malingering group (n=47) (z=-8.02, p<.001). ROC curve analysis suggested a score of ≥7 points as the optimal cut-off for a malingering level for the M-FAST. Kappa coefficients of malingering ± groups were found to be, M-FAST≥7 Kappa: .83; F>16 Kappa: .29; F-K>16 Kappa: .30. For diagnosis of malingering, M-FAST Scale and the MMPI inventory scales were evaluated with the Binary Logistic Regression analysis and only M-FAST scores were found to be significant in prediction of malingering. CONCLUSION: The findings of this study support that, M-FAST Turkish Form represents the structure of the original scale and can be used as a reliable and valid instrument.

Evaluation of the Relation between Deliberate Self-Harm Behavior and Childhood Trauma Experiences in Patients Admitted to a Secondary-Care Psychiatric Outpatient Clinic for Adolescents and Young Adults.

INTRODUCTION: The aim of this study was to determine the prevalence and the features of deliberate self-harm (DSH) behavior in patients admitted to the psychiatric outpatient clinic for adolescents and young adults and also to detect the association between the act of DSH and childhood traumas. METHOD: In this study, we included all patients who were admitted to the secondary-care psychiatric outpatient clinic for adolescents and young adults in Bakirkoy Research and Training Hospital Psychiatry, Neurology and Neurosurgery throughout a month. A sociodemographic data form, the Childhood Trauma Questionnaire (CTQ-28), Childhood Abuse and Neglect Question List and the Deliberate Self-Harm and Intent Screening Form were applied to three hundred participants. RESULT: The prevalence of DSH was 50.0% among the participants (56.8% for females and 28.8% for males). Childhood abuse was detected in 57.0% of all participants (60.4% of females and 46.6% of males). Among patients with act of DSH, the rate of childhood abuse was 71.3%, while it was 42.7% in the subjects without act of DSH. CONCLUSION: DSH is a common behavior among adolescent psychiatric patients. It is more common in females than in males. The prevalence of experience of childhood abuse and neglect is remarkably high and is associated with self-harm behavior.

Autism and metabolic cytopathy.

LETTER TO THE EDITOR: Autism is a wide spectrum disorder and a lot of factors play role in the etiology. Autism may accompany some genetic disorders such as fragile X, tuberosclerosis, neurofibromatosis and phenylketonuria [1]. However, the absence of sufficient evidence on the etiological roles of environmental, neuroanatomical and biochemical factors has shifted the direction of research to genetics and cytology [2].

A survey of verbal and physical assaults towards psychiatrists in Turkey.

BACKGROUND: Assaults on health professionals have been an area of burgeoning clinical and political interest in recent years. There is now a body of literature suggesting that violence towards psychiatrists is more common than to other doctors. Thus far the vast majority of research in this area has been conducted in Western European and North American clinical settings. For the first time, this study examines this issue in the context of Turkish psychiatric settings. OBJECTIVE: (i) The study aims to detect the prevalence of verbal and physical assaults towards psychiatrists in Turkey. (ii) It aims to compare the experience of verbal and physical assaults according to the gender and training experience of psychiatrists. (iii) The paper intends to investigate how psychiatrists reacted to and appraised the experience of violence. METHODS: A questionnaire was prepared to evaluate violence towards psychiatrists (adapted from the Overt Agression Scale). The questionaire was administered to psychiatric specialists and residents working in state hospitals, research and training hospitals, mental health hospitals and university psychiatry clinics. A response rate of 93% was achieved with 186 out of 200 psychiatrsits approached completing the study questionnaire. RESULTS: Of all the psychiatrists who responded, 71% reported having experienced verbal or physical assaults during their professional life (verbal assaults only (19.9%), physical assaults only (2.7%) and both (48.4%)). Of these, 26% suffered injury to at least a mild degree. There was no statistically significant difference in terms of gender and workplace. In spite of the extremely high rates of aggression and violence towards psychiatrists, roughly 50% perceived these acts a normal part of their job and only 5% formally reported the violent incident. CONCLUSION: The majority of psychiatrists described having been victims of verbal and physical assaults although half perceived aggression and violence as a normal part of their job. Levels of reporting of violence were very low in the context of this study. Studies such as this provide evidence to inform the development of improved management of violence and may encourage psychiatrists to report violence.

Substance abuse, conduct disorder and crime: assessment in a juvenile detention house in Istanbul, Turkey.

The purpose of the present study was to determine the rate of substance abuse in the juvenile detention house and to determine the relationship between crime and substance abuse and conduct disorder. Two hundred and thirty cases in the biggest juvenile detention house in Istanbul, Turkey were assessed according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria. Law files and data of crime were examined. A total of 80 out of 230 juvenile detainees (34.8%) were found to have substance abuse excluding nicotine and alcohol. The substances abused in preferential order were cannabis (72.5%), volatile substances (21.3% bally and 3.7% thinner; 25%) and sedative hypnotic drugs and biperidents (2.5%). The rate of conduct disorder was 46.3% in substance abusers and 25.3% in the others (odds ratio: 2.536). The rate of substance abuse was 48.5% in the juveniles who had committed multiple crimes and 14.1% in the others (odds ratio: 5.735). The study shows that conduct disorder was very high in juvenile detainees. Conduct disorder was higher in substance-abusing than in non-abusing juvenile detainees. Substance-abusing juvenile detainees were found to have a higher detention rate than non-abusing juvenile detainees. There was a close relation between conduct disorder and substance abuse and multiple crimes. In the light of these results, diagnosis and treatment for conduct disorder in juvenile detainees are of great importance.

Prevalence of alcohol use in Istanbul.

The current research assessed the prevalence of alcohol use in Istanbul, Turkey along with characteristics and severity of related problems. The data were collected from structured interviews including the CAGE Questionnaire to eliminate the severity of alcohol-related problems of 1,550 residents (743 women, 807 men) of Istanbul, ages 12 to 65 years. Current alcohol use was 25.6% (397 persons, 118 women and 279 men), including 15.9% of the women and 34.5% of the men. 67% reported never having used alcohol. The rate of alcohol use was highest in the 40- to 49-yr. age group: the onset of use was reported as most common for the 16- to 19-yr.-olds. Prevalence of risky drinking was 6.8% (106 persons). Men were more likely to have an earlier initiation to alcohol use, to consume more [5.2 standard drinks (SD=3.4) vs 3.6 standard drinks (SD=2.5)] and be problem drinkers (31.5% vs 15.2%) than women. Prevalence of alcohol use seems to be relatively low in Istanbul. Data on characteristics of alcohol use are important in estimating groups at risk for problems and in planning prevention strategies.

[Is substance abuse among physicians a problem?]. / Doktorlar arasinda madde kötüye kullanimi bir sorun mu?

In today's medical community, there is growing concern about substance use among physicians, not only because of their own health, but also because of the potential adverse effects on their clinical practices. Physicians affect public health both by treatment and preventive studies and as role models. Prevalence data concerning substance abuse are generally lacking. There is no consensus on the rates of substance abuse being higher among physicians than among the general public. Physicians are less likely to smoke cigarettes and use illicit substances (like marijuana, cocaine and heroin) and more likely to use alcohol and two types of prescription medications--benzodiazepines and minor opioids--compared with their age groups. Doctors are at special risk of developing addiction problems owing to the strain of medical practice, erosion of the taboo against injecting and using opiates, and particularly access to supplies. The most common precipitating factors mentioned are physical pain and illness, usually chronic, with family tragedy such as death of a wife or child next. The third most common factor is an addicted wife. Stress, overwork and marital problems are also mentioned. No data were found about physicians' substance use in Turkey. This article generally aims to review the knowledge on the prevalence of substance use among physicians, the drug of choice, the development of dependence, the treatment and prognosis and to discuss the importance of this issue by evaluating three cases treated at the Alcohol and Drug Addiction Treatment and Research Center (AMATEM), Bakirköy State Hospital for Mental and Neurological Diseases.