Comprehensive analysis of social stigma of individuals with substance use disorder in Turkey in the context of Erving Goffman's stigma theory.

Goffman defines stigma as a disgrace and social outcast/disqualification. Individuals with substance disorder are exposed to stigma at certain periods of their lives. Stigma particularly affects their thoughts, behaviors, and treatment processes, as well as their social life and identity perception. This paper examines the effects of social stigma experienced by individuals with substance disorder in Turkey and its reflections on social life in terms of Goffman's stigmatization theory. In this regard, studies examining the social stigmatization of individuals with addictions and social perceptions and attributes toward these individuals in Turkey were analyzed. This analysis suggests that socio-demographic and cultural factors play a significant role in stigmatization, that society has negative perception and representations toward addicts, that stigmatized addicts are likely to avoid interactions with "normals" and are often stigmatized by the media, colleagues, and health professionals, and that stigma develops/creates "an addicted identity.". This paper suggests the need for robust social policies that would aim to minimize stigmatizing attitudes and misconceptions toward individuals with addiction, ensure access to effective treatment, fulfill their social functioning, and integrate them into society should be implemented.

The effect of perceived social support on quality of life in Turkish men with alcohol, opiate and cannabis use disorder.

OBJECTIVE: The purpose of this study was to investigate the effect of perceived social support on the quality of life of male patients with alcohol, opiate and synthetic cannabinoid use disorders by considering sociodemographic factors and mood, and to compare these three groups in terms of social support and quality of life. METHOD: One hundred and thirtyone (131) patients who were hospitalized at Addiction Clinic of Istanbul Erenkoy Psychiatric and Neurological Diseases Training and Research Hospital in Turkey and diagnosed as alcohol, opiate and synthetic cannabinoid use disorder were included in the study. Sociodemographic Data Form, Turkish version of the World Health Organization Quality of Life Questionnaire Scale (WHOQOL-BREF-TR), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Multidimensional Scale of Perceived Social Support (MSPSS), API (Addiction Profile Index) were applied to the participants. RESULTS: A total of 131 male patients were 32 synthetic cannabinoids, 51 opiates and 48 alcohol use disorders diagnosed. The mean age of alcohol users was higher than the other groups. Separation/divorce rate was higher in alcohol users and single rate in opiate users. Alcohol use was higher in living alone and opiate users lived with first degree relatives. The crime history was higher in the cannabis group. Prison experience, probation and self-injury were higher among opiate users. Family history of substance use was higher in opiate users. Crime was found to be less in alcohol users. In the comparison of alcohol and substance (opiate, cannabis) groups, the rate of self-injury (93.8%) was found to be significantly higher in the substance user' group. There was no statistically significant difference between the groups in terms of depression and anxiety scores. When the alcohol and substance (opiate, cannabis) comparisons were made between the groups, the mean depression (21.02 ± 11.6) and anxiety (20.09 ± 17.49) of the alcohol group was significantly higher. The "effect on life" (31.8 ± 6.13) and "motivation" subscales (10.38 ± 2.39) of API was found to be significantly higher in patients with substance use. In the opioid group, physical, environmental and psychological subscales of the WHOQOL-BREF-TR did not show significant correlation with MSPSS, and the family, friend' subscales and total perceived social support were significantly correlated with the social subscale of WHOQOL-BREF-TR. In the alcohol group, the environmental and social subscales of WHOQOL-BREF-TR showed a significant correlation with perceived social support from the family and private person and total perceived support. CONCLUSION: Addiction is a recurrent and chronic disease and inevitably reduces quality of life. Social support has an important role on the quality of life. Improving the quality of life seems to be one of the main goals during the addiction treatment. For this purpose, it is very important to provide psychosocial support with pharmacological treatment by evaluating the medical, mental and social needs of the dependent patient as a whole.

Self-reported changes in alcohol and tobacco use during COVID-19: findings from the eastern part of WHO European Region.

BACKGROUND: The COVID-19 pandemic might impact substance use behaviours around the globe. In this study, we investigate changes in alcohol and tobacco use in the second half of 2020 in countries of the eastern part of the WHO European Region. METHODS: Self-reported changes in alcohol and tobacco use among 11 295 adults from 18 countries in the eastern part of the WHO European Region were collected between August 2020 and January 2021. The non-probabilistic sample was weighted for age, gender and education. For each country, proportions of respondents reporting a decrease, no change or increase in substance use over the past 3 months were examined, and multinomial regression models were used to test associations with age, gender and past-year alcohol use. RESULTS: In most countries, about half of the respondents indicating past-year alcohol or tobacco use reported no change in their substance use. Of those alcohol users who reported changes in their alcohol use, a larger proportion reported a decrease than an increase in most countries. The opposite was true for tobacco use. Women, young adults and past-year harmful alcohol users were identified as being more likely to change their substance use behaviour. CONCLUSION: We found diverging overall trends for alcohol and tobacco use in the second half of 2020. The patterns of change vary according to age, gender and past-year substance use. Individuals at risk to increase their substance use during the COVID-19 pandemic require most policy considerations.

Clinical and Cognitive Effects of Computer Assisted Cognitive Remediation Method in Turkish Men with Opioid Use Disorder: A Randomized Controlled Trial.

Objective: Substance use disorders are associated with significant cognitive impairments causing many individual or social problems besides poor treatment outcomes. The cognitive remediation method is effective in so many neuropsychiatric disorders. This study aimed to evaluate the effects of this method among individuals with opioid use disorder. Method:60 patients diagnosed with opioid use disorder under buprenorphine-naloxone treatment and who accepted the informed consent were included. Seven patients left the study initially. 53 male patients were randomly assigned to receive treatment in the usual control or cognitive remediation-intervention group. The intervention group completed 3 to 4 sessions a week, 8 different exercises in each session, for 4 weeks, a total of 12 sessions, individually. Addiction Profile Indeks, Barrat Impulsivity Scale-SF, CGI, and Delay Discounting scores were measured before and after the 1 month cognitive Remediation practices. Three months later, patients were contacted, and their remission status was evaluated. Results: In the intervention group; 17(89.5%) people had remission and 2(10.5%) people had relapse. In the control group, 7(31.8%) individuals had remission, and 15(68.2%) had relapsed at the end of the 3 months. It was determined that craving, addiction severity, and self-reported and behavioral impulsivity values decreased while the improvement in treatment response was higher in the intervention group. Conclusion: Our results showed that the computer-assisted cognitive remediation method, in addition to buprenorphine-naloxone treatment, improves treatment response, increases remission, and has positive clinical and cognitive effects on individuals with opioid use disorder. It suggests that cognitive remediation practices can be added to the treatment programs for addiction.

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.

Mental health and factors related to life satisfaction in nursing home and community-dwelling older adults during COVID-19 pandemic in Turkey.

BACKGROUND: The geriatric population is supposed to be at high risk for psychological distress as well as adverse outcomes and mortality during the COVID-19 pandemic. This study aimed to investigate the levels of depression, anxiety, death anxiety and life satisfaction levels and factors related to life satisfaction in individuals aged 65 years and older during the pandemic and to compare these variables between nursing home (NH) and community-dwelling older adults. METHOD: This study has a cross-sectional and descriptive design, and a total of 133 nursing NH and community-dwelling older adults were enrolled in the study. Turkish death anxiety scale (TDAS), life satisfaction scale (SLS) and depression anxiety stress scale-21 (DASS-21) were used for the assessment. RESULTS: The majority of the older adults had no or mild depression, anxiety and stress symptoms in spite of the prolonged confinements, and were slightly satisfied with their lives. However, depression, anxiety, stress and TDAS levels were higher in participants aged 80 years and older. Residents of NHs had higher TDAS, depression and anxiety levels and lower SLS levels than community-dwelling older adults. Participants who were meeting their children and/or grandchildren less than 2 h a week, were found to have significantly lower SLS and higher depression scores. The increase in depression and TDAS scores predicted a decrease in SLS scores in older adults. CONCLUSIONS: As NH resident older adults have higher psychological distress and decreased life satisfaction due to the social isolation caused by the prolonged confinements, NH staff should be regularly informed on both preventive measures and mental health consequences of the pandemic, and should be trained for basic therapeutic interventions. Older adults should be supported to use telecommunication technologies to contact their families and friends, and participate in safe and accessible person-centred activity programs.

Intentions to use mental health and suicide prevention resources among individuals with symptoms of the suicide crisis syndrome and/or suicidal ideation.

INTRODUCTION: The suicide crisis syndrome (SCS) has demonstrated efficacy in predicting suicide attempts, showing potential utility in detecting at-risk individuals who may not be willing to disclose suicidal ideation (SI). The present international study examined differences in intentions to utilize mental health and suicide prevention resources among community-based adults with varying suicide risk (i.e., presence/absence of SCS and/or SI). METHODS: A sample of 16,934 community-based adults from 13 countries completed measures about the SCS and SI. Mental health and suicide prevention resources were provided to all participants, who indicated their intentions to use these resources. RESULTS: Individuals with SCS (55.7%) were just as likely as those with SI alone (54.0%), and more likely than those with no suicide-related symptoms (45.7%), to report willingness to utilize mental health resources. Those with SI (both with and without SCS) were more likely to seek suicide prevention resources (52.6% and 50.5%, respectively) than those without SI (41.7% and 41.8%); however, when examining endorsements for personal use, those with SCS (21.6%) were more likely to use resources than individuals not at risk (15.1%). CONCLUSIONS: These findings provide insight into individuals' willingness to use resources across configurations of explicitly disclosed (SI) and indirect (SCS) suicide risk.

Is there a relationship between age at menarche and clinical and temperamental characteristics in bipolar disorder?

BACKGROUND: This study investigated whether age at menarche in women with bipolar disorder (BD) is different from that in healthy women and if there is a relationship between age at menarche and clinical and temperamental characteristics of BD. METHODS: We consecutively evaluated 126 euthymic women diagnosed with BD according to DSM-IV. The healthy control group comprised 100 individuals of similar mean age and socioeconomic level. After the diagnostic interview, BD patients completed the Mood Disorders Diagnosis and Follow-Up Form and Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire. RESULTS: Age at menarche in BD patients was similar to that in controls. A strong inverse correlation was found between age at menarche and total duration of depressive episodes (r = -0.532). In BD patients, an inverse correlation has been found between age at menarche and depressive and cyclothymic temperament scores (r = -0.384 and r = -0.421). However, a strong correlation has been found between age at menarche and irritable temperament scores (r = 0.488). CONCLUSIONS: Age at menarche is associated with the clinical course of BD. Moreover, age at menarche seems to be associated with traits related to mood.

Electrocardiographic Abnormalities During and After Withdrawal in Patients Diagnosed with Opioid Use Disorder.

Introduction: Opioid withdrawal is one of the most critical complications of opioid use disorder. In this study, we aimed to examine the possible risk of ventricular arrhythmia and sudden cardiac death by calculating electrocardiography (ECG) changes, the markers of ventricular repolarization, in opioid withdrawal. Methods: A total of 90 patients diagnosed with opioid withdrawal who met the inclusion and exclusion criteria were included in the study. QT, QTc, TPe/QT, and TPe/QTc ratios of patients with a Clinical Opiate Withdrawal Scale (COWS) score higher than five and a Framingham heart risk score lower than 10% were measured in 12-lead ECG. Results: A significant difference was found between the patients' heart rate, QT, QTc, and TPe/QT values during withdrawal (entry-first) and after withdrawal (second) (p<0.05). Mean QT First Value (380.69±22.46) was significantly different and higher than Mean QT Second Value (372.82±19.998); Mean QTc First Value (435.41±16.22) was significantly different and higher than Mean QTc Second Value (418.03±17.79); Mean Tpe First Value (81.62±6.009) was significantly different and higher than Mean Tpe Second Value (79.93±5.524); and The Mean Tpe/QT First Value (0.221±0.005) was significantly different and higher than the Mean Tpe/QT Second Value (0.213±0.004) (p<0.05). Conclusion: The findings of our study show that electrocardiographic QT, QTc, Tpe and Tpe/QTc values, which indicate the risk of sudden cardiac death and ventricular arrhythmia, are significantly higher during opioid withdrawal. In addition to the regulation of addiction treatment during opioid withdrawal, it should be considered that individuals may be at cardiac risk, and the patient should be monitored for cardiac arrhythmia during the withdrawal period.

Electrocardiographic Changes During and After Alcohol Withdrawal.

Background: Our study aimed to examine the possible risk of ventricular arrhythmia and sudden cardiac death by calculating the electrocardiographic changes and indicators of ventricular repolarization during and after alcohol withdrawal. Methods: One hundred participants who were identified with alcohol withdrawal and who met the inclusion criteria were included in the study. Data were collected between July 2020 and August 2020. The distance interval between Q and T waves, corrected distance interval between Q and T waves, T peak/distance interval between Q and T waves, and T peak/corrected distance interval between Q and T waves interval ratios ratios were measured in 12-lead electrocardiographic measurements during the withdrawal period and after withdrawal symptoms subsided in patients with a Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised score >7 and a Framingham heart risk score <10%. Results: There was a significant difference between the patient's heart rate, distance interval between Q and T waves, corrected distance interval between Q and T waves interval, and T peak/distance interval between Q and T waves values during withdrawal (input) and after alcohol withdrawal (output) (P < .05). The mean corrected distance interval between Q and T waves interval input value (433.63 ± 17.79) is significantly different and higher than the output value of the mean corrected distance interval between Q and T waves (420.67 ± 13.78) (P < .05). Similarly, the mean T peak input value (81.36 ± 5.90) is significantly different and higher than the mean T peak output value (79.94 ± 5.39) (P < .05) and the mean T peak/input value of the distance interval between Q and T waves (0.222 ± 0.00) than the mean T peak / output value of the distance interval between Q and T waves (0.214 ± 0.00) (P < .001). Conclusion: These consequences suggest the risk for an accelerated hazard of ventricular arrhythmias in participants with alcohol withdrawal. Significantly, considering the improvement of the electrocardiographic changes of the patients after terminating alcohol intake, a possible cardiac arrhythmia may be more common during this period. Close monitoring of electrocardiograms and timely withdrawal treatment can prevent life-threatening arrhythmias in alcohol withdrawal patients.

HCV Genotype Distribution Among People Who Inject Drug in Turkey: Findings from Multicenter and Cross-Sectional Study.

Background: Hepatitis C virus (HCV) infection is very common in people who inject drugs (PWID). Studies about the prevalence and genotype distribution of the HCV among PWID are very crucial for developing strategies to manage HCV infection. This study's objective is to map the distribution of HCV genotypes among PWID from various regions of Turkey. Method: This prospective, multicenter, cross-sectional study involved 197 PWID who tested positive for anti-HCV antibodies from 4 different addiction treatment facilities in Turkey. Interviews were done with people who had anti-HCV antibodies, and blood samples were taken to check the HCV RNA viremia load and genotyping. Results: This study was conducted on 197 individuals with a mean age of 30.3 ± 8.6 years. 9.1% (136/197 patients) had a detectable HCV-RNA viral load. Genotype 3 was the most commonly observed genotype by 44.1%, followed by genotype 1a by 41.9%, genotype 2 by 5.1%, genotype 4 by 4.4%, and genotype 1b by 4.4%. Whereas genotype 3 was dominant with 44.4% at the central Anatolia region of Turkey, the frequencies of genotypes 1a and 3, which were predominantly detected in the south and northwest regions of Turkey, were very close to each other. Conclusion: Although genotype 3 is the predominant genotype in the PWID population in Turkey, the prevalence of HCV genotype varied across the country. To eliminate HCV infection in the PWID, treatment and screening strategies that differ by genotype are essentially required. Especially identification of genotypes will be useful in developing individualized treatments and determining national prevention strategies.

The prevalence and psychological relation of problem shopping: data from a large-scale sample from Turkey.

BACKGROUND: The purpose of the present study was to comprehensively examine the measurement aspects, the prevalence, and the psychological correlates of problem shopping among a large-scale national sample of Turkish adults. RESULT: Participants (N = 24,380, 50% men, M age = 31.79 years, age range = 18-81 years) completed a questionnaire that comprised the Shopping Addiction Risk Questionnaire, the Brief Symptom Inventory, the Positive and Negative Affect Schedule, and the Experiences in Close Relationships-Revised. Results showed that 1.8% of the participants had probable shopping addiction. Being female, being younger, psychiatric distress, positive affect, negative affect, anxious attachment, and avoidant attachment were positive correlates of problem shopping. CONCLUSION: The results of this large sample size study suggest that shopping addiction is not a rare condition in Turkey. Further research is needed to understand different motives that underlie the problematic shopping behavior in the young and female population in comparison to older and male populations. Preventive programs or any interventions for people with PSB needs to address regulation difficulties and development of healthy strategies to cope with psychiatric distress.

Attachment Styles of Parents with Alcohol Use Disorder and the Relation of Their Parenting Perception to Their Parenting Attitudes.

Objective: Many neurobiological, genetic, environmental, and spiritual factors are involved in addiction etiology. This study aims to examine parental perceptions, attachment styles, and parental attitudes. Methods: This is a cross-sectional study. Patients diagnosed with alcohol use disorder (AUD) were enrolled in the Addiction Clinic of the Erenköy Mental Hospital. The structured clinical interview for DSM-5 (SCID-5) was applied, and the sociodemographic data form, Adult Attachment Style, Family Life and Child Rearing Attitude Scale, and Parent Attachment Scale were administered to the participants. Results: It was determined that 21.5% of participants had depressive episode and anxiety disorder diagnoses; 15.4% of participants had children with a history of psychiatric treatment; 16.9% had children with a history of alcohol/substance use. The avoidant attachment score average of individuals with APD was found to be higher. The positive perception of parents participating in terms of care and protection toward their own parents was significant in all subdimensions with secure attachment. When the child-rearing attitudes of parents with secure attachment were examined, the dimensions of democratic attitude and recognition of equality were statistically significantly higher. Conclusion: Parenting and attachment are associated with many steps of addiction. In the fight against addiction, it is very important to treat addiction as a family problem. The education and interventions to be made can be protective in terms of psychopathology and addiction issues, which may provide early intervention for these problems. In addition, constructive interventions related to family relationships are important in increasing the social support of people who are being treated for AUD.

Investigation of the discrimination and characterization of blood serum structure in patients with opioid use disorder using IR spectroscopy and PCA-LDA analysis.

Harmful illicit drug use, such as opioid use disorder (OUD), causes multiple diseases that result in physiological, pathological, and structural changes in serum biochemical parameters based on the period of use. Fourier-transform infrared (FTIR) spectrometry is a noninvasive optical technique that can provide accurate evidence about the biochemical compounds of analytical samples. This technique is based on the detection of functional groups and the spectral analysis of the region of the selected bands, which provides a reliable and accurate tool for evaluating changes in the biochemical parameters of OUD patients. In the present study, the Attenuated Total Reflection (ATR)-FTIR technique and clinical laboratory biochemical results were used to investigate the phospholipid-protein balance in the blood serum of participants with OUD by comparing their data to that of healthy controls. To compare the biochemical laboratory results with serum vibrational spectroscopy, we used infrared (IR) spectroscopy to distinguish the serum of the OUD patients, who had an average duration of use of 7.31 ± 3.8 years (ranging from 6 to 15 years). We aimed to compare the clinical reports with findings from IR spectroscopy coupled with chemometrics analysis, principal component analysis (PCA), and linear discriminant analysis (LDA). The serum samples of the OUD male patients (n = 20) and healthy male individuals (n = 14) were evaluated using FTIR spectroscopy (range of 4000 cm-1 - 400 cm-1). We focused on the areas where the results showed significant band differences and significant chemometric differences at the fingerprint region (1800 cm-1- 900 cm-1), Amide I (1700 cm-1-1600 cm-1), C-H stretching band (3000 cm-1-2800 cm-1), triglyceride (Tg) levels and cholesterol esters (1800 cm-1-1700 cm-1), and total protein region (1700 cm-1 -1350 cm-1). The intensity of these band areas was significantly different (p < 0.01) between OUD patients and healthy controls. Moreover, different bands on the serum spectrum of the OUD patients were explored. The results successfully specified the distinctions between OUD and the healthy controls (HCs). We compared the results with biochemical markers, such as albumin (Alb), Tg, and total cholesterol (Tc) levels of the patients, as well as the data of the healthy subjects obtained from the hospital. Additionally, we found that the Tg, Tc, and Alb levels decreased as the duration of heroin use increased based on the biochemical markers of the OUD patients. The laboratory biochemical reports and the vibrational spectroscopic analysis were correlated. The confidence of specificity, sensitivity, and accuracy was 100%, 92.85%, and 97.06% in the second derivative, respectively. Thus, we demonstrated that IR spectroscopy, multivariate data analysis, and clinical reports are consistent and correlated. Furthermore, FTIR is a simple and readily available diagnostic test that can successfully differentiate the serum samples of OUD patients from those of healthy subjects.

Biochemical assay and spectroscopic analysis of oxidative/antioxidative parameters in the blood and serum of substance use disorders patients. A methodological comparison study.

Substance abuse such as opioids, cannabis, and alcohol causes activation on the immune system and the release of reactive oxygen species (ROS) into the blood and serum. These substances cause an effect on oxidant and antioxidant status in patients with substance abuse. Mainly, wide-open to the ROS are lipids and proteins included blood, which suffers peroxidation. In this study, for the first-time differentiation of the effects of cannabis, alcohol and other synthetic substances on blood and serum samples, were performed. For this purpose, the level of the malondialdehyde (MDA) and glutathione (GSH) in serum and red blood cells, was measured using biochemical assay methods and Fourier Transform InfraRed spectroscopy (FTIR). The results showed, that peroxidation which is dignified as the production of MDA was increased for substance use disorder (SUD) patients (18.01 ±â€¯2.97) compared to the control group (10.75 ±â€¯2.28) (p < 0.001) and for antioxidant capacity, GSH level were significantly increased for SUD patients (p < 0.001). For the discrimination of protein and lipid region obtained from FTIR spectroscopy, we extracted features by principal component analyze (PCA) of protein (1800 cm-1 to 900 cm-1) and lipid (3200 cm-1 to 2800 cm-1) regions for blood and serum samples collected from patients with different types of SUD and healthy control (HC) participants. For the consideration of lipid oxidation, lipid saturation, lipid desaturation and protein aggregation the peak heights at 1740 cm-1 to 2960 cm-1, 2920 cm-1 to 2960 cm-1, 3012 cm-1 to 2960 cm-1, and 1630 cm-1 to 1650 cm-1 regions were studied for SUD and HC. Moreover, more visible changes were noticed for proteins region, than for lipids. The most notice structural changes were observed in amide II in serum spectra. Then we classified protein and lipid region's PCA results of blood and serum by Linear discriminant analysis (LDA) and Support vector machine (SVM). Confidence of the specificity, sensitivity and accuracy of blood and serum were obtained as 100%, 100% and 100% individually. This is the first comparative study on the spectrochemical tool and biochemical assay on SUD. Our results presented 100% discrimination of disorder region compared to healthy subjects.

Impact of childhood trauma and affective temperament on resilience in bipolar disorder.

BACKGROUND: The aim of this study was to investigate whether childhood trauma (CT) and affective temperament have an impact on resilience in bipolar patients. METHODS: One hundred cases with bipolar disorder (BD) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) were evaluated consecutively in their euthymic period during outpatient follow-up interviews. Diagnostic interviews were done with SCID-I, affective temperament was evaluated with the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, and resilience was evaluated with the Resilience Scale for Adults (RSA). The presence of CT was determined and measured with the Childhood Trauma Questionnaire (CTQ). RESULTS: Among the bipolar patients, it was found that 35 cases (35%) were CT+. Depressive, cyclothymic, and anxious temperament scores were higher in CT+ cases. However, resilience scores were higher in CT- cases. In bipolar patients with and without childhood trauma, the relationship between temperament and resilience appears to be different. A negative relation between sexual abuse, emotional abuse, emotional neglect, and anxious temperament scores and resilience scores was shown in regression analysis. CONCLUSIONS: CT and affective temperament both have an impact on resilience in bipolar patients.