CORRELATION AMONG EXPERIENTIAL AVOIDANCE, ANXIETY SENSITIVITY AND BEHAVIORAL INHIBITION SYSTEM IN GENERALIZED ANXIETY DISORDER AND PANIC DISORDER PATIENTS.

PURPOSE: This study aimed to analyze the concepts of experiential avoidance, anxiety sensitivity and behavioral inhibition system through healthy volunteers and patients diagnosed with anxiety disorder. It was planned to analyze and evaluate the correlation among the levels of experiential avoidance, anxiety sensitivity and behavioral inhibition system in various anxiety groups. METHOD: Within the scope of this study, clinical interviews were carried out with patients who sought treatment at the Psychiatry Department of the Hospital of Balikesir University Medical Faculty. The study included 50 Generalized Anxiety Disorder (GAD) patients and 50 Panic Disorder (PD) patients who fulfilled the study criteria and accepted to participate in the study. A voluntary control group of 50 individuals with similar age and gender with the patients was formed. The participants were evaluated through the Acceptance and Action Questionnaire-II (AAQ-II), Behavioral Inhibition System/Behavioral Approach System Scale (BIS/BAS Scale), and Anxiety Sensitivity Index-3 (ASI-3). RESULTS: In this study, the anxiety sensitivity, behavioral inhibition system sensitivity and experiential avoidance levels were all found to be higher in both the GAD and PD patients than the controls. On the other hand, the scale scores did not significantly differ between the GAD patients and PD patients. Positive correlations were determined among anxiety sensitivity, experiential avoidance and behavioral inhibition system. Our data provided findings supporting that the development of anxiety disorders entails increased anxiety sensitivity, behavioral inhibition system sensitivity and experiential avoidance levels. DISCUSSION: The literature has shown, through separate studies, a correlation among experiential avoidance, anxiety sensitivity and behavioral inhibition system as well as a correlation between these concepts and anxiety disorders, and this study handled them altogether to reveal their correlation with anxiety in a clinical environment.

The Impact of Repetitive Transcranial Magnetic Stimulation on Oxidative Stress in Subjects With Medication-Resistant Depression.

OBJECTIVES: Recent studies have shown that oxidative stress is involved in the neurobiology of depression. We investigated the effects of repetitive transcranial magnetic stimulation (rTMS) on a novel oxidative stress marker, thiol-disulfide homeostasis, in subjects with medication-resistant major depression (MRD). METHODS: Twenty-six subjects with MRD underwent 15 rTMS sessions. Sociodemographic and baseline and post-rTMS Montgomery-Asberg Depression Rating Scale (MADRS) data were collected. Serum levels of native thiol, total thiol, and disulfide and their pairwise ratios were measured in baseline and post-rTMS blood samples. RESULTS: Serum levels of native and total thiol were significantly decreased after rTMS treatment (P < 0.05). Serum levels of thiol-disulfide and their ratios did not significantly differ (P > 0.05) between rTMS treatment responders (>50% reduction in MADRS score, n = 11) and rTMS treatment nonresponders (n = 15). The percentage MADRS score changes did not correlate with the changes in the levels of serum thiol-disulfide from baseline to post-rTMS treatment in any subject (P > 0.05). CONCLUSIONS: Our results showed that rTMS treatment was effective in subjects with MRD and was associated with changes in serum thiol levels regardless of improvement in depression severity. Thus, the results did not support a possible therapeutic relationship between rTMS and thiol-disulfide homeostasis in subjects with MRD.

Investigating the relationship between plasma neuropeptide-S levels and clinical depression.

PURPOSE: Neuropeptide-S (NPS) is a novel 20-amino acid peptide, mainly expressed in the central nervous system and endocrine tissues. NPS has been linked to anxiety and fear-related behaviors. The association of NPS with depression in a human population has not been previously examined. The aim of the current study was to explore the potential association of NPS with clinical depression and comorbid anxiety. MATERIALS AND METHODS: Seventy-nine patients diagnosed with major depressive disorder and seventy-eight controls were included in the study. The Hamilton Depression Scale (HAM-D) and Hamilton Anxiety Scale (HAM-A) were used to measure depression and anxiety levels, respectively. Venous blood samples were obtained to measure plasma NPS levels. RESULTS: There were no statistically significant differences between the patients and controls in terms of sex, marital status, and smoking status. Plasma NPS levels were also not significantly different between the patients and controls. In patients with major depressive disorder, HAM-A and HAM-D scores were significantly higher than those of controls. No correlation was found between plasma NPS levels and age, body mass index (BMI), median HAM-A scores, and median HAM-D scores. CONCLUSIONS: Despite a significantly high level of comorbid anxiety among the patient group, we found no relationship between plasma NPS levels and depressive symptomatology.

Vitamin D Levels and Vitamin D Receptor Gene Polymorphism in Major Depression.

BACKGROUND: The aim of this study is to evaluate vitamin D levels and rs2228570 (FokI) polymorphism of vitamin D in patients with established diagnosis of major depressive disorder in order to investigate the impact of vitamin D levels and genetic polymorphisms on etiology and/or severity of the disease. SUBJECTS AND METHODS: The study included 86 patients who were diagnosed with major depressive disorder in Hospital of Balikesir University Faculty of Medicine, Department of Psychiatry, and 89 healthy volunteers with similar age, sex, education level and BMI. Psychiatric diagnosis was established by using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). For clinical evaluation, sociodemographic data form, Hamilton Depression Rating Scale, Hamilton Anxiety Scale were used. Blood samples were drawn after 12 hours of fasting from the patients volunteered and the control group who were given their informed consent for participation in the study. Vitamin D levels were determined by using the method of ECLIA (Electrochemiluminescent immunoassay). Genotype analysis was performed using the method of Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). RESULTS: In our study, median vitamin D levels (min-max) of the patient and control groups were 10.3 ng/mL (3.0-42.1) and 11.4 ng/mL (3.0-38.8), respectively. Statistically significant differences as for vitamin D levels between groups were not detected (p=0.729). Similiarly no statistically significant difference between groups in genotype distribution was observed (p=0.396). CONCLUSION: In conclusion, our findings do not support the relationship between depression, vitamin D levels and Fok 1 polymorphism of vitamin D receptor. To test these hypotheses in the light of literature we need further studies to be performed with large number of patients.

Evaluation of retinal and choroidal vascular structures in patients with anxiety disorder.

PURPOSE: To evaluate the retinal and choroidal vascular structures in patients with anxiety disorders. METHODS: Thirthy-four eyes of 34 patients who were diagnosed with any anxiety disorders were compared with 32 eyes of 32 age- and sex-matched controls. Central macular thickness (CMT), foveal vascular zone (FAZ) area, total retinal vascular densities of superficial and deep capillary plexus (VDSCP, VDDCP), outer retinal and choriocapillary layers (ORL, CCL) blood flow rates, central subfoveal choroidal thickness (SFCT) and choriodal vascularity index (CVI) were evaluated with optical coherence tomography angiography (OCT-A) and enhanced depth imaging optical coherence tomography (EDI-OCT). RESULTS: No statistical differences were found between the study and control groups in terms of CMT, FAZ area, VDSCP, VDDCP, ORL and CCL blood flow rates. The mean SFCT was 346.26 ± 64.26 µm in patients with anxiety disorder and was found to be statistically significantly thicker than the control group (319.56 ± 37.19 µm) (p = 0.042). Besides, CVI was significantly lower in the study group (71.09 ± 2.64 vs 73.13 ± 3.31, p = 0.008). CONCLUSION: In people with anxiety disorders, the SFCT was found to be thicker and CVI was found to be lower than normal subjects. Although anxiety and stress are important factors in central serous chorioretinopathy, multifactorial factors, including ocular factors, play a role in the pathophysiology of the disease. There is a need for prospective studies with larger series on the subject.

Effect of obesity on mood regulation and eating attitudes in mental disorders.

OBJECTIVE: The precise relationship between obesity and eating habits, attitudes, and emotion regulation is still ambiguous. The purpose of this study was to investigate possible correlations among body mass index, challenges related to managing emotions, and attitudes toward eating among adult participants with known psychiatric diagnoses. METHODS: The body mass indices of participants were calculated, and data on eating styles were collected using the Dutch Eating Behavior Questionnaire. The level of difficulty in managing emotions was evaluated using the Difficulties in Emotion Regulation Scale. RESULTS: The research findings indicated a meaningful positive association. An observation was made between body mass index and results from the Eating Attitude Test-40, as well as the restrained eating subdimension of the Dutch Eating Behavior Questionnaire. Conversely, a meaningful reverse relationship was identified between the scores of the "strategies" subdimension of the Difficulties in Emotion Regulation Scale. No meaningful differences in eating attitudes and emotion regulation were found between non-obese and obese patients. CONCLUSION: While a partial and meaningful correlation was observed among body mass index, eating attitudes, and emotion regulation difficulties, it is suggested that factors such as patients' age, disease duration, current body mass index, and the simultaneous presence of depression and anxiety should be considered.

Dysfunctional Metacognitive Beliefs, Experiential Avoidance,and Behavioral Inhibition System in Depressive Disorder.

Background: Dysfunctional metacognitive beliefs form the basis of the formation and maintenance of psychopathologies. In our study, we planned to examine the common aspects of the concepts of dysfunctional metacognition, experiential avoidance, and behavioral inhibition system in depressed patients compared to healthy individuals and their effects on each other. Methods: Fifty-five depressed patients and as a control group 54 healthy volunteers participated in the study. Beck Depression Inventory, Beck Anxiety Inventory, Metacognitions Questionnaire 30, Acceptance and Action Questionnaire II, and Behavioral Inhibition and Behavioral Activation Scale were used in the study. Results: Median (minimum-maximum) Acceptance and Action Questionnaire II score was 9 (7-35) points in the control group and 30 (9-46) points in the depressed patient group (P < .001). A statistically significant difference between the groups was observed only in the Behavioral Activation Scale-reward responsiveness subscale, with 20 (14-30) points in the control group and 23 (13-36) points in the patient group. A statistically significant difference was observed between the groups in all Metacognitions Questionnaire 30 subscale scores (P < .001). A statistically significant positive correlation was found between depression scores and experiential avoidance (r = 0.751; P < .001), reward responsiveness (r = 0.329; P < .001) and metacognition subscale scores. In addition, a positive correlation was found between experiential avoidance and metacognition subscale scores (P < .001). Conclusion: The data we obtained support the fact that as the severity of depression increases, the patients more strongly stick to dysfunctional metacognitive beliefs, exert more frequently experiential avoidance and less often impulsive behaviors. Considering these clinical features may contribute favorably to the individualized psychotherapy process.

Mentalizing self and others: A controlled study investigating the relationship between alexithymia and theory of mind in major depressive disorder.

BACKGROUND: Theory of mind (ToM) and alexithymia have been reported to relate with depression in recent studies. However, data regarding the role of alexithymia and ToM in depression remain uncertain. AIM: The aim of the current study was to determine the levels of alexithymia and ToM abilities as well as their relationship with each other and clinical features in major depressive disorder (MDD). MATERIALS AND METHODS: Patients diagnosed with MDD and healthy controls were undergone sociodemographic data, Beck Depression Inventory, Beck Anxiety Inventory, Toronto Alexithymia Scale (TAS-20), and reading the mind in the eyes test (RMET) to determine the depression, anxiety, alexithymia, and ToM abilities. RESULTS: Depression, anxiety, and alexithymia levels were higher, while ToM abilities were found to be decreased in MDD patients relative to controls. A positive correlation was observed between depression levels and alexithymia levels in terms of difficulty in identifying feelings subscale and total scores of TAS-20 (P = 0.006, P = 0.036, respectively), while a positive correlation was also observed between anxiety levels and alexithymia levels in terms of difficulty in describing feelings subscale scores of TAS-20 (P = 0.02) in depressed group. No correlation was found between depression, anxiety levels, and RMET accuracy scores. CONCLUSION: Our results suggest alexithymia and impaired ToM abilities might be prominent but prone to be distinct clinical constructs in MDD patients.

Effect of obesity on mood regulation and eating attitudes in mental disorders

SUMMARY OBJECTIVE: The precise relationship between obesity and eating habits, attitudes, and emotion regulation is still ambiguous. The purpose of this study was to investigate possible correlations among body mass index, challenges related to managing emotions, and attitudes toward eating among adult participants with known psychiatric diagnoses. METHODS: The body mass indices of participants were calculated, and data on eating styles were collected using the Dutch Eating Behavior Questionnaire. The level of difficulty in managing emotions was evaluated using the Difficulties in Emotion Regulation Scale. RESULTS: The research findings indicated a meaningful positive association. An observation was made between body mass index and results from the Eating Attitude Test-40, as well as the restrained eating subdimension of the Dutch Eating Behavior Questionnaire. Conversely, a meaningful reverse relationship was identified between the scores of the "strategies" subdimension of the Difficulties in Emotion Regulation Scale. No meaningful differences in eating attitudes and emotion regulation were found between non-obese and obese patients. CONCLUSION: While a partial and meaningful correlation was observed among body mass index, eating attitudes, and emotion regulation difficulties, it is suggested that factors such as patients' age, disease duration, current body mass index, and the simultaneous presence of depression and anxiety should be considered.

Plasma Neuropeptide-S Levels in Populations Diagnosed with Generalized Anxiety Disorder: A Controlled Study.

INTRODUCTION: Neuropeptide S (NPS) is a novel neuropeptide reported to be involved in fear-and stress-related conditions and their corresponding neuroendocrine processes. The aim of this study was to compare the plasma NPS levels in patients suffering from generalized anxiety disorder (GAD) and those of healthy controls. METHODS: A total of 40 subjects diagnosed with GAD and 40 healthy controls were recruited in the study. The Hamilton Anxiety Scale (HAM-A), Generalized Anxiety Disorder-7 (GAD-7), and Hamilton Depression Scale (HAM-D) were administered to all participants to determine the severity of participants' anxiety and concomitant depressive symptoms. The plasma NPS levels were measured from the fasting venous blood samples obtained from each participant. RESULTS: The median plasma NPS level was found to be significantly higher in the GAD group in comparison to the control group (28.8 pg/mL as against 19.1 pg/mL, p=0.01). A significant positive correlation was observed between the plasma NPS levels and HAM-A scores (rs=0.23, p=0.04) as well as the GAD-7 scores (rs=0.28, p=0.01). The p-value obtained from the correlation analysis between the plasma NPS levels and HAM-D scores was 0.052. A receiver operating characteristic (ROC) analysis revealed that the plasma NPS levels could enable the identification of GAD with 67.5% sensitivity and 62.5% specificity, when the cut-off value was determined as 25.06 pg/mL. CONCLUSIONS: Our results support the view that plasma NPS levels, which has demonstrated anxiolytic effects on the central nervous system, is related to the severity of anxiety in GAD and could be considered as a candidate marker for the identification of GAD.

Quality of life in children and adolescents with chronic kidney disease: a comparative study between different disease stages and treatment modalities.

This study aimed to compare the quality of life of children and adolescents in various stages of their chronic kidney disease (CKD) who were managed with different treatment modalities to that of children and adolescents without any chronic disease. The study included 18 renal transplant and 21 dialysis patients (8 on hemodialysis, 13 on peritoneal dialysis) and 16 patients who did not yet require renal replacement therapy. The control group consisted of 37 children without any chronic disease. Psychosocial Health Summary scores, Physical Health Summary scores, and Total Scale scores of Pediatric Quality of Life Inventory scores were estimated for the groups. CKD patients had lower scores in all scales of Pediatric Quality of Life Inventory than the control group. There were no differences in self-reported scores on the Pediatric Quality of Life scale scores between treatment groups; however, parents of the transplant patients had reported higher (more favorable) Physical Health Summary scores than those of the dialysis patients. Reports of parents and their children differed only in Physical Health Summary scores in the dialysis group; self-reports of the children were more favorable. These findings show that children and adolescents with CKD experience impaired quality of life on the physical and psychosocial functioning domains in comparison with healthy controls. The study findings implicate the need for further studies to investigate the quality of life in CKD patients at different stages as well as the perceptional differences between pediatric and adolescent CKD patients and caregiver proxy-reports about their quality of life.

Relationship between panic disorder and plasma neuropeptide-S level

Abstract Background: Panic disorder has long been associated with the changes in various neurotransmitters, such as Neuropeptide-S (NPS). Objective: In this study we aimed to determine whether there is a relationship between blood NPS levels and panic disorder. Methods: Twenty nine patients with panic disorder and thirty two healthy control subjects who were age and gender matched were enrolled to the study. Blood samples were taken from participants and plasma NPS levels were quantified by using an ELISA kit. Results: In the study group, median NPS blood level was 16.7 pg/mL and in the control group it was 32.5 pg/mL. There was a statistically significant difference (p = 0.021). Using receiver operating characteristics (ROC) curve, sensitivity and specificity of NPS blood level, for diagnosing panic disorder was calculated, and it was found 79.3% and 56.25% respectively (AUC:0.672, 95% CI: 0.540-0.787). Discussion: Malfunction at the NPS modulatory system in the cortical areas (which is causing excitations in brain areas, such as amygdala and hypothalamus) does not only increase anxiety symptoms and risk of panic disorder but also causes panic disorder patients to have lower plasma NPS levels than the control group. Therefore it can be argued that such malfunction can be treated with a systemic treatment. Baykan H et al. / Arch Clin Psychiatry. 2018;45(4):79-81