Investigation of Apraxia in Patients with Schizophrenia and Bipolar Disorder Type I.

BACKGROUND: Almost 50% of patients with schizophrenia experience problems in their praxia performance, whereas executive function losses can be seen in patients with bipolar disorder. Although schizophrenia and bipolar disorder can be categorized as different disorders, in patient groups with similar symptom clusters, we aimed to determine whether there are common or disorder-specific praxia defects and to investigate the relationship between the sociodemographic and clinical features with apraxia. SUBJECTS AND METHODS: 52 Schizophrenia and 77 Bipolar Disorder Type I outpatients in remission for at least 6 months were included in our study. Test of Upper Limb Apraxia (TULIA) and Mayo Clinic Praxia Assessment Test (MCPAT) were used to evaluate praxia performance. RESULTS: Patients with Schizophrenia performed poorer on the TULIA and MCPAT than patients with Bipolar Disorder Type I. While impairment in personal and social functioning was higher in the apraxic schizophrenia group compared to the non-apraxic group, the mean age of disease onset was lower. Functioning in the Apraxic Bipolar Disorder Type I group was lower than in the group without apraxia; whereas the patient's age, duration of disease and number of hospitalizations were higher. CONCLUSIONS: Although apraxia, which have an important effect on the functioning and quality of life of the patient by causing impairment in daily activities, are seen at higher rates in patients with schizophrenia, might be also seen in patients with bipolar disorder type I. Decreasing diagnostic confusion and developing appropriate treatment strategies, evaluation of apraxia seems to be clinically important in terms of prognosis of diseases and functioning of patients.

Clinical characteristics of antidepressant use and related manic switch in bipolar disorder.

OBJECTIVE: To examine the association between clinical and treatment characteristics and antidepressants (AD)-induced manic switch in bipolar disorder (BD). METHODS: Total of 238 euthymic BD patients, who had been followed-up for at least 6 months at the outpatient clinic of Haseki Training and Research Hospital in istanbul, Turkey, were enrolled in this cross-sectional study in 2016. Semi-structured data form, the mood chart, and the mirror-designated assessment were applied to all subjects. The files of the patients were retrospectively reviewed and the patients using ADs were compared as AD-monotherapy (AD-m) and AD-combination (AD-c) groups, then divided into 2 subgroups according to the presence/absence of manic switch under AD treatment. RESULTS: Fifty eight (47.15%) patients out of 123 who received ADs at least once had experienced a manic switch under AD treatment. The rate of manic switch in AD-m patients was significantly higher than the AD-c group. Independent from being monotherapy or combined treatment, AD use longer than 12 months was negatively associated with the occurrence of manic switch. CONCLUSION: Our study suggests that the risk of manic switch is especially prominent in the first months of AD use. Antidepressants use in combining it with a mood stabilizers (MS) may not be adequate in preventing switches in shorter terms. However, in longer term uses addition of MS to ADs may decrease the risk of switches.

Dissociative features of fibromyalgia syndrome.

OBJECTIVE: To assess the relationships between the dissociative features of FMS and the pain, psychological status, and functional status. METHODS: Twenty-seven women with fibromyalgia syndrome (FMS) and 24 controls from the Istanbul Physical Medicine and Rehabilitation Hospital (2013-2015) were included in this cross-sectional study. The Diagnostic and Statistical Manual of Mental Disorders Structured Clinical Interview for Axis I Disorders was used to evaluate the participants. A visual analogous scale (VAS), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were used to assess the levels of pain, quality of sleep and functional and psychological statuses. The Dissociative Experiences Scale (DES) was used to evaluate the dissociative features. RESULTS: The BDI, BAI and DES scores were statistically significantly higher in the cases of FMS. There were remarkable associations between all but 2 of the DES and FIQ scores, while positive correlations were found between the DES and, VAS pain and sleep quality scores. The prevalences of current and lifelong dysthymia, and major depressive disorder; not otherwise specified, common anxiety and somatoform disorders were higher in the cases of FMS. CONCLUSION: Pain, physical function and emotional status appear to be associated with dissociative features in FMS. Further studies are required to define these relationships and improve treatment.

Suicide attempts and clinical features of bipolar patients.

OBJECTIVES: To identify clinical predictors of suicide attempts in patients with bipolar disorder. METHODS: This study included bipolar patients who were treated in the Psychiatry Department, Haseki Training and Research Hospital, Istanbul, Turkey, between 2013 and 2014; an informed consent was obtained from the participants. Two  hundred and eighteen bipolar patients were assessed by using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis-I (SCID-I) in order to detect all possible psychiatric comorbid diagnoses. Clinical predictors of suicide attempts were examined in attempters and non-attempters. The study design was retrospective. RESULTS: The lifetime suicide attempt rate for the entire sample was 19.2%. Suicide attempters with bipolar disorder had more lifetime comorbidity of eating disorder. Female gender and family history of mood disorder were significant predictors for suicide attempts. There was no difference between groups in terms of bipolar disorder subtype, onset age of bipolar disorder, total number of episodes, first and predominant episode type, suicide history in first degree relatives, severity of episodes, and hospitalization and being psychotic. CONCLUSION: Our study revealed that female gender, family history of mood disorder, and eating disorder are more frequent in bipolar patients with at least one suicide attempt.

Comparison of clinical and sociodemographic features of bipolar disorder patients with those of social anxiety disorder patients comorbid with bipolar disorder in Turkey.

OBJECTIVES: To assess the impact of social anxiety disorder (SAD) comorbidity on the clinical features, illness severity, and response to mood stabilizers in bipolar disorder (BD) patients. METHODS: This retrospective study included bipolar patients that were treated at the Department of Psychiatry, Haseki Training and Research Hospital, Istanbul, Turkey in 2015, and who provided their informed consents for participation in this study. The study was conducted by assessing patient files retrospectively. Two hundred bipolar patients were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition axis-I (SCID-I) in order to detect all possible comorbid psychiatric diagnoses. The sample was split according to the presence of SAD comorbidity and the groups were compared. RESULTS: The SAD comorbidity was detected in 17.5% (35/200) of the BD patients. The SAD comorbid bipolar patients were more educated, had earlier onset of BD, lower number of manic episodes, and more severe episodes. There was no difference between groups in terms of total number of episodes, hospitalization, suicidality, being psychotic, treatment response to lithium and anticonvulsants. CONCLUSION: Social anxiety disorder comorbidity may be associated with more severe episodes and early onset of BD. However, SAD comorbidity may not be related to treatment response in bipolar patients.