Deep neural network to differentiate brain activity between patients with euthymic bipolar disorders and healthy controls during verbal fluency performance: A multichannel near-infrared spectroscopy study.

In this study, we aimed to differentiate between euthymic bipolar disorder (BD) patients and healthy controls (HC) based on frontal activity measured by fNIRS that were converted to spectrograms with Convolutional Neural Networks (CNN). And also, we investigated brain regions that cause this distinction. In total, 29 BD patients and 28 HCs were recruited. Their brain cortical activities were measured using fNIRS while performing letter versions of VFT. Each one of the 24 fNIRS channels was converted to a 2D spectrogram on which a CNN architecture was designed and utilized for classification. We found that our CNN algorithm using fNIRS activity during a VFT is able to differentiate subjects with BD from healthy controls with 90% accuracy, 80% sensitivity, and 100% specificity. Moreover, validation performance reached an AUC of 94%. From our individual channel analyses, we observed channels corresponding to the left inferior frontal gyrus (left-IFC), medial frontal cortex (MFC), right dorsolateral prefrontal cortex (DLPFC), Broca area, and right premotor have considerable activity variation to distinguish patients from HC. fNIRS activity during VFT can be used as a potential marker to classify euthymic BD patients from HCs. Activity particularly in the MFC, left-IFC, Broca's area, and DLPFC have a considerable variation to distinguish patients from healthy controls.

Factors associated with progression of depression, anxiety, and stress-related symptoms in outpatients and inpatients with COVID-19: A longitudinal study.

It is known that there is an increase in the frequency of psychiatric disturbances in the acute and post-illness phase of coronavirus disease (COVID-19). Comorbid psychiatric symptoms complicate the management of patients and negatively affect the prognosis, but there is no clear evidence of their progress. We aimed to determine psychiatric comorbidity in inpatients and outpatients with COVID-19 and recognize the factors that predict psychiatric comorbidity. For this purpose, we evaluated patients on the first admission and after 4 weeks. We investigated psychiatric symptoms in outpatients (n = 106) and inpatients (n = 128) diagnosed with COVID-19. In the first 7 days after diagnosis (first phase), sociodemographic and clinic data were collected, a symptom checklist was constructed, and the Hospital Anxiety and Depression Scale (HADS) and the Severity of Acute Stress Symptoms Scale (SASSS) were applied. After 30-35 days following the diagnosis, the SASSS and the HADS were repeated. In the first phase, the frequency of depression and anxiety were 55% and 20% in inpatients, and 39% and 18% in outpatients, respectively. In the second phase, depression scores are significantly decreased in both groups whereas anxiety scores were decreased only in inpatients. The frequencies of patients reporting sleep and attention problems, irritability, and suicide ideas decreased after 1 month. Patients with loss of smell and taste exhibit higher anxiety and depression scores in both stages. Our results revealed that the rate of psychiatric symptoms in COVID-19 patients improves within 1 month. Inpatients have a more significant decrease in both depression and anxiety frequency than do outpatients. The main factor affecting anxiety and depression was the treatment modality. Considering that all patients who were hospitalized were discharged at the end of the first month, this difference may be due to the elimination of the stress caused by hospitalization.

Long Acting Injectable Antipsychotics in the Treatment of Schizophrenia and Bipolar Disorder.

Schizophrenia and bipolar disorder (BD) are psychiatric disorders with economic and social effects that cause disability. Treatment non-compliance is one of the major problems faced by clinicians in both schizophrenia and BD. Treatment non-compliance is associated with recurrence and impaired functionality. Treatment compliance increases with long-acting injectable antipsychotics (LAIAs) and recurrence times are prolonged, hospitalization rates decrease compared to those who use an equivalent oral form of the same drug. The use of LAIAs in the maintenance treatment of schizophrenia has also been associated with a low mortality rate, decrease in caregiver burden, and increase in patient satisfaction. Studies show that LAIAs are cost-effective compared to their oral forms. Data on the use of LAIAs in first-episode schizophrenia and BD are relatively limited. The results of studies on the use of LAIAs in patients with first-episode schizophrenia indicate that LAIAs have advantageous in preventing relapse and re-hospitalization compared to oral antipsychotics. In BD, with the use of LAIAs, the rate of hospitalization due to mood episodes and the frequency of manic episodes have been decreased. LAIAs have not been found to be as effective in preventing depressive episodes in BD as manic episodes. Although there are many studies supporting the use of LAIAs in maintenance treatment of schizophrenia and BD, more studies are needed on this issue. In this article, studies on the use of LAIAs in schizophrenia, first episode schizophrenia and BD are reviewed and the place of LAIAs in treatment was discussed.

The role of COMT polymorphism in modulation of prefrontal activity during verbal fluency in bipolar disorder.

OBJECTIVE: Verbal fluency (VF) impairment is a strong predictor of social functioning in bipolar disorder (BPD). The enzyme catechol-O- methyltransferase (COMT) has a critical role in cognitive responses by modulating dopaminergic activity in the prefrontal cortex (PFC). Here, we investigated the role of COMT polymorphism (i) in VF performance as well as (ii) in modulation of PFC activity during a VF-task in euthymic BPD patients. METHODS: 30 subjects with remitted BPD-I and 23 healthy controls (HCs) were genotyped for COMT Val158Met (rs4680) polymorphism and were compared in a VF-task. PFC activity was measured by 24-Channel Functional Near Infrared Spectroscopy. RESULTS: Bipolar subjects displayed lower VF performance than HCs. During the VF-task, BPD-group displayed higher activity than HCs in the Brocca's area, Premotor-cortex and supplementary motor area (SMA). In the index group, Val/Met polymorphism was associated with higher activity in the left- frontopolar and dorsolateral PFC (DLPFC) during the VF-task. LIMITATIONS: Antipsychotic use may have interfered with the results. CONCLUSIONS: Increased activity in the Brocca's area may represent compensation of low VF performance, whereas hyperactivity in premotor-cortex and SMA may be associated with increased behavioral intention and/or restlessness in BPD. Higher activity in left-frontopolar and DLPC among Val/Met individuals compared to Met-homozygotes may represent less effective prefrontal dopaminergic signaling in Val/Met individuals with BPD.

Symptomatic and functional outcomes after treatment with paliperidone palmitate 3-month formulation for 52 weeks in patients with clinically stable schizophrenia.

BACKGROUND: Paliperidone palmitate 3-monthly (PP3M) formulation is a long-acting, injectable antipsychotic treatment approved in many countries worldwide for the maintenance treatment of adult patients with schizophrenia. This single-arm, open-label, phase IIIb study evaluated the efficacy and safety of converting patients with schizophrenia stabilized with paliperidone palmitate 1-month (PP1M) to PP3M in a naturalistic clinical setting. METHODS: After screening (days -7 to 1), patients were converted from PP1M (50-150 mg eq.) to PP3M (175-525 mg eq.), and entered a 52-week, flexible-dose PP3M treatment period. The primary efficacy endpoint was symptomatic remission (SR) (Andreasen criteria) at last observation carried forward (LOCF) endpoint. RESULTS: Patients (n = 305) received PP3M, of whom 291 (95.4%) completed the study. Doses of PP3M remained stable during the 12-month treatment period, and changes in dose were uncommon. Overall, 56.8% of patients [95% confidence interval (CI): 51.0, 62.4] achieved SR, and 31.8% achieved both symptomatic and functional remission (Personal and Social Performance scale total score > 70) at LOCF endpoint. Secondary endpoint results were generally consistent with primary endpoint results. There were improvements in Positive and Negative Syndrome Scale total, subscale and Marder factor scores, and also Clinical Global Impression-Severity and -Change scores from baseline to LOCF endpoint. Carer burden was reduced, and the proportion of patients requiring hospitalization for psychiatric reasons decreased from 13.5% in the 12 months prior to baseline to 4.6% during the treatment period. No new safety signals were identified. CONCLUSION: Results from this naturalistic study were similar to those observed in previous randomized clinical trials of PP3M and underline the importance of continuous maintenance treatment in patients with schizophrenia.

Efficacy and Safety of Paliperidone Palmitate Treatment in Patients With Schizophrenia: A Real-World Multicenter, Retrospective, Mirror-Image Study.

PURPOSE: The aim of the study was to assess efficacy and safety of paliperidone palmitate (PP) in schizophrenic patients using real-life data. METHODS: This national, multicenter, retrospective, and mirror-image study was performed reviewing the medical records of patients in 18 centers. Adult schizophrenic patients receiving PP treatment (n = 205) were enrolled. Patients' data covering the last 12 months before the initial PP injection and the period until the end of study with at least 12 months after the initial PP injection were evaluated. Patients' characteristics, scale scores, and adverse events were recorded. RESULTS: Nonadherence to prior medication was the most frequent reason for switching to PP treatment. Comparing with the period before PP treatment, the rate of patients visiting the hospital for relapse (79.5% vs 28.9%, P < 0.001) and the median number of hospitalizations (2 vs 0, P < 0.001) were lower during PP treatment. During PP treatment, the Positive and Negative Syndrome Scale score decreased by 20% or more (response to treatment) in 75.7% of the patients. The frequency of adverse events did not differ between the period before and during PP treatment. Improvement in functionality was higher in those with disease duration of 5 years or less. CONCLUSIONS: Paliperidone palmitate is effective and safe in treatment of schizophrenic patients and in switching to PP treatment in patients with schizophrenia, which reduced the percentage of patients admitted to the hospital for relapse and the median number hospitalization, and has positive effects on functionality.

The relationship between the serotonin 2A receptor gene -1438A/G and 102T/C polymorphisms and citalopram/sertraline-induced nausea in major depressed patients.

OBJECTIVE: The aim of the present study was to determine the relationship between the polymorphisms of -1438A/G and 102T/C in the 5-HT2A receptor (HTR2A) gene and nausea/vomiting as a side effect induced by sertraline (SERT) or citalopram (CIT) in patients with major depressive disorder. METHODS: A total of 128 patients were enrolled, 63 patients received CIT, whereas 65 patients were treated with SERT. Nausea/vomiting were assessed with the UKU Side-effects Rating Scale at baseline and at the end of the second and fourth weeks. Polymerase chain reaction-restriction fragment length polymorphism technique was employed to determine genetic differences. RESULTS: We have found that, in the patients treated with CIT, there was a nominally significant difference in the genotypic distribution associated with -1438A/G polymorphism between patients with and without nausea (X2  = 6.15, p = 0.041). Moreover, logistic regression analysis revealed a significant association between nausea/vomiting as a side effect and -1438A/G polymorphism. That is, patients with the G allele were at a higher risk for developing nausea/vomiting (p = 0.044, odds ratio = 2.213). The 102T/C polymorphism in the HTR2A gene had no significant effect on the nausea/vomiting as a side effect among participants treated with either CIT or SERT. CONCLUSION: The present study suggests the association of the HTR2A gene -1438A/G polymorphism with nausea/vomiting as a side effect related to CIT treatment.

[Positive Symptoms and Perceived Parental Acceptance-Rejection in Childhood: The Moderating Roles of Socioeconomic Status and Gender]. / Pozitif Belirtiler ve Çocuklukta Algilanan Ebeveyn Kabul-Reddi: Sosyoekonomik Düzey ve Cinsiyetin Düzenleyici Rolü.

OBJECTIVE: The current study aimed to investigate the moderating roles of socioeconomic status (SES) and gender in the relationship between the positive symptoms of patients with schizophrenia and their recollections of parental acceptance-rejection in childhood. METHOD: This study included 53 outpatients (20 females and 33 males) who were diagnosed with schizophrenia at the Ankara University and Ege University Faculty of Medicine Department of Psychiatry. Of the participants, 22.6% were from low SES families, 55.7% were from middle SES families, and 22.6% were from high SES families. The relationship between the participants' positive symptoms and recollections of parental acceptance-rejection in childhood were assessed by the Scale for the Assessment of Positive Symptoms and the Adult Parental Acceptance-Rejection Questionnaire/Control. RESULTS: Compared to schizophrenia patients from middle and high SES families, those from low SES families perceived their mothers and fathers as more cold, neglectful, rejecting, and less controlling in their childhood. Among the parental acceptance-rejection subscales, only maternal indifferences/neglect was related to the participants' positive symptoms. A three-way interaction (moderated moderation) analysis indicated that SES significantly moderated the effect of perceived maternal neglect on positive symptoms for female, but not male, patients with schizophrenia. CONCLUSION: The severity of positive symptoms of female patients with schizophrenia, especially those from low and middle SES families, may be reduced by examining recollections of maternal neglect in childhood and, if necessary, applying trauma or attachment-focused interventions.

Cognitive Features of High-functioning Adults with Autism and Schizophrenia Spectrum Disorders.

OBJECTIVE: Autism Spectrum Disorder (ASD) and schizophrenia share common features in terms of pathophysiology and clinical appearance. Cognitive deficits are also present in both disorders. However, ASD and schizophrenia are heterogeneous syndromes, and  few  studies  have addressed patients with these disorders who have above average educational attainment. In this study, we assessed the cognitive functions of a group of adult ASD patients with adequate mental development and verbal communication skills (High Functioning Autism, HFA) and compared them with a group of Schizophrenia patients matched for level of education. METHOD: Three groups of patients and controls [(HFA, n= 32), Schizophrenia (n= 17), Controls (n= 23)], all with at least a high school education, were assessed with the Wechsler Adult Intelligence Scale (WAIS), Wisconsin Card Sorting Test (WCST), and Rey Auditory Verbal Learning Test (RAVLT). For the assessment of HFA, scores on the Autism Spectrum Disorders in Adults Screening Questionnaire were taken into consideration. Clinical diagnoses were based on DSM-IV TR and DSM-5 criteria. RESULTS: High Functioning Autism and Schizophrenia groups performed similarly in all subtests except for WAIS Comprehension and Digit Symbol, WCST Perseveration, and RAVLT Learning. CONCLUSION: Comprehension abilities of educated adults with HFA could be higher than average in situations that do not involve social interaction. Tendency to perseveration in the presence of adequate concept formation ability may reflect the clinical symptoms of rigidity and repetitive behavior. In patients with higher levels of functioning and education, their diagnosis appears to be weakly associated with cognitive functioning. The potential roles of other variables, such as environmental factors, during development deserve further exploration in future studies.

Genotype and Allele Frequency of CYP3A4 -392A>G in Turkish Patients with Major Depressive Disorder.

OBJECTIVES: Genetic polymorphisms may help for individualized drug dosing and improved therapeutics. CYP3A4 is responsible for the metabolism of more than 50% of the commonly used drugs and metabolizes typical antipsychotic medications and antidepressant drugs. The objective of the study was to assess the genotype and allele frequencies of CYP3A4 -392A>G in Turkish patients with major depressive disorder receiving any SSRIs and to compare these results with the frequencies of other ethnic groups. MATERIALS AND METHODS: Genotyping analyses of CYP3A4 -392A>G was conducted on 84 Turkish patients using the PCR-RFLP technique. RESULTS: The allele frequencies were found as 0.982 (A) and 0.018 (G) for CYP3A4 -392A>G. The genotype frequencies were determined as 0.976 (AA), 0.012 (AG), and 0.012 (GG). The genotype frequencies were consistent with the Hardy-Weinberg equilibrium. CONCLUSION: The genotype and allele frequencies of CYP3A4 -392A>G were determined to be low in Turkish patients with major depressive disorder receiving SSRIs. Furthermore, the results of the study were compared with those of other ethnic groups and they displayed pronounced differences among other ethnic groups, especially black subjects.

[Prefrontal Cortex Activity During Facial Affect Processing in Schizophrenia: Association with Clinical Symptoms and Social Cognitive Functions]. / Sizofrenide Yüzdeki Duygu Ifadelerini Tanima Sirasindaki Prefrontal Korteks Aktivitesinin Klinik Belirtiler ve Sosyal Bilis Islevleriyle Iliskisi.

OBJECTIVES: In the present study, we aimed to investigate the prefrontal cortex (PFC) activity during facial affect recognition in schizophrenia, as well as the association of this activity with symptom severity and with the higher order social cognitive functions, namely recognition of false beliefs, faux-pas and hinting. METHOD: Functional near infrared spectroscopy (fNIRS) was used to measure frontal cortical activity during a neuroimaging task prepared with a standard set of pictures of facial affect. The data of the Index Group (IG) consisting of 27 subjects with DSM-IV based diagnoses of schizophrenia and schizophreniform disorder and control group (CG) (N=25) were compared. The control condition was to detect nonaffective changes on a neutral face. Associations with frontal activity during affect recognition and clinical symptoms, false belief recognition, hinting and faux-pas were investigated. RESULTS: Prefrontal activity during both affective and non-affective conditions was higher in the IG than the CG. The IG performed worse than the CG in social cognitive tests. Social cognitive test performance was not correlated with cortical activity. There were no correlations between education status, age and PFC activity in both groups. In the IG, right ventral prefrontal cortex (VPFC) and right medial prefrontal cortex (mPFC) activities were associated with hallucination severity. CONCLUSION: These results suggest the presence of hyperfrontality during face processing in schizophrenia. Results also suggest that schizophrenia patients require more frontal resources to achieve a performance comparable to that of healthy controls in order to detect both affective and non-affective changes on a face. There might be a relationship between facial processing and hallucinations.

Psychiatric Comorbidity, Sexual Dysfunction, and Quality of Life in Patients Undergoing Hemodialysis: A Case-Control Study.

INTRODUCTION: Due to disabilities caused by the disease and the requirement of dialysis, end-stage renal disease (ESRD) is frequently comorbid with psychiatric disorders, adversely affects quality of life, and causes significant sexual dysfunction (SD). We aimed to investigate the psychiatric comorbidity, quality of life, depression and anxiety levels, and SD in ESRD patients undergoing hemodialysis. METHODS: Forty-nine patients undergoing hemodialysis treatment in a dialysis center and 44 non-ESRD control subjects selected with snowball sampling were enrolled in the study. All subjects were assessed using Structured Clinical Interview for Axis-I Disorders (SCID-I). Sociodemographic data form, Hospital Anxiety and Depression Scale (HADS), Arizona Sexual Experience Scale (ASEX), and World Health Organization Quality of Life Short Form Turkish Version Scale (WHOQOL-BREF-TR) were applied to both groups. RESULTS: There was no difference between the groups in terms of sex, age, education period, marital status, presence of additional physical illness, and past history of psychiatric disorders. Compared with the control group, HADS depression subscale and ASEX scores were significantly high (p<0.01) in the patient group, and WHOQOL-BREF-TR psychological and physical domain scores were low (p<0.05 and p<0.01, respectively). There was a significant negative relationship between HADS scores and WHOQOL-BREF-TR psychological, environmental, and national environmental scores in the patient group (p<0.05). When the differences between the groups were re-analyzed after controlling HADS depression scores with covariance analysis, the significant difference in ASEX and WHOQOL-BREF-TR physical domain scores between the groups remained, but the significant difference in WHOQOL-BREF-TR psychological domain scores disappeared. CONCLUSION: The quality of life of ESRD patients was lower, especially in the psychological and physical domains, and psychiatric comorbidities and SD rates were higher than in non-ESRD control subjects. Quality of life is affected by SD. Recognizing and treating depressive symptoms will help improve the quality of life, especially in the psychological domain.

[The Relationship of Verbal Working Memory and Theory of Mind in First Degree Relatives of Patients With Schizophrenia and Bipolar Disorder]. / Sizofreni ve Psikotik Özellikli Bipolar Bozukluk Hastalarinin Birinci Derece Akrabalarinda Zihin Kurami ve Sözel Çalisma Belleginin Iliskisi.

OBJECTIVE: We aimed to compare Theory of Mind (ToM) functions and investigate the relationship between ToM functions and verbal working memory (VWM) in first degree relatives of bipolar disorder and schizophrenia patients. METHOD: The sample consisted of first degree relatives of patients with bipolar disorder (n=22), schizophrenia (n=28), and age, gender, education and total IQ matched healthy volunteers (n=27) without a family history of schizophrenia or bipolar disorder. We administered Auditory Consonants Test (ACT) to evaluate VWM, first and second order false belief tests (ToM-1, ToM-2), Faux Pas Test (FPT), Hinting Test (HT) to evaluate different domains of ToM functions. RESULTS: Both relative groups performed significantly lower in all components of ToM and VWM tests compared to the control group. When VWM scores were employed as covariate in the analyses, the FPT difference between the groups remained significant, HT difference regressed to a marginal level, and the difference between ToM-1 and ToM-2 disappeared. CONCLUSION: To our knowledge, this is the first study indicating the presence of ToM impairment among first degree relatives of bipolar disorder patients similar to relatives of schizophrenia patients. VWM performance seems to affect first and second order ToM functions in relatives of patients with schizophrenia and bipolar disorder. On the other hand, FPT and HT domains seem to be independent of VWM performances in these groups. FPT and HT impairments may be familial vulnerability markers that are independent from neurocognitive impairment.

Influence of CYP2B6 and CYP2C19 polymorphisms on sertraline metabolism in major depression patients.

BACKGROUND: Genetic polymorphisms in CYP2B6 and CYP2C19 may cause variability in the metabolism of sertraline, a widely used antidepressant in major depressive disorder treatment. OBJECTIVE: This study investigates the impact of CYP2B6*4 (785A > G), CYP2B6*9 (516G > T), CYP2B6*6 (516G > T + 685G > A) CYP2C19*2 (685G > A), CYP2C19*17 (-3402C > T) polymorphisms on plasma concentrations of sertraline and N-desmethyl sertraline in major depression patients treated with sertraline [n = 50]. SETTING: Participants were patients who admitted to an adult psychiatry outpatient unit at a university hospital. These were DSM-IV major depression diagnosed patients with a stable sertraline medication regimen [for at least one month]. METHODS: CYP2B6*4 (rs 2279343; 785A > G), CYP2B6*9 (516G > T; rs 3745274), CYP2B6*6 (516G > T + 685G > A) CYP2C19*2 (rs 4244285; 685G > A), CYP2C19*17 (rs 11188072; -3402C > T), polymorphisms were analyzed by polymerase chain reaction and restriction fragment length polymorphism. Plasma concentrations were measured by high-performance liquid chromatography in patients treated with SERT. MAIN OUTCOME MEASURE: The distribution of CYP2B6*4, *6, *9 and CYP2C19*2, *17 among patient group and the association between genotype and sertraline metabolism. RESULTS: Sertraline, N-desmethyl sertraline, N-desmethyl sertraline/sertraline and dose-adjusted plasma concentrations were statistically compared between individuals with wild-type and variant alleles both for CYP2B6 and CYP2C19 enzymes. The mean N-desmethyl sertraline/sertraline value, was significantly lower in all subgroups with *6 and *9 variant alleles (p < 0.05). Sertraline/C values were significantly higher (p < 0.05) and N-desmethyl sertraline/C values were lower in all subgroups with *6 and *9 variant alleles compared to wild-type subgroup. CONCLUSION: CYP2B6*6 and *9 variant alleles had a significant decreasing effect on sertraline metabolism in major depression patients which might result as variations in sertraline therapy.

Psychiatric and functional evaluation of professional athletes following anterior cruciate ligament reconstruction.

OBJECTIVE: The aim of this study is to evaluate early phase depression and anxiety in the proffessional athletes who underwent anterior cruciate ligament (ACL) reconstruction and compare them with the functional improvement of knee. METHODS: Thirty-eight patients (35 males, 3 females; mean age±SD: 26.84±8.03) were included in this study. Measurements were obtained immediately following the operation and at Week 6 of postoperative rehabilitation. Depression and anxiety symptoms were evaluated by the Hospital Anxiety and Depression Scale (HADS), and knee function was evaluated by Lysholm Knee Scoring Scale (LKSS). RESULTS: Change in total LKSS scores from the time of admission (56.4±20.2) to the end of the sixth week (78.7±13.8) was significant (t=-8.21, p<0.001). Neither the HADS depression nor the HADS anxiety scores were above the cutoff values in the 2 assessments. Significant difference was noted in HADS anxiety scores between the time of admission (6.21±3.50) and at the sixth week (5.33±3.33) (t=2.02, p=0.05). However, HADS depression scores were not statistically different between the 2 evaluations (5.95±3.68 and 5.35±3.50 at admission and Week 6 week, respectively) (t=1.07, p=0.29). Changes between the 2 LKSS and HADS anxiety assessments were negatively correlated (r=-0.49, p=0.002), but there no correlation was detected between the total LKSS and HADS score changes. CONCLUSION: The decline of the signs of anxiety and depression at the sixth week of rehabilitation indicate that proper rehabilitation positively affects the emotional status of ACL reconstruction patients.

Effect of a social defeat experience on prefrontal activity in schizophrenia.

The social defeat (SD) hypothesis of schizophrenia posits that repeated experiences of SD may lead to sensitization of the mesolimbic dopaminergic system and to precipitation of psychosis. Based on previous definitions adapted to a human experimental paradigm, we prepared a computer simulation of SD to mimic this subjective experience. We measured prefrontal cortex (PFC) activity in subjects with schizophrenia and healthy controls during exposure to a single SD experience with functional near infrared spectroscopy. PFC activity declined in both groups. Compared with the control condition, SD exposure was associated with a broader decline in left ventromedial, right medial and right lateral PFC activity in healthy controls (n=25), and a sharper decline in right ventrolateral PFC activity in subjects with schizophrenia (n=25). The activity in the right ventrolateral PFC, was significantly lower in patients compared with controls. This may be due to a deficiency in emotion regulation or self-control, or it may be related to impaired empathy in schizophrenia. Different patterns of brain activity during the SD experience in subjects with schizophrenia versus healthy controls may provide indirect evidence regarding the SD hypothesis of schizophrenia.

[Peripheral blood T-lymphocyte and T-lymphocyte subset ratios before and after treatment in schizophrenia patients not taking antipsychotic medication]. / Antipsikotik tedavi altinda olmayan sizofreni hastalarinda periferik T-lenfosit ve alt tip oranlari ve tedavi yanitiyla iliskisi.

OBJECTIVE: Immune system abnormalities in schizophrenia have been previously studied. According to the present point of view, an infection or autoimmune process might be occurring in the form of cellular and/or humoral immune system abnormalities in schizophrenia. Furthermore, several effects of antipsychotic medication on the immunological profile of schizophrenic patients have been demonstrated. The present study aimed to compare the total T-lymphocytes level and the T-lymphocyte subset ratios in schizophrenia patients not treated with antipsychotics and healthy controls. The relationship between disease duration, symptom severity, and treatment response and T-lymphocyte profiles were investigated. METHODS: The study included 14 patients (11 antipsychotic naive, 3 antipsychotic free for at least 6 months) diagnosed with schizophrenia or schizophreniform disorder that were compared to age- and sex-matched healthy controls in terms of the total T-lymphocytes level and T-lymphocyte subset ratios using flow-cytometry. The relationship of the T-lymphocyte profiles, to disease duration and treatment response was investigated. RESULTS: The groups were not different in terms of total T-lymphocytes level and T-lymphocyte subset ratios; however, the antipsychotic naive patients and the group with disease duration < 2 years had lower rates of T8-lymphocytes. Total T-lymphocytes and the T8-lymphocyte ratio increased after treatment. Clinical improvement was correlated with total T-lymphocytes and the T4-lymphocyte subset ratio. CONCLUSION: Cellular immune system abnormalities in schizophrenia may be intrinsic factors. Changes in the cellular immune system are associated with treatment response and might be candidates for biological markers.

[Social anxiety level in acne vulgaris patients and its relationship to clinical variables]. / Akne vulgaris hastalarinda sosyal kaygi düzeyi ve bunun klinik degiskenler ile iliskisi.

OBJECTIVE: The purpose of this study was to determine the level of social anxiety in acne vulgaris patients and to examine its relationship to the sociodemographic and clinical characteristics of acne, as well as to depression, self-esteem, and negative automatic thoughts. METHOD: The study included 83 acne vulgaris patients from the dermatology outpatient unit of a university hospital and 58 healthy controls. Sociodemographic and clinical questionnaires, and the Global Acne Grading System (GAGS), Hospital Anxiety and Depression Scale (HADS), Liebowitz Social Anxiety Scale (LSAS), Rosenberg Self-Esteem Scale (RSES), and Automatic Thoughts Scale (ATS) were administered to both groups. RESULTS: The degree of social anxiety, social avoidance/withdrawal, general anxiety, depression, and negative automatic thoughts were significantly higher, and self-esteem was significantly lower in the acne patients. Among the 83 patients, scoring above the scales' cut-off points was as follows: 25.6% on the LSAS, 32.9% on the LSAS-Anxiety Subscale, 27.7% on the LSAS-Avoidance Subscale, 36.1% on HADS, 30.1% on the HADS-Depression Subscale, and 50.6% on the HADS-Anxiety Subscale. Psychological symptoms were negatively correlated with age and level of education in the patient group; however no relationship was observed between the psychological symptoms, and gender, the severity of acne, or acne localization. The patients rated their symptoms more severely than did the clinicians; however, the subjective ratings of the patients were not correlated to their psychological symptoms. CONCLUSION: Acne vulgaris must be considered as an illness with the potential to negatively affect the psychological and emotional functioning of patients; therefore, routine psychiatric evaluation and psychological support should be part of the routine acne treatment plan.

[Development of a questionnaire to assess inter-episode functioning in bipolar disorder: Bipolar Disorder Functioning Questionnaire]. / Bipolar Bozuklukta Islevsellik Olçeginin Gelistirilmesi, Güvenilirlik ve Geçerliligi.

OBJECTIVE: Even though quality of life and functioning are topics that are point of interest, they are not assessed adequately in mood disorders. In this study, it is aimed to develop a functioning assessment scale in bipolar disorder. METHOD: Bipolar Disorder Functioning Questionnaire (BDFQ) is developed by the Scientific Section for Mood Disorders of the Psychiatric Association of Turkey. The questionnaire contains 58 items, and consists of eleven subscales: emotional functioning, intellectual functioning, sexual functioning, feelings of stigmatization, social withdrawal, household relations, relations with friends, participation to social activities, daily activities and hobbies, taking initiative and self sufficiency, and occupation. RESULTS: In this study, 252 remitted bipolar patients from 15 centers were included. In addition, thirty subjects without any lifetime psychiatric, neurological or physical disease were recruited. The mean age of the patients was 38.6+/-12.1 and 56% (n=141) were female. The mean duration of the bipolar disorder was 11.9+/-9.2 years, and 91.3% of the patients were diagnosed to have bipolar I disorder. In the reliability analyses, after the exclusion of six items with low reliability coefficients, The Cronbach alpha coefficient was calculated to be 0.91. The item-total scale correlations were between 0.22-0.86. In test-retest reliability, the correlation between the two ratings was high (r=0.82, p<0.0001). In validity analyses, 13 factors were obtained representing 65.1% of the total variance in exploratory factor analysis. In confirmatory factor analysis, 11 domains fit the model with a RMSEA of 0.061. BDFQ significantly correlated with GAF (r=0.428, p<.0001). BDFQ also showed significantly negative correlation with HAM-D (r=-0.541, p<0.0001) and YMRS (r=-0.365, p<0.0001). It discriminated the patients (mean score=111.8+/-15.2) from the healthy subjects (mean score=121.4+/-10.4) well (t=-2.300, p=0.038). CONCLUSION: With the six items excluded, it is suggested that the 52-item BDFQ is a reliable and valid instrument in the assessment of functioning in bipolar disorder.

Suicide attempts in Turkey: results of the WHO-EURO Multicentre Study on Suicidal Behaviour.

OBJECTIVE: To investigate the rate and method of attempted suicides in a catchment area in Turkey as part of the WHO-EURO Multicentre Study on Suicidal Behaviour. METHOD: All hospitals in the catchment area were screened to identify suicide attempts for 4 years between January 1, 1998, and December 31, 2001. RESULTS: In the 4-year period, 737 individuals attempted suicide (514 women and 223 men). The mean annual rate per 100,000 was 46.89 for men and 112.89 for women. The parasuicide rate increased by 93.59% between 1998 and 2001. The most frequent method used by both men and women was self-poisoning. CONCLUSION: Compared with the results from other European research centres, attempted suicide rates in Turkey were relatively low. However, the increase in rates was striking. This upward trend may be related to the intense economic difficulties, increasing unemployment, and rapid social change experienced in Turkey in recent years. The risk groups appeared to be younger and female.