Empathy in Social Anxiety Disorder: The Association with Attention Deficit Hyperactivity Disorder.

Objectives: Our main hypothesis in this study was that patients with social anxiety disorder (SAD) and comorbid attention deficit hyperactivity disorder (ADHD) had lower empathy levels than those without ADHD. Also, after controlling for the severity of SAD and depression, we hypothesized that ADHD symptoms contributed to lower levels of empathy in SAD patients.Methods: 72 patients (46 females, 32 males) with SAD between the ages of 18-65 years were divided into two groups as those with (n = 32) and those without ADHD (n = 40). Participants were evaluated using the Liebowitz Social Anxiety Scale (LSAS), Turgay's Adult Attention-Deficit/Hyperactivity Disorder, Beck Depression Inventory (BDI), and Empathy Quotient. In this study, Mann Whitney-U test, Spearman correlation test, logistic and multiple regression analysis were used.Results: Education level (U = 371.5, p = .002) and empathy scores (U = 259.5, p < .0001) of SAD patients with ADHD were significantly lower than those without ADHD. BDI (U = 206.5, p < .0001), LSAS total (U = 454.5, p = .036), fear (U = 457.0, p = .038), and avoidance scores (U = 453.0, p = .034) were higher in SAD patients with ADHD than those without ADHD. Low levels of empathy (B = - 0.119, Exp(B) = 0.895, p = .014) and high severity of current depression (B = 0.119, Exp(B) = 1.127, p = .001) were significantly associated with comorbidity between SAD and ADHD. ADHD-inattention (ß = -0.369, Exp(B) = -0.541, p = .004), and depression (ß = -0.262, Exp(B) = -0.212, p = .036) negatively predicted empathy levels.Conclusions: Our findings may provide some evidence for the contribution of ADHD-inattention and depression to poor empathy in SAD patients. Therefore, it is recommended that symptoms of ADHD-inattention and depression should be carefully evaluated in SAD patients with low empathy.

Separation Anxiety Disorder in Panic Disorder Patients with and without Comorbid Agoraphobia.

Objective: Previous studies have focused on the relationship between childhood separation anxiety disorder (SAD) and adult panic disorder (PD)-agoraphobia. It is not clear enough whether SAD, which continues into adulthood, is associated with PD with and without comorbid agoraphobia in adult patients. Our primary hypothesis was that PD patients with comorbid agoraphobia had a higher rate of SAD that continues into adulthood than those without agoraphobia. We also hypothesized that adulthood SAD symptoms were more likely to be associated with PD-agoraphobia than PD without agoraphobia.Method: 151 patients who were diagnosed with PD with (n = 106), and without comorbid agoraphobia (n = 45) were compared using Panic and Agoraphobia Scale, Structured Clinical Interview for Separation Anxiety Symptoms, Separation Anxiety Symptom Inventory, Adult Separation Anxiety Questionnaire, and State-Trait Anxiety Inventory. We performed Student's t-test, Pearson correlation test, and multiple linear regression analysis in this study.Results: PD patients with comorbid agoraphobia were more likely to have SAD both in childhood and adulthood (p = .028), than those without agoraphobia. There were mild to moderate significant correlations between PD severity and state anxiety (p = .002), trait anxiety (p = .006), and SAD in childhood (p = .049), and in adulthood (p = .001). SAD in adulthood (ß = 0.278, Exp(B) = 0.136, p = .003), and state anxiety (ß = 0.236, Exp(B) = 0.164, p = .012) significantly predicted the severity of PD in patients with comorbid agoraphobia.Conclusion: SAD that continues in adulthood may be related to the severity of PD in patients with agoraphobia. Our findings might provide some evidence of the role of SAD in adulthood in patients with adult-onset PD-agoraphobia.

Which factors may differentiate lifetime suicide attempters from ideators in obsessive-compulsive disorder patients?

BACKGROUND: The causes underlying suicidal behaviour in patients with obsessive-compulsive (OCD) are not fully understood. AIM: In this study, we examined whether lifetime suicide attempt (SA), and suicide ideation (SI) was associated with affective temperaments, impulsivity, childhood traumatic events or separation anxiety. METHODS: We compared OCD patients with lifetime SA (Group 1; n=25), lifetime suicide ideation (SI) (Group 2; n=62), and without lifetime SI and SA (Group 3; n=73) through Beck Scale for Suicidal Ideation (BSSI), Childhood Trauma Questionnaire Questionnaire (CTQ-SF), Separation Anxiety Symptom Inventory (SASI), Baratt Impulsiveness Scale (BIS-11), Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-A), and Beck Depression Inventory (BDI). RESULTS: Post hoc tests showed that educational level was significantly lower in Group 1 than in both Group 2 and 3. Childhood abuse were significantly higher in attempters than ideators, and non-suicidal patients. The depressive, cyclothymic, and anxious temperaments were significantly higher in attempters and ideators compared to control subjects. The aggressive obsessions (p=0.002), childhood abuse history (p=0.009), lifetime major depression (p=0.017), and lower educational levels (p=0.006) strongly predicted the increased risk of lifetime SA, compared to non-suicidal patients. Childhood abuse (p=0.022) was the most significant predictor of lifetime SA in OCD. CONCLUSION: We suggested that childhood abuse history emerged as the most significant variable that distinguished lifetime attempters from only ideators in OCD patients.

Affective temperament traits may explain high expressed emotion in caregivers of patients with Alzheimer's disease.

BACKGROUND: The negative interactions between Alzheimer's disease (AD) patients and their caregivers may provoke criticism, hostility, and emotional overinvolvement that characterise highly expressed emotion (EE) attitudes. In this study, we hypothesised that affective temperament traits of AD caregivers are related to their high EE levels independent from other patient and caregiver characteristics. METHODS: Eighty AD patients were assessed through Clinical Dementia Rating Scale (CDR), and Mini-Mental State Examination. Expressed Emotion Scale (EES), Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire, and Hamilton Depression Rating Scale were applied to the caregivers. The high (n = 41) and low EE caregivers (n = 39) were compared with respect to some sociodemographic and clinical characteristics of the patients and caregivers, and affective temperament traits of caregivers. The associations of caregiver EES scores with multiple variables related to patients and caregivers were examined by Pearson correlation tests. We performed multiple linear regression analysis to determine the possible predictors of total EES scores. RESULTS: High EE caregivers had significantly higher depressive, cyclothymic, and anxious temperament traits than in low EE subjects. A weak positive correlation was found between the total EES scores and Personal Care scores of CDR. Home and hobbies subscale scores of CDR had a moderately significant positive correlation with total EES scores. There was also moderate significant positive correlations between total EE scores and depressive, cyclothymic, anxious, and irritable temperament traits. Linear regression analysis indicated that depressive temperament significantly predicted the high levels of caregiver EE. CONCLUSION: These findings suggest that caregivers' depressive temperament is predominantly related to their EE levels even after controlling for the severity of AD, and lower educational level of caregivers. Our results may provide evidence that high EE might be a reflection of caregivers' depressive temperament traits, in accordance with the trait hypothesis.

Mediating role of childhood abuse for the relationship between schizotypal traits and obsessive-compulsive disorder

Abstract Background The mediating role of childhood trauma in the relationship between schizotypal symptoms and obsessive-compulsive disorder (OCD) was not sufficiently investigated to date. Objectives In the present study, our major goal was to analyse the mediator role of childhood abuse (emotional, physical, and sexual), and neglect (emotional and physical) on the link between schizotypal symptoms and OCD, after controlling for duration of OCD, the mean number of comorbid Axis I disorders, and current anxiety. Methods One hundred fifteen patients (aged 18-65 years) who had primary diagnosis of OCD and Yale-Brown Obsessive-Compulsive Scale score ≥16 were assessed using the short form of Childhood Trauma Questionnaire questionnaire (CTQ-SF), Schizotypal Personality Questionnaire (SPQ), and Beck Anxiety Inventory (BAI). Results The all types of schizotypal symptoms were significantly correlated with the scores of childhood abuse and neglect, and BAI. The childhood abuse as a mediator significantly predicted the total YBOCS scores (p = 0.02) after when BAI scores were controlled. However, childhood neglect was not multivariately related to current OCD severity, and did not mediate the relationship between schizotypal traits and total YBOCS scores. Discussion We suggested that childhood trauma mediated the schizotypal traits in relationship with current OCD severity independent from anxiety severity.

The Clinical Characteristics of ADHD and Obsessive-Compulsive Disorder Comorbidity.

Objective: To investigate the clinical implications of obsessive-compulsive disorder (OCD) and ADHD comorbidity in adults. Method: The OCD patients who had and had no diagnosis of adulthood ADHD were compared in terms of several demographic and clinical variables. Results: The mean number of obsessions and compulsions; hoarding, symmetry, and miscellaneous obsessions; ordering/arranging and hoarding compulsions; total, attentional, and motor subscale scores of Barratt Impulsivity Scale (BIS)-11 were more frequent among the patients with OCD-ADHD. The mean age of onset was more likely to be earlier in ADHD-OCD group than in OCD group. Impulsivity, symmetry obsessions, and hoarding compulsions strongly predicted the coexistence between ADHD and OCD. Conclusion: OCD-ADHD comorbidity in adults seemed to be associated with an earlier onset of OCD, with the predominance of impulsivity, and with a different obsessive-compulsive symptom (OC) profile from OCD patients without a diagnosis of ADHD.

The characteristics of the comorbidity between social anxiety and separation anxiety disorders in adult patients.

Objective: In the present study, we compared social anxiety disorder (SAD) patients with (n = 31) and without childhood and adulthood separation anxiety disorder (SeAD) (n = 50) with respect to suicidal behavior, avoidant personality disorder (AvPD), other anxiety disorders (ADs), and major depression as well as some sociodemographic variables. Methods: In assessment of patients, we used Structured Clinical Interview for Separation Anxiety Symptoms, childhood and adulthood Separation Anxiety Symptom Inventories, Liebowitz Social Anxiety Scale, The SCID-II Avoidant Personality Disorder Module, Beck Depression Inventory, and Beck Scale for Suicidal Ideation. Results: SAD patients with SeAD had higher comorbidity rates of AvPD, other lifetime ADs and panic disorder, and current major depression than those without SeAD. The current scores of SAD, depression, and suicide ideation and the mean number of AvPD symptoms were significantly higher in comorbid group compared to pure SAD subjects. The SAD and SeAD scores had significant associations with current depression, suicide ideations, and AvPD. The mean number of AvPD criteria and the current severity of depression were significantly associated with the comorbidity between SAD and SeAD. Conclusion: Our findings might indicate that the comorbidity of SeAD with SAD may increase the risk of the severity of AvPD and current depression.

The association of temperament with nausea and vomiting during early pregnancy.

ABSRACT We aimed to investigate the relationship between affective temperaments and the severity of nausea and vomiting symptoms in early pregnancy (NVP). The pregnant women who did (n = 187) or did not report (n = 71) any nausea and vomiting at three consecutive assessments with the Pregnancy-Unique Quantification of Emesis Scoring Index (PUQE) (n = 71) were examined. Affective temperamental traits were assessed by Temperament Evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire (TEMPS-A). The anxious (p < .0001), depressive (p = .003), cyclothymic (p = .03) and irritable (p = .021) temperament traits in NVP patients were significantly higher than in controls. There were significant correlations between the PUQE scores and depressive (p = .002), cyclothymic (p = .001), irritable (p = .001) and anxious (p = .001) traits. Anxious temparement (p = .004) and being a housewife (p = .012) were significantly associated with NVP. Our results suggest that women with a predominantly anxious temperament are more vulnerable to developing somatic complaints such as nausea and vomiting during pregnancy. IMPACT STATEMENT What is already known on this subject? Although some studies have examined the link between NVP and some psychiatric disorders, to our knowledge the relationship between NVP and affective temperament has not been well investigated. What do the results of this study add? Predominantly anxious temperament make the individuals vulnerable to develop some somatic complaints such as nausea and vomiting during pregnancy. What are the implications of these findings for clinical practice and/or further research? The association of temperament and NVP might be linked to a psychosomatic process in pregnancy. Future research are required to examine the associations of temperament with NVP by including several other biological, social and psychological variables.

The importance of avoidant personality in social anxiety disorder with and without attention-deficit/hyperactivity disorder.

In the present study, our primary aim was to compare the generalized social anxiety (GSAD) patients with and without attention-deficit/hyperactivity disorder (ADHD) in terms of avoidant personality disorder (AVPD), and some clinical variables. We also investigated the relationship of AVPD and depression with ADHD and GSAD. We hypothesized that ADHD may be associated with AVPD in patients with GSAD. Seventy-six patients with GSAD were evaluated for depression, AVPD, and childhood and adulthood diagnoses of ADHD. The GSAD patients with (n = 34) and without adulthood ADHD (n = 30) were compared with respect to some sociodemographic and clinical variables. GSAD patients with adulthood ADHD had significantly higher comorbid diagnosis of AVPD, more avoidant personality and depression symptoms than those without ADHD. Pearson's correlation coefficient in total sample (n = 76) showed that the mean number of AVPD criteria was significantly associated with the severity of Beck Depression Inventory, Wender Utah Rating Scale (WURS), and inattention symptoms of ADHD. There were no correlations between the total and subscale scores of Liebowitz Social Anxiety Scale and the mean number of AVPD criteria. The scores of WURS significantly predicted the mean number of AVPD criteria (ß = 0.305, p= 0.007). The severity of current depression (ß = 0.143, p = 0.30) and inattention symptoms of adulthood ADHD (ß = 0.112, p = 0.46) were not associated with the severity of AVPD symptoms. These results might demonstrate that comorbid AVPD in adult SAD patients was related to a childhood ADHD independent from depression, and inattention symptoms of ADHD in adulthood.

Temperament in Adulthood Attention Deficit-Hyperactivity Disorder without Bipolar Disorder.

OBJECTIVE: We examined whether some temperamental traits would be associated with persistence of attention deficit-hyperacitivty disorder (ADHD) in adulthood independent from bipolar disorder (BD). METHODS: Eighty-one ADHD patients without a comorbid diagnosis of BD were divided into two groups, those with childhood ADHD (n=46), and those with Adulthood ADHD (n=35). The severity of childhood and adulthood ADHD were assessed by using the Wender Utah Rating Scale (WURS-25) and Turgay's Adult ADD/ADHD Diagnosis and Evaluation Scale (DES). Subjects' temperamental characteristics were examined using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-auto questionnaire (TEMPS-A). RESULTS: The mean scores of WURS-25 were higher in adult ADHD group than in childhood ADHD group (p<0.001). Adult ADHD group had significantly higher scores on cyclothymic (p=0.002), irritable (p<0.0001), and anxious (p=0.042) subscales of TEMPS-A. The scores of WURS-25 in adulthood ADHD group were positively correlated with cyclothymia scores (r=0.366, p=0.033). Total scores of Turgay's Adult ADD/ADHD DES were positively correlated with cyclothymic (r=0.354, p=0.040), hyperthymic (r=0.380, p=0.026), and irritable (r=0.380, p=0.026) subscale scores. Cychlothymic and irritable temperaments were significantly associated with the severity of adulthood symptoms of ADHD. CONCLUSION: We might suggest that cyclothymic and irritable temperaments would predict the diagnosis of adulthood ADHD independent from BD.