Physical comorbidities of older age bipolar disorder (OABD) patients: A global replication analysis of prevalence and sex differences.

OBJECTIVES: To compare the prevalence of physical morbidities between older aged patients with bipolar disorder (OABD) and non-psychiatric comparisons (NC), and to analyze sex differences in prevalence. METHODS: OABD was defined as bipolar disorder among adults aged ≥50 years. Outcomes analyzed were the prevalence of diseases affecting the cardiovascular, respiratory, gastrointestinal, genitourinary, renal, musculoskeletal, and endocrine systems. The analysis used cross-sectional data of OABD participants (n = 878; mean age 60.9 ± 8.0 years, n = 496 (56%) women) from the collaborative Global Aging & Geriatric Experiments in Bipolar Disorder (GAGE-BD) dataset and NC participants recruited at the same sites (n = 355; mean age 64.4 ± 9.7 years, n = 215 (61%) women). RESULTS: After controlling for sex, age, education, and smoking history, the OABD group had more cardiovascular (odds ratio [95% confidence interval]: 2.12 [1.38-3.30]), renal (5.97 [1.31-43.16]), musculoskeletal (2.09 [1.30-3.43]) and endocrine (1.90 [1.20-3.05]) diseases than NC. Women with OABD had more gastrointestinal (1.56 [0.99-2.49]), genitourinary (1.72 [1.02-2.92]), musculoskeletal (2.64 [1.66-4.37]) and endocrine (1.71 [1.08-2.73]) comorbidities than men with OABD, when age, education, smoking history, and study site were controlled. CONCLUSIONS: This replication GAGE-BD study confirms previous findings indicating that OABD present more physical morbidities than matched comparison participants, and that this health burden is significantly greater among women.

Neurotrophic factor levels and executive functions in children of parents with bipolar disorder: A case controlled study.

BACKGROUND: In the current study, it was aimed to evaluate neurotrophic factor levels and their relationship with executive functions in high-risk children and adolescents (high-risk group) whose parents were diagnosed with bipolar disorder (BD) but not affected by any psychiatric disease,and in order to determine possible vulnerability factors related to the disease. METHODS: The study sample consisted of 32 high-risk group and 34 healthy controls. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-Turkish Adaptation (KSADS-PL-T), Stroop Test, Serial Digit Learning Test (SDLT) and Cancellation Test to evaluate executive functions were administered to all participants by the clinician.Serum levels of neurotrophic factors were measured using commercial enzyme linked immunosorbent assay kits. RESULTS: Serum BDNF, NT-3, NT-4 levels and SDLT scores were significantly lower in the high-risk group for BD compared to the healthy control group. A moderate negative correlation was found between BDNF levels and the Cancellation Test scores in the high-risk group. In addition to these results, the odds ratios of age, NT-4, SDLT scores for being in the risky group in terms of BD diagnosis were 1.26, 0.99 and 0.86 respectively. LIMITATIONS: This was a cross-sectional study. Causality between study results is therefore difficult to establish. The relatively small sample size of the study is another limitation. CONCLUSION: The results of the present study suggest that BDNF, NT-3, NT-4 may play a role in the physiopathology of BD and may be associated with impaired executive function areas such as attention and response inhibition in the high-risk group.

Bipolar symptoms, somatic burden and functioning in older-age bipolar disorder: A replication study from the global aging & geriatric experiments in bipolar disorder database (GAGE-BD) project.

OBJECTIVES: The Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) project pools archival datasets on older age bipolar disorder (OABD). An initial Wave 1 (W1; n = 1369) analysis found both manic and depressive symptoms reduced among older patients. To replicate this finding, we gathered an independent Wave 2 (W2; n = 1232, mean ± standard deviation age 47.2 ± 13.5, 65% women, 49% aged over 50) dataset. DESIGN/METHODS: Using mixed models with random effects for cohort, we examined associations between BD symptoms, somatic burden and age and the contribution of these to functioning in W2 and the combined W1 + W2 sample (n = 2601). RESULTS: Compared to W1, the W2 sample was younger (p < 0.001), less educated (p < 0.001), more symptomatic (p < 0.001), lower functioning (p < 0.001) and had fewer somatic conditions (p < 0.001). In the full W2, older individuals had reduced manic symptom severity, but age was not associated with depression severity. Age was not associated with functioning in W2. More severe BD symptoms (mania p ≤ 0.001, depression p ≤ 0.001) were associated with worse functioning. Older age was significantly associated with higher somatic burden in the W2 and the W1 + W2 samples, but this burden was not associated with poorer functioning. CONCLUSIONS: In a large, independent sample, older age was associated with less severe mania and more somatic burden (consistent with previous findings), but there was no association of depression with age (different from previous findings). Similar to previous findings, worse BD symptom severity was associated with worse functioning, emphasizing the need for symptom relief in OABD to promote better functioning.

The effect of mobbing on the development of depression in anesthesia workers: A prospective, multicenter, observational study.

BACKGROUND: Mobbing in the workplace is a critical problem affecting healthcare workers' psychological health and performance. However, there is a lack of data on the relationship between mobbing and depression and a lack of regulations to create a decent working environment. OBJECTIVE: We aimed to determine the frequency of exposure to mobbing and the depression levels that may be related to mobbing among the employees of the Anesthesiology and Reanimation Clinic. METHODS: In this multi-center cross-sectional study, employees were evaluated with Leymann's Inventory of Psychological Terror scale and the Beck Depression Inventory. RESULTS: Of the participants, 86.2% stated that they were exposed to mobbing. The presence of mobbing was also associated with the presence of psychological and depressive symptoms. CONCLUSION: The frequency of mobbing was relatively high among Anesthesiology and Reanimation clinic employees. Mobbing exposure was found to be associated with a high level of depression. Institutional and legal precautions should be taken, and awareness of mobbing should be increased to eliminate mobbing and its consequences on healthcare workers.

Exploratory study of ultraviolet B (UVB) radiation and age of onset of bipolar disorder.

BACKGROUND: Sunlight contains ultraviolet B (UVB) radiation that triggers the production of vitamin D by skin. Vitamin D has widespread effects on brain function in both developing and adult brains. However, many people live at latitudes (about > 40 N or S) that do not receive enough UVB in winter to produce vitamin D. This exploratory study investigated the association between the age of onset of bipolar I disorder and the threshold for UVB sufficient for vitamin D production in a large global sample. METHODS: Data for 6972 patients with bipolar I disorder were obtained at 75 collection sites in 41 countries in both hemispheres. The best model to assess the relation between the threshold for UVB sufficient for vitamin D production and age of onset included 1 or more months below the threshold, family history of mood disorders, and birth cohort. All coefficients estimated at P ≤ 0.001. RESULTS: The 6972 patients had an onset in 582 locations in 70 countries, with a mean age of onset of 25.6 years. Of the onset locations, 34.0% had at least 1 month below the threshold for UVB sufficient for vitamin D production. The age of onset at locations with 1 or more months of less than or equal to the threshold for UVB was 1.66 years younger. CONCLUSION: UVB and vitamin D may have an important influence on the development of bipolar disorder. Study limitations included a lack of data on patient vitamin D levels, lifestyles, or supplement use. More study of the impacts of UVB and vitamin D in bipolar disorder is needed to evaluate this supposition.

Evaluation of the Role of Affective Temperamental Features, Automatic Thoughts, and Symptom Interpretation on Disease Activity in Patients with Axial Spondyloarthritis.

Objective: Axial spondyloarthritis is a systemic and chronic inflammatory disease. Psychological liability to depression and anxiety influences the disease process, prognosis, and treatment outcomes of other medical conditions. Early detection and treatment of these psychiatric conditions would also help in improving the physical functioning of patients with axial spondyloarthritis by reducing the patient's anxiety and depression symptoms. We evaluated the affective temperamental features, automatic thoughts, symptom interpretation, and their relationship with disease activity in patients with axial spondyloarthritis. Methods: A total of 152 patients diagnosed with axial spondyloarthritis are recruited. Axial spondyloarthritis disease activity was calculated by Bath Ankylosing Spondylitis Disease Activity Index. Depression and anxiety levels were screened with Hospital Anxiety and Depression Scale while affective temperament was evaluated with Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-autoquestionnaire version and automatic thoughts were screened with Symptom Interpretation Questionnaire, and Automatic thoughts questionnaire. Results: It was observed that 48% (n = 73) were female. The mean age was 43.5 (10.5) years, Bath Ankylosing Spondylitis Disease Activity Index score was 3.97 (1.14). According to the Bath Ankylosing Spondylitis Disease Activity Index scale, 53.30% (n = 81) of the patients were in high disease activity. We found that HAD-depression, HAD-anxiety, Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-autoquestionnaire version, Symptom Interpretation Questionnaire, and Automatic Thoughts Questionnaire scores were significantly higher in the high disease activity group. Conclusion: Patients' temperament characteristics and mood disorders may affect composite disease activity scores such as Bath Ankylosing Spondylitis Disease Activity Index. In patients with high disease activity scores despite receiving appropriate treatment, mood disorders may need to be evaluated. There is a need to develop disease activity scores unaffected by mood disorders.

Essential data dimensions for prospective international data collection in older age bipolar disorder (OABD): Recommendations from the GAGE-BD group.

BACKGROUND: By 2030, over 50% of individuals living with bipolar disorder (BD) are expected to be aged ≥50 years. However, older age bipolar disorder (OABD) remains understudied. There are limited large-scale prospectively collected data organized in key dimensions capable of addressing several fundamental questions about BD affecting this subgroup of patients. METHODS: We developed initial recommendations for the essential dimensions for OABD data collection, based on (1) a systematic review of measures used in OABD studies, (2) a Delphi consensus of international OABD experts, (3) experience with harmonizing OABD data in the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD, n ≥ 4500 participants), and (4) critical feedback from 34 global experts in geriatric mental health. RESULTS: We identified 15 key dimensions and variables within each that are relevant for the investigation of OABD: (1) demographics, (2) core symptoms of depression and (3) mania, (4) cognition screening and subjective cognitive function, (5) elements for BD diagnosis, (6) descriptors of course of illness, (7) treatment, (8) suicidality, (9) current medication, (10) psychiatric comorbidity, (11) psychotic symptoms, (12) general medical comorbidities, (13) functioning, (14) family history, and (15) other. We also recommend particular instruments for capturing some of the dimensions and variables. CONCLUSION: The essential data dimensions we present should be of use to guide future international data collection in OABD and clinical practice. In the longer term, we aim to establish a prospective consortium using this core set of dimensions and associated variables to answer research questions relevant to OABD.

Decreased miR-15b-5p/miR-155-5p levels and increased miR-134-5p/miR-652-3p levels among BD patients under lithium treatment.

BACKGROUND: There is an increasing interest about the role of miRNAs in the pathogenesis of bipolar disorder (BD). In this study, we aimed to examine the role of miRNAs as potential diagnostic and clinical biomarkers in BD. METHODS: Fifteen miRNAs in plasmas obtained from BD patients (n = 66) and from the healthy control group (n = 66) were analyzed by a qPCR test. Clinical variables including lithium treatment response were assessed with various test batteries. The correlation of the miRNA levels with the clinical variables and scale scores was examined. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed using the DIANA-miRPath v.3.0 software to identify the possible target genes. RESULTS: The miR-132, miR-134, miR-152, miR-607, miR-633, and miR-652 levels were significantly increased, whereas the miR-15b and miR-155 levels were found to be significantly decreased in the patient group compared to the controls. The miR-15b-5p and miR-155-5p levels and increases in the miR-134-5p and miR-652-3p levels were calculated to have 83.3 % sensitivity and 78.8 % specificity in determining the risk of BD. miR-155-5p was associated with the disease burden and severity. Fatty acid biosynthesis and metabolism, viral carcinogenesis, the EBV infection, and extracellular matrix and adhesion pathways were highlighted as target pathways. CONCLUSION: We can conclude that miRNAs may play a role in the pathophysiology of BD through various biological pathways and that miRNAs may be used as a screening test to distinguish bipolar patients from healthy controls. Our findings will provide a basis for long-term follow-up studies with larger samples.

Association between polarity of first episode and solar insolation in bipolar I disorder.

OBJECTIVE: Circadian rhythm disruption is commonly observed in bipolar disorder (BD). Daylight is the most powerful signal to entrain the human circadian clock system. This exploratory study investigated if solar insolation at the onset location was associated with the polarity of the first episode of BD I. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area of the Earth. METHODS: Data from 7488 patients with BD I were collected at 75 sites in 42 countries. The first episode occurred at 591 onset locations in 67 countries at a wide range of latitudes in both hemispheres. Solar insolation values were obtained for every onset location, and the ratio of the minimum mean monthly insolation to the maximum mean monthly insolation was calculated. This ratio is largest near the equator (with little change in solar insolation over the year), and smallest near the poles (where winter insolation is very small compared to summer insolation). This ratio also applies to tropical locations which may have a cloudy wet and clear dry season, rather than winter and summer. RESULTS: The larger the change in solar insolation throughout the year (smaller the ratio between the minimum monthly and maximum monthly values), the greater the likelihood the first episode polarity was depression. Other associated variables were being female and increasing percentage of gross domestic product spent on country health expenditures. (All coefficients: P ≤ 0.001). CONCLUSION: Increased awareness and research into circadian dysfunction throughout the course of BD is warranted.

Investigation of the correlation between mood disorder symptoms and disease activity and functional status in rheumatoid arthritis patients

Background/aim: To investigate the correlation between depressive-anxiety symptoms, mixed features, disease activity, and functional status in patients with rheumatoid arthritis (RA) in the light of the shared underlying etiology in both disorders. Materials and methods: The study included 556 patients with RA. RA disease activity was measured using the Disease Activity Score 28-joint count C reactive protein (DAS28-CRP), and the patients were evaluated by a Health Assessment Questionnaire (HAQ). The Hospital Anxiety and Depression Scale (HADS), Mood Disorder Questionnaire (MDQ), and Modified Hypomania Checklist (mHCL) were used to evaluate the mixed depression and bipolarity status of the patients. Results: Of the patients, 430 (77.3%) were female and 126 (22.7%) were male. The median age was 57 years, the median HAQ score was 0.55 points, and the median DAS28-CRP score was 4.1 points. The evaluation of the patients by DAS28-CRP revealed that 58.5% of the patients had moderate and severe disease activity, while only 23.4% of them were in remission. The group using the combination of synthetic disease-modifying anti-rheumatic drugs (sDMARD) and steroid therapy had significantly higher HAD-depression, HAD-anxiety, mHCL, DAS28-CRP, HAQ, and MDQ scores than the group using sDMARD alone. The grouping of the patients based on the DAS28-CRP cut-off scores showed that the patients with moderate and severe disease activity had significantly higher HADS, mHCL, MDQ scores than those in remission and those with mild disease activity (p < 0.001). Conclusion: Disease severity and functional status in RA can be affected by comorbid anxiety-depressive and mixed symptoms. Therefore, clinicians should consider screening the depressive-anxiety and mixed mood symptoms of RA patients. Moreover, patients who use steroid therapy are more susceptible to mood symptoms (anxiety, depression, bipolarity), which should also be considered during the follow-up of patients.

Treatment of Comorbid Psychiatric Disorders with Bipolar Disorder.

Life time psychiatric comorbidities of bipolar disorders are highly prevalent. Anxiety disorders, alcohol-substance use disorders, obsessive-compulsive disorder and attention deficit and hyperactivity disorder are the most common comorbid psychiatric conditions in bipolar disorders. Psychiatric comorbidity of bipolar disorders is strongly associated with poor treatment response, higher recurrence of mood episodes, suicide attempts, rapid-cycling, worse general functioning and quality of life. Therefore, considering the huge impact of comorbidity on the bipolar disorder illness course, treatment is usually challenging. The primary aim of the treatment in psychiatric comorbidity of bipolar disorder should be mood stabilization and prevention of mood episodes. Then, first line treatment options recommended for the specific psychiatric disorders might be preferred for the treatment of bipolar disorder comorbidity. With this rationale, quetiapine can be listed as a first line treatment for anxiety disorders comorbidity in bipolar disorders while serotonergic antidepressants and olanzapine are recommended as second line options. For the treatment of alcohol-substance use disorders comorbidity, first line mood stabilizers such as valproate and lithium and new generation antipsychotic quetiapine seem to be the leading options. Serotonergic antidepressants for obsessive-compulsive disorder and stimulants for the attention-deficit hyperactivity disorders are the key treatment choices. However, both treatment agents might cause to manic switch and mood destabilization. Thus, clinicians should be aware of these complications when prescribing in bipolar disorders comorbidity.

Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder.

BACKGROUND: Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. METHODS: Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun's electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). RESULTS: This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01. CONCLUSION: A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.

[Relationship between Childhood Adversities, Emotion Dysregulation and Cognitive Processes in Bipolar Disorder and Recurrent Depressive Disorder]. / Bipolar Bozukluk ve Yineleyici Depresif Bozuklukta Çocukluk Çagi Travmalari ve Duygu Düzenleme Güçlükleri ile Bilissel Süreçler Arasindaki Iliski.

OBJECTIVE: Cognitive development is susceptible to environmental distress, leading to cognitive distortions. Cognitive distortions may affect clinical course of psychiatric disorders. We aimed to assess whether childhood maltreatment and emotion dysregulation impair automatic thoughts (ATs) and meta-cognitions (MCs) in Bipolar Disorder (BD) and Major Depressive Disorder - Recurrent (MDB-RE) in this study. METHOD: 85 patients with BD, 81 MDD-RE in remission and 86 healthy participants were enrolled. Automatic Thoughts Scale (ATS), Metacognition Questionnaire (MCQ-30), Childhood Trauma Questionnaire (CTQ- 28), Difficulties in Emotion Regulation Strategies Scale (DERS) were the measures used. RESULTS: ATs were determined by CTQ physical abuse (ß=0.34, p<0.01), DERS goals (ß=-0.37, p<0.01), impulse (ß=0.53, p<0.01) and non-accept (ß=0.23, p<0.05) subscales in BD (F=21.08, p<0.01) and CTQ emotional neglect (ß=0.22, p<0.05), DERS strategies (ß=0.39, p<0.05) in MDD-RE (F=9.97, p<0.05). MCs were predicted by sexual abuse (ß=0.46, p<0.01) in BD (F=4.88, p<0.01), and emotional abuse (B=-0.30, p<0.05) in MDD-RE (F= 7.02, p<0.01). CONCLUSION: These results suggest that emotion dysregulation and childhood adversities are associated with cognitive processes such as MCs and ATs in MDD-RE and BD. Cognitive processes can cause various clinical manifestations and emotion dysregulation and childhood traumas should be considered as psychopathological components that can affect the course of mood disorders via various components. Further follow-up studies and larger samples are needed to better understand the effects of these components.

Evaluation of the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients.

OBJECTIVE: We aimed to evaluate the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients by comparing them with a matched control group in terms of age, gender, and education level. METHOD: The patient group (n = 84) and the healthy controls (HCs, n = 92) filled in the questionnaire including the socio-demographic form, Hospital Anxiety Depression Scale, Multidimensional Perceived Social Support Scale, and Brief Coping Orientation to Problems Experienced through the online survey link. RESULTS: The COVID-19 patients had higher perceived social support and coping strategies scores than the HCs. However, anxiety and depression scores did not differ significantly between the two groups. In logistic regression analysis performed in COVID-19 patients, the presence of chest CT finding (OR = 4.31; 95% CI = 1.04-17.95) was a risk factor for anxiety and the use of adaptive coping strategies (OR = 0.86; 95% CI = 0.73-0.99) had a negative association with anxiety. In addition, the use of adaptive coping strategies (OR = 0.89; 95% CI = 0.79-0.98) and high perceived social support (OR = 0.97; 95% CI = 0.93- 0,99) had a negative association with depression symptoms. CONCLUSIONS: Longitudinal studies involving the return to normality phase of the COVID-19 pandemic are needed to investigate the effects of factors such as coping strategies and perceived social support that could increase the psychological adjustment and resilience of individuals on anxiety and depression.

Minor Physical Anomalies in Bipolar Disorder.

OBJECTIVE: High-arched palate is more frequent in schizophrenia and bipolar disorder (BD). Upto 40% of patients develop schizophrenia in 22q11.2 Deletion Syndrome manifested with cleft lip and palate, which originate from the first pharyngeal arch in embryo. The auricle also originates from the dorsal ends of the first and second pharyngeal arches; hence, we aimed to determine the associations between auricular anomalies and BD. METHODS: We screened for 36 minor physical anomalies of the auricle in 146 patients with BD. RESULTS: 7 out of the of 36 assessed anomalies highly differed between healthy subjects and BD patients. A regression model including the differing anomalies predicted healthy subjects and BD-patients by 78.8% and 68.5%, respectively. CONCLUSIONS: Assessing minor anomalies in psychiatric disorders may help to discover novel pathogenesis pathways and even new endophenotypes.

Evaluation of Bruxism and Its Relation with Treatment Regimens among Remitted Bipolar Patients.

BACKGROUND: The aim of this study was to evaluate the association of bruxism and treatment regimens among remitted bipolar patients. SUBJECTS AND METHODS: The total case group included 222 adult patients with BD. Diagnosis of bruxism was based upon the on 'self-reports' plus the outcome from the clinical examinations. RESULTS: The sample consisted of 112 (50.5%) bipolar patients with bruxism and 110 (49.5%) without bruxism. Remitted bipolar patients who were on mood stabilizer plus atypical antipsychotic treatment had lower bruxism rates than patients on other than bipolar patients on mood stabilizer treatment regimen (p=0.04) and bipolar patients on polypharmacy (p=0.01). CONCLUSION: Our findings have supported the existence of psychotropic drug-bruxism relation and atypical antipsychotic related therapeutic effect among bipolar patients.

Comparison of the Emotion Regulation and Temperament Characteristics Between Depressive Patients With and Without Mixed Features.

INTRODUCTION: "Depressive disorder with mixed features" has been included in the official classification in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Hypothesizing that difficulties in emotion regulation and affective temperament scores are higher in mixed depression comparing to pure depression, we aimed to evaluate the relationship between these phenomena and mixed symptoms. METHODS: Depressive patients diagnosed by a psychiatrist according to the DSM-5 and had not received any psychiatric treatment for the last 3 months, were included in the study. The Hamilton Rating Scale (HDRS), modified Hypomania Checklist (mHCL), Difficulties in Emotion Regulation Scale (DERS), and the TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionaire) were applied to all participants. RESULTS: Of the 63 participants, 40 (63.5%) were women. The mean age was 37.8±12.4 years while mean duration of education was 10.8±4.3 years. The proportion of mixed-depression assessed by the mHCL was 23.8% (n=15). No significant difference was found between the groups concerning gender, age, family history, age at onset of illness, the total number of episodes and temperament scores. Depressive patients with mixed features had significantly higher DERS nonacceptance subscale scores. Multiple regression analysis demonstrated that the cyclothymic temperament scale scores significantly affected the total mHCL scores. CONCLUSION: In mixed depression group, higher scores in nonacceptance subscale seems to reflect a tendency to fluctuations in the emotional reactions of a person to the stress. Association between mixed depression, DERS nonacceptance subscale and cyclothymic temperament support the spectrum view that mixed depression is placed between pure depression and bipolarity.

[Ten-Year Risk of Cardiovascular Disease in Patients with Bipolar Disorder]. / Bipolar Bozukluk Tanili Hastalarda 10 Yillik Kardiyovasküler Hastalik Riski.

OBJECTIVE: Patients with bipolar disorder (BPD) are less likely to seek treatment for cardiovascular diseases (CVD) despite the two fold increased CVD-related death rate in BPD. The aim of this study was to evaluate the relationship between clinical variables, exercise characteristics and 10-year risk of CVD in patients with bipolar I disorder (BPD-I). METHOD: The study was carried out with 106 euthymic BPD-I patients who were followed up at the Mood Disorders Centers of Bakirköy Hospital for Mental and Neurological Diseases and Selcuk University Faculty of Medicine. The physical activity status of the patients were evaluated with the Godin Leisure-Time Exercise Questionnaire (GLTEQ) and the prospective 10-year risk of CVD was assessed by the QRISK®2-2017 - CVD risk algorithm. RESULTS: Mean age of the patients were 39.5±8.6 years. The mean QRISK2 score of the patients was 3.64±0.46 %, which did not differ with respect to the gender. Patients' mean healthy heart age (QAGE) was 8.49±6.46 years ahead of their current age. There was a weak negative correlation between GLTEQ total score and QRISK2 score (r= 0.168), but this was not statistically significant. However, statistically significant positive correlations were determined between the categorical QRISK2 score and the disease age of onset (RR:1.18; 95%CI:1.09-1.28), treatment duration (RR:1.16; 95%CI:1.05-1.29) and the inclusion of atypical antipsychotic agents in the treatment received (RR:5.99; 95%CI:1.12-31.90). CONCLUSION: A strong positive correlation was determined in this study between the QRISK2 score and the use of atypical antipsychotic drugs in the treatment of the BPD-I patients. It is important to identify patients diagnosed with bipolar disorder with a high risk of developing CVD to review the psychiatric treatment and to encourage the patients for preventive approaches.

Suicide attempts and related factors in schizophrenia patients.

OBJECTIVES: To investigate the relationship between suicide attempts and demographic-clinical variables and to assess the methods used in suicide attempts by comparing schizophrenia patients with and without suicide attempts. METHODS: A retrospective study with a total of 223 schizophrenia patients aged 18-65 years that were admitted to the Department of Psychiatry, Selcuk University and the Beyhekim Psychiatric Clinic Konya Training and Research Hospital, Konya, Turkey, between January 2014 and January 2018. The data collection forms created by researchers were completed using hospital medical records. Results: It was determined that 40.8% of schizophrenia patients attempted suicide at least once and that 39.6% of schizophrenia patients who attempted suicide had recurrent suicide attempts. Those with suicide attempts had a significantly longer mean duration of untreated psychosis and a higher total number of hospitalizations compared to those without suicide attempts. In addition, the use of depot antipsychotic drugs was significantly lower in those with suicide attempts. There was a statistically significant difference in the presence of traumatic life events between those with and without suicide attempts. Conclusion: Suicidal behavior is an important problem in schizophrenia. Identifying risk factors and high-risk individuals will guide us in the development of preventive interventions.

Affective Temperament and Seasonality in Bipolar Disorder.

BACKGROUND: Both affective temperaments and seasonality impact on the illness course in bipolar disorder (BD). This exploratory study aims to investigate the link between seasonality and affective temperament in BD. SUBJECTS AND METHODS: Sixty-six euthymic patients with BD-I were recruited. The Seasonal Pattern Assessment Questionnaire (SPAQ) and Temperament Evaluation Memphis, Pisa, Paris and San Diego-Autoquestionnaire version scale (TEMPS-A) were applied. RESULTS: The seasonal BD rate was 39.4% (n=26). Depressive and anxious temperament scores were higher in patients with seasonality. The SPAQ total scores were also associated with depressive, cyclothymic, and anxious affective temperament scores. CONCLUSION: Our findings warrant further investigation to understanding the complex interaction between seasonality, mood regulation, and temperament collectively moderating illness course in BD. This study implies that affective temperament may have some value in discerning the link between seasonality and illness course in BD.