Social Cognition and Functioning in Patients With Social Anxiety Disorder and/or Attention-Deficit/Hyperactivity Disorder.

ABSTRACT: In recent years, social cognition and one of its dimensions, the theory of mind, have been more commonly investigated in patients with social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD). In this study, SAD, ADHD, comorbid SAD-ADHD, and healthy control (HC) groups, each consisting of 30 participants, were included and compared in terms of social cognition and functionality. Mean global functioning assessment scores were found to be significantly higher in the HC group compared with the other three groups and in the ADHD group compared with the SAD and SAD-ADHD groups. Mean Dokuz Eylül Theory of Mind Index total scores were found to be significantly higher in the HC group compared with the other three groups and in the SAD and SAD-ADHD groups compared with the ADHD group. These findings suggest that SAD patients with or without ADHD show better social cognition but worse functioning compared with pure ADHD patients.

The effects of the COVID-19 pandemic on patients with obsessive-compulsive disorder.

OBJECTIVE: Little is known about the impact of the COVID-19 pandemic on obsessive-compulsive disorder (OCD). The main aim of this study was to investigate how the pandemic has affected OCD patients and the relationship between the clinical features and the fear and obsession with COVID-19. METHODS: A total of 30 consecutive patients with OCD and 30 age-and sex-matched healthy controls were included in this cross-sectional study. Based on retrospective information provided by the patients, we evaluated changes in the severity of their OCD during the pandemic compared to the pre-pandemic period. We compared patients with OCD and healthy subjects using scores obtained from various scales. RESULTS: We found that symptom severity worsened in 60% of OCD patients during the pandemic compared to the pre-pandemic period, remained unchanged in 30%, and improved in 10%. The levels of obsession with COVID-19 were found to be higher in OCD patients than in healthy control subjects. The levels of fear of and obsession with COVID-19 both correlated with the anxiety levels of patients with OCD and healthy controls. CONCLUSIONS: Our results suggest that the levels of COVID-19 related fear and obsession are not linked to the severity of OCD, but to anxiety levels. Key pointsObsessive-compulsive symptom severity worsened in 60% of OCD patients in the pandemic.COVID-19 obsession levels were higher in OCD patients than healthy controls.COVID-19 fear levels did not differ between the OCD and healthy control groups.COVID-19 obsession levels were correlated with anxiety severity in OCD and healthy control groups.

Psychological Reactions of Turkish Healthcare Workers During Covid-19 Outbreak: The Impact of Stigmatization.

Introduction: The Coronavirus Disease 2019 (COVID-19) outbreak has resulted in huge psychological distress, especially for people working under risky conditions, such as healthcare workers. We aimed to investigate the psychological challenges of Turkish healthcare workers during the outbreak and discuss the factors that increase their burden, including stigmatization. Methods: A cross-sectional online survey composed of sociodemographic data, questions about perceived stigma, and concerns about working conditions was completed. Depression Anxiety and Stress Scale-21 (DASS-21) was also used. Results: 634 participants completed the survey and the prevalence of moderate to severe depression, anxiety, and stress-related symptoms were 36%, 35%, and 22%, respectively. Being female, working with close contact with patients with COVID-19 and having a psychiatric disorder history were risk factors for psychological distress. The healthcare workers with significantly higher depression, anxiety, and stress scores described having less amount of personal protective equipment, lower support from their supervisors, and more unsafe working conditions. Additionally, 7% of the participants stated that they perceived stigmatization by their families and close friends, 14% perceived stigmatization by their neighbours, relatives, and less intimate friends; and 7% perceived stigmatization by unfamiliar people. Healthcare workers who perceived other people as more dismissive had significantly higher depression and anxiety scores. Conclusion: Our study shows that healthcare workers are at risk of developing psychological disturbances during infectious outbreaks. To minimize the psychological impact, additional risk factors such as having a previous psychiatric disorder, working under unsafe conditions, and stigmatization should be taken into account and a more supportive and safer environment should be provided.

Comparing retinal changes measured by optical coherence tomography in patients with schizophrenia and their siblings with healthy controls: Are retinal findings potential endophenotype candidates?

AIM: The aim of our study is to examine whether differences in retinal structure may reflect endophenotypes for schizophrenia by comparing thicknesses of retinal layers between patients with schizophrenia, their unaffected siblings, and healthy control groups and investigating the relationship between OCT findings and disease parameters. MATERIAL AND METHODS: 46 patients with schizophrenia, their 46 healthy siblings, and 46 age and gender-matched healthy controls were enrolled in the study and underwent spectral domain OCT (examinations to assess differences in peripapillary retinal nerve fiber layer (RNFL) thickness, ganglion cell layer (GCL)+ inner plexiform layer (IPL) thicknesses and macular volumes (MV) in both eyes). Clinical variables were also recorded in the patient group. RESULTS: There was no difference between the groups in terms of RNFL thicknesses. The GCL+IPL thicknesses of the siblings are between the patients and controls but according to post hoc comparisons the GCL+IPLs of the patients were only thinner than controls. Additionally, MVs were significantly lower in the patient group compared to the sibling group. There was no correlation between any clinical parameters and the GCL+IPLs of all groups, however there were some correlations between RNFL and clinical features especially in the patients group. CONCLUSION: GCL+IPL values do not seem to be affected by the disease parameters or the factors like body mass index or nicotine use. On the other hand, further studies are needed to determine whether GCL+IPL could be an endophenotype candidate.

Clinical profile of delusional disorder and its subtypes: a descriptive study from Turkey.

The fact that delusional disorder (DD) received minimal research attention indicates the need for descriptive studies that will better delineate the clinical and socio-demographic characteristics of DD. We conducted a chart review descriptive study in a tertiary hospital from Turkey. A total of 99 cases of DD were identified through hospital registry system. 57 were male (57.6%), and mean age at first admission was 49.34±13.49. The most common type of DD was persecutory (36.4%), followed by jealous type (28.3%), mixed type (18.2%), and somatic type (16.2%). Jealous type DD patients were more likely to be married, and mixed type DD patients were more likely to be divorced. The presence of hallucinations was significantly associated with history of hospitalization. About one-tenth of the patients had a family history of psychotic spectrum disorder. Comorbid depressive disorder was present in 42.9% of the patients, whereas only 9.2% had comorbid anxiety disorder. Depressive disorder comorbidity in DD seems to be associated with continued treatment for longer periods of time in psychiatry services. While most of our data were comparable with the literature on DD, our divergent findings like higher rates of male patients and jealous type of the disorder might be attributed to the cultural and geographical factors. This situation points out that future research with larger populations and from different regions would contribute to better understanding of clinical and socio-demographical characteristics of delusional disorder.

Is Olfactory Reference Syndrome a Diagnostic Entity Under Obsessive-Compulsive and Related Disorders?: A Case Report. / Olfaktör Referans Sendromu Obsesif Kompulsif ve Iliskili Bozukluklar Basligi Altinda Degerlendirilebilir mi? Bir Olgu Sunumu.

Olfactory reference syndrome (ORS) is a rare psychiatric condition involving embarrassment and distress due to persistent mental preoccupation with the idea of emitting body odours foul and offensive enough to disturb others. This disorder is often accompanied by shame, embarrassment, significant distress, avoidance behavior, social phobia and social isolation. The patients may worry that they spread odours originating from their mouth, sweat, genital areas or the gut. This belief may lead the patients to misinterpret the behaviours of others, they may frequently smell themselves, shower and change clothing during the day. There are differences of opinion whether ORS should be considered as a delusional disorder or appear in under the rubric of obsessive-compulsive related disorders. One of the reasons that create this uncertainty is the variation in the response to different treatments. The treatment strategies generally include the use of antipsychotics, the antidepressants, they are preferentially used in combination. In this report we aimed to discuss the case of a 33-year old male patient whose first complaints had been diagnosed 14 years prior, with a diagnosis of OCD with low insight. Shortly after improvement of the OCD symptoms he developed ORS symptoms. We aimed here to discuss the place of ORS in the diagnostic systems with reference to this case.

Social Support Promotes Mental Health During the COVID-19 Outbreak: A Cross-Sectional Study from Turkey.

BACKGROUND: Coronavirus-19 (COVID-19) has several negative effects on mental health, given its rapid transmission, hygiene and isolation measures and associated social and financial difficulties. In this study, we aimed to investigate the mental health burden of the Turkish population and vulnerable groups during the COVID-19 outbreak, especially exploring the effects of social support. SUBJECTS AND METHODS: We assessed depression, anxiety, stress symptoms and perceived social support among 894 people all over Turkey, using the Depression Anxiety Stress Scales (DASS-21) and Multidimensional Scale of Perceived Social Support (MSPSS) two months after the declaration of the first COVID-19 case in Turkey. RESULTS: According to DASS-21 subscale scores, the findings showed that the prevalence of moderate to severe depression, anxiety and stress-related symptoms was 24.8%, 21.9% and 12.6%, respectively. Female gender, being single, having a lifetime psychiatric disorder, lower education level and financial concerns were significantly associated with higher DASS-21 scores. Also, there was a negative correlation between all subgroups of perceived social support, especially from the family, and the total DASS-21 score. CONCLUSIONS: Vulnerable groups should be identified and protected to reduce adverse psychiatric outcomes of COVID-19. Besides, further strategies should be provided to maintain protective factors, such as social support, under stressful conditions.

The Features of Comorbidity of Childhood ADHD in Patients With Obsessive Compulsive Disorder.

Objective: Our aim is to investigate the impact of childhood ADHD comorbidity on the clinical features of obsessive compulsive disorder (OCD). Method: Ninety-five adult outpatients with a diagnosis of OCD were assessed by using the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version, ADHD module, and the Yale-Brown Obsessive Compulsive Scale. Patients with or without childhood ADHD were compared in terms of the sociodemographic and clinical features, psychiatric comorbidities, and rating scales. Results: The rate of episodic course of OCD (p < .001), religious and sexual obsessions (p = .009, p = .020, respectively), lifetime comorbidity of bipolar disorder (BD), social anxiety disorder (SAD; p = .001, p = .009, respectively), and tic disorder (TD) comorbidity (p < .001) were higher in the OCD + ADHD group than in the OCD without ADHD group. Conclusion: Childhood ADHD may be associated with higher rates of BD, SAD, and TD comorbidity and episodic course of OCD as well as higher frequency of certain types of obsessions.

Comorbidity in social anxiety disorder: diagnostic and therapeutic challenges.

Comorbid disorders are highly prevalent in patients with social anxiety disorder, occurring in as many as 90% of patients. The presence of comorbidity may affect the course of the disease in several ways such as comorbidity in patients with social anxiety disorder (SAD) is related to earlier treatment-seeking behavior, increased symptom severity, treatment resistance and decreased functioning. Moreover, comorbidities cause significant difficulties in nosology and diagnosis, and may cause treatment challenges. In this review, major psychiatric comorbidities that can be encountered over the course of SAD as well as comorbidity associated diagnostic and therapeutic challenges will be discussed.

Is there a prodrom period in patients with social anxiety disorder? A discussion on the hypothesis of social anxiety disorder development secondary to attention-deficit/hyperactivity disorder.

The association between social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD) is poorly established. In fact, increasing and converging evidences suggest that there is a close relationship between the two disorders. High comorbidity rate between these two disorders, follow-up studies showing high rates of later development of SAD in ADHD and treatment studies in which ADHD medications have been helpful for both conditions all indicate this relationship. Recently, we have published a hypothesis regarding the development of SAD secondary to ADHD. In this hypothesis, we recognized that patients with SAD seem to go through a prodromal period that we labeled as "pre-social anxiety." Detecting patients in this period before meeting full-blown SAD criteria provides early intervention and prevention of SAD. New, comprehensive follow-up studies which will investigate whether ADHD causes later SAD secondarily are needed. In the current review, taken into account our developmental hypothesis, we will discuss whether high comorbidity of SAD and ADHD is a chance finding (i.e., the two disorders are found in cases with no causal relationship between them) or can SAD develop secondarily due to childhood ADHD. Is there a prodrom period in patients with SAD as in cancer or psychosis patients? We are going to summarize the overlapping features of SAD and ADHD in terms of child/parents interaction and family issues, aversive childhood experiences, social skill deficits, and development of cognitive distortions.

Clinical Effects of ADHD Subtypes in Patients With Social Anxiety Disorder.

Objective: Our aim in this study is to evaluate the impacts of inattentive and combined types of childhood ADHD (ADHD-I, ADHD-C) in patients with social anxiety disorder (SAD). Methods: A total of 142 adult outpatients with a primary diagnosis of SAD were included. All patients were assessed by using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), ADHD module and a clinical and sociodemographic data form and scales were filled out. Results: Childhood ADHD comorbidity rates was found to be 88 (62%) in patients with SAD, and 63 of these patients had the diagnosis of ADHD-I. ADHD-I group had higher scores of social anxiety and avoidance and had earlier onset of SAD than the ADHD-C group. Conclusion: The inattentive subtype of ADHD may have a more specific relationship with SAD than ADHD-C.

Extended-release methylphenidate monotherapy in patients with comorbid social anxiety disorder and adult attention-deficit/hyperactivity disorder: retrospective case series.

BACKGROUND: The relationship between social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD) is a subject which has recently become a topic of interest for research. METHODS: In this study, 20 patients with comorbid SAD and adult ADHD who were treated with extended-release methylphenidate monotherapy were evaluated retrospectively. RESULTS: Clinical response for both ADHD and SAD symptoms was observed in 17 of 20 patients. Overall, one patient did not respond to treatment and two patients dropped out of treatment at the beginning due to adverse effects. CONCLUSION: Extended-release methylphenidate improved both SAD and ADHD symptoms and was generally well tolerated. Further studies are required to investigate the relationship between SAD and ADHD.

The Presence of Childhood Attention Deficit/Hyperactivity Disorder May Be Associated With Interpersonal Sensitivity in Patients With Social Anxiety Disorder.

The goal of this study was to evaluate a possible association between childhood attention deficit/hyperactivity disorder (ADHD) and interpersonal sensitivity in patients with social anxiety disorder (SAD). The study involved 125 adult outpatients with a primary diagnosis of SAD. To evaluate childhood ADHD, the ADHD module of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) was used. Clinical and sociodemographic data were collected and clinical rating scales were completed. Mean total scores on the Interpersonal Sensitivity Measure were significantly higher in the group with SAD and ADHD than in the group with SAD without ADHD. Interpersonal Sensitivity Measure total scores were positively correlated with the severity of SAD symptoms and negatively correlated with mean age of onset of SAD. The presence of childhood ADHD may be associated with greater interpersonal sensitivity in patients with SAD.

Deficits in Go and NoGo P3 potentials in patients with schizophrenia.

Cognitive control processes elicited during a cued continuous performance test were evaluated using event-related potentials in 46 patients who were within the first 5 years of diagnosis of schizophrenia, and 29 healthy controls. Patients had longer reaction times, lower hit rates, and higher false alarm rates compared with controls. Patients had an overall P3 amplitude reduction that was more prominent on NoGo compared with Go trials. This greater P3 reduction on NoGo trials was present in central and parietal regions, but was absent in the frontal region, where the P3 reduction was comparable on NoGo and Go trials. Our findings suggest that the neural activity contributing to Go and NoGo P3s are both deteriorated in schizophrenia, but those contributing to central and parietal NoGo P3s are the most severely affected ones. We conclude that the cognitive control processes engaged during execution, and particularly during inhibition of a prepared motor response were disturbed in the early course of schizophrenia. Our findings might be related to our sample being in relatively early stages of schizophrenia and/or related to the use of atypical antipsychotics by most of our patients.

Evidence for alterations of the right inferior and superior longitudinal fasciculi in patients with social anxiety disorder.

The aim of our study was to detect white matter (WM) regions being involved in the pathophysiology of SAD. We applied diffusion tensor imaging in 22 consecutive adult patients (11 women and 11 men) with SAD and 22 age and sex-matched healthy control subjects. We examined white matter (WM) alterations between the patients with social anxiety disorder (SAD) and healthy controls by a whole-brain analysis. We found that fractional anisotropy (FA) was reduced in patients with SAD compared with controls in the temporal part of right inferior longitudinal fasciculus (ILF) and the occipito-temporal part of the right superior longitudinal fasciculus (SLF). We also identified that in these regions FA was negatively correlated with the severity of anxiety. Our results suggest that the lateral temporal and occipito-temporal WM microstructure plays a role in mediating social interactions, and a pattern of WM abnormality in the right ILF and SLF may be implicated in the pathophysiology of SAD plausibly through leading to deficits in face processing mechanisms.

Serotonin transporter promoter polymorphism is associated with executive function impairments in patients with obsessive compulsive disorder.

OBJECTIVE: In the present study, we investigate the association between the 5-HTTLPR polymorphism and executive functions in a sample of patients with obsessive compulsive disorder (OCD). METHOD: A total of 98 unmedicated patients diagnosed with OCD according to DSM-IV criteria and 80 healthy controls were included in this study. The genotype frequencies of 5-HTTLPR polymorphism were compared in OCD and healthy control groups. The four subgroups of OCD and healthy control participants, determined according to having LaLa genotype (high expressing) or S- and/or Lg alleles (low expressing), were also compared using neuropsychological tests of executive functions. RESULTS: The frequency of SLa genotype of 5-HTTLPR polymorphism was found to be higher in patients with OCD compared with healthy controls. The mean scores of conceptual level responses of the Wisconsin Card Sorting Test (WCST) were significantly lower in the OCD-high-expressing subgroup compared with the low-expressing control group. The mean scores of the number of moves of the Tower of London were found to be significantly higher in the OCD-high-expressing subgroup, compared with the high-expressing subgroup of healthy controls. CONCLUSION: Our findings suggest that the high-expressing variant may be associated with lower performance on some abstraction and planning measures in OCD patients.

Attention deficit and hyperactivity in social anxiety disorder: relationship with trauma history and impulsivity.

The aim of this study is to investigate the rate of childhood traumatic experiences and assess the relationship between childhood trauma and impulsivity in the presence of attention deficit-hyperactivity disorder (ADHD) in patients with social anxiety disorder (SAD). A total of 123 patients with a primary diagnosis of SAD were enrolled. All patients were assessed by using the clinical version of Structured Clinical Interview for DSM-IV (SCID-I/CV) and Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime version (K-SADS-PL), ADHD module. A clinical and sociodemographic data form and rating scales were filled out. We found higher rates of emotional traumatic experiences and impulsivity along with more severe symptoms of depression, anxiety and social anxiety in the group of SAD patients with childhood ADHD than in SAD patients without ADHD in childhood. The presence of ADHD is associated with higher severity in several domains in patients with SAD. Patients with SAD should be assessed carefully whether they have ADHD, especially when their SAD symptoms are severe, when they have a history of traumatic experiences or problems with impulse control.

Proton Magnetic Resonance Spectroscopy in Social Anxiety Disorder.

In the present study, 24 nonmedicated patients with social anxiety disorder (SAD) were compared with 24 healthy control subjects to assess metabolite levels in the anterior cingulate, insula, caudate, and putamen using proton magnetic resonance spectroscopy. The ratio of N-acetylaspartate (NAA)/creatine (Cr) was significantly higher in patients with SAD than in healthy control subjects in the anterior cingulate and insula. NAA/Cr ratios in the insula correlated positively with the Liebowitz Social Anxiety Scale total scores in patients with SAD. Our results support the significance and biochemical involvement of the anterior cingulate and insula in the pathophysiology of SAD.

Predictors of early or late treatment seeking in patients with social anxiety disorder.

BACKGROUND: Social anxiety disorder (SAD) is common in the general population and usually begins at an early age. It is well established that patients with SAD rarely seek treatment, and their first treatment contact usually takes many years after onset. The aim of this study was to determine the predictors of early and late treatment seeking in patients with SAD. METHODS: This study enrolled 180 patients with generalized SAD. The mean and median durations between the emergence of SAD and first treatment contact were 15 and 14 years, respectively. Multiple linear regression with the backward elimination method was applied to assess the factors that affect the amount of time between occurrence of the disorder and first treatment contact. RESULTS: Older age, earlier onset of SAD, and lower level of education were associated with late treatment seeking, whereas earlier onset of comorbid major depressive episodes and lifetime history of comorbid obsessive-compulsive disorder were associated with earlier treatment seeking. CONCLUSIONS: Age of onset, comorbid psychiatric conditions, and level of education are associated with the timing of treatment seeking in patients with SAD. It is important to try to change the common perception that SAD is a personality trait rather than a psychiatric disorder.

Gray matter abnormalities in patients with social anxiety disorder: A voxel-based morphometry study.

The main objective of this study was to investigate the gray matter volume (GMV) differences between the patients with social anxiety disorder (SAD) and healthy controls, using VBM analysis. A total of 27 consecutive patients (15 women and 12 men) with SAD and 27 age and sex-matched healthy control subjects were included in this study. With magnetic resonance imaging, we examined GMV differences between SAD and healthy control groups. We found that GMV in the right middle and inferior temporal, left superior parietal, left precuneus and right fusiform areas were significantly greater in patients with SAD than in healthy controls. In addition, GMV in the right inferior and middle temporal regions were positively correlated with the social avoidance and total social anxiety scores of the participants in the SAD group. Lastly, greater GMV in the left superior parietal and precuneal regions were correlated with the higher disability in the social life of the patients with SAD. Our results suggest that the regions that showed significant GMV differences between the two groups play an important role in the pathophysiology of SAD and increased GMV in these regions might reflect a pathological process of neural abnormalities in this disorder.