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.

Reliability and Validity Study of the Turkish Version of Bipolar Spectrum Diagnostic Scale. / Bipolar Spektrumu Tani Ölçegi Türkçe Formu’nun Güvenilirlik ve Geçerlilik Çalismasi.

OBJECTIVE: The purpose of this study is to evaluate the reliability and validity of the Turkish Version of the Bipolar Spectrum Diagnostic Scale (BSDS). METHOD: The study was carried out with 130 patients diagnosed with bipolar I disorder, 15 patients diagnosed with bipolar II disorder, and 38 patients diagnosed with major depressive disorder attending the outpatient psychiatry departments of the Bakirköy Prof. Dr. Mazhar Osman Training and Research Hospital for Mental Health and Neurological Diseases. The Mood Disorder Questionnaire (MDQ) was used for convergent validity. The internal consistency coefficient, itemtotal score correlation coefficients, test-retest correlation coefficient, confirmatory factor analysis, correlation with concurrent scale, and ROC curve were statistically calculated. RESULTS: Confirmatory factor analysis indicated that the 20-item version did not show adequate goodness-of-fit. The item 4 with a relatively low regression weight was removed from the model. For the 19-item revised and corrected model, the observed goodness-of-fit indexes were RMSEA = 0.040, CFI = 0.900, GFI = 0.890, IFI = 0.900 and χ2/df = 1.230. The internal consistency Cronbach's alpha coefficient was 0.831. The correlation coefficient between the Turkish version of the BSDS and the MDQ was 0.54. The cutoff point of the scale calculated by the ROC analysis was 12 with a sensitivity of 78.6% and a specificity of 86.8%. CONCLUSION: The Turkish Version of the BSDS, has been shown to be reliable and valid tool for screening bipolar disorder after removal of the item 4 of the original version of the scale.

Oral Health among Patients with Bipolar Disorder.

PURPOSE: To compare the oral health of patients with bipolar disorder (BD) with a control group of subjects. MATERIALS AND METHODS: The study sample comprised 242 patients with BD and a mean age of 35.8 years. The control group comprised 187 subjects and a mean age of 37.3 years. Oral health was assessed through clinical examination by the Decayed, Missing, and Filled Teeth (DMFT) Index, the Community Periodontal Index (CPI), and the Simplified Oral Hygiene Index (OHI-S). RESULTS: Patients with BD had higher caries prevalence, poorer periodontal health, and poorer oral hygiene than control group subjects. The average DMFT index score was 10.0 (SD = 5.7) in the BD group and 8.1 (SD = 5.2) in the control group (p = 0.002). The mean value of decayed teeth in patients with BD (4.5) was significantly higher than that of the control group (2.3) (p < 0.001). Periodontal diseases were significantly more prevalent among patients with BD (p < 0.001), particularly regarding shallow and deep pockets (47.1% vs. 16.6%). Oral dryness (xerostomia) and severe tooth wear were also more prevalent among patients with BD (p < 0.001). Statistically significant risk factors for higher DMFT scores were: older age and having BD; CPI scores of 3 or 4; having BD, male gender, older age, and lower educational level. CONCLUSION: Poorer oral health among patients with BD is represented mostly as caries and advanced periodontal disease. The results of this study highlight the necessity to intensify preventive dentistry in this vulnerable population.

[Correction: Eyes Test Performance Among Unaffected Mothers of Patients with Schizophrenia Turk Psikiyatri Derg 2015; 26 (1): 33-39. DOI: 10.5080/u7460]. / Düzeltme: Þizofreni Annelerinin Gözler Testi Performanslarýnýn Deðerlendirilmesi. Turk Psikiyatri Derg 2015; 26 (1): 33-39. DOI: 10.5080/u7460.

This corrects the article DOI: 10.5080/u7460.

Palate size and shape in schizophrenia.

The palate is considered typical of the structures in which schizophrenia-related minor physical anomalies may occur. In this study, we aimed to compare the dimensions and form of palate in patients with schizophrenia with nonpsychiatric controls in a blinded manner. Dental stone casts of 127 patients with schizophrenia and 127 controls were prepared from impressions of the maxillary dental arch. Palate dimensions were measured on the stone casts using a digital caliper and palatometer. Palate length did not differ significantly between the groups, but there was a significant difference in palate width and depth, which were significantly higher in the schizophrenia group. As a result of using multivariate analysis for assessing independent risk factors affecting patients with schizophrenia, furrowed palate shape, palate width, and ellipsoid maxillary dental arch shape were found to be significant. This study also revealed that patients with schizophrenia demonstrate certain gender-related predilections in the differences of palate parameters compared to same-sex controls. As the palate develops in conjunction with both the face and brain, our study findings can significantly contribute to the assumption that there might be structural abnormalities of the palate that could represent specific markers of embryological dysmorphogenesis underlying schizophrenia.

Experiential avoidance, empathy, and anger-related attitudesin antisocial personality disorder.

BACKGROUND/AIM: In prevailing opinion, a strong relation exists between lack of empathy and antisocial personality disorder (ASPD). However, recent data fail to wholly clarify this relation, especially in consideration of empathy dimensions. In this study our aim was to address ASPD and social functionality from a contextual behavioral science viewpoint. MATERIALS AND METHODS: The present study was conducted with a sample of 34 individuals with ASPD and 32 healthy individuals as the control group. The participants were assessed with a sociodemographic form, Structured Clinical Interviews for DSM I and II (SCID-I and SCID-II), Social Functioning Scale (SFS), Acceptance and Action Questionnaire-II for measuring experiential avoidance, Interpersonal Reactivity Index for measuring empathy dimensions, and the State-Trait Anger Scale for anger-related attitudes. RESULTS: Experiential avoidance, dysfunctional anger regulation patterns, and lack of perspective-taking levels were higher in the ASPD group than in the control group. Experiential avoidance and perspective-taking processes were related with social functioning in ASPD. CONCLUSION: These findings may provide initial data for understanding ASPD clinical features and related social interaction problems. Further relations between scales and social functionality also analyzed and discussed.

Metacognitive and Meta-Emotional Styles in Patients With Alcohol and the Other Substance Dependence.

BACKGROUND: Both alcohol and other substances are utilized for emotional and cognitive regulation. OBJECTIVES: The purpose of the present study was to compare metacognitive styles and distress intolerance in patients with alcohol and other substance dependence. PATIENTS AND METHODS: According to DSM-IV TR criteria, 45 patients with alcohol dependence (AD), 44 patients with substance dependence (SD), and 43 volunteers without AD or SD (control group) were enrolled. Socio-demographic information form, Distress Tolerance Scale (DTS), and metacognitive questionaire-30 (MCQ-30) were used to evaluate the participants. RESULTS: Patients with AD had significantly lower "tolerance" subscale and total DTS scores than those with SD and control group (P = 0.008 for SD sample and P = 0.004 for control group). Patients with SD had significantly higher scores in "appraisal" subscale DTS than control group (P = 0.005). Patients of both AD and SD groups had significantly higher scores in "positive beliefs" subscale of MCQ-30 than control group (P = 0.012 for AD group and P = 0. 001 for SD group). There was no significant difference between AD and SD groups in any MCQ-30 subscale and total scores (P = 0.440). CONCLUSIONS: Metacognitive regulation strategies are more considerable prediction than emotional regulation strategies in SD group than in AD group. Individuals with AD use alcohol as a means of both cognitive and emotional regulation strategy.

LACK OF ASSOCIATIONS BETWEEN CLU AND PICALM GENE POLYMORPHISMS AND ALZHEIMER'S DISEASE IN A TURKISH POPULATION.

BACKGROUND AND PURPOSE: To investigate the association between the rs11136000 single nucleotide polymorphism (SNP) of the clusterin (CLU) gene, the rs541458 and rs3851179 SNPs of the phosphatidylinositol-binding clathrin assembly protein (PICALM) gene and Alzheimer's disease (AD) in a Turkish population, and to determine whether there are any relationships between the CLU and the PICALM genotypes and behavioral and psychological symptoms of dementia (BPSD) in the Turkish population. METHODS: One-hundred and twelve AD patients and 106 controls were included in this study. BPSD were evaluated by the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). SNPs in the CLU and the PICALM gene were genotyped by Real-Time PCR. Genotype distributions were assessed for the groups of patients and controls, for the patient groups with and without each BPSD, and "No BPSD" and "BPSD". RESULTS: The CLU and the PICALM genotypes were similar in the AD and control subjects, and the groups with and without each BPSD. There were also no significant differences between the "No BPSD" and the "BPSD" groups for the PICALM genotypes, but even without a statistical significance, it is notable that none of the "No BPSD" patients had genotype pattern CLU-rs11136000-TT, and the female subjects with genotype pattern CLU-rs11136000-TT had higher mean score of BEHAVE-AD. CONCLUSION: This study claims that investigated SNPs are not genetic risk factors for AD in a Turkish population. In addition, the rs541458 and rs3851179 of PICALM SNPs are not related to development of BPSD, but the rs11136000 of CLU SNP might be related to development of BPSD in AD female Turkish subpopulation.

Illness perception of dropout patients followed up at bipolar outpatient clinic, Turkey.

Dropout is a common problem in the treatment of psychiatric illnesses including bipolar disorders (BD). The aim of the present study is to investigate illness perceptions of dropout patients with BD. A cross sectional study was done on the participants who attended the Mood Disorder Outpatient Clinic at least 3 times from January 2003 through June 2008, and then failed to attend clinic till to the last one year, 2009, determined as dropout. Thirty-nine dropout patients and 39 attendent patients with BD were recruited for this study. A sociodemographic form and brief illness perception questionnaire were used to capture data. The main reasons of patients with BD for dropout were difficulties of transport (31%), to visit another doctor (26%), giving up drugs (13%) and low education level (59%) is significant for dropout patients. The dropout patients reported that their illness did not critically influence their lives, their treatment had failed to control their illnesses, they had no symptoms, and that their illness did not emotionally affect them. In conclusion, the nonattendance of patients with serious mental illness can result in non-compliance of therapeutic drug regimens, and a recurrence of the appearance symptoms. The perception of illness in dropout patients with BD may be important for understanding and preventing nonattendance.

[Eyes test performance among unaffected mothers of patients with schizophrenia]. / Sizofreni Annelerinin Gözler Testi Performanslarinin Degerlendirilmesi.

OBJECTIVE: Theory of Mind (ToM) deficit is a widely accepted feature of schizophrenia. A number of studies have examined ToM deficits of first degree relatives of schizophrenic patients as genetic markers of schizophrenia. Examination of mentalization capacity among mothers of schizophrenia patients may improve our understanding of theory of mind impairments in schizophrenia. The aim of this study is to use Reading Mind in the Eyes test to examine theory of mind capacity among mothers of schizophrenic patients. METHOD: Performance during the test "Reading the Mind in the Eyes" (Eyes Test) was compared between the mothers of schizophrenic patients (n=47) and mothers whose children have no psychotic mental illness (n=47). Test results were analyzed based on the categorization of test items as positive, negative, and neutral. RESULTS: Mothers of schizophrenic patients displayed poorer performance during the Eyes Test compare to mothers in the control group, particularly in the recognition of positive and neutral mental representations. There was no statistically significant difference in the recognition of negative mental representations between mothers of patients and the control groups. CONCLUSION: The results of this study indicate that mothers of schizophrenic patients differ in some theory of mind patterns. Theory of mind may be an important developmental or endophenotipic factor in the pathogenesis of schizophrenia and should be further evaluated using other biological markers.

Electrocardiography changes in bipolar patients during long-term lithium monotherapy.

OBJECTIVE: Cardiovascular side effects of lithium have been reported to occur mainly at higher-than-therapeutic serum levels. We aimed to investigate the impact of the long-term lithium use on electrocardiogram (ECG) parameters in association with the serum levels in patients with bipolar disorder (BD) and in healthy controls (HCs) serving as the reference group. METHODS: The study sample consisted of 53 euthymic BD type I patients on lithium monotherapy at therapeutic serum levels (M = 0.76, S.D. = 0.14, range = 0.41-1.09 mmol/l) for at least 12 months and 45 HCs. A 12-lead surface ECG was obtained from all participants at resting state for at least half an hour for 5-min recording. Heart-rate, Pmax, Pmin, QRS interval, QT dispersion, QT dispersion ratio (QTdR) and Tpeak-to-end interval (TpTe) were measured. RESULTS: Regression analyses revealed that QTdR (B = 14.17, P = .001), TpTe (B = 18.38, P < .001), Pmax (B = 17.84, P<.001) and Pmin (B = 25.10, P < .001) were increased in BD patients who were on chronic lithium treatment than in HCs after controlling for age, sex and strict Bonferroni correction for multiple testing. There were no associations between serum lithium levels and ECG parameters. CONCLUSION: Our findings suggest that the use of lithium is associated with both atrial and ventricular electrical instability, even when lithium levels are in the therapeutic range.

Affective temperaments in patients with rheumatoid arthritis.

AIM: The issue whether patients with rheumatoid arthritis (RA) have certain personality characteristics has been discussed. The temperament and personality characteristics of the patient may influence success in competing with stress. The aims of the study were to determine the most common dominant affective temperaments in patients with RA and whether temperament affects the disability. METHODS: A total of 88 patients with RA participated in this cross-sectional study. The Turkish version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire scale was used to determine the dominant affective temperament, and the Health Assessment Questionnaire (HAQ) was used to determine functional ability. RESULTS: Depressive temperament was found in 52 patients (59.1%) as the most common dominant affective temperament followed by irritable temperament in 17 patients (19.3%). There was no significant difference in HAQ scores of the patients according to the subscales of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire. Disability levels of patients were found as low-level disability in 65 patients and high-level disability in 23 patients. Multiple linear regression analysis indicated that HAQ score was not associated with gender, body mass index, duration of the disease, depressive temperament, anxious temperament, cyclothymic temperament or irritable temperament. CONCLUSION: The current study showed that depressive and irritable temperaments are the most common affective temperaments in patients with RA. The dominant affective temperament does not affect the functional ability of patients with RA.

Detection of subclinical atherosclerosis and diastolic dysfunction in patients with schizophrenia.

BACKGROUND: Patients with schizophrenia have a higher risk for cardiovascular diseases, which is associated with early mortality compared with the nonschizophrenic population. Early diagnosis of cardiovascular diseases in asymptomatic periods in patients with schizophrenia would enhance their quality of life and reduce mortality. Echocardiography, carotid ultrasonography, and ankle brachial index (ABI) measurement are known to be beneficial methods of detecting subclinical cardiovascular diseases and of risk stratification. The present study investigated carotid intima media thickness (CIMT) and ABI and echocardiographic parameters measured via conventional and tissue Doppler echocardiography in patients with schizophrenia in comparison with a control group. METHODS: The present case-control study included 116 patients with schizophrenia and 88 healthy patients. Participants with any current comorbid psychiatric disorder, current or lifetime neurological and medical problems, current coronary artery disease, diabetes, hypertension, hypothyroidism, or hyperthyroidism or who were using antihypertensives, antidiabetic agents, or antiobesity drugs were excluded. High-resolution B-mode ultrasound images were used to measure CIMT. Conventional and tissue Doppler measurements were performed according to the recommendations of the American Society of Echocardiography. RESULTS: Low ABI, mitral ratio of the early (E) to late (A) ventricular filling velocities, septal E', septal S', lateral E', lateral S', septal E'/septal A', lateral E'/lateral A', and high septal A', mitral E/septal E', mitral E/lateral E', and CIMT values were observed in the schizophrenia group compared with the control group. CONCLUSION: Doppler parameters supported the hypothesis that patients with schizophrenia are at high risk for cardiovascular diseases.

Report on 3 years' experience in electroconvulsive therapy in bakirkoy research and training hospital for psychiatric and neurological diseases: 2008-2010.

OBJECTIVE: We present our 3 years' experience with electroconvulsive therapy (ECT) practice in Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases (BAKIRKOY) ECT Center after modification of ECT regulations in Turkey. Also included in this article is a brief overview and discussion on ECT applications. METHODS: Bakirkoy medical records in electronic database were examined retrospectively (between January 2008 and December 2010), focusing on several aspects of short-term use of ECT: patient's age, sex, and diagnosis; mean number of treatments per patient; duration of stay in hospital; percentage of ECT use in hospitalized patients; and frequency and types of adverse events. RESULTS: A total of 3490 patients hospitalized for acute conditions (2138 men and 1352 women) were treated with ECT in a period of 3 years, with a total of 27,660 ECT treatments performed. The total number of psychiatric patients hospitalized for acute conditions was 24,310 (14,132 men and 10,178 women) during the same period. The ratio of ECT use among acute care hospitalizations was 1:6.97 (14.36%). The mean ± SD age of patients treated with ECT was 35.02 ± 11.29. The mean ± SD number of ECT sessions was 7.89 ± 2.86. Affective disorders (46.99%) and psychotic disorders (52.12%) were among the leading diagnoses. No deaths occurred during ECT sessions, and no severe adverse events were observed. CONCLUSION: The percentage of patients treated with ECT in BAKIRKOY is similar to rates reported in most Asian countries, which is higher than those reported in Western psychiatric centers. Absence of any life-threatening adverse effect or death, and presence of relatively few adverse effects, may be considered as an indication of conformity to current guidelines.

An Unusual Case: The Comorbidity of Mood Disorder and 17-α-Hydroxylase Deficiency.

17-α-hydroxylase enzyme has a crucial role in the steroid biosynthesis and, deficiency of this enzyme is an autosomal recessive monogenic disorder which is one of the two hypertensive form of congenital adrenal hyperplasia. It is characterized with the deficiency in glucocorticoid, adrenal androgen, and sex steroid synthesis with concomitant mineralocorticoid excess due to genetic defect in steroid biosynthesis. The relationship of hormone system physiology with psychiatric signs and syndromes are complex. Any problem in the hypothalamo-pituitary axis may cause psychiatric syndromes. On the other hand, many psychiatric disorders, such as mood-anxiety symptoms, depression, mania, psychosis, and delirium can be seen secondary to the treatment of hormone deficiency. We present the case of a male patient with pseudohermaphroditism who has been followed and treated in Rasit Tahsin Mood Clinic with the diagnosis of mood disorder not otherwise specified and was diagnosed with 46, XY karyotype and 17-α-hydroxylase deficiency after referring to a hospital with delayed puberty. Considering the medical literature, 17-α-hydroxylase deficiency has been evaluated from the aspects of gender-related behavioral disorders, psychological developmental and anxiety disorders. To the best of our knowledge, in the medical literature, this is the first case of 17-α-hydroxylase deficiency associated with mood disorder. Here, the relationship between mood disorders and hypothalamo-pituitary axis is discussed in the light of the literature.

Association of MDR1 C3435T polymorphism with bipolar disorder in patients treated with valproic acid.

P-glycoprotein (P-gp), an efflux transporter protein, is an ABC transporter encoded by the multidrug resistance 1 gene (MDR1, ABCB1). The common synonymous C3435T polymorphism in exon 26 is reported to associate with lower P-gp functional expression and drug uptake. Many extended pharmacogenomics, functional, and complex disease association studies focused mainly on this polymorphism. We investigated the association of exon 26 C3435T genetic variants of MDR1 gene with susceptibility to bipolar disorder and serum valproic acid concentration. Totally, 104 patients meeting DSM-IV criteria for bipolar disorder and 169 controls were admitted to the study. There was statistically significant difference between the genotypes of bipolar patients (CT 91.2%, TT 6.8%, and CC 2%) and controls (CT 52.7%, TT 26%, CC 21.3%) although their allelic distribution was similar. The serum valproic acid concentrations of the patients with CT, TT and CC genotypes were 72.92 +/- 20.55, 80.47 +/- 14.01 and 68.29 +/- 12.17 microg/ml, respectively, and there was no significant difference between the C3435T genotypes.

Affective temperament in stroke patients.

OBJECTIVE: The aims of this study were to determine the dominant affective temperament changes in stroke survivors and whether temperament affects the disability. METHODS: A total of 63 stroke patients were included in this study. Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire was used to determine the dominant affective temperament (depressive, hyperthymic, cyclothymic, irritable or anxious). The disability level was measured with the Barthel index (BI). RESULTS: Depressive temperament (17.5%) and anxious temperament (12.7%) were the most common dominant affective temperaments. The frequencies of irritable, cyclothymic and hyperthymic temperaments were 4.8, 3.2 and 0%, respectively. The mean BI score was 78.1 ± 18.3 in patients with depressive temperament and 67.4 ± 28.4 in patients without depressive temperament (p = 0.403). The mean BI score was 78.1 ± 15.3 in patients with anxious temperament and 68.0 ± 28.3 in patients without anxious temperament (p = 0.541). Multiple linear regression analysis indicated that BI score was not associated with affective temperament changes. CONCLUSION: The results of the current study suggest that depressive and anxious temperaments are the most common affective temperaments and that there appears to be no association between disability level and dominant affective temperament in stroke survivors.

The effects of electroconvulsive therapy on ghrelin, leptin and cholesterol levels in patients with mood disorders.

The effects of electroconvulsive therapy (ECT), which is a widely used treatment for psychiatric disorders, have not yet been established. Therefore, we aimed to explore whether the patients' serum ghrelin and leptin levels are associated with the action of ECT treatment. In the case of the mood disorders, which occurred in 16 patients with major depressive episode (MDE) and 12 patients with bipolar disorder-manic episode (BD-me) and 25 healthy controls, we have determined the serum levels of ghrelin, leptin and cholesterol before ECT and 2 days after ECT. The BMI was also calculated in all subjects. Although ECT treatment did not change mean the BMI and serum leptin level, the mean serum ghrelin level decreased and the total cholesterol level increased after ECT compared with before ECT. While the leptin levels in the patient group were significantly lower than the controls before and after ECT, the mean serum ghrelin and total cholesterol levels differed statistically only before ECT, but not after ECT than those in controls. The ghrelin levels have decreased significantly after ECT in both sub-groups MDE and BB-me. However, the mean serum total cholesterol level increased statistically after ECT only in the MDE sub-group, and the leptin levels did not differ in both sub-groups after ECT compared with before ECT. In conclusion, ECT treatment seems to be associated with decreased ghrelin levels and increased cholesterol levels but not leptin levels. However, more comprehensive and detailed studies are needed to decipher the exact role of ECT on ghrelin, leptin and total cholesterol in mood disorders.