Relationship between Alexithymia, Depression and the Negative Symptoms in Schizophrenia with and without Deficit Syndrome. / Eksiklik Sendromu Olan ve Olmayan Sizofrenide Aleksitimi, Depresyon ve Negatif Belirtiler Arasindaki Iliski.

OBJECTIVE: The aim of this study was to compare schizophrenia patients with and without Deficit Syndrome (DS) with respect to alexithymia, depression and negative symptoms and to investigate the relationship between these variables. METHOD: A total of 210 schizophrenia patients who joined the study were grouped on the basis of the Schedule for the Deficit Syndrome (SDS). Each patient was evaluated using the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), the Toronto Alexithymia Scale (TAS) and the UKU - Side Effect Rating Scale (UKU-SERS). RESULTS: The DS group had higher alexithymia scores that were not related to the negative symptoms. The prevalence of depression was significantly lower in the same group. Positive symptoms in the DS group were negatively correlated with the two TAS subscales of difficulty describing and identifying feelings. The negative symptoms scores of all the patients with and without DS correlated positively with the mean score on the TAS subscales. The severity of depressive and the negative symptoms predicted alexithymic symptoms. CONCLUSION: Lack of a correlation between the negative symptoms and alexithymic symptoms in DS suggested that the respective symptoms represented different independent phenomena in schizophrenia. A future study might explore the relationship between alexithymia and negative symptoms in association with cognitive functioning.

Do mentalization skills affect the perception of stigma in patients with epilepsy?

PURPOSE: We aimed to study the relationship between the mentalizing ability and stigma in patients with epilepsy. METHODS: Patients with epilepsy were administered the following battery of tests: Mini-International Neuropsychiatric Interview (MINI) form, Reading the Mind in the Eyes Test (Eyes Test), Stigma Scale of Epilepsy (SSE), Internalized Stigma of Mental Illness (ISMI) Scale, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS: Assessment of an association between the Eyes Test score, ISMI Scale total score, and subscale scores revealed a negative significant correlation of Eyes Test scores with approval of stereotypes, perceived discrimination, stigma resistance, and total score. Eyes Test score and BDI scores appears to be significant predictor of internalized stigma among the clinical variables that were studied. A positive significant correlation was detected between BDI score and alienation, perceived discrimination, and total score. CONCLUSION: The presence of a correlation between the mentalization and stigma perception in our study demonstrates that these two concepts are connected and that this connection needs further study. In particular, mentalization-based therapy can have an effect on the reduction of the stigma perceptions and in this way can improve the course of the disease, potentially improving the patients' quality of life.

Electroacupuncture Therapy in Nicotine Dependence: A Double Blind, Sham-Controlled Study.

INTRODUCTION: The number of non-pharmacological controlled studies is insufficient in the treatment of nicotine dependence (ND). Nevertheless, non-pharmacological treatments, such as electroacupuncture (EA), are becoming increasingly popular in the treatment of ND. The aims of this study were to determine the efficacy and safety of "true EA therapy" (TEAT) compared to those of "sham EA therapy" (SEAT) in ND treatment. METHODS: Eligible patients who met the DSM-IV criteria for ND (n=450) were included in the study. This study was a double-blinded, sham-controlled clinical trial with a 4-week treatment period and 4-week follow-up conducted between June and December 2009 at a psychiatry outpatient clinic. One hundred and sixty four adult (≥18 years; 44 men, 120 women) cigarette smokers out of 450 patients who met the inclusion and exclusion criteria were enrolled in the study in a ratio of 1:1 to receive TEAT (n=84) or SEAT (n=80). Routine biochemical and hematological tests, chest X-Ray, and ECG were carried out; end-expired carbon monoxide (CO) levels were measured too. Clinical characteristics were obtained through the Fagerström Nicotine Dependence Test (FNDT), Hamilton Rating Scale for Depression (HRSD), and Hamilton Anxiety Scale (HAS). EA was carried out by a trademark device, Antismoke 3000®. Efficacy analyses were performed on "intent-to-treat analysis." Primary outcome was the differences from baseline to endpoint in mean FNDT, number of cigarettes smoked per day, and CO levels at week 4. Secondary outcomes were the same variables at week 8. These variables were assessed via analysis of covariance (ANCOVA). RESULTS: Mean baseline FNDT, HRSD, HAS, and CO levels of the groups were statistically similar. TEAT and SEAT groups demonstrated no significant changes in the outcome variables and smoking cessation rates (35.7% and 30%, respectively). Of those remaining outside of the study, 8.3% were from the TEAT group and 8.7% were from the SEAT group; there was no statistical difference between the groups. The rate of treatment discontinuation was similar between the TEAT (44%) and SEAT (43.7%) groups (p>0.05). The rates of adverse events were not similar too. CONCLUSION: This study showed that both TEAT and SEAT have similar efficacy and safety profiles in patients with ND.

[The Relationship of Suicide Attempts with Affective Temperament and Relevant Clinical Features in Patients with Mood Disorders]. / Intihar Girisimi Bulunan Duygudurum Bozuklugu Tanili Hastalarda Mizaç Özellikleri.

OBJECTIVE: In this study, patients with affective disorders with or without suicide attempts were examined according to whether their disorder was unipolar or bipolar. An analysis was made of their socio-demographic variables, comorbid psychiatric symptoms, and affective temperament dimensions in order to understand the effects of these variables on suicide risk. METHOD: The study populations consisted of 246 inpatients with affective disorders who had been admitted to the Erenköy Research and Training Hospital for Mental and Neurological Disorders (93 patients with unipolar disorders, 153 with bipolar disorders). The TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire), the Beck Hopelessness Scale (BHS) and the Symptom Checklist-90-Revised (SCL-90-R) psychological symptom screening tests were applied to all patients. In order to determine the affective disorder diagnosis and to identify suicide attempts, a Mini International Neuropsychiatric Interview (MINI) was performed during the first 48 hours of hospitalization. RESULTS: The cyclothymic and anxious temperament dimensions measured using TEMPS-A, somatic symptoms obtained from a symptom checklist, and psychiatric disorders in the family were found to be good indicators of suicide attempts in patients with unipolar disorders in this study. An investigation of predictors of suicide attempts in bipolar patients showed that cyclothymic temperament pattern, paranoid symptoms, evaluated through symptom screening test and having a psychiatric disorder in the family are good predictors of a suicide attempt. CONCLUSION: The findings are expected to guadiance to preventing suicide in patients with affective disorders. The inclusion in this study of patients with different index episodes of illness, including manic, depressive and mixed periods, can be accepted as a significant limitation of this study.

Do ictal EEG characteristics predict treatment outcomes in schizophrenic patients undergoing electroconvulsive therapy?

OBJECTIVE: The aim of this study is to investigate the relationship between features of electroencephalography (EEG), including seizure time, energy threshold level and post-ictal suppression time, and clinical variables, including treatment outcomes and side-effects, among schizophrenia inpatients undergoing electroconvulsive therapy (ECT). METHOD: This is a naturalistic follow-up study on schizophrenia patients, diagnosed using DSM-IV-TR criteria, treated by a psychosis inpatient service. All participants completed the Brief Psychiatric Rating Scale (BPRS), the Global Assessment of Functioning (GAF) scale, the Frontal Assessment Battery (FAB) and a Data Collection Form. Assessments were made before treatment, during ECT and after treatment. FINDINGS: Statistically significant improvements in both clinical and cognitive outcome were noted after ECT in all patients. Predictors of improvement were sought by evaluating electrophysiological variables measured at three time points (after the third, fifth and seventh ECT sessions). Logistic regression analysis showed that clinical outcome/improvement did not differ by seizure duration, threshold energy level or post-ictal suppression time. DISCUSSION AND CONCLUSION: We found that ictal EEG parameters measured at several ECT sessions did not predict clinical recovery/outcomes. This may be because our centre defensively engages in "very specific patient selection" when ECT is contemplated. ECT does not cause short-term cognitive functional impairment and indeed improves cognition, because symptoms of the schizophrenic episode are alleviated.

Clinical correlates of childhood trauma and dissociative phenomena in patients with severe psychiatric disorders.

In this present study, we aim to investigate the possibility of a link between psychotic disorders and traumatic experiences in a group of female patients diagnosed with psychotic disorders by comparing childhood trauma exposure with a group of non-psychotic psychiatric disorder attending the same pschiatric clinic. Secondary purpose of this study is to examine the clinical correlates of trauma exposure, dissociative phenomena and psychiatric symptomatology between these two group of patients. Two psychiatric sample groups, those with psychotic disorders-mostly schizophrenic-(n = 54), and those with a non-psychotic severe psychiatric disorders (n = 24), were recruited. Data were collected for demographic, psychiatric and trauma histories and psychiatric symptomatology for all patients. In this study, high prevalance rates of childhood traumatic experiences and dissociative phenomena were found in both groups. Total scores of childhood trauma questionnaire in favor of the non-psychotic group were found to be close to significance (p = 0.052). DES scores of non-psychotic group were also higher although not statistically significant. 54.2 % of nonpsychotic cases had DES scores >20 on the other hand, that percentage of psychotic cases were found to be as 38.9 %. Furthermore, psychiatric patients who have suffered childhood traumatic experiences are far more likely to try to kill themselves than psychiatric patients who have not experienced such abuse. The high rates of childhood traumatic events in our present samples of both schizophrenia-spectrum patients and nonpsychotic patients confirm the need for clinicans to take trauma histories routinely.

Schizophrenia-like psychosis and dandy-walker variant comorbidity: case report.

Dandy-Walker variant is a developmental malformation consisting of cerebellar hypoplasia and cystic dilatation of the fourth ventricle. Previous research has proposed a possible role for the cerebellum in cognition and in schizophrenia. In this paper we report a schizophrenia-like psychotic disorder in a 30 year-old woman with Dandy-Walker variant. The patient was treated with risperidone 6 mg/day, biperiden 4 mg/day and risperidone depot 50 mg injections fortnightly, and most of the symptoms were ameliorated within 2 months. The similar cognitive profile to populations with cerebellar pathology and rarity of the condition strongly suggests that there may be direct relationship between cerebellar pathology and appearence of psychotic symptoms.

Attention-deficit hyperactivity disorder in patients with premature ejaculation: a pilot study.

PURPOSE: The etiology of both adult-type ADHD and PE is not completely understood, but the studies revealing common etiologic factors for both conditions suggest a high likelihood of coexistence. We aimed to find out the prevalence of ADHD among adult males with lifetime PE. METHODS: The patients with lifetime PE were included in the study. Both patients and controls were evaluated with the 10-item premature ejaculation index of Althof and Rosen for premature ejaculation, Wender Utah rating scale (WURS) and Conner's adult ADHD rating scales (CAARS) for determining the presence of attention-deficit hyperactivity disorder syndrome. RESULTS: A total of 38 patients and 27 controls were included in the study. Patient and control groups were similar in terms of age and (p < 0.878), but different IELT (p < 0.001). ADHD was detected in 16 (42.1 %) of patients with PE, while ADHD symptoms were detected in only 1 (3.7 %) of control patients. Distribution of patients in the study group according to ADHD types was as follows: Type 1, Type 2, Type 3 in 2 (5.3 %), 4 (10.5 %), and 10 (26.3 %) patients, respectively. CONCLUSIONS: ADHD is significantly more frequent among patients with PE than controls. The close relationships between these two diseases must be examined by prospective studies.

Evaluation of general psychopathology, subjective sleep quality, and health-related quality of life in patients with obesity.

OBJECTIVE: Recently, the increasing rate of obesity has been elucidated as a major public health problem. The aim of this study was to examine the psychological distress, subjective sleep quality, and health-related quality of life (HRQOL) in a group of patients diagnosed with obesity. METHODS: A total of 124 obese patients (32 of them Class I obesity (BMI: 30-34.9 kg/m2), 92 Class II obesity (BMI: > or = 35kg/m2)) and 106 healthy control subjects were involved in the study. Subjects were evaluated with self-administered questionnaires including the Symptoms Checklist-90-Revised (SCL-90-R), Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Short Form 36 (SF-36). Several clinical and socio-demographic data were also recorded. RESULTS: Class II obesity group had a significantly worse psychological status, quality of life, and sleep quality than control group, Although Class I obesity group did not differ from Class II and control groups according to sleep quality and psychological status, they had worse HRQOL than the control group. BMI scores positively correlated with the majority of subscales of psychological distress (SCL-90-R) and sleep quality (PSQI, ESS) and negatively correlated with all dimensions of HRQOL (SF-36). CONCLUSIONS: Obesity is associated with psychological distress, poor sleep quality, and reduced quality of life. Thus, obesity should be evaluated in a biopsychosocial manner, including management of patients' psychopathology.

[The relationship between subjective sleep quality and aggression in male subjects with antisocial personality disorder]. / Antisosyal kisilik bozuklugu olan erkek bireylerde subjektif uyku kalitesinin saldirganlik ile iliskisi.

OBJECTIVE: The aim of this study was to evaluate subjective sleep quality and to determine its relationship to aggression in male subjects diagnosed with antisocial personality disorder (APD). METHODS: The study included 125 male soldiers with APD that consecutively presented to the outpatient psychiatric unit of GATA Haydarpasa Training Hospital. A control group of 125 normal volunteers with no known medical or psychiatric disorders were selected from among male military personnel. The subjects were evaluated with an assessment battery, which included the Pittsburgh Sleep Quality Index and Aggression Questionnaire, during a semi-structured interview. RESULTS: The main finding was that more of the APD patients suffered from disturbed sleep quality than did the controls. Compared to the matched controls the APD patients had lower subjective sleep quality, longer sleep latency, shorter duration of sleep, less habitual sleep efficiency, more sleep disturbances, more use of sleeping medication, and a higher level of daytime dysfunction. In the APD group, elevated levels of aggression were also significantly correlated with impaired sleep quality. CONCLUSIONS: The present study provides support for a strong link between subjective sleep quality and aggression in APD. Recognition of sleep disturbances in APD patients is also relevant to the management of APD because effective strategies to improve sleep in this patient group might also lead to vast reductions in their aggressive behaviors.

A case with euprolactinemic galactorrhea induced by escitalopram.

Endocrine and reproductive side effects of serotonergic antidepressants are uncommon and galactorrhea is only rarely mentioned among SSRI-related side effects. Perhaps through suppression of dopamine neurotransmission releasing prolactin from tonic inhibitor control of dopamine, serotonin-enhancing antidepressants may result in a rise in prolactin levels. However, we here describe a case of euprolactinemic galactorrhea induced by the SSRI escitalopram and discuss potential mechanisms of action.

[Comparison of right thalamus and temporal cortex metabolite levels of drug-naive first-episode psychotic and chronic schizophrenia in patients]. / Ilaç Kullanmamis Ilk Psikotik Atak Hastalari ile Kronik Sizofreni Hastalarinda Sag Talamus ve Temporal Korteks Metabolit Seviyelerinin MRS ile Karsilastirilmasi.

OBJECTIVE: The aim of this study was to use Magnetic Resonance Spectroscopy (MRS) to investigate whether patients with chronic schizophrenia have different brain metabolite levels in the temporal cortex and thalamus than drug-naive first-episode patients. METHOD: We compared right-handed male first-episode patients (n=13) and chronic schizophrenic cases (n=15) with gender- and handedness-matched controls (n=10). Right temporal and right thalamic N-Acetylaspartate (NAA)/Creatine (Cre), NAA/Choline (Cho), and Cho/Cre ratios were obtained with MRS. RESULTS: Right temporal NAA/Cre, NAA/Cho, and right thalamus NAA/Cre ratios were significantly lower both in the chronic and first-episode patient groups when compared to normal controls (p<. 001), suggesting decreased neuronal integrity in both patient groups. There were no significant correlations between symptom severity and functional status with MRS variables (p=.027). These results suggested that both patient groups had neural integrity problems. Duration of illness (days) in the first-episode patients was significantly correlated with right temporal NAA/Cre and NAA/Cho. CONCLUSIONS: These results suggested that first-episode and chronic patients had significantly impaired neural integrity, particularly in the temporal cortex. It seems that in the acute phase of the first-episode, neural integrity impairment increased along with days elapsed without treatment.

[Factors affecting the satisfaction of recruits with the military environment]. / Acemi erlerin yasam kosullarindan memnuniyetini belirleyen faktörlerin incelenmesi.

OBJECTIVE: Life satisfaction is one of the global indicators of adjustment. The purpose of this study was to investigate the roles of individual and familial characteristics, and attitudes towards military service of new recruits in terms of their satisfaction with the fundamental principles of military service and daily military lifestyle and environment. METHODS: The study was conducted among 214 soldiers recruited one month previously in an orientation camp for privates located in an Istanbul military center. All subjects were administered a questionnaire concerning individual and familial sociodemographic features and their feelings about the fundamental principles of military service and daily military lifestyle and environment. RESULTS: Variables included in the questionnaire such as "prior concern about military service", "unexpected timing of military service", "disappointment with military service", "older age at onset of military service" and "higher education level of the subject himself or his mother", were found to be negatively correlated with the satisfaction levels of soldiers. All these items, excluding the education level of the mother, were determined to predict a low level of satisfaction in recruits. CONCLUSIONS: Satisfaction with the fundamental principles of military service and daily military life and environment of recruits, which is a good indicator of adjustment, is concluded to have been affected by the attitudes of individuals towards military service and expectations from this position, the educational level of soldiers and the age of the soldier at the start of military service.