A rare clinical presentation after COVID-19: Manic episode with psychotic features.

Neuropsychiatric manifestations of the COVID-19, caused by SARS-CoV-2, are under close scrutiny as the virus is shown likely to either directly or indirectly affects the central nervous system although it mainly targets the respiratory tract. Here, we describe a middle-aged male who developed acute psychiatric symptoms after a recent COVID-19 infection with no prior personal or family history of psychiatric disorder. Although there are reported cases of diagnosed psychosis or affective disorders following COVID-19 infection in the literature, to our knowledge, this is the first case where the development of autoimmune encephalitis after COVID-19 was considered and ruled out. This case report describes the comprehensive evaluation of all possible organic etiology. We also aimed to discuss possible biological underpinnings of such an exceptional comorbidity.

Common Biomarkers Associated with Delirium in Hospitalized Patients with COVID-19 at the Epicentre of Turkish Coronavirus Outbreak: A Case-Control Study.

Introduction: To investigate the differences in biochemical characteristics between Coronavirus Disease 2019 (COVID-19) patients with and without delirium in non-intensive care (IC) COVID-19 units was aimed. Methods: This study was designed as an observational, single-centered, and case-control study consisting of 43 delirious patients and matched 45 non-delirious patients admitted to non-IC COVID-19 units. Delirium was diagnosed by a consultant psychiatrist according to the DSM-5 delirium diagnostic criteria. Independent variables such as laboratory tests at the time of admission, clinical features, and patient characteristics were obtained from electronic medical records by researchers. In the primary analyses, binomial logistic regression models were used to investigate the factors associated with delirium, which was identified as the outcome variable. Multivariate logistic models were then adjusted for potential confounding factors, including age, gender, history of neurocognitive disorders and Charlson Comorbidity Index (CCI). Results: We observed higher levels of urea, d-dimer, troponin-T, proB-type natriuretic peptide, and CCI in patients with delirium compared to patients without delirium. We also observed lower levels of estimated glomerular filtration rate (eGFR), serum albumin, and O2 saturation and a decrease in the length of stay at the hospital. After adjusting for confounding factors such as gender, age, and comorbidity, we found that urea (adjusted estimate=0.015; 95% Confidence Interval [CI]=0.058-0.032, P=0.039), urea/creatinine ratio (adjusted estimate=0.008; 95% CI=0.002-0.013, P=0.011), and troponin-T (adjusted estimate=0.066; 95% CI=0.014-0.118, P=0.014) were independent biomarkers associated with delirium. Conclusion: Delirium is associated with higher urea levels and urea/creatinine ratios in COVID-19 patients. In addition, the relationship between troponin-T and delirium may help understand the potential link between the brain and the heart in COVID-19. Additional multi-centred studies with larger sample sizes are needed to generalise these results.

Resilience and Associated Factors in Schizophrenia. / Sizofrenide Dayaniklilik ve Iliskili Etmenler.

OBJECTIVE: Resilience in schizophrenia has been associated with multiple clinical variables that, to the best of our knowledge, do not include impulsiveness, aggression and also personality and insight with possible influences, which remain as poorly investigated topics. This study investigated the relationships of resilience with depression, aggression, impulsivity, personality and insight in order to assess the factors that explain resilience in schizophrenia. METHOD: The study included 139 individuals with clinically stable schizophrenia. Data were acquired by means of the Resilience Scale for Adults (RSA), the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), the Schedule for Assessment of Insight (SAI), the Eysenck Personality Questionnaire Revised-Abbreviated (EPQR-A), the Barratt Impulsiveness Scale, 11th version (BIS-11) and the Buss-Perry Aggression Questionnaire (BPAQ). Correlations of the scores of the RSA with the scores of the other psychometric scales and the demographic and clinical data were evaluated. Linear regression analysis was used to determine the factors predicting resilience. RESULTS: The PANSS total and general psychopathology scores and scale scores on depression, impulsiveness and aggression were negatively correlated with resilience scores. Attentional impulsiveness, neuroticism and depression predicted low levels of resilience. There were no significant correlations between insight and the total or subdimension scores of resilience except for the subdimension structural style. CONCLUSION: Treatments focusing only on clinical remission in schizophrenia are not sufficiently effective. Interventions for enhancing resilience in schizophrenia should consider depressive symptoms, attentional impulsivity and personality traits such as neuroticism.

Perinatal Grief and Related Factors After Termination of Pregnancy for Fetal Anomaly: One-Year Follow-up Study.

INTRODUCTION: Many people grieve in a resilient manner, often having a sense of equilibrium restored within six months. The most devastating type of loss is usually considered to be the death of the child. For such a loss, bereavement may take a period of distressing years with signs and symptoms that are related to grief. There have been different phases identified in the grieving process, and this process encompasses various difficulties with different levels of psychological effects. Women with perinatal losses can suffer long periods of grief. The purpose of this study was to monitor the grief in women who had undergone a termination of pregnancy due to fetal anomaly. METHODS: Forty-six women who applied to the Gynaecology Clinic of Istanbul University Cerrahpasa Faculty of Medicine and who decided to terminate their pregnancy due to fetal anomaly were included in the study. The Perinatal Grief Scale (PGS), the Impact of Event Scale-Revised (IES-R), Beck Anxiety Inventory (BAI), the Edinburgh Postnatal Depression Scale (EPDS), the Multidimensional Relationship Questionnaire (MRQ) and the Adult Attachment Scale (AAS) were administered to the participants six weeks after termination. Participants' grief signs were re-evaluated with the PGS at the sixth and 12th months. RESULTS: There was no relationship between severity of grief symptoms and socio-demographic and clinical characteristics of the patients. The perinatal grief symptoms can decrease gradually from termination of pregnancy to six months and can persist for a period of six months up to a year. There was positive correlation between the scores of PGS and BAI, IES-R hyper-arousal. The mean score of PGS changed significantly from sixth week to sixth month and from sixth week to 12th months. IES-R hyper-arousal and MRQ relational satisfaction were found to be the predictors for PGS total score at the first year. CONCLUSION: The diagnosis of fetal anomaly and especially the termination of pregnancy itself may be traumatic and disruptive. In women with perinatal loss, grief may become persistent after the first six months. It would be helpful to examine how the women resolve this experience. Especially the anxiety and the hyper-arousal signs following the termination should not be ignored. Perinatal grief is a unique bereavement experience; specific interventions should be performed for detecting and treating severe perinatal grief.

Resilience and insight in euthymic patients with bipolar disorder.

BACKGROUND: The relationship between resilience and insight may be of potential importance for coping with stress in bipolar disorder (BD). The aim of this study was to investigate if there was a relation between insight and resilience in euthymic patients with BD and also to analyze the associations between resilience, impulsivity, aggression, alcohol use and affective temperament. METHODS: 142 patients with BD type I in remission period were involved. Resilience Scale for Adults-Turkish version, Schedule for Assessment of Insight, Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, Barratt Impulsiveness Scale, Buss-Perry Aggression Questionnaire, Michigan Alcoholism Screening Test were used. RESULTS: Total insight scores were negatively correlated with the scores of perception of future. As distinct from other subscales of resilience, family cohesion had independent significant associations with insight in relabelling of psychotic experiences and attention impulsivity. There was no relationship between total insight and total resilience scores. Resilience scores were negatively correlated with number of depressive episodes and number of suicide attempts. Degree of aggression, degree of impulsivity, scores of depressive and hyperthymic temperament significantly predicted resilience. LIMITATIONS: Recruitment of patients from a tertiary centre limits the generalizability of the findings. CONCLUSIONS: Better insight was related to negative perception of the future and did not have significant associations with total resilience. Number of depressive episodes, number of past suicide attempts correlated with resilience, emphasizing the importance of interventions to increase resilience in BD.

Sex difference in the progression of manic symptoms during acute hospitalization: A prospective pilot study.

OBJECTIVES: Acute mania is a serious medical condition that impacts men and women equally. Longtime presentation of manic symptoms is sex-dependent; however, little is known about acute symptoms of mania. The objective of this study is to track and compare acute manic symptoms for sex differences during inpatient hospitalization. METHODS: All patients with bipolar mania admitted to a large university hospital between January and October 2017 were invited to participate in this longitudinal naturalistic follow-up study. Manic (YMRS), depressive (MADRS), and psychotic (PAS) symptoms were tracked daily from admission to discharge. RESULTS: The total YMRS scores decreased significantly overtime (p < .0001) in both male (n = 34) and female (n = 23) patients (p = .7). However, male patients scored significantly higher in sexual interest (p = .01), disruptive and aggressive behavior (p = .01), and appearance (p < .001) while females had better insight into their illness (p = .01). Males and females received similar doses of lithium (p = .1), but males received significantly higher doses of valproic acid (VPA) in comparison with females (p = .003). However, plasma lithium and VPA concentrations at discharge were not significantly different between sexes. CONCLUSION: Our results show sex differences in the progression of certain domains of manic symptoms in a cohort of 23 female and 34 male patients admitted to a large academic center in Turkey. Males, in this sample, exhibited more sexual interest, disruptive and aggressive behaviors, better grooming, and less insight compared to females. While these results are concordant with our preclinical findings and with anecdotal clinical observations, replication in larger samples is needed.

Phenomenological subtypes of mania and their relationships with substance use disorders.

OBJECTIVE: The aim of the present study was to determine the distinct clusters of subtypes among patients with bipolar disorder (BD) and the relationship between the clinical features of BD patients, particularly substance use disorders (SUDs) and the clusters. METHOD: The present study initially assessed 96 inpatients who were hospitalized in the psychiatric clinic of Bakirköy Prof. Mazhar Osman Training and Research Hospital for Psychiatry and Neurology, for a BD manic episode. All patients were evaluated during the initial 3 days of their admission using the Young Mania Rating Scale (YMRS), the Montgomery-Asberg Depression Rating Scale (MADRS),the Scale for the Assessment of Positive Symptoms (SAPS), the Michigan Alcoholism Screening Test (MAST) and a sociodemographic questionnaire. The factor structures of the psychopathological scale items were determined with factor analyses and based on the factor loadings, cluster analyses were performed. The relationships among the clusters and the clinical variables were then evaluated. RESULTS: The factor analyses generated three factors: increased psychomotor activity, dysphoria, and psychosis. A hierarchical cluster analysis was applied to the three factor loadings, and revealed that factor 1 (increased psychomotor activity) was high in cluster 1 and that the effects of factors 2 (dysphoria) and 3 (psychosis) were high in cluster 2. Within cluster 1 (Psychomotor elevation), 39% of patients were diagnosed with an alcohol use disorder while 31.6% of patients in the cluster 2 (dysphoric-psychotic) were diagnosed with both alcohol and cannabis use disorders. Within cluster 2 (dysphoric-psychotic), 47.4% of patients had one suicide attempt and 21.1% of patients had two or more attempts during their lifetime. CONCLUSION: There was a significant difference in the presence of SUDs between patients with psychomotor elevation and patients in dysphoric-psychotic cluster. This may be point out that pure manic patients with BD self-medicate using the sedative effects of alcohol and the causal relationship between cannabis and psychosis. Using a dimensional approach to study BD may enhance detection of the biological correlates of BD and improve the treatment and outcomes of the disorder.

Depression, loneliness, anger behaviours and interpersonal relationship styles in male patients admitted to internet addiction outpatient clinic in Turkey.

BACKGROUND: 'Internet addiction' is excessive computer use that interferes with daily life of a person. We designed this study in order to evaluate the predictor effect of depression, loneliness, anger and interpersonal relationship styles for internet addiction as well as develop a model. SUBJECTS AND METHODS: Forty (40) male internet addicted patients were selected from our hospital's internet Addiction Outpatient Clinic. During the study, the Internet Addiction Test (IAT), the Beck Depression Inventory (BDI), the State Trait Anger Expression Scale (STAXI), the UCLA-Loneliness Scale (UCLA-LS), and the Interpersonal Relationship Styles Scale (IRSS) were used for the evaluation of the patients. RESULTS: The results of this study showed that the 'duration of internet use' (B=2.353, p=0.01) and STAXI 'anger in' subscale (B=1.487, p=0.01) were the predictors of internet addiction. CONCLUSION: When the clinicians suspect for the internet overuse, regulation of internet usage might be helpful. Psychiatric treatments for expressing anger and therapies that focus on validation of the feelings may be useful.

Attachment and family functioning in patients with internet addiction.

OBJECTIVE: Although the Internet is used effectively in many areas of life, some users experience problems because of over-use due to a lack of control. The diagnostic criteria for Internet addiction include disruptions in family relationships, but adequate data on the attachment styles and family functioning associated with this condition are limited. This study aimed to investigate the attachment styles and family functioning of patients with Internet addiction. METHOD: The sample included 30 male patients consecutively admitted to the Bakirköy Mental Health and Research Hospital Internet Addiction Outpatient Clinic, who were diagnosed in clinical interviews as having Internet addiction according to Young's (1998) criteria. Thirty healthy males who were matched with the experimental group in terms of sociodemographic characteristics were included as control subjects. Both groups provided sociodemographic data and completed the Beck Depression Inventory (BDI), the Experiences in Close Relationships Questionnaire-r (ECR-r) and the Family Assessment Device (FAD). RESULTS: Patients with Internet addiction had higher BDI scores (P<.001) and higher attachment anxiety subscores on ECR-r (P<.001) compared with those in the control group. Patients with Internet addiction evaluated their family functioning as more negative and reported problems in every aspect addressed by the FAD. Scores on the FAD behaviour control, affective responsiveness, and problem-solving subscales (P<.05) and on the FAD communication, roles, and general functioning subscales (P<.001) were significantly higher in the patient compared with the control group. CONCLUSION: Patients with Internet addiction have more anxious attachment styles as well as prominent disruptions in family functioning. Thus, it may be important to evaluate the attachment styles and family functioning of patients with Internet addiction. Indeed, comprehensive treatment approaches including other family members may make important contributions to treatment success.

Coping Strategies in Patients Who Had Suicide Attempts.

INTRODUCTION: The aim of this study was to investigate coping strategies suggested to be a determinant of suicide attempt and to compare them with coping strategies of healthy volunteers. METHODS: This study was conducted on 50 patients who had suicide attempts within the past two months and 52 healthy volunteers who did not have any suicide attempt. They were evaluated with the Turkish version of COPE inventory. The results were analyzed using SPSS version 15.0 for Windows. RESULTS: In the suicide attempt group, 'active coping', 'planning', 'positive reinterpretation and growth' scores were found to be lower than that in the control group. On the other hand, 'restraint coping', 'acceptance', 'focus on and venting of emotions', 'behavioral disengagement', 'substance use' and nonfunctional coping total points were significantly higher in the suicide attempt group. The patients with depression in the suicide group were found less of the 'positive reinterpretation and growth' but more of the 'substance use' compared to the healthy group. Subjects who attempted suicide more than once tended to 'substance use' rather than 'active coping'. 'Focus on and venting of emotions' scores in suicide attempters were higher in women than in males. CONCLUSION: We observed that individuals who attempted suicide have fewer functional coping strategies and more nonfunctional coping strategies than who do not attempt suicide. It was determined that under stressful situations, individuals with depression tended to alcohol and substance abuse instead of positive reinterpretation and growth. In subjects who had recurrent suicidal attempts, alcohol and substance abuse was more common than active coping. Women were using focusing on and venting of emotions techniques much more than men. We assume that to monitor, and in case of necessity, to change the coping strategies in suicide attempters are vitally important for preventing suicide attempts.

Two Cases of Excessive Internet Use with Comorbid Family Relationship Problems.

Although the internet is used effectively and beneficially in every aspect of life, several users have been experiencing some problems due to excessive and uncontrolled use. While the term "internet addiction" still remains controversial, disturbed family relationships are considered to be a diagnostic criterion. The use of the internet, even in non-excessive levels, is associated with disturbance in family and social life. As considering from systemic point of view; while family relationships may be disturbed with internet addiction, people who have problems with their family relationships also may use internet excessively. This case report is composed of both the cases with excessive internet usage and those who had problems in complying with the changes in their family systems following the decrease in duration of internet usage during the treatment process.

The relationship between disability, quality of life and fear-avoidance beliefs in patients with chronic low back pain.

AIM: The aim of this study is to investigate the relationship between fear and avoidance beliefs with the disability of patients with chronic low back pain and the prediction of quality of life. MATERIAL AND METHODS: 105 outpatients with chronic low back pain were included in the study. Patients were evaluated with a sociodemographic questionnaire Visual Analog Scale Roland Morris Disability Questionnaire Beck anxiety inventory Beck depression inventory, Somatosensory Amplification Scale Fear and avoidance beliefs questionaire and Short form-36 health survey questionnaire. RESULTS: As pain intensity increased, FABQ increased. Higher levels of anxiety, depression, FABQ (work) leads to higher level of disability. The disability predictors were found to be pain intensity and level of anxiety. When levels of pain intensity, level of anxiety and depression, FABQ increased, physical function decreased. Pain intensity and FABQ (physical) were found to be the predictors of quality of life. CONCLUSION: Findings of our study were compatible with the previous studies that evaluated the relationship between pain intensity and FAB with the disability of patients with chronic low back pain. We think that it'd have a role for the perception of disability and connected to this to prevent the impairment of life quality by implications for FAB in these patients.

[Clinical correlates of social anxiety disorder comorbidity in schizophrenia]. / Sizofrenide Sosyal Bunalti Bozuklugu Estanisi; Sosyodemografik ve Klinik Özellikler ile Iliskisi.

OBJECTIVE: The aim of this study is to investigate the social anxiety disorder comorbidity and clinical features in schizophrenia. METHOD: 102 (23 women and 79 men) outpatients who had been followed in the Psychotic Disorders Unit in Bakirköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were diagnosed with schizophrenia according to DSM-IV criteria were included in the study. Schizophrenia and Social anxiety disorder were assessed by a structured clinical interview for DSM-IV. Patients were evaluated with a questionnaire which included demographics, clinical characteristics, Liebowitz social anxiety scale, Positive and Negative Syndrome Scale (PANSS), Calgary depression scale for schizophrenia (CDSS),The Scale of Unawareness of Mental Disorders (SUMD), Short form-36 health survey questionnaire and state-trait anxiety inventory. RESULTS: In remission, 22 patients (21.6%) had co-morbid social anxiety disorder. Patients with social anxiety disorder comorbidity, had higher levels of awareness. Their depression scores were higher and functional impairments were lower. These patients had been treated with typical and atypical antipsychotics and antidepressants. CONCLUSION: Social anxiety disorder comorbidity in schizophrenia adversely affects the quality of life and is not rare. Future studies should be planned with the assesment of social anxiety disorder treatment as well as schizophrenia treatment.

The relationship between insight and clinical features in bipolar disorder.

OBJECTIVE: The aim of this study is to examine the relationship between insight dimensions and clinical features in bipolar disorder. METHOD: One hundred and four inpatients with bipolar disorder( manic or mixed episodes) diagnosed according to DSM-IV criteria participated in the study. Patients were evaluated both during an acute episode and in remission, prior their discharge from the hospital by the Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), Positive and Negative Syndrome Scale (PANSS), The Scale of Unawareness of Mental Disorders (SUMD), and a questionnaire regarding demographic and clinical characteristics. RESULTS: In remission, 57 patients (54.8%) had insight of their illness while 14 (13.5%)did not have insight. Besides %6.7 of patients did not have the Insight into the effects of medication. We also found that 27.9% of patients were unaware of the social consequences of their illness. Patients with psychotic symptoms had a significantly low level of awareness to the effects of their medication as well as the severeness of their manic episode. We found an unawareness of delusion in these patients. In terms of all SUMD items, female patients had significantly poorer insight compared to men. No correlation was found between the number of hospitalizations, the number of episodes or the first episode type and insight dimensions. CONCLUSION: Lack of insight in bipolar disorder is not rare. The assesment of insight addresses different components of the illness and the treatment awareness. The severity of illness, aggressive impulse control difficulties, psychotic symptoms especially the presence of delusions, female sex may be important predictors of impaired insight.