[The perceived burden of care and its correlates in schizophrenia]. / Sizofrenide Ailenin Yükünü Etkileyen Etmenler.

OBJECTIVE: The present study aimed to investigate the perceived level of burden of care and its correlates in family members of schizophrenia patients. METHOD: The study included 239 schizophrenic patients that were followed-up at the psychiatric outpatient clinics of Izmir Ataturk Education and Research Hospital, and Celal Bayar University Medical School, and 239 of their primary caregivers. Patients were assessed using the Positive and Negative Syndrome Scale (PANNS), Global Assessment of Functioning Scale (GAF), Social Functioning Scale (SFS), Brief Cognitive State Examination (BCE), and UKU Side Effect Rating Scale. Their primary caregivers were assessed using the Perceived Family Burden Scale (PFBS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). RESULTS: Caregiver PFBS scores ere correlated with male patients, female caregivers, inadequate social support, economic difficulty, the presence of chronic physical disorder in the caregivers, patient violence toward the caregivers, total duration of illness, the number of patient hospitalizations, PANNS total and subscale scores, and SFS, BDI, and BAI scores. Perceived burden of care was predicted by the severity of the patients' positive symptoms, SFS independence/competence and interpersonal functioning subscale scores, and caregivers' anxiety and depression levels. CONCLUSION: In order to decrease the burden of care in schizophrenia we recommend effective management of patient symptoms, enhancement of patient social functioning, interventions that target caregivers with high levels anxiety and depression, and social support provided by healthcare professionals.

Reasons for clozapine discontinuation in patients with treatment-resistant schizophrenia.

Although clozapine is more effective than other antipsychotics in the treatment of schizophrenia, the rate of its discontinuation is also high. The aim of this retrospective chart-review study was to investigate the causes of clozapine discontinuation in patients with treatment-resistant schizophrenia. This study included a total of 396 patients with schizophrenia, 240 still on clozapine therapy and 156 who discontinued clozapine, and compared their clinical characteristics. Those who discontinued clozapine had a longer history of illness and more hospitalizations before clozapine and tended to be older. Inadequate response was more common among clozapine discontinuers compared to continuers. The most common reason for discontinuation was the side-effects associated with clozapine (49%). Discontinuation from patient decision or by the psychiatrist due to noncompliance was the second (29.7%) and discontinuation due to lack of efficacy was the third most frequent reason (21.3%). The patients who discontinued clozapine because of cardiac side effects were younger, had shorter duration of clozapine use, and had lower maximum clozapine dose compared to the other discontinuers. Our findings point out the importance of enhancing psychiatrists' ability to handle manageable side effects to minimize discontinuations and maximize the benefits of clozapine in patients with treatment-resistant schizophrenia.

[The symptomatology and prevalence of symptoms of premenstrual syndrome in Manisa, Turkey]. / Manisa ilinde premenstrüel sendrom belirti orüntüsü ve belirti yayginliginin arastirilmasi

OBJECTIVE: The aim of this study was to investigate the prevalence of premenstrual syndrome (PMS) symptoms, the frequency and severity of the symptoms, and their association with sociodemographic variables in fertile women between the ages of 15 and 49 years. METHOD: The study included 541 women living in the area of the 7th Primary Health Care Center of Manisa, Turkey. Face-to-face interviews were conducted and a sociodemographic data form, a DSM-IV diagnostic criteria form, and the premenstrual evaluation form (PEF) were administered. In the analysis of the data, K-means cluster analysis was performed and cluster analysis with 3 categories according to the severity was used. In the evaluation of the 18 subscales possible maximum variation quotient is obtained by dividing the maximum possible PEF score to the scores the subjects got. In the group comparison analyses, chi-square test for the categorical variables, and t-test for continuous variables were used. RESULTS: Among the study group, 6.1% had severe PMS symptoms and 72.2% of these women had some dysfunction as defined by DSM-IV. The most common symptoms were feeling irritable and restless (72%), anxiety (67.3%), feeling fullness, discomfort or pain in the abdomen (66.6%), lack of energy or easily fatigued (66.6%), and fatigue in the legs (65.5%). CONCLUSION: The prevalence of the risk of PMS was 6.1%. The most common and severe PMS symptoms were feeling irritable and restless.

The developmental origins of metacognitive deficits in schizophrenia.

The deficits in metacognition have been observed in schizophrenia but developmental roots of impaired metacognition are not well understood. Accordingly, this study compared metacognitive abilities of patients with schizophrenia and healthy group and examined the relationship between childhood trauma, attachment style and caregiver attitudes with metacognitive capacity which might contribute to metacognitive deficits in patient group. 35 patients with schizophrenia and 35 healthy people were included in the study. Metacognitive capacity was measured using the Metacognition Assessment Scale Abbreviated (MAS-A). This scale comprises four domains: self-reflectivity, understanding other's mind, decentration and mastery. Group comparisons revealed that schizophrenia patients had greater deficits in metacognitive ability. We found that the report of childhood emotional abuse, a pattern of anxious attachment and over protection by caregivers were uniquely related to metacognitive capacity.

Efficacy and tolerability of switching to ziprasidone from olanzapine, risperidone or haloperidol: an international, multicenter study.

To compare the effectiveness of a switch from haloperidol (N=99), olanzapine (N=82), or risperidone (N=104) to 12 weeks of treatment with 80-160 mg/day ziprasidone in patients with stable schizophrenia or schizoaffective disorder. Stable outpatients with persistent symptoms or troublesome side effects were switched using one of three 1-week taper/switch strategies as determined by the investigator. Efficacy was assessed using the Brief Psychiatric Rating Scale score, Clinical Global Impression, Positive and Negative Symptom Scale, Montgomery-Asberg Depression Rating Scale, and the Global Assessment of Functioning Scale, and tolerability by using standard measures of weight change, extrapyramidal symptoms, and laboratory findings. Suboptimal efficacy was the primary reason for switching. The preferred switch strategy was immediate discontinuation, and the preferred dosing regimen was 120 mg/day. Completer rates were 68, 60, and 86% in the haloperidol, risperidone, and olanzapine pre-switch groups, respectively. At week 12, a switch to ziprasidone resulted in statistically significant improvement from baseline on the Brief Psychiatric Rating Scale score, Clinical Global Impression-Improvement, Positive and Negative Symptom Scale, and Global Assessment of Functioning scales, reduction in extrapyramidal symptoms and a neutral impact on metabolic parameters. Switch from olanzapine and risperidone resulted in weight reduction and from haloperidol in some weight increase. In conclusion, oral ziprasidone of 80-160 mg/day with food was a clinically valuable treatment option for stable patients with schizophrenia or schizoaffective disorder experiencing suboptimal efficacy or poor tolerability with haloperidol, olanzapine, or risperidone.

Developing a quality of life instrument in patients with psoriasis: the Psoriasis Quality of Life Questionnaire (PQLQ).

BACKGROUND AND DESIGN: Psoriasis is a chronic skin disease which causes psychological, social and physical problems and affects quality of life. The aim of this study was to develop a quality of life instrument for patients with psoriasis which is suitable for Islamic populations. MATERIALS AND METHODS: The psychosocial and daily life problems defined by 75 patients with psoriasis, their relatives and physicians were used to construct a questionnaire, the reliability and validity of which were determined in a group of 156 patients with psoriasis. RESULTS: For reliability, Chronbach's alpha coefficient was 0.87, and item-total correlations were between 0.37 and 0.60 for internal consistency. There was high test-retest reliability (r = 0.98, P < 0.001). For validity, three factors were extracted in the principal components method for construct validity. The maximum factor loadings of each item were between 0.456 and 0.681. For convergent validity, all patients' self-ratings and Psoriasis Area and Severity Index (PASI) were correlated with the questionnaire score (P < 0.001). CONCLUSION: The questionnaire consisting of 17 items was found to be suitable for both epidemiologic and clinical trials.

Postnatal depression in turkey: epidemiological and cultural aspects.

BACKGROUND: In some periods of a woman's life the risk of depression increases and the postnatal period is one of these. The prevalence and the risk factors of postnatal depression are not systematically studied in Turkey. The aim of this study is to investigate the epidemiological aspects and the cultural factors that may affect postnatal depression in our country. METHOD: According to the records of ten primary health care centres in Manisa, a city in western Turkey, there were 1,337 women who had given birth in the previous 6 months. A sample group of 317 mothers were randomised among these women and 257 (81.7%) of the sample group could be reached. Data were collected by use of the Edinburgh Postnatal Depression Scale and a questionnaire on sociodemographic variables designed for this study. RESULTS: The mean depression score was found to be 7.54 +/- 4.66. When the cut-off point was taken into consideration, 14% of mothers had a syndromal depression. The factors which affected the prevalence of depression were the number of living children, living in a shanty, being an immigrant, serious health problems in the baby, previous psychiatric history, psychiatric disorder in the spouse, and having bad relations with the spouse and his parents. CONCLUSION: These findings revealed that the prevalence of postnatal depression in the Manisa province and the factors affecting it were very similar to other studies; but the negative impact of bad relations of the mother with her family-in-law on postnatal depression seems to be a distinguishing aspect of Turkish culture.