Assessment of the Psychological Effect of the COVID-19 Pandemic on Patients with Generalized Anxiety Disorder.

BACKGROUND: The pandemic caused by the coronavirus disease of 2019 (COVID-19) has affected the mental health of the general population, leading to an increase in depression, anxiety and stress. The results of the studies on the psychological effects of the pandemic in patients with psychiatric illnesses were contradictory in that some reported higher adverse effects in patients with psychiatric illnesses compared to the healthy control subjects, whereas some did not. Thus, the aim of this study is to compare the patients with a diagnosis of generalized anxiety disorder and the healthy control subjects in terms of certain psychological parameters during the pandemic period. SUBJECTS AND METHODS: 81 patients, who were diagnosed with generalized anxiety disorder and 80 healthy volunteers of matching characteristics were included in this study. Both the patient and control groups were administered a sociodemographic questionnaire, short form of the Depression, Anxiety and Stress Scale (DASS-21) and the Revised Impact of Event Scale (IES-R). The resulting research data were analyzed using the SPSS 22.0 software. RESULTS: No significant difference was found between the two groups in terms of depression, stress, intrusion, hyperarousal and avoidance. On the other hand, the increase observed in the anxiety symptoms was found to be significant in the patient group compared to the control group. CONCLUSION: The findings of this study revealed that the depression, stress and trauma-related stress responses of GAD patients have not differred during the COVID-19 pandemic period, whereas that their anxiety levels have increased significantly, as compared to the healthy control subjects. In this context, it is recommended that the clinicians take into consideration that the pandemic may lead to an increase in the symptoms of individuals diagnosed with anxiety disorder.

Evaluation of inflammatory parameters in patients who attempted suicide by taking drugs.

OBJECTIVES: Neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and mean platelet volume (MPV) are markers reflecting the inflammation process that can be easily calculated in the hemogram examination. In this study, we aimed to investigate the changes in NLR, PLR and MPV values ​​in patients who attempted suicide by taking drugs. METHODS: In total, 124 patients who were admitted to the emergency department after attempting suicide by taking drugs and who were followed up in the internal medicine department for observation purposes for 24-72 hours were included in the study. The study was retrospective and the data of the patients were recorded by scanning the hospital automation system. The NLR, PLR and MPV of the patients at the time of admission to the emergency department and at the time of discharge were evaluated and compared with each other. RESULTS: The NLR and PLR values ​​of the patients at admission were found to be significantly higher than those values ​​at discharge. In our study, NLR and PLR values were found to be high during the period when patients attempted suicide. CONCLUSION: The high detection of these markers of inflammation suggests that it may be a marker predictive of suicide attempt by taking medication (Tab. 4, Ref. 28).

The molecular basis and genotype-phenotype correlations of congenital adrenal hyperplasia (CAH) in Anatolian population.

Congenital adrenal hyperplasia (CAH) is an autosomal recessive genetic disorder due to presence of mutations in the genes involved in the metabolism of steroid hormones in adrenal gland. There are two main forms of CAH, classic form and non-classic form. While classic form stands for the severe form, the non-classic form stands for the moderate and more frequent form of CAH. The enzyme deficiencies such as 21-hydroxylase, 11-beta-hydroxylase, 3-beta-hydroxysteroid dehydrogenase, 17-alpha-hydroxylase deficiencies are associated with CAH. In this study, we aimed to investigate CYP21A2, CYP11B1, HSD3B2 genes which are associated with 21-hydroxylase, 11-beta-hydroxylase and 3-beta-hydroxysteroid dehydrogenase enzyme deficiencies, respectively, in 365 individuals by using Sanger sequencing method. We emphasized the classification of variants according their disease causing potential, and evaluated variants' frequencies including newly discovered novel variants. As a result, 32 variants of CYP21A2 including 10 novel variants, 9 variants of CYP11B1 including 3 novel variants and 6 variants of HSD3B2 including 4 novel variants were identified. The conclusions of our study showed that in Anatolia, discovery of novel variants is quite common on account of tremendous ratios of consanguineous marriages which increases the frequency of CAH. These results will contribute to the understanding of molecular pathology of the disease.

Hopelessness and life satisfaction in patients with serious mental disorders: A cross-sectional study.

OBJECTIVE: The main purpose of treatment and management in chronic mental disorders is to improve the quality of life (QOL). Hopelessness indicates a significant cognitive vulnerability that is associated with suicide risk. It is important for clinicians to have information about their patients' life satisfaction and spirituality. This study was conducted to determine hopelessness and life satisfaction in patients who received service from a community mental health center (CMHC). METHODS: This cross-sectional study was conducted with patients diagnosed with psychosis (n=66) and bipolar disorder (n=24) according to Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) criteria, at a community mental health center serving in a hospital located in eastern Turkiye. Data was collected by a psychiatrist between January and May 2019 with face-to-face interviews, using a questionnaire, Beck Hopelessness Scale (BHS) and Satisfaction with Life Scale (SWLS). RESULTS: In the study, it was found that the mean BHS and SWLS scores of the patients did not differ significantly between the diagnosis groups (p>0.05). A moderately negative correlation was found between the patients' mean BHS and SWLS scores (rs=-0.450, p<0.001). In addition, it was determined that the hopelessness level of the secondary school graduates was low (p<0.05), the mean BHS score increased as the age and time from diagnosis of the patients increased (p<0.001), and there was a low negative correlation between the time from diagnosis and the mean SWLS score (rs: -0.208; p<0.05). CONCLUSION: In this study, it was found that the hopelessness level of the patients was low, their life satisfaction was moderate, and as the hopelessness level increased, their life satisfaction decreased. In addition, it was determined that the hopelessness and life satisfaction levels of the patients did not differ by to the diagnosis groups. It is extremely important for mental health professionals to consider aspects such as hope and life satisfaction, which are key in the recovery of patients.

A case of dose-dependent lithium-induced tardive dyskinesia.

Tardive dyskinesia (TD) is a serious side effect that manifests itself mainly with choreiform and athetotic movement disorders, and generally occurs in the long term during antipsychotic treatments and is generally irreversible. We report a 67-year-old female patient having a diagnosis of Bipolar Disorder (BD) for 25 years, receiving 1200 mg/day lithium monotherapy for 10 years and in remission. The patient had been showing signs of TD-like syndrome for the last 6 months. Because the patient responded to lithium well and because other treatment options for TD were unsuccessful, the lithium dose was reduced to 600 mg/day and the patient was monitored. Three months after the dose reduction, the patient's remission state continued, and the TD findings regressed. TD mainly due to antipsychotics is known as irreversible. This case suggests that lithium-induced TD may be reversible in a dose-dependent manner.

Healthcare workers' socio-psychological status after a year with COVID-19 pandemic: a cross-sectional face-to-face survey in Erzincan, Turkey.

Introduction: on January 7th 2020, SARS-CoV-2 was identified in Wuhan, China, and on March 11th, 2020, the World Health Organization declared it a "Pandemic". The aim of this research is to assess depression, anxiety, work, and social status in healthcare workers during the COVID-19 pandemic. Methods: the research was designed to be a cross-sectional face-to-face survey. The study included 111 healthcare employees and 222 non-healthcare workers between the ages of 18 and 65 who applied to the hospital. For some reason, no one was excluded from the research. Socio-demographic and lifestyle-related questions, depression, anxiety, work-social adjustment scores, and pandemic-social status-operation connections were all assessed using a self-report questionnaire containing psychometric measures. Results: the mean age of the participants in the study was 33.67±10.01 and 59% of the participants were female. PHQ9: 11.67±6.41, GAD7: 9.06±5.81, and W&SAS: 17.55±10.98 were the scores of the healthcare professional groups. PHQ9: 10.25±6.21, GAD7: 7.59±5.65, and W&SAS: 14.75±10.27 were the non-healthcare professional groups' results. When the PHQ9, GAD7, and W&SAS scores of both groups were compared, there was no statistically significant difference in the PHQ9 depression score between the two groups (p=0.107), the GAD7 (p<0.05) and W&SAS (p<0.05) scores of the healthcare professionals were statistically significantly higher. Conclusion: in comparison to the non-healthcare worker group, healthcare professionals had the same level of depression, greater levels of moderate and high anxiety, and higher levels of work-social adjustment disorder. Unlike the literature, we found that the degree of depression fell to the same level as the non-health professional group in our study, but it was still disadvantaged in terms of anxiety and work-social adjustment.

Atherogenic index of plasma as a cardiovascular risk marker in manic, depressive, and euthymic stages of bipolar disorder.

OBJECTIVE: Individuals with bipolar disorder (BD) frequently suffer from cardiovascular disease (CVD), and it is a leading cause of mortality. Clinicians use routine laboratory tests, including a lipid profile, to predict cardiovascular risk. In addition, a particular lipid ratio, the atherogenic index of plasma (AIP), is a sensitive, new parameter that can be used to assess highrisk groups. To our knowledge, this is the first study evaluating cardiovascular risk via AIP in different stages of BD. METHODS: The study group consisted of male patients with BD who were in a manic, depressive, or euthymic state, and age- and gender-matched healthy controls. Lipid profiles were analyzed and the AIP parameter of logarithm of triglyceride (TG) / high-density lipoprotein cholesterol (HDLc) was calculated for all of the participants. The significance level was set at p<0.05. RESULTS: A total of 44 BD patients experiencing a manic episode, 35 depressive BD patients, 42 euthymic patients, and 41 healthy controls matched for age, gender, and smoking status were enrolled in the study. The AIP level was significantly different between groups (p=0.009). Pairwise comparisons of the groups revealed that the AIP level of depressive patients was significantly higher than that of the manic, euthymic, and control groups (p=0.013, p=0.048, and p=0.021, respectively). The AIP level was positively correlated with body mass index, waist circumference, metabolic syndrome, total cholesterol, low-density lipoprotein, and triglyceride level, and was negatively correlated with the HDLc level. CONCLUSION: In this study, male BD patients in a depressive episode demonstrated an increase in cardiovascular risk. The significant correlations between AIP and other conventional cardiovascular risk factors indicate that AIP may be more useful to identify individuals with BD at high risk for CVD than absolute lipid parameters.

Serum NUCB2/nesfatin-1 levels in different stages of alcohol dependence: Is there a relationship with craving?

INTRODUCTION: In the literature, the relationship between appetite regulating peptides and alcohol craving is on the debate. AIM: This study aims to investigate serum level of NUCB2/nesfatin-1, which is discovered as appetite-related neuropeptide, in patients with alcohol dependence who were in craving and abstaining phase and to compare with healthy controls. SETTINGS AND DESIGN: Research, Treatment, and Training Center for Alcohol and Substance Dependence, (AMATEM) Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, case-control and prospective study design were used. STATISTICAL ANALYSIS: Chi-square, Mann-Whitney U, paired samples, independent samples t- and Pearson correlation tests were used for analysis. MATERIALS AND METHODS: Forty-three patients with alcohol dependence who have been admitted for detoxification and thirty healthy controls were included in the study. The blood samples were drawn after the 1st day of admission and postdetoxification treatment in inpatients who reached to abstinence period and from 30 healthy controls. The Penn Alcohol Craving Scale and the Obsessive Compulsive Drinking Scale were applied to detect craving scores. RESULTS: Initial serum NUCB2/nesfatin-1 levels in patients were significantly lower than in the healthy control group (P < 0.001). The NUCB2/nesfatin-1 level of initial phase was significantly lower than abstinence phase (P = 0.027). No correlation was found between craving scores and NUCB2/nesfatin-1 level (P > 0.05). CONCLUSION: This study is the first that showed significant differences of serum NUCB2/nesfatin-1 level according to different stages of alcohol dependence. Plasma NUCB2/nesfatin-1 levels were lower in highest craving phase and tended to normalize after abstinence. Since we could not find a correlation between craving and NUCB2/nesfatin-1 levels, the increase of NUCB2/nesfatin-1 in abstinence phase might have been resulted from other reasons apart from craving.

Serum soluble urokinase-type plasminogen activator receptor levels in male patients with acute exacerbation of schizophrenia.

Inflammatory abnormalities have been shown in the pathogenesis of schizophrenia. Soluble urokinase-type plasminogen activator receptor (suPAR) is a protein that is measurable in the circulating blood and reflects the inflammation in the body. We aimed to investigate serum suPAR levels in patients with schizophrenia who were in acute state and to compare with healthy controls. Forty five patients and 43 healthy controls were included in the study. We found no significant difference in suPAR levels between patients and controls, suggesting that suPAR as an inflammatory marker does not have a role in the inflammatory process of acute schizophrenia.

Neutrophil-lymphocyte and platelet-lymphocyte ratios as inflammation markers for bipolar disorder.

In the present study we investigated the involvement of inflammatory cells and their ratios as inflammation markers in Bipolar Disorder. We have enrolled 61 manic, 55 euthymic patients and 54 control subjects to the study. Neutrophil-lymphocyte and platelet-lymphocyte ratios were found significantly higher in both manic and euthymic patients compared to control group. These findings suggest that the inflammatory cells have a role in the pathophysiology of bipolar disorder manic and even in euthymic state.

Plasma BDNFs level initially and post treatment in acute mania: comparison between ECT and atypical antipsychotic treatment and healthy controls.

BACKGROUND: Inconsistent findings concerning brain-derived neurotrophic factor (BDNF) levels across different episodes in bipolar disorder have been reported, which is also in line with the treatment effects on BDNF levels in acute mania. We aimed to compare plasma BDNF level alterations after pure antipsychotic drug or ECT plus antipsychotic drug treatment in acute mania. METHODS: Sixty-eight patients with mania were divided into two treatment arms: the antipsychotic treatment arm (AP) and electroconvulsive therapy (ECT)+AP arm. In addition, 30 healthy controls were included in the study. RESULTS: There was no significant statistical difference according to mean age, education level, marital and working status between patients and healthy controls. The initial serum BDNF level in patients with acute mania was significantly lower than healthy controls. The initial BDNF level between the ECT arm and AP arm was not significant. The BDNF level decreased significantly after reaching remission in patients with acute mania. The change in BDNF level in the AP arm was not significant while in the ECT arm it was significant after treatment. CONCLUSIONS: In this study, for the first time we revealed a significant decrease in BDNF levels after ECT sessions in acute manic patients. Besides clinical remission after treatment in acute mania, the decrement in BDNF levels does not seem to be related to clinical response. Thus cumulative effects of mood episodes for the ongoing decrease in BDNF levels might be borne in mind despite the achievement of remission and/or more time being required for an increase in BDNF levels after treatment.