Social Cognition in Opioid Use Disorder.

Background: Opioid use disorder (OUD) is associated with significant functional impairment and neurocognitive dysfunction, but only a handful of studies have investigated social cognitive abilities in this condition. This study aimed to investigate facial emotion recognition accuracy/biases and two different aspects of theory of mind (ToM) (ToM-decoding vs ToM-reasoning) in people with recovered OUD. Methods: The participants included 32 people with recovered OUD who were on Buprenorphine + Naloxone (B/N) maintenance treatment and 32 healthy controls. In addition to neurocognitive tasks, both groups were assessed by a facial emotion recognition task, the faux pas recognition task, and the reading the mind from the eyes task. Results: In comparison to healthy controls, people on B/N maintenance treatment showed deficits in facial emotion recognition (d = 1.32) and both aspects of ToM (d = 0.87-1.21). In analyses of individual emotions, people on B/N maintenance treatment had decreased accuracy in recognition of anger and fear and had a bias to identify other emotions as sad. The duration of opioid use was robustly associated with difficulties in the recognition of anger. Conclusion: People in B/N maintenance treatment have significant difficulties in recognizing the emotions and mental states of others. Deficits in social cognition might be important for understanding the difficulties in interpersonal and social functioning in people with OUD.

Alexithymia and emotional intelligence in patients with panic disorder, generalized anxiety disorder and major depressive disorder.

Emotional Intelligence (EI) is a broad personality construct signifying the ability to perceive and to regulate affects within oneself. Alexithymia is another personality construct denoting difficulty in identifying and expressing emotions, with an externally oriented thinking style. Although previously considered to be independent, some studies have shown that these constructs overlap. The aim of this study was to evaluate and compare the levels of EI and alexithymia in patients with panic disorder, major depressive disorder (MDD), and generalized anxiety disorder (GAD). The subjects included 171 psychiatric patients and 56 non-clinical controls. Psychiatric diagnoses were based on DSM-IV criteria. The Emotional Intelligence Scale-34 (EIS-34) and the Toronto Alexithymia Scale (TAS-20) were used to assess EI and alexithymia. All three patient groups scored statistically significantly higher than the non-clinical controls on TAS-20 total score and the TAS-20 subfactors of difficulty identifying feelings and difficulty describing feelings. EIS-34 scores were lower in patient groups than in the non-clinical controls, but only the EIS-34 intrapersonal subscale was significant difference. Total TAS-20 and EIS-34 scores in the patient cohort were inversely and significantly correlated These results reaffirm an overlap between EI and alexithymia with the intrapersonal factor of EI to be more dependent on the difficulty identifying feelings dimension of alexithymia in subjects with MDD and GAD.

Associations Between Blood Levels of NLRP3 Inflammasome Components and Obsessive Compulsive Disorder.

Introduction: Even though the effect of inflammation on pathogenesis of obsessive compulsive disorder (OCD) is known, information regarding the underlying mechanisms are yet to be revealed. The NLRP3 inflammasome complex is an important component of the innate immune system that initiates and mediates inflammatory response to a variety of stimuli. This study aims to inquire into a possible association between NLRP3 inflammasome complex and OCD. Methods: This case-control study included 103 participants (51 cases with OCD and 52 healthy controls). All participants were evaluated with the Yale Brown Obsessive Compulsive Scale, Hamilton Depression Scale, and Hewitt Multidimensional Perfectionism Scale. RNA and proteins were extracted from peripheral blood mononuclear cells. Expression of NLRP3 inflammasome components were determined using quantitative real-time polymerase chain reaction (PCR) and Western blotting. Levels of Serum IL-1beta and IL-18 cytokine were determined by ELISA. Results: NEK7 and CASP1 mRNA levels were significantly higher in OCD patients, compared to controls. Pro-caspase-1 protein levels were elevated, as well. Regression analysis showed that NEK7 mRNA and pro-caspase-1 protein levels can differentiate OCD and healthy control groups. Conclusion: Our results provide insight into the molecular alterations that could explain the inflammation-OCD association.

The Relationship Between Cardiovascular Disease Risk and Major Depression.

Introduction: Cardiovascular risk in depression has been investigated in small clinical samples and population-based studies revealing inconclusive results. However, cardiovascular risk in drug-naive depressed patients has not been tested extensively. Methods: Body mass index-based Framingham Cardiovascular Risk Scores and soluble intercellular adhesion molecule-1 (sICAM-1) levels were used to assess the risk of cardiovascular disease in drug-naive depressed patients and healthy volunteers. Conclusion: There were no significant differences in Framingham Cardiovascular Risk Scores and individually assessed risk variables between patients and healthy controls (HC). Both groups were comparable in terms of sICAM-1. Results: The widely recognized association between cardiovascular risk and major depression might be more prominent in older depressed patients and patients with recurring episodes.

Ethnic and migrational impact on the clinical manifestation of depression.

PURPOSE: Depressive disorders are still underdiagnosed. Ethnic and cultural factors may influence the way depression is presented and therefore contribute to problems in assessing these disorders in different ethnic populations appropriately. In this investigation, the impact of both ethnicity and migration on the manifestation of depression was studied. METHODS: Three groups of depressed female patients (n = 136) were included in this investigation on the variation in depressive symptomatology by ethnic groups. Group 1 consisted of Austrian patients living in Austria, group 2 were Turkish patients who had migrated to Austria and group 3 were Turkish patients living in Turkey. Participants were rated using the Montgomery-Åsberg Depression Rating Scale (MADRS), the Beck Depression Inventory (BDI), the Bradford Somatic Inventory (BSI) and an additional list of physical symptoms. RESULTS: Both Turkish groups had significantly higher BSI scores and more somatic symptom severity. Migrated Turkish patients scored significantly higher in the items headache, backache and dry mouth than Turkish patients in Turkey. In addition, there were between-group differences in non-physical symptoms. CONCLUSIONS: Depressive symptomatology varies between ethnic groups. These differences are mainly due to ethnicity as such but migration may play an additional role. It is essential for physicians to be aware of atypical presentation forms of depression in minority groups.

Increased telomerase activity in major depressive disorder with melancholic features: Possible role of pro-inflammatory cytokines and the brain-derived neurotrophic factor.

The biological mechanisms responsible for depression symptoms are not yet understood. For this reason, it is important to reveal the etiopathogenetic mechanisms in this disease. This study aims to compare the levels of pro-inflammatory cytokines, Brain-Derived Neurotrophic Factor (BDNF), and telomerase activity in patients with major depressive disorder (MDD) and healthy controls. Plasma BDNF, interleukin-6 (IL-6), IL-1beta, and Tumor Necrosis Factor-alpha (TNF-alpha) levels, and telomerase activity were measured in 39 patients with major depression and 39 healthy controls matched with patients in terms of age, gender, and education year. Plasma concentration of BDNF, IL-6 levels, and telomerase activity was significantly different between patients with MDD and healthy controls. Correlation analysis showed a positive trend between plasma BDNF levels and plasma IL-6 levels in patients with MDD with melancholic features. Furthermore, the path analysis results showed that the telomerase activity was indirectly affected by gender, IL-1ß, IL-6, BDNF, and BMI, via the severity of depression and anxiety and MDD status as the mediators. Further studies are needed to examine the molecular mechanism of the telomerase activity and the role of BDNF and pro-inflammatory cytokines in the telomerase activation in MDD.

Maternal psychiatric status and infant wheezing: The role of maternal hormones and cord blood cytokines.

RATIONALE: Maternal psychosocial stress might be associated with development of allergic diseases in the offspring. OBJECTIVES: To evaluate the association of maternal depression and anxiety with ever wheezing and recurrent wheezing among infants and to assess the role of maternal hypothalamo-pituatary-adrenal axis changes and fetal immune response in this association. METHODS: This study encompasses two designs; cohort design was developed to evaluate the association of prenatal depression with development of wheezing in infants while nested case-control design was used to assess the role of maternal cortisol and tetranectin and cord blood interleukin 13 and interferon γ. RESULTS: We enrolled 697 pregnant women. Elementary school graduate mother (odds ratio [OR] = 1.5, p = .06), maternal smoking during pregnancy (OR = 3.4, p = .001), familial history of asthma (OR = 2.7, p < .001) increased the risk of ever wheezing. Elementary school graduate mother (OR = 2.6, p = .002), maternal smoking during pregnancy (OR = 4.8, p < .001) and familial history of asthma (OR = 1.7, p = .01) increased the risk of recurrent wheezing. Maternal previous psychiatric disease, or Edinburgh Postnatal Depression Scale or Spielberger State-Trait Anxiety Inventory scores were not associated with wheezing. Maternal tetranectin levels were significantly higher among never wheezers compared to the ever wheezers (264.3 ± 274.8 vs. 201.6 ± 299.7, p = .04). CONCLUSIONS: In conclusion, the major risk factors for ever wheezing and recurrent wheezing were maternal smoking, level of education and family history of asthma. However, maternal depression and anxiety were not determined as risk factors for wheezing. Maternal tetranectin carries potential as a biomarker for wheezing in the infant.

History of suffocation, state-trait anxiety, and anxiety sensitivity in predicting 35% carbon dioxide-induced panic.

The aim of this study was to examine the effects of history of suffocation, state-trait anxiety, and anxiety sensitivity on response to a 35% carbon dioxide (CO2) challenge in panic disorder patients, their healthy first-degree relatives and healthy comparisons. Thirty-two patients with panic disorder, 32 first-degree relatives, and 34 healthy volunteers underwent the 35% CO2 challenge. We assessed baseline anxiety with the Anxiety Sensitivity Index (ASI) and State-Trait Anxiety Inventory (STAI1), and panic symptoms with the Panic Symptom List (PSL III-R). A history of suffocation was associated with greater risk of CO2 reactivity in the combined sample. Patients had more anxiety sensitivity and state and trait anxiety than relatives and healthy comparisons; the difference between relatives and healthy comparisons was not significant. In female patients, trait anxiety predicted CO2-induced panic. Having a CO2-sensitive panic disorder patient as a first-degree relative did not predict CO2-induced panic in a healthy relative. History of suffocation may be an important predictor of CO2-induced panic. Trait anxiety may have a gender-specific relation to CO2 reactivity.

[The validity and reliability of the Turkish version of the anxiety sensitivity index-3]. / Anksiyete Duyarliligi Indeksi-3'ün Türkçe Formunun Geçerlik ve Güvenilirlik Calismasi.

OBJECTIVE: Anxiety sensitivity has been defined as an excessive fear from senses and symptoms of anxiety. The aim of the present study is to investigate the validity and reliability of Anxiety Sensitivity Index-3 (ASI-3) and adapting it into Turkish. METHOD: The study group consisted of 150 healthy individuals without any psychiatric disorder and 300 patients with an anxiety disorder and/or major depressive disorder according to DSM-IV criteria. All subjects included in the study were evaluated by means of the Mini International Neuropsychiatric Interview, ASI-3, Anxiety Sensitivity Index (ASI), State-Trait Anxiety Inventory-Trait Form (STAI-T), Beck Depression Inventory (BDI) and Somatosensory Amplification Scale (SAS). RESULTS: The validity part of the study revealed that the scale differentiates the patients from the healthy group in all patient subgroups except for anxiety disorder NOS. The scale was found to be highly correlated to ASI (r=0.85) and moderately correlated to STAI-T (r=0.68), BDI (r=0.57) and SAS (r=0.47). In factor analysis, ASI-3 was found to be composed of 3 factors: physical, cognitive and social. It was also found that ASI-3 had a high internal consistency (Cronbachalpha=0.93) and the scale had a fairly good test-retest reliability (r=0.64, p<0.001). CONCLUSION: According to the present study, the ASI-3 Turkish version was shown to be a valid and a reliable scale.

[Undergraduate psychiatric training in Turkey]. / Türkiye'de Mezuniyet Oncesi Psikiyatri Egitiminin Bugünü

OBJECTIVE: The current trend in medical education is to abandon the experience-based traditional model and embrace the competency-based education model (CBE). The basic principle behind CBE is standardization. The first step in standardization is to determine what students must know, what they must accomplish, and what attitude they should display, and the establishment of educational goals. One of the goals of the Psychiatric Association of Turkey, Psychiatric Training Section is to standardize psychiatric training in Turkish medical schools. This study aimed to determine the current state of undergraduate psychiatric training in Turkish medical schools. METHOD: Questionnaires were sent to the psychiatry department chairs of 41 medical schools. Data were analyzed using descriptive statistical methods. RESULTS: Of the 41 department chairs that were sent the questionnaire, 29 (70%) completed and returned them, of which 16 (66.7%) reported that they had already defined goals and educational objectives for their undergraduate psychiatric training programs. The Core Education Program, prepared by the Turkish Medicine and Health Education Council, was predominately used at 9 (37.5%) medical schools. Pre-clinical and clinical training schedules varied between medical schools. In all, 3 of the medical schools did not offer internships in psychiatry. The majority of chairs emphasized the importance of mood disorders (49.9%) and anxiety disorders (40%), suggesting that these disorders should be treated by general practitioners. Computer technology was commonly used for lecturing; however, utilization of interactive and skill-based teaching methods was limited. The most commonly used evaluation methods were written examination (87.5%) during preclinical training and oral examination (91.6%) during clinical training. CONCLUSION: The most important finding of this study was the lack of a standardized curriculum for psychiatric training in Turkey. Standardization of psychiatric training in Turkish medical schools must be developed.

[Character and temperament dimensions of patients with temporomandibular disorder]. / Temporomandibuler bozuklugu olan hastalarda mizaç ve karakter boyutlari.

OBJECTIVE: The nature of the relationship between personality and temporomandibular disorder is an important, but still unexplored question. The objective of this study was to assess the personality profile of a sample of patients with temporomandibular disorder using the Temperament and Character Inventory (TCI). METHOD: The study included 81 patients [17 male (21%) and 64 female (79%)] with temporomandibular disorder and 80 healthy control subjects [15 male (18.75%) and 65 female (81.25%)]. A Turkish version of TCI was used for personality self-assessment. The data were evaluated with multivariate analyses of variance. RESULTS: Multivariate analyses of variance showed that the temperamental dimension, novelty seeking (F= 8.61, P= 0.004), was associated with temporomandibular disorder. Higher novelty seeking is thought to be linked to higher impulsiveness, exploratory excitability, and disorderliness. Also, there were significant differences between patients and healthy subjects on fatigability, purposefulness, compassion, and principled subscales of TCI. Gender differences were also found for different temperament and character dimensions. Women scored significantly higher on the self-directedness dimension, whereas male patients with temporomandibular disorder had significantly higher scores on the temperamental dimension of harm avoidance and its sub-dimension, shyness. CONCLUSION: Our study offers clinical evidence of the relationship between temporomandibular disorder and the personality profile of a high level of novelty seeking, which is considered to be associated with cluster B personality disorders. Assessing personality in patients with temporomandibular disorder should be considered while implementing treatment.

Development of social anxiety disorder secondary to attention deficit/hyperactivity disorder (the developmental hypothesis).

Social anxiety disorder (SAD) may develop secondary to childhood attention deficit/hyperactivity (ADHD) in a subgroup of the patients with SAD. Patients pass through a number of identifiable stages of developmental pathways to SAD as they grow up. Patients with ADHD have maladaptive behaviours in social settings due to the symptoms of ADHD. These behaviours are criticized by their parents and social circle; they receive insults, humiliation and bullying. After each aversive incident, the individual feels shame and guilt. A vicious cycle emerges. The patients then develop social fears and a cognitive inhibition that occurs in social situations. The inhibition increases gradually as the fear persists and the individual becomes withdrawn. Patients start to monitor themselves and to focus on others' feedback. Finally, performative social situations become extremely stimulating for them and may trigger anxiety/panic attacks. If this hypothesis is proven, treatment of 'patients with SAD secondary to ADHD' should focus on the primary disease.

Basilar artery blood flow velocity changes in patients with panic disorder following 35% carbon dioxide challenge.

PURPOSE: We compared the mean basilar artery blood flow velocity (BABFV) between patients with panic disorder and healthy subjects both at rest and immediately following carbon dioxide (CO(2)) challenge, and examined the effects of treatment on BABFV. METHODS: Twenty four patients with panic disorder with or without agoraphobia and 12 healthy comparison subjects were studied. Visual Analog Anxiety Scale was used to evaluate the anxiogenic effect of 35% CO(2) inhalation. Mean BABFV was monitored using transcranial Doppler ultrasonography at rest and 10, 20, 30, 60, 90, 120 s after 35% CO(2) challenge both before and after four weeks treatment with paroxetine. RESULTS: The hemodynamic response pattern of basilar artery to CO(2) inhalation was significantly different between two groups. CO(2) rapidly triggered blood flow velocity in basilar artery amongst panic patients but not in healthy comparisons. The mean time to normalization of BABFV was significantly longer in panic patients. Four weeks of treatment with paroxetine led to a significantly reduced mean BABFV after 35% CO(2) inhalation in comparison with pretreatment. CONCLUSIONS: Patients with panic disorder had impaired cerebral regulatory mechanisms observed as a change in response characteristics in BABFV in response to CO(2) inhalation. Treatment with paroxetine reduced the increase of BABFV seen in patients after the CO(2) challenge.

Vestibular migraine patients are more anxious than migraine patients without vestibular symptoms.

The link between vertigo and anxiety is well known. The aim of this study is to compare anxiety disorders in 3 groups: patients with vestibular migraine (VM), patients with migraine but without vertigo (MO) and healthy controls (HC).We performed cross-sectional analysis of following tests: (a) Hamilton Anxiety Rating Scale (HAMA); (b) State-Trait Anxiety Inventory (STAI-X1 and STAI-X2); (c) Beck Depression Inventory (BDI); (d) Panic-Agoraphobic Scale and (e) Penn State Worry Questionnaire (PSWQ). ANOVA, Kruskal-Wallis and Chi-square tests were used for comparisons and least significant difference was used for further post-hoc analysis. There were 35 definite VM patients, 31 MO patients and 32 volunteer HC. There were no significant differences between three groups in age, total years of education or duration of headaches in VM and MO patients. On the other hand, vertigo severity  was moderately and positively correlated with headache severity and with headache duration. There were significant differences in scores of HARS, BDI, PSWQ, and various PAS-R sub-scales between the three groups. Our study shows that VM patients are significantly more anxious and agoraphobic than MO patients and HC, displaying higher sensitivity to separation and being more prone to seeking medical reassurance.

[Factorial structure, validity, and reliability of the Turkish temperament and character inventory]. / Mizaç ve Karakter Envanteri'nin Türkçe Formunun Faktör Yapisi, Geçerlik ve Güvenilirligi.

OBJECTIVE: To assess the factorial structure, reliability and validity of the Turkish version of the Temperament and Character Inventory (TCI), a 240-item, self-report, paper-and-pencil test, and true-false format inventory based on Cloninger's psychobiological model of personality. It measures the four higher-order temperament dimensions and three character dimensions. METHOD: Using samples consisting of 470 healthy volunteers and 544 psychiatric patients, psychometric features were explored. RESULTS: The internal consistency of the scales was good (Cronbach alpha coefficients between 0.68 and 0.84), but weak for Reward dependence (0.55) and Persistence (0.56). The factor structures of the temperament and character dimensions, explored separately, were in agreement with the hypothesized constructs, except for the scales NS1 (Novelty Seeking 1 = exploratory excitability) and SD4 (Self-directedness 4 -- self-acceptance). The present study also confirmed that the TCI scales were weakly related among themselves. On the whole, psychiatric patients had higher harm avoidance and lower self-directedness, persistence, cooperativeness, and self-transcendence scores than the normal subjects. Gender differences were also found for different dimensions. CONCLUSION: The findings of this study suggest that the TCI can be applied in the investigation of psychiatric and normal populations.

[Anxiety disorder due to epilepsy: a case report]. / Epilepsiye Bagli Anksiyete Bozuklugu Olgusu.

Epileptic patients present with psychiatric disorders more frequently than the general population and patients with other chronic medical conditions. Psychiatric disorders can co-occur with epilepsy and can be caused by epilepsy. Personality changes, as well as psychosis, and mood or anxiety disorders can occur in association with epilepsy. Anxiety disorders due to epilepsy can manifest as generalized anxiety disorder, panic disorder, phobias, or obsessive-compulsive disorder. The risk of an anxiety disorder is higher in patients with focal epilepsy, especially those with temporal lobe epilepsy, but an anxiety disorder can also occur in patients with frontal lobe epilepsy or generalized tonic-clonic epilepsy. Herein we present a 41-year-old female patient with comorbid anxiety disorder and epilepsy that improved following initiation of antiepileptic medication. The patient's EEG showed abnormalities, particularly in the frontal lobe. Epileptic activation-associated anxiety disorder presented as phobia of swallowing and the patient exhibited features of generalized anxiety disorder. Following initiation of antiepileptic medication, the seizures stopped and the symptoms of anxiety disappeared in two weeks. The patient was receiving psychotherapy once every 2 weeks. The patient remained asymptomatic during 2-years of follow-up. This case highlights the importance of differential diagnosis of underlying epilepsy in patients with acute severe anxiety and the efficacy of proper medical treatment, which was given in the presented case for the underling pathology of anxiety.

Comparison of Cognitive Impairment between Patients having Epilepsy and Psychogenic Nonepileptic Seizures.

INTRODUCTION: The aim of this study was to evaluate cognitive impairment in patients having epilepsy or psychogenic nonepileptic seizures (PNESs) using selected neuropsychological tests at different time periods related to the seizure. METHODS: In this study, selected neurocognitive tests were administered to the patients. Within 24 h, the previously applied neurocognitive tests were repeated within 24 h following the observation of typical seizures when monitoring and normalizing electroencephalography (EEG) activity. Basal neurocognitive tests were also administered to the healthy control group, and repeat neurocognitive evaluation was performed within 24-96 h. RESULTS: The basal neurocognitive evaluation revealed that verbal learning and memory scores as well as Stroop test interference time were significantly lower in the PNES group compared with those in the controls. In the basal cognitive tests administered to the patients with epilepsy, verbal learning and memory scores, long-term memory, and total recognition test scores were significantly lower than those of the controls. Following the repeat cognitive tests, significant progress was found in the verbal categorical fluency score of the PNES group. No significant difference was determined in the epilepsy group. Significant contraction was determined in the Stroop interference time in the control group, but no similar change was recorded in the epilepsy or PNES groups. CONCLUSION: While memory problems seemed to be most prominent in the assessed patients with epilepsy, attention and executive function problems were more dominant in the patients with PNESs. These findings are probably related to numerous factors such duration of disease, mood disorders, and specific drug use. No deterioration in attention and executive functions was reported in the early post-seizure period in either patient group.

Sertraline versus paroxetine in the treatment of panic disorder: an acute, double-blind noninferiority comparison.

OBJECTIVE: Several classes of medications have demonstrated efficacy in panic disorder, but direct comparison of 2 proven treatments is still uncommon. The purpose of this study was to compare sertraline and paroxetine in the acute treatment of panic disorder. METHOD: Adult outpatients with panic disorder with or without agoraphobia (DSM-IV and ICD-10 criteria) were randomly assigned in double-blind fashion to 12 weeks of treatment with flexible doses of sertraline (titrated up to 50-150 mg/day; N = 112) or paroxetine (titrated up to 40-60 mg/day; N = 113). Patients were then tapered off medication over 3 weeks. The primary analysis was a noninferiority analysis of Panic and Agoraphobia Scale (PAS) scores. Secondary measures included panic attack frequency and the Clinical Global Impressions-Improvement scale (CGI-I) (with responders defined as those with a CGI-I score < or = 2). Data were collected from January 2000 to June 2001. RESULTS: Sertraline and paroxetine were associated with equivalent levels of improvement on the PAS total score, as well as on all secondary outcome measures. Eighty-two percent of patients taking sertraline versus 78% of those taking paroxetine were CGI-I responders at endpoint. Numerically more patients on paroxetine treatment compared with sertraline treatment discontinued due to adverse events (18% vs. 12%; NS), and a significantly higher proportion of paroxetine patients showed > or = 7% weight gain (7% vs. < 1%; p <.05). During the taper period, the proportion of panic-free patients increased by 4% with sertraline but decreased by 11% with paroxetine (p <.05). CONCLUSION: Sertraline and paroxetine had equivalent efficacy in panic disorder, but sertraline was significantly better tolerated and was associated with significantly less clinical worsening during taper than paroxetine.

Assessing the severity of panic disorder and agoraphobia: validity, reliability and objectivity of the Turkish translation of the Panic and Agoraphobia Scale (P&A).

The aim of the present study was to determine the psychometric properties of the Turkish translation of both the observer-rated (P&Ao) and self-rated (P&As) versions of the Panic and Agoraphobia Scale (P&A). Discriminant and convergent validity of P&A were assessed in patients with panic disorder with or without agoraphobia (n = 119), by comparing the P&A with the Clinical Global Impression Scale (CGI), Hamilton Anxiety Scale (HAMA), Phobia and Anxiety sub-scales of Symptom Check List, Spielberger State and Trait Anxiety Inventory and the Beck Depression Inventory (BDI). Inter-rater and test-retest reliability were determined. Correlation coefficients between the CGI and the P&Ao and the P&As were .85 and .74, respectively, and .85 between the two versions of the P&A. Cronbach's alpha for the P&Ao, and the P&As was .88 and .86, respectively. The Turkish version of the P&A has yielded good psychometric properties and was found to be a reliable instrument for assessing severity in panic disorder.

[Panic-agoraphobic spectrum]. / Panik-Agorafobi Spektrumu Kavrami.

Current diagnostic classification systems have provided reliable, objective and valid diagnoses of mental disorders. They present both categorical and dichotomous approaches to mental disorders. However, rigid usage of diagnostic criteria may cause high comorbidity rates. Moreover, these classification systems fail to identify subthreshold conditions, atypical signs and symptoms, and personality traits associated with the core symptoms of a given mental disorder. These subclinical manifestations are clinically meaningful in terms of disability and effects on quality of life. For these reasons, many researchers have begun to develop dimensional or spectral approaches for a number of mental disorders. Studies on panic disorder with or without agoraphobia have revealed a substantial clinical heterogeneity. The panic-agoraphobic spectrum concept was defined to overcome these difficulties. This concept includes DSM-IV and ICD-10 diagnostic criteria together with atypical and subthreshold symptoms of panic disorder, and constitutes a broader band of panic and agoraphobia symptoms. The panic-agoraphobic spectrum incorporates eight domains of clinical features: 1) separation sensitivity, 2) panic-like symptoms, 3) stress sensitivity, 4) medication and substance sensitivity, 5) anxious expectation, 6) agoraphobia, 7) illness phobia and hypochondriasis, 8) reassurance orientation. In this article, we reviewed the spectrum conceptualization of panic disorder and agoraphobia, particularly focusing on the domains of the panic-agoraphobic spectrum and their assessment.