Introduction: The UK-based AESOP study conducted over a two-year period in three UK sites simulta... more Introduction: The UK-based AESOP study conducted over a two-year period in three UK sites simultaneously (London, Nottingham, and Bristol), is the largest study to date to conduct a first contact case-control study of psychosis. The study found that rates of schizophrenia were markedly elevated in both African-Caribbean and Black African people, in both sexes and across all age groups. Subjects and methods: English language literature published up to 2016 was searched. The initial search included: PubMed, The Cochrane Library, and Web of Science. A second search was conducted using Medical Subject Headings (MeSH) and keywords. Studies selected for retrieval were assessed by two independent reviewers. Results: The search yielded eight results, all of which supported the conclusion of an increased incidence of schizophrenia in Black African and Black Caribbean population in the AESOP study. Conclusion: England is a multicultural landscape; multiplicity of cultures makes diagnosis difficult. The lessons we must learn from the AESOP study is the need for transcultural training and the removal of blinding to ethnicity when a large epidemiological study is conducted - psychiatrists need to be cognisant of cultures and aware of the context of symptoms.
Objective: There is an association between bipolar disorder and autism spectrum disorders. The ai... more Objective: There is an association between bipolar disorder and autism spectrum disorders. The aim of the current study is to examine the autistic characteristics of bipolar patients and to determmine their relationship with the clinical features of the
Background The aim of the present study is to compare the cognitive functions of patients with an... more Background The aim of the present study is to compare the cognitive functions of patients with and without metabolic syndrome (MetS) in schizophrenia and schizoaffective disorder, and to investigate the relationship between the clinical symptomatology and MetS-related components with cognitive functions. Methods This cross-sectional study included 79 patients diagnosed with schizophrenia/schizoaffective disorder. All participants were assessed using the Positive PANSS and a neurocognitive battery to assess memory, attention and executive function. Results In the study group, 35 (44.30%) patients met the criteria for MetS. The MetS group performed worse than those without MetS on verbal memory subtests. There was no difference in attention and executive functioning of the Mets and non-MetS groups. Multiple regression analyses showed that, elevated HDL were significantly associated with better scores for verbal memory, visual memory, and executive functions. In contrast, a higher BMI was significantly associated with poorer scores on visual memory, verbal memory, attention and executive functioning. Unexpectedly, a greater waist circumference was associated with better scores for executive functioning. Conclusion MetS and related components are associated with impaired cognitive functioning in patients with schizophrenia/schizoaffective disorder. Early interventions such as reducing risk related BMI values or increasing HDL levels, may reduce risk factors for MetS and have positive effects on cognitive functioning in patients with schizophrenia.
BACKGROUND This study aimed to determine the prevalence of psychiatric disorders in patients with... more BACKGROUND This study aimed to determine the prevalence of psychiatric disorders in patients with keratoconus and the effect of clinical parameters and psychiatric morbidity on quality of life in this patient group. MATERIALS AND METHODS This cross-sectional study enrolled 94 patients with keratoconus. All patients underwent a complete ophthalmic and psychiatric examination and completed the The National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI-RQL-42), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) questionnaires. The current diagnosis of psychiatric disorders was determined using the Structured Clinical Interview for DSM-IV (SCID). The impact of disease severity (binocular BCVA ≥0.4 logMAR, steep K reading ≥52, and Amsler-Krumeich grades) on vision-related quality of life was also analyzed. RESULTS The patients' mean age was 23.9 ± 4.8 (range, 18-40) years. Of the 94 participants 35 (37.2%) had a psychiatric diagnosis, 13 (13.8%) had moderate-severe depression and 20 (21.2%) had moderate-severe anxiety according to the BDI and BAI, respectively. The probability of having a psychiatric disorder was higher if the keratoconus was more severe. Patients with a psychiatric diagnosis scored lower on physical functioning, role limitations due to emotional problems, energy/fatigue; emotional well-being, social functioning and pain subscales of the Short Form-36 (SF-36). Having a SCID-1 psychiatric diagnosis and the presence of a psychiatric disorder did not significantly affect NEI-RQL-42 questionnaire scores. CONCLUSIONS There was high psychiatric morbidity among patients with keratoconus. Having a psychiatric disorder was associated with lower QoL as measured using the SF-36.
Journal of Rational-Emotive & Cognitive-Behavior Therapy, 2020
A transdiagnostic approach to psychiatric disorders presents an opportunity to evaluate the relat... more A transdiagnostic approach to psychiatric disorders presents an opportunity to evaluate the relationship between alexithymia and the concepts of psychopathology according to the psychological flexibility model. This study aimed to investigate the relationship between alexithymia, cognitive fusion and experiential avoidance. A total of 133 outpatient participants were included in this cross-sectional study.
OBJECTIVES: We aimed to compare patients with bipolar disorder and major depressive disorder, who... more OBJECTIVES: We aimed to compare patients with bipolar disorder and major depressive disorder, who were either in an acute depressive episode or in remission, and a healthy control group on their cognitions related to depression and mania/hypomania, and on their response styles. METHODS: A total of 300 participants who presented to our outpatient psychiatry department were included in the study (100 participants with unipolar depression (DG), 100 with bipolar disorder, and 100 with no previous or current psychiatric disorder (CG)). The participants completed the Cognition Checklist (CCL), the Cognition Checklist for Mania (CCL-M-R), the Cognitive Distortions Questionnaire (CDQ), the Dysfunctional Attitude Scale (DAS), the Hypomanic Attitudes and Positive Predictions Inventory (HAPPI), the Brief Core Schemas Scale (BCSS), Ruminative Response Scale (RRS), and the Responses to Positive Affect Questionnaire (RPAQ). The groups were compared with each other by one-way analysis of variance, independent samples t-test, and chi-square tests. RESULTS: The DG scored higher than the other groups on the CCL, the frequency and intensity subscales of the CDQ, the DAS, and the negative-self and negative-others subscales of the BCSS, the RRS, and on the dampening subscale of the RPAQ. The clinical groups scored higher than the CG on the scores of the relationships subscale of the CCL-M-R, the total score of the CDQ, and the HAPPI. The CG scored higher than the clinical groups on the positive-self subscale of the BCSS, and on the emotion focused positive rumination subscale. CONCLUSIONS: These findings are important in the differential diagnosis of mood disorders, and for their treatment with cognitive behavioural psychotherapy.
Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2016
Gastrointestinal symptoms in psychiatry: comparison of direct applications and referrals Objectiv... more Gastrointestinal symptoms in psychiatry: comparison of direct applications and referrals Objective: Clinical experience and observations suggest that there are some discrepancies between patients who directly apply to psychiatry clinic, and who are referred from gastroenterology clinic to psychiatry clinic. Thus, we aimed to investigate differences related to the demographic and clinical characteristics of these patients. Method: The study included 115 consecutive patients aged between 18-65 years. Sixty-one of the patients applied directly to the psychiatry clinic, and 54 patients were referred for consultation to the psychiatry clinic. Primary gastrointestinal complaints, psychiatric diagnoses and personality features were recorded on the scoiodemographic data form, and the severity of psychiatric disorders were assessed by the Clinical Global Impression Scale-Severity Subscale. Results: Patients who directly applied to psychiatry clinic were more likely to be female, older, and married. They attributed their gastrointestinal symptoms also more likely to be of psychogenic origen. Patients who directly applied to psychiatry clinic suffered more likely from a sense of fullness/abdominal tension, while patients who were referred to psychiatry clinic more frequently complained of bloating, abdominal pain, and constipation. Patients who directly applied to psychiatry clinic were more frequently diagnosed with depressive disorders, trauma related disorders, and personality disorders, whereas referrals were more frequently diagnosed with psychotic disorders. Directly admitted patients were also more likely to exhibit impulsivity as a personality feature. Conclusion: Patients with gastrointestinal symptoms who directly presented to psychiatry differed from those who were referred from gastroenterology clinics on some of their demographic aspects, primary psychiatric diagnoses and personality traits.
Background: Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized with physical... more Background: Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized with physical and affective symptoms during the luteal phase of susceptible women. Objective: The aim of this study was to investigate the association of Dopamine D3 receptor (DRD3) polymorphism, and Cannabinoid receptor Type 1 (CNR1) polymorphism with PMDD. Materials and Methods: Fifty one participants with documented PMDD according to the DSM IV criteria and 51 healthy controls were included in this cross sectional study. Symptom severity was measured with daily self-rating, monthly premenstrual assessment forms and psychiatric interviews. The genotyping of DRD3 receptor and Cannabinoid type 1 receptors were performed using Taqmanfluorogenic assay method. Results: Distribution of DRD3 and CNR1 polymorphism was not different between patients and controls. Conclusion: These findings do not support a major role of DRD3, and CNR1 polymorphisms in contributing to susceptibility to premenstrual dysphoric...
Özet Antipsikotik ilaçlar sıklıkla istenilmeyen ekstrapiramidal yan etkilere neden olmak-tadır. B... more Özet Antipsikotik ilaçlar sıklıkla istenilmeyen ekstrapiramidal yan etkilere neden olmak-tadır. Bu yan etkilerden olan akut distoni, antipsikotik başlanması veya dozunun arttırılmasından ya da akut ekstrapiramidal yan etkileri tedavi etme amacıyla kul-lanılan antikolinerjik ilaçların dozunun azaltılmasından sonra birkaç gün içinde gelişen anormal postür ve kas kasılmaları olarak tanımlanır. Akut distoni sıklıkla tipik antipsikotiklere bağlı gelişir. Atipik bir antipsikotik olan ziprasidonun tipiklerden daha az ekstrapiramidal yan etkiye neden olduğu bilinir. Bu yazıda, ziprasidonun ikinci düşük dozu sonrası akut distoni tablosu gelişen olgu sunulmuştur. Abstract Antipsychotics medication frequently leads to different undesirable extrapyrami-dal side effects. Acute dystonia is one of them. It is defined as sustained abnormal postures or muscle spasms that develop within few days of starting or increasing the dose of the antipsychotic treatment or of reducing the anticholinergic medication used to treat extrapyramidal symptoms. Usually acute dystonia appears during treatment with typical antipsychotics. It is known that ziprasidone as an atypical antipsychotic drug causes less extrapyramidal side effects than typical ones do. In this report, we present a case, which developed acute dystonia after second low dose of ziprasidone (40mg/day).
Journal of Rational-Emotive & Cognitive-Behavior Therapy
Many studies have described grief and psychiatric symptomatology as a typical feature following m... more Many studies have described grief and psychiatric symptomatology as a typical feature following miscarriage. How women who had a miscarriage (MG) respond to trauma in terms of negative cognitions about their selves and the world, the coping strategies they employ to overcome the effects of the trauma, and what factors might be indicative of posttraumatic growth (PTG) in this population have not been extensively studied so far. We aimed to identify whether women who had a miscarriage (N = 74 vs. N = 82 control subjects) exhibited higher levels of psychological distress symptoms, dysfunctional cognitions, and maladaptive coping strategies, and whether women with lower PTG employed more maladaptive coping strategies, and reported higher levels of dysfunctional cognitions. Group comparisons according to the diagnostic groups based on self-report measures for depression, anxiety, posttraumatic stress disorder and according to the level of PTG, and stepwise linear regression analyses with PTG as the outcome were performed. Our study demonstrated that the MG does not necessarily differ from the control group on some measures of psychopathology, coping mechanisms, dysfunctional cognitions, or PTG. Yet, the MG who exhibited higher levels of PTG had specific predictors, and women with a psychiatric diagnosis differed from participants with no diagnoses on some measures of dysfunctional cognitions, coping mechanisms, and PTG. Further studies with a prospective design could further clarify the needs of the MG requiring psychotherapeutic interventions.
The essential feature for the diagnosis of kleptomania is a recurrent failure to resist impulses ... more The essential feature for the diagnosis of kleptomania is a recurrent failure to resist impulses to steal items, even though those items are not needed for personal use or for their monetary value. The individual experiences an increasing sense of tension just prior to the theft and feels pleasure, gratification, or relief when committing the theft. These patients are usually referred to psychiatry for the evaluation of criminal liability by a court order. The content of the court file as well as the act defined by the subject and the presence of a mental disorder should be taken into account. In case of shoplifting, malingering must be ruled out first even if the subject has a previously confirmed diagnosis of kleptomania. Here we present a different case of a patient with kleptomania who was referred to us by a court order to determine her criminal liability for shoplifting.
The International journal of social psychiatry, Jan 31, 2016
Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety disorders. We a... more Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety disorders. We aimed to investigate the relationship between EE and demographic and clinical characteristics of patients with panic disorder (PD), to determine whether there is a difference between PD, major depressive disorder (MDD) patients and healthy controls (HC) in terms of EE and to investigate the effect of EE on quality of life (QOL) in patients with PD. Our study involved a total of 150 participants (50 patients in each group). All participants were given the Level of Expressed Emotion (LEE) scale and the short-form health survey (SF)-36 . Furthermore, the EE scale was completed by the participant's key relatives. EE was associated with some sociodemographic and clinical variables in patients with PD. There was no significant difference between PD and MDD and between PD and HC in terms of the LEE and the EE and their subscale scores. It was also demonstrated that EE had no effect on the QO...
KLINIK PSIKOFARMAKOLOJI BULTENI-BULLETIN OF CLINICAL PSYCHOPHARMACOLOGY, 2015
Prediction of response to antipsychotic drugs in schizophrenia patients within the early phase of... more Prediction of response to antipsychotic drugs in schizophrenia patients within the early phase of treatment Objective: Currently, schizophrenia guidelines recommend waiting for 3 to 6 weeks before considering a patient as non-responder. However, recent studies indicate that the response to antipsychotic medications starts within the first two weeks of treatment. The aim of this study is to determine the predictive value of early improvement at 2 or 4 weeks for non-response at 6 weeks. Methods: Twenty seven in-and outpatients with a diagnosis of schizophrenia according to DSM-IV, between the ages of 18 to 65 years, who were moderately-to-severely ill (baseline Positive and Negative Syndrome Scale (PANSS) total score ≥ 75, with at least "moderate" level of severity / score>4 on at least 2 of the 4 Brief Psychiatric Rating Scale (BPRS) psychotic cluster items) were included. Ten patients were receiving antipsychotic treatment for the first time, and 17 patients' treatment was changed due to nonresponse to prior antipsychotic treatment. The patients were evaluated with the PANSS and the Clinical Global Impression-Severity (CGI-S) scale at 0, 2, 4 and 6 weeks of antipsychotic treatment. Non-response at endpoint was defined in 3 different ways to reflect the variations in the level of response to medication: "not minimally improved", "not much improved" and "not remitted". As previously described, "not minimally improved" and "not much improved" were defined as less than 28% and 53% improvement in the PANSS total scores, respectively. "Not remitted" was defined according to the criteria developed by "The Remission in Schizophrenia Working Group" without the time criterion. Signal detection methods using receiver operating characteristics (ROC) curves were implemented to detect the optimal threshold of early nonresponse at 2 and 4 weeks. Total accuracy, sensitivity, specificity and positive and negative predictive value of cutoff points were calculated for predicting "not minimally improved", "not much improved" and "not remitted" at endpoint. Results: The early response threshold for predicting "not minimally improved' was less than 15.3% reduction in PANSS total score at week 2, less than 15.5% reduction at week 4. The early response threshold for predicting "not much improved" was less than 22.1% reduction at week 2 and less than 44.3% reduction at week 4; for "not remitted" was less than 17.5% reduction at week 2 and less than 23.2% reduction at week 4. Specific thresholds of "much improvement" and "remission" were not identified at week 2, whereas thresholds calculated for week 4 had good discriminative power. Conclusion: The findings of this study did not support the findings of earlier studies indicating that nonresponse at 2 weeks accurately predicts subsequent lack of response in patients with schizophrenia. Instead, the findings revealed that non-response could best be predicted at 4 weeks as in some other previous studies. The question of which time point for early prediction of response could be best predicted in schizophrenia patients needs to be further addressed in subsequent studies with larger sample size.
Identification of homogeneous subgroups of obsessive compulsive disorder (OCD) patients may have ... more Identification of homogeneous subgroups of obsessive compulsive disorder (OCD) patients may have important implications for improving effective treatment options. It has been proposed that obsessive thoughts can be classified into two subtypes, i.e. autogenous and reactive obsessions. Although it has been shown that patients with autogenous obsessions may display a worse response to treatment, no studies have yet addressed whether there is a different need for the psychopharmacological treatment options in the subtypes of OCD patients. To investigate the clinical characteristics and treatment differences between autogenous (A-OCD) and reactive (R-OCD) subtypes of OCD patients. Both OCD subgroups (n = 50 for A-OCD, n = 130 for R-OCD) were compared with each other in terms of their demographic and clinical parameters. Odds ratio values for gender, treatment options, co-morbidity, severity of OCD, and response to treatment were computed. Multivariate hierarchical regression analyses were performed to identify any predictors for treatment options, severity of OCD, and response to treatment. Our results indicated that the A-OCD and R-OCD groups differed from each other on some demographic and clinical variables in addition to their psychopharmacological treatment needs. Patients in the A-OCD group were found to be prescribed an atypical antipsychotic 2.3 times more likely than the R-OCD group. The odds for a combination treatment, or the improvement of OCD symptoms from baseline levels did not differ between the two subtypes of obsession groups. Autogenous and reactive subtypes of obsessions may need to be offered different psychopharmacological treatment options.
Medical science monitor : international medical journal of experimental and clinical research, Jan 23, 2015
Background In this study we investigated the potential of neutrophil/lymphocyte ratio (NLR), plat... more Background In this study we investigated the potential of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell width distribution (RDW) as new inflammatory markers to identify chronic inflammations during symptom-free periods in children diagnosed with Familial Mediterranean Fever (FMF). Material and Methods The study included 153 children diagnosed with FMF based on the Tel-Hashomer Criteria, and 90 healthy volunteers. Hospital records were obtained to collect NLR, PLR, MPV, RDW, and FMF scores and the FMF mutation analyses of the patients enrolled in the study. Data on proteinuria were also collected and defined as a protein/creatinine ratio >0.2. Results NLR, PLR, MPV, and RDW were significantly higher in symptom-free FMF patients than in the control group. C-reactive protein values also weakly correlated with NLR, PLR, MPV, and RDW, but the correlation was not statistically significant. NLR had the strongest correlation ...
Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has be... more Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has been used increasingly to diagnose and manage a variety of retinal diseases. Since the axons in retinal nerve fiber layer (RNFL) are nonmyelinated within the retina, OCT has been used in various neurodegenerative diseases to visualize the process of neurodegeneration. Decreases in RNFL and ganglion cell inner plexiform layer (GCIPL) thicknesses were observed in patients with schizophrenia. To date, there is no clinical research investigating OCT parameters in patients with MD. We compared the RNFL thickness, GCIPL thickness in 58 MD patients and 57 healthy controls, and investigated their correlation with clinical variables of depression. Depressed patients were not different from the healthy controls with regard to OCT parameters. GCIPL and nasal RNFL were correlated with the duration of the latest depressive episode. Some measures of OCT were negatively associated with clinical variables like a family history of psychiatric diagnosis and the duration of the latest episode. Larger studies including depressed patients of different severity, including structured interviews and controlling for the effect of antidepressant treatment will provide better results.
ABSTRACT Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized with physical an... more ABSTRACT Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized with physical and affective symptoms during the luteal phase of susceptible women. The aim of this study was to investigate the association of Dopamine D3 receptor (DRD3) polymorphism, and Cannabinoid receptor Type 1 (CNR1) polymorphism with PMDD. Fifty one participants with documented PMDD according to the DSM IV criteria and 51 healthy controls were included in this cross sectional study. Symptom severity was measured with daily self-rating, monthly premenstrual assessment forms and psychiatric interviews. The genotyping of DRD3 receptor and Cannabinoid type 1 receptors were performed using Taqmanfluorogenic assay method. Distribution of DRD3 and CNR1 polymorphism was not different between patients and controls. These findings do not support a major role of DRD3, and CNR1 polymorphisms in contributing to susceptibility to premenstrual dysphoric disorder.
Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is c... more Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is characterized by a seasonal onset. SAD is proposed to be related to the seasonal changes in naturally occurring light, and the use of bright light therapy for depressive symptoms has been shown to reduce them in placebo controlled trials. Cognitive behavioral therapy has also been demonstrated to be effective in SAD. This review article aims to focus on the psychopharmacological treatment options for SAD. According to clinical trial results, first line treatment options seem to be sertraline and fluoxetine, and are well tolerated by the patients. There is some evidence that other antidepressants (e.g. bupropion) might be effective as well. Although clinical trials have shown that some of these antidepressants may be of benefit, a recent review has concluded that there is not enough evidence to support the use of any of these agents for the treatment of SAD yet. Moreover, more studies are ...
Introduction: The UK-based AESOP study conducted over a two-year period in three UK sites simulta... more Introduction: The UK-based AESOP study conducted over a two-year period in three UK sites simultaneously (London, Nottingham, and Bristol), is the largest study to date to conduct a first contact case-control study of psychosis. The study found that rates of schizophrenia were markedly elevated in both African-Caribbean and Black African people, in both sexes and across all age groups. Subjects and methods: English language literature published up to 2016 was searched. The initial search included: PubMed, The Cochrane Library, and Web of Science. A second search was conducted using Medical Subject Headings (MeSH) and keywords. Studies selected for retrieval were assessed by two independent reviewers. Results: The search yielded eight results, all of which supported the conclusion of an increased incidence of schizophrenia in Black African and Black Caribbean population in the AESOP study. Conclusion: England is a multicultural landscape; multiplicity of cultures makes diagnosis difficult. The lessons we must learn from the AESOP study is the need for transcultural training and the removal of blinding to ethnicity when a large epidemiological study is conducted - psychiatrists need to be cognisant of cultures and aware of the context of symptoms.
Objective: There is an association between bipolar disorder and autism spectrum disorders. The ai... more Objective: There is an association between bipolar disorder and autism spectrum disorders. The aim of the current study is to examine the autistic characteristics of bipolar patients and to determmine their relationship with the clinical features of the
Background The aim of the present study is to compare the cognitive functions of patients with an... more Background The aim of the present study is to compare the cognitive functions of patients with and without metabolic syndrome (MetS) in schizophrenia and schizoaffective disorder, and to investigate the relationship between the clinical symptomatology and MetS-related components with cognitive functions. Methods This cross-sectional study included 79 patients diagnosed with schizophrenia/schizoaffective disorder. All participants were assessed using the Positive PANSS and a neurocognitive battery to assess memory, attention and executive function. Results In the study group, 35 (44.30%) patients met the criteria for MetS. The MetS group performed worse than those without MetS on verbal memory subtests. There was no difference in attention and executive functioning of the Mets and non-MetS groups. Multiple regression analyses showed that, elevated HDL were significantly associated with better scores for verbal memory, visual memory, and executive functions. In contrast, a higher BMI was significantly associated with poorer scores on visual memory, verbal memory, attention and executive functioning. Unexpectedly, a greater waist circumference was associated with better scores for executive functioning. Conclusion MetS and related components are associated with impaired cognitive functioning in patients with schizophrenia/schizoaffective disorder. Early interventions such as reducing risk related BMI values or increasing HDL levels, may reduce risk factors for MetS and have positive effects on cognitive functioning in patients with schizophrenia.
BACKGROUND This study aimed to determine the prevalence of psychiatric disorders in patients with... more BACKGROUND This study aimed to determine the prevalence of psychiatric disorders in patients with keratoconus and the effect of clinical parameters and psychiatric morbidity on quality of life in this patient group. MATERIALS AND METHODS This cross-sectional study enrolled 94 patients with keratoconus. All patients underwent a complete ophthalmic and psychiatric examination and completed the The National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI-RQL-42), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) questionnaires. The current diagnosis of psychiatric disorders was determined using the Structured Clinical Interview for DSM-IV (SCID). The impact of disease severity (binocular BCVA ≥0.4 logMAR, steep K reading ≥52, and Amsler-Krumeich grades) on vision-related quality of life was also analyzed. RESULTS The patients' mean age was 23.9 ± 4.8 (range, 18-40) years. Of the 94 participants 35 (37.2%) had a psychiatric diagnosis, 13 (13.8%) had moderate-severe depression and 20 (21.2%) had moderate-severe anxiety according to the BDI and BAI, respectively. The probability of having a psychiatric disorder was higher if the keratoconus was more severe. Patients with a psychiatric diagnosis scored lower on physical functioning, role limitations due to emotional problems, energy/fatigue; emotional well-being, social functioning and pain subscales of the Short Form-36 (SF-36). Having a SCID-1 psychiatric diagnosis and the presence of a psychiatric disorder did not significantly affect NEI-RQL-42 questionnaire scores. CONCLUSIONS There was high psychiatric morbidity among patients with keratoconus. Having a psychiatric disorder was associated with lower QoL as measured using the SF-36.
Journal of Rational-Emotive & Cognitive-Behavior Therapy, 2020
A transdiagnostic approach to psychiatric disorders presents an opportunity to evaluate the relat... more A transdiagnostic approach to psychiatric disorders presents an opportunity to evaluate the relationship between alexithymia and the concepts of psychopathology according to the psychological flexibility model. This study aimed to investigate the relationship between alexithymia, cognitive fusion and experiential avoidance. A total of 133 outpatient participants were included in this cross-sectional study.
OBJECTIVES: We aimed to compare patients with bipolar disorder and major depressive disorder, who... more OBJECTIVES: We aimed to compare patients with bipolar disorder and major depressive disorder, who were either in an acute depressive episode or in remission, and a healthy control group on their cognitions related to depression and mania/hypomania, and on their response styles. METHODS: A total of 300 participants who presented to our outpatient psychiatry department were included in the study (100 participants with unipolar depression (DG), 100 with bipolar disorder, and 100 with no previous or current psychiatric disorder (CG)). The participants completed the Cognition Checklist (CCL), the Cognition Checklist for Mania (CCL-M-R), the Cognitive Distortions Questionnaire (CDQ), the Dysfunctional Attitude Scale (DAS), the Hypomanic Attitudes and Positive Predictions Inventory (HAPPI), the Brief Core Schemas Scale (BCSS), Ruminative Response Scale (RRS), and the Responses to Positive Affect Questionnaire (RPAQ). The groups were compared with each other by one-way analysis of variance, independent samples t-test, and chi-square tests. RESULTS: The DG scored higher than the other groups on the CCL, the frequency and intensity subscales of the CDQ, the DAS, and the negative-self and negative-others subscales of the BCSS, the RRS, and on the dampening subscale of the RPAQ. The clinical groups scored higher than the CG on the scores of the relationships subscale of the CCL-M-R, the total score of the CDQ, and the HAPPI. The CG scored higher than the clinical groups on the positive-self subscale of the BCSS, and on the emotion focused positive rumination subscale. CONCLUSIONS: These findings are important in the differential diagnosis of mood disorders, and for their treatment with cognitive behavioural psychotherapy.
Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2016
Gastrointestinal symptoms in psychiatry: comparison of direct applications and referrals Objectiv... more Gastrointestinal symptoms in psychiatry: comparison of direct applications and referrals Objective: Clinical experience and observations suggest that there are some discrepancies between patients who directly apply to psychiatry clinic, and who are referred from gastroenterology clinic to psychiatry clinic. Thus, we aimed to investigate differences related to the demographic and clinical characteristics of these patients. Method: The study included 115 consecutive patients aged between 18-65 years. Sixty-one of the patients applied directly to the psychiatry clinic, and 54 patients were referred for consultation to the psychiatry clinic. Primary gastrointestinal complaints, psychiatric diagnoses and personality features were recorded on the scoiodemographic data form, and the severity of psychiatric disorders were assessed by the Clinical Global Impression Scale-Severity Subscale. Results: Patients who directly applied to psychiatry clinic were more likely to be female, older, and married. They attributed their gastrointestinal symptoms also more likely to be of psychogenic origen. Patients who directly applied to psychiatry clinic suffered more likely from a sense of fullness/abdominal tension, while patients who were referred to psychiatry clinic more frequently complained of bloating, abdominal pain, and constipation. Patients who directly applied to psychiatry clinic were more frequently diagnosed with depressive disorders, trauma related disorders, and personality disorders, whereas referrals were more frequently diagnosed with psychotic disorders. Directly admitted patients were also more likely to exhibit impulsivity as a personality feature. Conclusion: Patients with gastrointestinal symptoms who directly presented to psychiatry differed from those who were referred from gastroenterology clinics on some of their demographic aspects, primary psychiatric diagnoses and personality traits.
Background: Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized with physical... more Background: Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized with physical and affective symptoms during the luteal phase of susceptible women. Objective: The aim of this study was to investigate the association of Dopamine D3 receptor (DRD3) polymorphism, and Cannabinoid receptor Type 1 (CNR1) polymorphism with PMDD. Materials and Methods: Fifty one participants with documented PMDD according to the DSM IV criteria and 51 healthy controls were included in this cross sectional study. Symptom severity was measured with daily self-rating, monthly premenstrual assessment forms and psychiatric interviews. The genotyping of DRD3 receptor and Cannabinoid type 1 receptors were performed using Taqmanfluorogenic assay method. Results: Distribution of DRD3 and CNR1 polymorphism was not different between patients and controls. Conclusion: These findings do not support a major role of DRD3, and CNR1 polymorphisms in contributing to susceptibility to premenstrual dysphoric...
Özet Antipsikotik ilaçlar sıklıkla istenilmeyen ekstrapiramidal yan etkilere neden olmak-tadır. B... more Özet Antipsikotik ilaçlar sıklıkla istenilmeyen ekstrapiramidal yan etkilere neden olmak-tadır. Bu yan etkilerden olan akut distoni, antipsikotik başlanması veya dozunun arttırılmasından ya da akut ekstrapiramidal yan etkileri tedavi etme amacıyla kul-lanılan antikolinerjik ilaçların dozunun azaltılmasından sonra birkaç gün içinde gelişen anormal postür ve kas kasılmaları olarak tanımlanır. Akut distoni sıklıkla tipik antipsikotiklere bağlı gelişir. Atipik bir antipsikotik olan ziprasidonun tipiklerden daha az ekstrapiramidal yan etkiye neden olduğu bilinir. Bu yazıda, ziprasidonun ikinci düşük dozu sonrası akut distoni tablosu gelişen olgu sunulmuştur. Abstract Antipsychotics medication frequently leads to different undesirable extrapyrami-dal side effects. Acute dystonia is one of them. It is defined as sustained abnormal postures or muscle spasms that develop within few days of starting or increasing the dose of the antipsychotic treatment or of reducing the anticholinergic medication used to treat extrapyramidal symptoms. Usually acute dystonia appears during treatment with typical antipsychotics. It is known that ziprasidone as an atypical antipsychotic drug causes less extrapyramidal side effects than typical ones do. In this report, we present a case, which developed acute dystonia after second low dose of ziprasidone (40mg/day).
Journal of Rational-Emotive & Cognitive-Behavior Therapy
Many studies have described grief and psychiatric symptomatology as a typical feature following m... more Many studies have described grief and psychiatric symptomatology as a typical feature following miscarriage. How women who had a miscarriage (MG) respond to trauma in terms of negative cognitions about their selves and the world, the coping strategies they employ to overcome the effects of the trauma, and what factors might be indicative of posttraumatic growth (PTG) in this population have not been extensively studied so far. We aimed to identify whether women who had a miscarriage (N = 74 vs. N = 82 control subjects) exhibited higher levels of psychological distress symptoms, dysfunctional cognitions, and maladaptive coping strategies, and whether women with lower PTG employed more maladaptive coping strategies, and reported higher levels of dysfunctional cognitions. Group comparisons according to the diagnostic groups based on self-report measures for depression, anxiety, posttraumatic stress disorder and according to the level of PTG, and stepwise linear regression analyses with PTG as the outcome were performed. Our study demonstrated that the MG does not necessarily differ from the control group on some measures of psychopathology, coping mechanisms, dysfunctional cognitions, or PTG. Yet, the MG who exhibited higher levels of PTG had specific predictors, and women with a psychiatric diagnosis differed from participants with no diagnoses on some measures of dysfunctional cognitions, coping mechanisms, and PTG. Further studies with a prospective design could further clarify the needs of the MG requiring psychotherapeutic interventions.
The essential feature for the diagnosis of kleptomania is a recurrent failure to resist impulses ... more The essential feature for the diagnosis of kleptomania is a recurrent failure to resist impulses to steal items, even though those items are not needed for personal use or for their monetary value. The individual experiences an increasing sense of tension just prior to the theft and feels pleasure, gratification, or relief when committing the theft. These patients are usually referred to psychiatry for the evaluation of criminal liability by a court order. The content of the court file as well as the act defined by the subject and the presence of a mental disorder should be taken into account. In case of shoplifting, malingering must be ruled out first even if the subject has a previously confirmed diagnosis of kleptomania. Here we present a different case of a patient with kleptomania who was referred to us by a court order to determine her criminal liability for shoplifting.
The International journal of social psychiatry, Jan 31, 2016
Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety disorders. We a... more Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety disorders. We aimed to investigate the relationship between EE and demographic and clinical characteristics of patients with panic disorder (PD), to determine whether there is a difference between PD, major depressive disorder (MDD) patients and healthy controls (HC) in terms of EE and to investigate the effect of EE on quality of life (QOL) in patients with PD. Our study involved a total of 150 participants (50 patients in each group). All participants were given the Level of Expressed Emotion (LEE) scale and the short-form health survey (SF)-36 . Furthermore, the EE scale was completed by the participant's key relatives. EE was associated with some sociodemographic and clinical variables in patients with PD. There was no significant difference between PD and MDD and between PD and HC in terms of the LEE and the EE and their subscale scores. It was also demonstrated that EE had no effect on the QO...
KLINIK PSIKOFARMAKOLOJI BULTENI-BULLETIN OF CLINICAL PSYCHOPHARMACOLOGY, 2015
Prediction of response to antipsychotic drugs in schizophrenia patients within the early phase of... more Prediction of response to antipsychotic drugs in schizophrenia patients within the early phase of treatment Objective: Currently, schizophrenia guidelines recommend waiting for 3 to 6 weeks before considering a patient as non-responder. However, recent studies indicate that the response to antipsychotic medications starts within the first two weeks of treatment. The aim of this study is to determine the predictive value of early improvement at 2 or 4 weeks for non-response at 6 weeks. Methods: Twenty seven in-and outpatients with a diagnosis of schizophrenia according to DSM-IV, between the ages of 18 to 65 years, who were moderately-to-severely ill (baseline Positive and Negative Syndrome Scale (PANSS) total score ≥ 75, with at least "moderate" level of severity / score>4 on at least 2 of the 4 Brief Psychiatric Rating Scale (BPRS) psychotic cluster items) were included. Ten patients were receiving antipsychotic treatment for the first time, and 17 patients' treatment was changed due to nonresponse to prior antipsychotic treatment. The patients were evaluated with the PANSS and the Clinical Global Impression-Severity (CGI-S) scale at 0, 2, 4 and 6 weeks of antipsychotic treatment. Non-response at endpoint was defined in 3 different ways to reflect the variations in the level of response to medication: "not minimally improved", "not much improved" and "not remitted". As previously described, "not minimally improved" and "not much improved" were defined as less than 28% and 53% improvement in the PANSS total scores, respectively. "Not remitted" was defined according to the criteria developed by "The Remission in Schizophrenia Working Group" without the time criterion. Signal detection methods using receiver operating characteristics (ROC) curves were implemented to detect the optimal threshold of early nonresponse at 2 and 4 weeks. Total accuracy, sensitivity, specificity and positive and negative predictive value of cutoff points were calculated for predicting "not minimally improved", "not much improved" and "not remitted" at endpoint. Results: The early response threshold for predicting "not minimally improved' was less than 15.3% reduction in PANSS total score at week 2, less than 15.5% reduction at week 4. The early response threshold for predicting "not much improved" was less than 22.1% reduction at week 2 and less than 44.3% reduction at week 4; for "not remitted" was less than 17.5% reduction at week 2 and less than 23.2% reduction at week 4. Specific thresholds of "much improvement" and "remission" were not identified at week 2, whereas thresholds calculated for week 4 had good discriminative power. Conclusion: The findings of this study did not support the findings of earlier studies indicating that nonresponse at 2 weeks accurately predicts subsequent lack of response in patients with schizophrenia. Instead, the findings revealed that non-response could best be predicted at 4 weeks as in some other previous studies. The question of which time point for early prediction of response could be best predicted in schizophrenia patients needs to be further addressed in subsequent studies with larger sample size.
Identification of homogeneous subgroups of obsessive compulsive disorder (OCD) patients may have ... more Identification of homogeneous subgroups of obsessive compulsive disorder (OCD) patients may have important implications for improving effective treatment options. It has been proposed that obsessive thoughts can be classified into two subtypes, i.e. autogenous and reactive obsessions. Although it has been shown that patients with autogenous obsessions may display a worse response to treatment, no studies have yet addressed whether there is a different need for the psychopharmacological treatment options in the subtypes of OCD patients. To investigate the clinical characteristics and treatment differences between autogenous (A-OCD) and reactive (R-OCD) subtypes of OCD patients. Both OCD subgroups (n = 50 for A-OCD, n = 130 for R-OCD) were compared with each other in terms of their demographic and clinical parameters. Odds ratio values for gender, treatment options, co-morbidity, severity of OCD, and response to treatment were computed. Multivariate hierarchical regression analyses were performed to identify any predictors for treatment options, severity of OCD, and response to treatment. Our results indicated that the A-OCD and R-OCD groups differed from each other on some demographic and clinical variables in addition to their psychopharmacological treatment needs. Patients in the A-OCD group were found to be prescribed an atypical antipsychotic 2.3 times more likely than the R-OCD group. The odds for a combination treatment, or the improvement of OCD symptoms from baseline levels did not differ between the two subtypes of obsession groups. Autogenous and reactive subtypes of obsessions may need to be offered different psychopharmacological treatment options.
Medical science monitor : international medical journal of experimental and clinical research, Jan 23, 2015
Background In this study we investigated the potential of neutrophil/lymphocyte ratio (NLR), plat... more Background In this study we investigated the potential of neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell width distribution (RDW) as new inflammatory markers to identify chronic inflammations during symptom-free periods in children diagnosed with Familial Mediterranean Fever (FMF). Material and Methods The study included 153 children diagnosed with FMF based on the Tel-Hashomer Criteria, and 90 healthy volunteers. Hospital records were obtained to collect NLR, PLR, MPV, RDW, and FMF scores and the FMF mutation analyses of the patients enrolled in the study. Data on proteinuria were also collected and defined as a protein/creatinine ratio >0.2. Results NLR, PLR, MPV, and RDW were significantly higher in symptom-free FMF patients than in the control group. C-reactive protein values also weakly correlated with NLR, PLR, MPV, and RDW, but the correlation was not statistically significant. NLR had the strongest correlation ...
Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has be... more Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has been used increasingly to diagnose and manage a variety of retinal diseases. Since the axons in retinal nerve fiber layer (RNFL) are nonmyelinated within the retina, OCT has been used in various neurodegenerative diseases to visualize the process of neurodegeneration. Decreases in RNFL and ganglion cell inner plexiform layer (GCIPL) thicknesses were observed in patients with schizophrenia. To date, there is no clinical research investigating OCT parameters in patients with MD. We compared the RNFL thickness, GCIPL thickness in 58 MD patients and 57 healthy controls, and investigated their correlation with clinical variables of depression. Depressed patients were not different from the healthy controls with regard to OCT parameters. GCIPL and nasal RNFL were correlated with the duration of the latest depressive episode. Some measures of OCT were negatively associated with clinical variables like a family history of psychiatric diagnosis and the duration of the latest episode. Larger studies including depressed patients of different severity, including structured interviews and controlling for the effect of antidepressant treatment will provide better results.
ABSTRACT Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized with physical an... more ABSTRACT Premenstrual dysphoric disorder (PMDD) is a mood disorder characterized with physical and affective symptoms during the luteal phase of susceptible women. The aim of this study was to investigate the association of Dopamine D3 receptor (DRD3) polymorphism, and Cannabinoid receptor Type 1 (CNR1) polymorphism with PMDD. Fifty one participants with documented PMDD according to the DSM IV criteria and 51 healthy controls were included in this cross sectional study. Symptom severity was measured with daily self-rating, monthly premenstrual assessment forms and psychiatric interviews. The genotyping of DRD3 receptor and Cannabinoid type 1 receptors were performed using Taqmanfluorogenic assay method. Distribution of DRD3 and CNR1 polymorphism was not different between patients and controls. These findings do not support a major role of DRD3, and CNR1 polymorphisms in contributing to susceptibility to premenstrual dysphoric disorder.
Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is c... more Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is characterized by a seasonal onset. SAD is proposed to be related to the seasonal changes in naturally occurring light, and the use of bright light therapy for depressive symptoms has been shown to reduce them in placebo controlled trials. Cognitive behavioral therapy has also been demonstrated to be effective in SAD. This review article aims to focus on the psychopharmacological treatment options for SAD. According to clinical trial results, first line treatment options seem to be sertraline and fluoxetine, and are well tolerated by the patients. There is some evidence that other antidepressants (e.g. bupropion) might be effective as well. Although clinical trials have shown that some of these antidepressants may be of benefit, a recent review has concluded that there is not enough evidence to support the use of any of these agents for the treatment of SAD yet. Moreover, more studies are ...
Psikiyatrik rahatsızlıkların tedavisinde kullanılan antidepresanlar, duygudurum dengeleyiciler, a... more Psikiyatrik rahatsızlıkların tedavisinde kullanılan antidepresanlar, duygudurum dengeleyiciler, antipsikotik ve anksiyolitik ilaçların kilo alımıyla ilişkili olduğu bilinmektedir . Psikotrop ilaçlara bağlı kilo alımı önemli bir risk oluşturmaktadır. Kilo alımının hastaların tedaviye uyumsuzluğuna yol açıp rahatsızlıklarının nüks edebileceğine, tekrar hastaneye yatışlarının gerekebileceğine ve tedavi maliyetlerinin artabileceğine neden olduğu bilinmektedir. Kilo alımı sonucunda hastalar sağlık problemlerinde (hipertansiyon, koroner kalp hastalığı, iskemik inme, bozulmuş glukoz toleransı, diyabet, hiperlipidemi, solunum problemleri, osteoartrit, kanser) artışın yanında moral bozukluğu ve sosyal damgalanma gibi psikososyal problemlerle de karşı karşıya kalmaktadır. Psikotrop ilaçlara bağlı kilo alımında genetik faktörlerin yanında nörotransmitterlerin (histamin, serotonin), nöropeptidlerin (leptin, ghrelin) , nöroendokrin sistemin ve inflamatuar sitokinlerin de etkili olduğu bilinmektedir. Bunların dışında depresyon ve psikoz belirtilerindeki düzelmenin de iştah artışından sorumlu olabileceği unutulmamalıdır. Genel olarak histamin H1, serotonin 5-HT2C ve dopamin D2 reseptörlerini bloke eden ilaçların kilo alımıyla ilişkili olduğu bilinmektedir
OBJECTIVE: Major depression is associated with cellular loss in key brain regions1,2.Optical cohe... more OBJECTIVE: Major depression is associated with cellular loss in key brain regions1,2.Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has been used increasingly to diagnose and manage a variety of retinal diseases3. Since the axons in retinal nevre fiber layer (RNFL) are nonmyelinated within the retina, OCT has been used in various neurodegenerative diseases to visualize the process of neurodegeneration. Decreases in RNFL and ganglion cell iner plexiform layer (GCIPL) thicknesses were observed in patients with schizophrenia4,5. To date, there is no clinical research investigating OCT parameters in patients with MD. METHODS: The sample consisted of 58 depressed participants, and 57 healthy control subjects Socio-demographic data was collected by using a questionnaire and all participants were given Quick Inventory of Depressive Symptoms – Self Report, 16 Item (QIDS). We compared the RNFL thickness, GCIPL thickness, total and mean macular volume (MV) in 58 MD patients and 57 healthy controls, and investigated their correlation with clinical variables of depression; such as age at onset, total number of episodes, total number of suicide attempts, duration of the latest episode and QIDS total score. RESULTS: The groups did not differ significantly in terms of age, sex, marital status, SES or smoking status. About 70 % of depressed patients were in their first episode, 51 (88 %) of them were female, 15 patients (25 %) were using antidepressant treatment and the mean QIDS score for the depressed grup was 12.43 ± 4.91. Depressed patients were not diferent from the healthy controls with regard to OCT parameters. GCIPL and nasal RNFL were correlated with the duration of the latest depressive episode. The GCIPL thickness was significantly associated with a positive family history of psychiatric disorder, and the duration of the latest depressive episode. Finally, the total RNFL thickness was significantly associated with both a family history of psychiatric disorder, and the total QIDS score. DISCUSSION: Patients with MD were not diferent from the healthy controls with regard to OCT parameters.The low score of QIDS scale and and the low rate of the history of previous suicide attempts (0.12 %) in our depressed grup indicates a mild level of depression. The female prepondarence in the depressed group, and the heterogeneity of the depressed group might have played a role on the results, as well. The duration of the latest episode was negatively and weakly correlated with the GCIPL and nasal RNFL thickness. Decreased GCL and IPL thickness was determined in patients with schizophrenia both parameters were correlated with disorder parameters such as disorder duration5. The small sample size of the present study, and having mild depression in the depressed group were two important limitations of this study. Since, it was demonstrated that antidepressant treatment changed some retinal parameters6, antidepressant treatment might have a confounding effect on our
Strategies for management of sedation with antipsychotics includes the following: 1) Select the ... more Strategies for management of sedation with antipsychotics includes the following: 1) Select the initial antipsychotic based on effectiveness rather than relying on side effects—such as sedation. 2) Rule out psychiatric and medical conditions that can produce fatigue and sedation, such as depression, hypothyroidism, obstructive sleep apnea, and restless legs syndrome 3) Rule out comorbid alcohol and substance use 4) Review the patient’s medication list to determine if other potentially sedating medications can be reduced or eliminated. 5) To reduce daytime sedation, instruct the patient to take all or most of the antipsychotic dose at bedtime 6) Educate the patient about sleep hygiene. 7) Consider gradually reducing the patient’s antipsychotic dose, and closely monitor for worsening of psychosis. If sedation persists despite these interventions; 8) Consider switching the patient to a less sedating antipsychotic such as ziprasidone or aripiprazole 9) Offer caffeine or off-label bupropion—75 to 100 mg once in the morning or up to twice daily—might help the patient feel more alert. 10) For excessive sedation, consider prescribing stimulant agents, such as methylphenidate, modafinil, armodafinil, some amphetaminic agents and orexin agonists. As stimulating agents increase dopamine release in the CNS, which theoretically can worsen psychosis; its use for patients with schizophrenia is controversial. Clinicians must weigh the risks and benefits of prescribing stimulants in patients with schizophrenia.
Uploads
Papers by Mesut yıldız
Psikotrop ilaçlara bağlı kilo alımında genetik faktörlerin yanında nörotransmitterlerin (histamin, serotonin), nöropeptidlerin (leptin, ghrelin) , nöroendokrin sistemin ve inflamatuar sitokinlerin de etkili olduğu bilinmektedir. Bunların dışında depresyon ve psikoz belirtilerindeki düzelmenin de iştah artışından sorumlu olabileceği unutulmamalıdır. Genel olarak histamin H1, serotonin 5-HT2C ve dopamin D2 reseptörlerini bloke eden ilaçların kilo alımıyla ilişkili olduğu bilinmektedir