Ongoing or re-emerging subjective insomnia symptoms after full/partial remission or recovery of major depressive disorder mainly with the selective serotonin reuptake inhibitors and risk of relapse or recurrence: a 52-week follow-up study.

BACKGROUND: Many patients who remit fully/partially or recover from an episode of major depression continue to suffer from sleep problems, mainly insomnia. Our study assesses the frequency and types of ongoing or re-emerging subjective insomnia symptoms and their relationship to subsequent depressive relapse or recurrence in a group of full/partial remitters or recoverers. METHOD: Sixty patients, 18 to 65 years of age, with current MDD defined using DSM-IV-TR criteria were participated in the study. They began a 24-week course of open-label acute plus continuation phase treatment mainly with SSRIs. Maintenance treatment was not planned for not affecting natural relapse or recurrence rates. All participants were evaluated by CGI-S, BDI, HAMD-17, PSQI, and ISI at weeks 0, 4, 12, 24, and 52. RESULTS: Majority of the participants (83.33%) had subjective sleep disturbance, insomnia prior to relapse or recurrence. Repeated measures ANOVA was used to evaluate changes in scores of depression and sleep scales over time between recurred (N = 12) and non-recurred groups (N = 48). Differences between means were calculated with post hoc Bonferroni comparison test. The changes in scores of entire clinical scales over time between recurred and non-recurred groups were statistically significant. LIMITATIONS: The limitations of this study include the use of a relatively small, mostly young female sample and the lack of an objective sleep measure to corroborate self-report scales. CONCLUSIONS: Early recognition and treatment of disturbances of the sleep-wake cycle may be important for treatment and prevention of recurrence of depression.

[Psychopharmacological treatment and quality of life in obsessive compulsive disorder]. / Obsesif kompulsif bozuklukta psikofarmakolojik tedavinin yasam kalitesine etkisi.

OBJECTIVE: Obsessive compulsive disorder (OCD) is an illness that considerably influences the family, academic, occupational and social functioning of patients. In this study, we aimed to investigate the impact of psychopharmacological treatment on quality of life in patients with OCD. METHOD: Using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS) and the World Health Organization Quality of Life Measurement Instrument Short Form, Turkish Version (WHOQOL-Bref TR) we assessed 53 patients who met the DSM-IV criteria for OCD to establish baseline values. The patients were consecutively assigned to receive either sertraline (100-200 mg/day), fluvoxamine (200-300 mg/day) or paroxetine (40-80 mg/day). We reassessed 36 (68%) of the initial group after 12 weeks. RESULTS: The scores of obsession, compulsion and depression severity at follow-up were significantly lower than those of baseline scores. There is no significant difference between the pre and post-treatment quality of life domain scores. While psychological health scores at follow-up was significantly associated with baseline HDRS scores (r=-0.35, p<0.05), social relationship scores at follow-up was significantly associated with baseline social relationship scores (r=0.63, p<0.001) and compulsion scores (r=-0.37, p<0.05). Regression analyses revealed that social relationship scores at follow-up was associated with baseline compulsion severity whereas other follow-up quality of life domain scores were not predicted by any baseline variable. CONCLUSIONS: Clinical viewpoint and objective evaluations should be essential in the evaluation of treatment outcome, and quality of life researches may be important complement to clinical researches.

[Therapeutic response to plasmapheresis in four cases with obsessive-compulsive disorder and tic disorder triggered by streptococcal infections]. / Streptokok enfeksiyonu ile iliskili OKB ve tik bozuklugu olan dört olguda plazmaferez tedavisine yanit.

The acronym PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) has been assigned to a subgroup of patients experiencing pediatric onset obsessive-compulsive symptoms and tics as a result of autoimmune response to group A beta-hemolytic streptococcal infection. It has been hypothesized that an immune process initiated by infection affects the basal ganglia and causes neuropsychiatric symptoms. In cases with severe neuropsychiatric symptoms, the use of treatment strategies that interrupt the autoimmune process responsible for the pathogenesis of PANDAS, such as therapeutic plasmapheresis or intravenous immunoglobulin, has been proposed. In this paper, we discuss the effect of plasmapheresis treatment in 4 adult cases of obsessive-compulsive disorder and tic disorder triggered by streptococcal infections.

Mood changes after sleep deprivation in morningness-eveningness chronotypes in healthy individuals.

Inconsistent results have been found in the studies evaluating the effect of both total and partial sleep deprivation (SD) on mood in healthy subjects and a few variables have been analyzed as possible predictors. In the present study, we examined whether circadian preference modifies the effect of SD on mood changes in healthy subjects. Sample consisted of 60 healthy volunteers (including 30 morningness and 30 eveningness subjects). Then, the two groups were again divided into two groups for two SD procedures. Fifteen morningness and 15 eveningness chronotypes were total sleep deprived and 15 morningness and 15 eveningness subjects were partial sleep deprived. The mood changes were evaluated before and after SD using Profile of Mood States. Two main results were obtained from our study: a significant increase in depression subscale in morningness chronotypes and a significant decrease in depression subscale score after total SD (TSD) in eveningness chronotypes. The changes in depression-dejection scores of eveningness chronotypes after total (P < 0.01) and partial SD (P < 0.01) were significantly different from changes in morningness chronotypes after TSD. Our results suggest that the effect of SD on mood in normal subjects is related to their circadian preferences. The morningness or eveningness characteristics of the shift workers have significant impact on their mood states. Therefore, adjusting the work schedule with the morningness and eveningness characteristics of the workers may improve their mood alterations.

Factors associated with major depressive disorder occurring after the onset of obsessive-compulsive disorder.

BACKGROUND: We aimed to investigate the correlates of major depressive disorder (MDD) occurring after the onset of obsessive-compulsive disorder (OCD). METHODS: Forty-three OCD patients who developed MDD after the onset of OCD (OCD-MDD group) and 67 OCD patients without MDD (non-MDD, NMDD group) were compared with regard to sociodemographic characteristics, clinical history, symptom severity, types of obsessions and compulsions, insight degree, comorbid axis I and axis II diagnosis and quality-of-life level. RESULTS: The OCD-MDD group scored significantly higher on measures of obsessions, compulsions and depression severity than did the NMDD. Significantly more aggressive obsessions were identified in the OCD-MDD group than in the NMDD group. The OCD-MDD group was also significantly more likely than the NMDD group to have generalized anxiety disorder (GAD). There was no significant difference in the rate of personality disorders between the groups. The OCD-MDD group reported significantly lower levels of quality of life (QOL) in the domains of physical health, psychological health and social relationships. Depression severity was associated with obsession but not with compulsion severity. In a logistic regression model, obsession severity, presence of GAD and aggressive obsessions emerged as the factors associated with the occurrence of MDD. LIMITATIONS: To exclude ineligible patients, we gathered the information about past mood episodes cross-sectionally. CONCLUSIONS: These results suggest that psychopathological processes mediated by specific obsessions as well as excessive anxiety and worries may render the neurocircuities more vulnerable to the development of MDD. The occurrence of MDD in OCD cannot sufficiently be explained as a secondary complication to the disability of OCD.

Nightmares, suicide attempts, and melancholic features in patients with unipolar major depression.

OBJECTIVES: Recently, there has been a growing interest in the relationship between sleep disturbances and suicidality in major depression. Sleep disturbances are one of the 'modifiable risks' for suicide in major depression. The present study examines whether there is a relationship among nightmares, suicide attempts, and melancholic features in unipolar major depressed patients. METHODS: One hundred (49 males and 51 females) depressed patients with melancholic features and 49 (23 males and 26 females) patients without melancholic features were included in the study. All patients were classified as those who attempted suicide at least once during current depressive episode and as those who never attempted. RESULTS: Melancholic attempters had higher rates of nightmares, middle, and terminal insomnia than melancholic non-attempters. There was no significant difference between non-melancholic patients with and without suicidal attempts in terms of the frequency of all types of insomnia and nightmares. LIMITATIONS: This study does not have polysomnographic records for sleep variables. CONCLUSIONS: Feeling worse in the morning than later in the day may be related to the intervening dream content and affect and predict suicidal tendency. Melancholia may be associated with increased risk of suicide attempts due to repetitive and frightening dreams.

[The correlates of healthcare seeking behavior in obsessive-compulsive disorder: a multidimensional approach]. / Obsesif Kompulsif Bozuklukta Saglik Yardimi Arama Davranisi Ile Iliskili Etmenler: Hastalik Ile Iliskili ve Genel Etmenlerin Rolü.

Obsessive-compulsive disorder (OCD) is a chronic, distressing, and disabling illness that influences the family, academic, occupational, and social functioning of patients. One of the 10 leading causes of disability worldwide is OCD; however, despite the considerable distress and disability associated with the disorder and the availability of treatment options, many OCD sufferers usually are not inclined to seek healthcare. The factors that may be central to healthcare seek behavior in OCD has scarcely been described in the literature. It has been thought that the best predictor of healthcare seeking is severity of illness; however, individuals with OCD may have various barriers to seeking healthcare. Although non-disease and disease-related factors that may influence health care seeking are related in complex ways through reciprocal influences and feedback, each factor might be an independent predictor of use of healthcare services. This review aims to discuss the impact of the disease and general factors that impact healthcare seeking behavior in OCD. In this way, new information might be provided for the identification of targets to enhance the use of mental health services among OCD sufferers in the community.

A discrimination based on autogenous versus reactive obsessions in obsessive-compulsive disorder and related clinical manifestations.

INTRODUCTION: Although putative subtypes of obsessive-compulsive disorder (OCD) have been gradually more recognized, there is no generally accepted subtype discrimination. It has been suggested that autogenous and reactive obsessions stem from different cognitive process. This study aimed to assess existence of gender, age at onset of illness, and comorbidity differences in OCD patients suffering from autogenous and reactive obsessions. METHODS: The medical records of 177 OCD patients were evaluated retrospectively for gender, age at onset, comorbid diagnoses, and predisposing life events. Obsessions and compulsions were coded according to the Yale-Brown Obsessive-Compulsive Scale. All patients were grouped as the patients with autogenous (autogenous group [AG] n=32), reactive (reactive group [RG] n=77) and mixed obsessions (mixed group [MG] n=68). RESULTS: AG patients were significantly more likely to be male, compared with the RG and MG patients. They also had significantly later onset of illness. Dissociative disorders were less common among AG patients compared with the other groups. CONCLUSION: Results suggest that the discrimination between autogenous and reactive obsessions are not only based on their development and maintenance mechanism through different cognitive process but that there also clinical manifestations of this discrimination.

Nightmares and serum cholesterol level: a preliminary report.

OBJECTIVE: To examine whether there is a relation between nightmares and serum lipid levels. METHODS: Fifteen subjects who met DSM-IV criteria for the diagnosis of nightmare disorder and 15 healthy control subjects participated in the study. We used an enzymatic colorimetric method for cholesterol and triglyceride determination. We measured high-density lipoprotien (HDL) cholesterol using the direct HDL-cholesterol method. Low-density lipoprotein (LDL) was calculated according to the Friedewald formula. RESULTS: Patients with nightmare disorder had lower serum triglyceride, lower total cholesterol, and lower LDL levels than healthy control subjects. CONCLUSION: These findings suggest that nightmares are associated with low serum lipid levels.

Nightmares and terminal insomnia in depressed patients with and without melancholic features.

To investigate the relationship between nightmares and melancholic features (MF) in depression, we compared depressed patients with and without MF (n=82 and n=75, respectively) regarding the presence of nightmares. Nightmares were significantly more frequent in patients with MF. Depressed mood in the morning may be related to negative dream content.

Serum lipid levels in patients with dissociative disorder.

OBJECTIVE: There may be an association between a low serum cholesterol level and dissociative disorders. METHOD: The subjects of the study were 16 patients with dissociative disorder and 16 normal comparison subjects (two men and 14 women in each group). Total cholesterol, triglyceride, high-density lipoprotein, low-density lipoprotein, and very low density lipoprotein levels were compared. RESULTS: Patients with dissociative disorders had lower serum triglyceride, total cholesterol, low-density lipoprotein, and very low density lipoprotein levels than normal comparison subjects. CONCLUSIONS: Low serum lipid concentrations may be related to a high incidence of self-injurious behaviors and borderline features in patients with dissociative disorders.

Serum lipid levels, suicidality, and panic disorder.

Although the effects of serum total cholesterol and other lipids have been implicated as a predictor of suicidal behavior in major depression, the role of cholesterol level on suicide risk for panic disorder patients is not considered as a biological marker in the literature. In this study, we examined the relationship of suicidality with serum cholesterol concentration in panic disorder. The subjects of the study were 10 suicidal panic disorder patients, 19 nonsuicidal panic disorder patients, and 15 normal control subjects. The suicidal patients with panic disorder had lower serum total cholesterol and low-density lipoprotein (LDL) levels than normal control subjects. These findings suggest that there may be an association between suicidality and low serum cholesterol levels in panic disorder. We also discuss the possible role of serotonin in the brain in the relationship of suicidal behavior or ideation with low cholesterol concentration in panic disorder.

Serum lipid concentrations in obsessive-compulsive disorder patients with and without panic attacks.

OBJECTIVE: To examine serum lipid levels in patients with obsessive-compulsive disorder (OCD) and to test whether panic symptoms affect lipid concentrations in OCD patients. METHODS: We assessed 33 OCD patients and 33 healthy control subjects matched for sex and age. RESULTS: OCD patients had higher low-density lipoprotein, very-low-density lipoprotein, and tryglyceride levels, but lower high-density lipoprotein levels, than normal control subjects. We also found that only OCD patients with panic attacks had higher serum lipid concentrations, compared with normal control subjects. Serum lipid levels of pure OCD patients did not differ from control values. CONCLUSION: These findings suggest that high serum lipid concentrations are related to panic anxiety rather than other symptoms of the illness.

Clinical importance of nightmare disorder in patients with dissociative disorders.

In the present study the prevalence of nightmare disorder (ND) was examined in patients with dissociative disorders (DD), and comparison was made between those with ND and those without nightmares in terms of clinical characteristics. The 30 patients with DD (5 male and 25 female) were recruited over 12 months in the Yüzüncü Yil University Research Hospital Department of Psychiatry. The subjects were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (4th edn) criteria for ND. The Dissociative Experiences Scale, Beck Depression Inventory, and a semistructured interview schedule for childhood traumatic events were administered to the subjects. A 57% prevalence of ND was found among patients with DD. Among patients with DD, those with ND had a higher rate of self-mutilative behavior, a history of suicide attempt in the last year, and comorbidity with borderline personality disorder than those without ND. Nightmares or dreams should be considered in the therapy of DD patients.

Nightmares and dissociative experiences: the key role of childhood traumatic events.

In order to examine the co-occurrence of nightmares with dissociative experiences in the adolescent population and to demonstrate the impact of childhood traumatic events in this association, 292 undergraduate students were interviewed for childhood traumatic events. The Van Dream Anxiety Scale (VDAS) and Dissociative Experiences Scale (DES) were also administered to the subjects. For nightmares a 7.5% prevalence of 'often' and a 58.2% prevalence of 'sometimes' was found for college students. Nightmare prevalence was higher in women than in men. The rate of childhood traumatic experiences was higher in nightmare sufferers than in those who did not have nightmares. The subjects who had undergone physical and sexual abuse had higher VDAS global scores and item scores. When the DES scores of the subjects with nightmares were compared with that of those who had never reported nightmares, the subjects with nightmares had significantly higher scores on DES. The DES scores were also negatively correlated with duration of nightmares in subjects who had childhood traumatic experiences. These findings suggest that the subjects with childhood traumatic events failed to psychologically integrate their traumatic experiences and used dissociation as a coping strategy.