The Relationship Between Emotional Dysregulation, Alexithymia and Somatization in Patients with Bipolar Disorder.

Objective: Emotional dysregulation is a basic feature found in patients with bipolar disorder. It was also reported that higher alexithymia scores are a predictive factor for a decrease in social functionality. It is known that patients with bipolar disorder experience more somatic symptoms than the general population. No study has yet been conducted on the interrelation of these 3 clinical domains, which are known to negatively affect the functionality and quality of life in bipolar disorder patients. Methods: This study included 72 bipolar disorder-1 patients. The Difficulties in Emotion Regulation Scale was used to determine the emotional state of the patients, the Toronto Alexithymia Scale was used to determine the alexithymia scores, and the Somatization Scale was used to determine the somatization scores. Results: As a result of hierarchical multiple linear regression analysis, the first model was found to be significant (P < .001), and the emotional dysregulation total scale score significantly predicted the Toronto Alexithymia Scale total scale score (P < .001). The second model was also found to be significant (P < .001), and the emotional dysregulation total scale score significantly predicted the somatization total scale score (P < .001). Conclusion: This study found that ED predicted alexithymia and somatization in euthymic bipolar patients. The therapeutic approaches targeting these 3 clinical domains that negatively affect patients' quality of life and functionality may provide positive clinical outcomes.

Psychiatric emergency visit trends and characteristics in a mental health epicenter in Istanbul during COVID-19 lockdown.

BACKGROUND: We aimed to explore the impact of the preventive measures and partial lockdown to the psychiatric emergency department (PED) visits during COVID-19 pandemic in a mental health epicenter in Istanbul. METHODS: A total of 5839 patients admitted to PED during the lockdown period (LP) between March 30 and May 31, 2020, were enrolled in this retrospective cohort study. Data of these patients were compared to those of patients in the same period in 2019 between April 1 and June 2, 2019 (non-LP). We also investigated the monthly number of PED visits and hospitalizations between March 1 and December 31, 2020, and compared it to the same period in 2019. RESULTS: The volume of PED visits and hospitalizations in LP decreased by 12% and 41.6%, respectively. The rates of patients presenting anxiety and depressive disorders and bipolar disorders were found to significantly increase in LP than non-LP (p < 0.001; p < 0.001; p < 0.01, respectively). Depressive disorders, prior history of mental illness, and aggressive behavior were found to predict frequent PED visits while decrease in age and male gender found to predict hospitalizations. Regarding suicide attempt, younger patients and those with new-onset mental disorders were found to be at high risk in LP. Patients diagnosed with COVID-19 in PED visits were mostly with psychotic and bipolar disorders. CONCLUSION: Policy-makers should focus on studies on mental health services to reorganize and enhance such services, which are crucial to prevent and manage adverse mental health consequences of the pandemic and congestion in PEDs.

Psychiatric comorbidity and temperament-character traits of the patients with lichen simplex chronicus: The relation with the symptom severity of the disease.

The aim of this study is to evaluate psychiatric comorbidity, temperament and character traits, depression and anxiety levels, and their relation with symptom severity in patients with lichen simplex chronicus (LSC). About 50 patients with LSC were enrolled in the study along with 49 controls. The Structured Clinical Interview for DSM-5 (SCID-5), Temperament and Character Inventory (TCI), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) were administered to all subjects for psychiatric assessment. Skindex-16 symptom scale was performed for assessing the symptom severity of LSC. LSC group were showing an incidence of 62% in terms of psychiatric comorbidity and 14% of them had two psychiatric diagnoses. The most common psychiatric disorders were major depressive disorder (32%), dysthymia (18%), and generalized anxiety disorder (12%). LSC group had significantly higher mean BDI (18.60 ± 11.77 vs 7.40 ± 4.90) and BAI scores (18.56 ± 13.75 vs 5.18 ± 5.34) than the control group. Patients with LSC displayed higher scores in Harm Avoidance Dimension (19.74 ± 5.18 vs 15.00 ± 5.13) of temperament and regarding character dimensions, they had lower scores in self-directedness (25.52 ± 6.69 vs 29.51 ± 5.54). When analysis of covariance (ANCOVA) was performed while BDI and BAI scores were taken as covariates cooperativeness became significantly higher in the LSC group. Patients with LSC had a high incidence of psychiatric comorbidity, significantly higher depression and anxiety levels, and differed from control group in terms of TCI profile and these conditions were related to symptom severity of the LSC. Comorbid psychiatric conditions and personality traits should be considered as crucial factors for the effective treatment of LSC.

Level of serum thioredoxin and correlation with neurocognitive functions in patients with schizophrenia using clozapine and other atypical antipsychotics.

Thioredoxin is a serum antioxidant that has been investigated in the etiology of schizophrenia. The aim of this study is investigating the relationship between serum thioredoxin levels and cognitive functions in acute psychotic episode and remission state patients with schizophrenia; and examining whether there were differences between patients using clozapine and other atypical antipsychotics; including risperidone, olanzapine and amisulpride. This research was performed in schizophrenia patients hospitalized with acute psychotic episode (n=57), reevaluated patients after the initiation of treatment (mean 16 weeks) (n=46), and healthy controls (n=41). Positive and Negative Syndrome Scale, Clinic Global Impressions Scale, Neuropsychologic test battery to assess cognitive performance, and serum thioredoxin levels measured by ELISA were used in this research. Serum thioredoxin levels were highest in acute psychotic episode, lower in the remission state and the lowest in healthy controls. Significant correlation has been established between serum thioredoxin levels and Trail Making Test-A performance in remission state patients. In conclusion, serum thioredoxin levels were increased in acute psychotic episode and decreased in remission state, and its relationship with attention is worth to consider in schizophrenia patients.

Changing Trends in Treatment of Acute Mania: Experience of a Tertiary Centre Over a Decade.

We investigated trends over a decade in the prescription of lithium, antiepileptics, and antipsychotic agents at discharge for patients hospitalised for acute mania. We conducted a retrospective review of medical records for 165 inpatients with acute mania who had been hospitalised in Cerrahpasa Faculty of Medicine, Department of Psychiatry during 2001-2002 and 2011-2012. Among 165 patients, prescription of olanzapine at discharge increased from 3 to 46 % (p < 0.001), while prescription of haloperidol decreased from 55 to 21 % (p < 0.001). Use of other atypical antipsychotics did not change significantly (risperidone decreased from 14 to 11 %, p = 0.5; quetiapine increased from 10 to 16 %, p = 0.2). Use of valproate, carbamazepine, and lithium did not change significantly. Use of electroconvulsive therapy in acute mania decreased by half from 27 to 13 % (p = 0.02). Typical antipsychotics alone or in combination with antiepileptics were the most common treatment regimen at discharge at 2001-2002; while 10 years later, they had been largely replaced by lithium or antiepileptics combined with second generation antipsychotics. Antipsychotic agents remained to be an important component of acute treatment of mania in our practice.

Psychodermatology: Knowledge, Awareness, Practicing Patterns, and Attitudes of Dermatologists in Turkey.

OBJECTIVE: Approximately, 1 in 3 patients in dermatology settings has psychiatric comorbidity. Thus, we conducted a survey in Turkey to explore the awareness, knowledge, practicing patterns, and attitudes of dermatologists toward psychocutaneous disorders. METHOD: The questionnaire-based study was performed from March 1, 2013, to May 20, 2013. Study participants included 115 dermatologists. The questionnaire consisted of 9 multiple-choice questions and 2 open-ended questions. RESULTS: Of the 115 dermatologists in the study, 38 were men and 77 were women. More than 85% of dermatologists indicated that they examine > 30 patients per week in their practice, while only 2% saw < 10 patients per week. The most frequent dermatologic condition associated with psychiatric involvement seen by dermatologists was acne (49.1%). The top 3 diagnoses referred by dermatologists to psychiatrists were psoriasis (42.6%), alopecia areata (38.2%), and pruritus (27.8%). CONCLUSIONS: A need for collaboration between primary care, psychiatry, and dermatology disciplines in handling patients with psychocutaneous conditions is widely accepted. Investigating the knowledge, attitudes, and awareness of dermatologists about psychocutaneous disorders might contribute to the development of new educational strategies and elicit qualified biopsychosocial approaches.

The impact of cognitive impairment, neurological soft signs and subdepressive symptoms on functional outcome in bipolar disorder.

BACKGROUND: Cognitive impairments and subsyndromal depressive symptoms are present during euthymic periods of bipolar disorder (BD). Most studies have determined that cognitive impairments and residual depressive symptoms have major impacts on psychosocial functioning. The aim of the present study was to identify the major factor responsible for low psychosocial functioning in a subgroup of patients with BD despite clinical recovery. METHODS: Sixty patients with bipolar I disorder and 41 healthy subjects were enrolled in this study. Cognitive performance, neurological soft signs (NSSs), psychosocial functioning, residual mood symptoms and illness characteristics were assessed. Using the median value of the Functioning Assessment Short Test (FAST) as the cut-off point, the patients were divided into two groups, high- (n=29) or low-functioning (n=31), and they were compared based on total NSS, residual depressive symptoms, cognitive performance and clinical variables. RESULTS: Performances on the verbal memory tests and social functioning were significantly worse in the euthymic patients with BD. Increased rates of NSS were identified in the patients compared with the normal controls. The low-functioning patients performed significantly worse on verbal memory, and their NSS and residual depressive symptoms were significantly higher compared to high-functioning patients. In the regression analysis, subsyndromal depressive symptoms and verbal learning measures were identified as the best predictors of psychosocial functioning. LIMITATIONS: The patients were artificially separated into two groups based on a FAST score cut-off. CONCLUSIONS: In this study, residual depressive symptoms and verbal memory impairments were the most prominent factors associated with the level of functioning.