The effect of chronotypes on follow-up outcomes of patients with substance use disorder.

Substance use disorder (SUD) can have circadian characteristics and individuals with evening chronotype are more prone to addiction. In this study, the effect of chronotypes on the treatment outcomes of SUD was investigated. The study included 66 patients who were diagnosed with SUD according to DSM-5. Two clinical interviews were conducted at 6-month intervals, and remission/relapse status was evaluated at the second interview. The Structured Clinical Interview Form for DSM-IV Axis I Disorders (SCID-I), Addiction Profile Index Practitioner Form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburg Sleep Quality Index and Morningness-Eveningness Questionnaire (MEQ) were applied to the patients. MEQ scores of relapsed patients were found to be different in terms of eveningness than those in remission (45.62 ± 8.70 versus 49.75 ± 7.60, p = 0.045). As the craving and addiction profile index total scores (addiction severity) increased, eveningness chronotype scores also increased (r = - 0.387 and r = - 0.286, respectively). The mean scores of craving and BDI were higher in relapsed patients compared to those in remission (p = 0.003 and p = 0.015, respectively). Our results suggest that patients with SUD had a lower morningness chronotype than the general population; additionally, more relapsed patients had an eveningness chronotype. Thus, chronotypes may play a role in the onset, prevention, and treatment outcome of SUD.

Prevalence of probable attention-deficit/hyperactivity disorder in inmates and its relationship with recidivism.

The aim of the current study was to determine the prevalence of probable attention-deficit/hyperactivity disorder (ADHD) in prisoners and to assess the relationship between ADHD and recidivism. We studied 356 inmates, who were evaluated using the Wender Utah Rating Scale and Adult ADHD Self-Report Scale. Type of crime and other crime-related data were compared between inmates with and without ADHD. The group with probable ADHD had a higher average number of convictions compared to the group without ADHD. The probable ADHD group also demonstrated higher incidence of extortion crime, drug trade, disciplinary action at school, and military service than the group without ADHD. Linear regression analysis revealed that the presence of probable ADHD was effective on the number of convictions. The findings of our study support that the presence of probable ADHD carries a potential risk of being prone to certain crimes and demonstrate a correlation between the presence of probable ADHD and early involvement in crime and the number of convictions.

Comparison of vitamin B12, vitamin D and folic acid blood levels in patients with schizophrenia, drug addiction and controls.

Schizophrenia (SCH) and drug addiction are chronic disorders that are frequently accompanied by physical diseases, poor nutrition and reduced self-care, all of which are likely to result in vitamin deficiencies. The objective of this study was to compare vitamin levels in SCH patients, substance use disorder (SUD) patients and healthy controls (HCs). The study included 189 SCH patients, 119 SUD patients and 109 HCs. Information on vitamin B12, folic acid and vitamin D levels were retrieved from the hospital's database, and mean values and deficiency/insufficiency were evaluated. Vitamin D deficiency (<30 ng/ml) was more common in the SCH group than in the SUD and HC groups (88.4%, 74.8% and 86.4%, respectively). Although there were no significant differences in folic acid deficiency (<3.0 ng/ml) in the SUD and SCH groups (15.1% and 8.5%, respectively), the incidence of folic acid deficiency was significantly higher in both groups as compared with that in the HC group (5.8%). Significantly higher numbers of patients in the SCH group than in the SUD group had vitamin B12 deficiency (45.5% vs. 28.3%). The prevalence of vitamin B12 deficiency in the SUD group was significantly higher than that the HC group (28.3% vs.11.5%). As compared with the HC group, vitamin D and B12 levels were significantly lower in SCH group, and folic acid and B12 levels were significantly lower in the SUD group. Several vitamin deficiencies appear to be common in both SCH and SUD. Possible reasons should be investigated.

Quality of life in rheumatological patients: The impact of personality disorders.

OBJECTIVE: Rheumatological diseases are associated with lower quality of life (QoL) levels. Psychiatric disturbances are frequently observed in these patients. This study examined the impact of personality disorders on the QoL of patients with rheumatological diseases. METHOD: The study sample consisted of 142 participants including patients suffering from rheumatological disease with a personality disorder (n = 30), without any personality disorder (n = 112), and healthy control participants without physical or psychiatric disorders (n = 60). The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID-I) and the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders (SCID-II) were used to determine Axis I and Axis II psychiatric disorders, respectively. QoL levels were assessed by means of the World Health Organization QoL Assessment-Brief. RESULTS: The subscale scores of physical health, psychological health, and social relationships were significantly lower in patients with rheumatological disease regardless of the existence of personality disorder compared with the control participants. Rheumatological patients with a personality disorder had significantly lower subscale scores of psychological health (p = 0.003) and social relationships (p < 0.003) compared with patients without any personality disorder. CONCLUSIONS: Personality disorders seem to be a relevant factor that maybe associated with QoL in patients suffering from rheumatological disease.

Postpartum-onset obsessive-compulsive disorder: incidence, clinical features, and related factors.

OBJECTIVE: The aims of this study were to investigate the incidence rate and symptomatology of postpartum-onset obsessive-compulsive disorder (PPOCD), to investigate the factors associated with PPOCD, and to compare clinical characteristics of obsessive-compulsive disorder (OCD) with and without postpartum onset. METHOD: The study data were collected from 302 women who delivered at a child and maternity hospital in Turkey from August 2005 to November 2005 and a control group of 33 women who were admitted to the psychiatric outpatient clinic of a university hospital during the same time period and who met DSM-IV criteria for OCD. The 2 clinical interviews with women who delivered were performed face-to-face on the first day after childbirth and at 6 weeks postnatally. OCD and comorbid Axis II disorders were diagnosed by means of the Structured Clinical Interview for DSM-IV and the Structured Clinical Interview for DSM-III-R Personality Disorders, respectively. Obsessive-compulsive symptomatology was assessed with the Yale-Brown Obsessive Compulsive Scale. RESULTS: The incidence of PPOCD was 4% at 6 weeks postnatally. The most common obsessions in women with PPOCD were contamination (75%), aggressive (33.3%), and symmetry/exactness (33.3%), and the most common compulsions were cleaning/ washing (66.7%) and checking (58.3%). The patients with PPOCD had significantly more frequent aggressive obsessions (p = .039) and less severe obsessive-compulsive symptoms (p = .013) than the OCD patients without postpartum onset. The predictors of PPOCD were avoidant (p = .000) and obsessive-compulsive (p = .004) personality disorders. CONCLUSIONS: This study suggests that the puerperium is a risk period in terms of new-onset OCD and that avoidant and obsessive-compulsive personality disorders predict PPOCD.

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.

Quality of life in patients with Behçet's disease: the impact of major depression.

OBJECTIVE: Behçet's disease (BD) is a multisystemic inflammatory disorder associated with high levels of depressive symptoms and lower quality of life (QoL). In this study, we aimed to investigate the impact of major depression (MD) on the QoL of patients with BD. METHOD: BD outpatients (n=25) and psychiatric outpatients (n=25) with only MD among the Axis I psychiatric disorders, and BD outpatients (n=25) and healthy controls (n=25) without any Axis I psychiatric disorder were included in the study. The Structured Clinical Interview for DSM-IV (SCID-I) was used to determine Axis I psychiatric disorders. Depression and QoL levels were assessed with the Beck Depression Inventory (BDI) and the World Health Organization QoL Assessment-Brief (WHOQOL-BREF), respectively. RESULTS: There was no significant difference with regard to demographic characteristics between the groups. Psychiatric and BD patients with MD had significantly lower overall WHOQOL-BREF subscale scores than BD patients without MD and healthy controls. No significant difference was found in terms of QoL between the groups of psychiatric and BD patients with MD, nor between the groups of BD patients without MD and healthy controls. Overall, there was a significantly negative correlation between all WHOQOL-BREF subscale and BDI scores in BD patients. CONCLUSION: The study suggests that concurrent MD has a negative impact on QoL of BD patients and that QoL is negatively correlated with the severity of depressive symptoms.

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.

Longitudinal assessment of symptom and subtype categories in obsessive-compulsive disorder.

Although it has been postulated that symptom subtypes are potential predictors of treatment response, few data exist on the longitudinal course of symptom and subtype categories in obsessive-compulsive disorder (OCD). Putative subtypes of OCD have gradually gained more recognition, but as yet there is no generally accepted subtype discrimination. Subtypes, it has been suggested, could perhaps be discriminated based on autogenous versus reactive obsessions stemming from different cognitive processes. In this study, our aim was to assess whether symptom and subtype categories change over time. Using the Yale-Brown Obsessive Compulsive Symptom Checklist (Y-BOCS-SC), we assessed 109 patients who met DSM-IV criteria for OCD to establish baseline values, then reassessed 91 (83%) of the initial group after 36+/-8.2 months. Upon reassessment, we found significant changes from baseline within aggressive, contamination, religious, symmetry and miscellaneous obsessions and within checking, washing, repeating, counting and ordering compulsion categories. Sexual, hoarding, and somatic obsessions, and hoarding and miscellaneous compulsions, did not change significantly. In accordance with the relevant literature, we also assigned patients to one of three subtypes--autogenous, reactive, or mixed groups. Though some changes in subtype categories were found, no subtype shifts (e.g., autogenous to reactive or reactive to autogenous) were observed during the course of the study. Significantly more patients in the autogenous group did not meet OCD criteria at follow-up than did patients in the other groups. Our results suggest that the discrimination between these two types of obsession might be highly valid, because autogenous and reactive obsessions are quite different, both in the development and maintenance of their cognitive mechanisms, and in their outcome.

[The prevalence of generalized anxiety disorder and comorbidity among psychiatric outpatients]. / Ayaktan Psikiyatri Hastalarinda Yaygin Anksiyete Bozuklugunun Yayginligi ve Ek Tanilar.

OBJECTIVE: In this study, we aimed to investigate the prevalence, association with sociodemographic characteristics, and comorbidity with other anxiety and depressive disorders of generalized anxiety disorder (GAD) among psychiatric outpatients. METHOD: In the first phase of the study, outpatient psychiatry clinic physician interviewed with consecutive 950 patients who applied to psychiatry outpatient clinic of an university hospital by using GAD module of CIDI (Composite International Diagnostic Interview, version 2.1) during 4-month. Ninety-nine patients with diagnosis of GAD in the first phase were referred to the researcher physician for further evaluation. In the second phase, patients were interviewed by using CIDI anxiety and mood (major depression, dysthymic disorder) disorder modules. By this way, 12-month additional diagnoses were examined, and diagnosis of GAD was confirmed. One patient was excluded, because did not meet the GAD criteria during reexamination by the researcher physician. RESULTS: Ninety-eight patients (10.3%) met DSM-IV criteria for GAD. Eighty-nine (90.8%) of the cases had comorbid any anxiety or depressive disorder. The rates of comorbidity with any of depressive disorders and anxiety disorders were found 84.7% and 56.1%, respectively. The most common comorbid diagnosis was major depression (83.7%). The most common anxiety disorders were social phobia (30.6%), OCD (19.4%) and specific phobia (17.4%). The prevalence of GAD was observed significantly higher in women, married ones, housewives, unworking girls, subjects with history of medical illness and lower educational status. CONCLUSION: Our results show that among psychiatric outpatients, GAD has high comorbidity rates with depressive and other anxiety disorders, and it is associate with some sociodemographic characteristics such as gender, and marital, working and educational status.

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.

The prevalence of parasomnias in preadolescent school-aged children: a Turkish sample.

STUDY OBJECTIVES: To survey the prevalence of parasomnias in a population of children aged 7 to 11 years and to determine whether parasomnias are associated with medical and neurobehavioral properties. DESIGN: Parents and children completed a pediatric sleep questionnaire that contains 27 items developed by the authors to assess parasomnias in children. Parents and children were also interviewed about the children's medical and sociofamilial history, schooling, psychological difficulties, medication intake, and the history of psychomotor and psychosocial development. SETTING: NA PARTICIPANTS: 971 preadolescent school-aged children from 4 locations in Turkey participated in the study. RESULTS: We found a 14.4% prevalence of parasomnia in preadolescent school-aged children. Almost every sixth child had about at least 1 parasomnia. When we examined parasomnias separately, bruxism, nocturnal enuresis, and night terrors were the most common parasomnias among both girls and boys. The prevalence of parasomnias was higher in the 9- and 10-year-old age groups than in the other age groups. Girls and boys did not differ. Children with parasomnias had higher rates of past physical illness, delays in toilet raining, behavior disturbances, adjustment problems, and learning difficulties. CONCLUSIONS: These results suggest that the prevalence of parasomnias was high in the 9- and 10-year-old age groups. Parasomnias are associated with a history of physical illness and neurobehavioral abnormalities.

The predictors of health care seeking behavior in obsessive-compulsive disorder.

A majority of individuals with obsessive-compulsive disorder (OCD) do not seek health care. To better understand why not, health care-seekers (HCS) with OCD (n = 25) were compared with non-health care-seekers (NHCS) with OCD (n = 23) regarding their sociodemographic variables, symptom severity, types of obsessions and compulsions, insight degree, comorbid diagnosis, and quality-of-life (QOL) level. There was no significant difference for sociodemographic characteristics between the groups. NHCS scored significantly lower on a measure of illness severity than HCS. The NHCS group had significantly poorer insight degree than the HCS group. Aggressive and religious obsessions were significantly less identified in the NHCS group compared to the HCS group. NHCS were significantly less likely to have comorbid diagnosis than HCS. The NHCS group reported significantly higher levels of QOL in psychological health and level of independence domains [corrected]. To identify the predictors of health care seeking behavior, probable variables were entered in a logistic regression model. Insight degree and level of independence emerged as the predictors of health care seeking. Our results suggest that health care seeking behavior in OCD is associated with the individuals' ability to recognize their symptoms as a disorder and subjective interpretation regarding the impact of OCD on their level of independence. Results of the present study extend findings of two recent studies that have investigated factors related to health care seeking in OCD.

[Nicotine dependence and psychiatric comorbidity among university students]. / Universite ogrencilerinde nikotin bagimliliginin psikiyatrik bozukluklarla birlikteligi.

OBJECTIVE: The relationship between psychiatric disorders and nicotine use has been studied in recent years. In this study, the comorbidity between psychiatric disorders and nicotine dependence (ND) and nicotine abstinence (NA) was evaluated in a randomly selected group of university students. METHOD: We used the 12-month version of CIDI 2.1 (Composite International Diagnostic Interview) for the interviews of a total of 323 students (M/F: 168/155), who were randomly selected among and represented all students in Selçuk University. The mean age of students was 20.9 (SD: 5.4, range: 16-34). ND, NA and other psychiatric disorders were diagnosed according to DSM-IV criteria. RESULTS: One-year prevalence of ND and NA was 17% (n=55) and 4% (n=13), respectively among the 323 students interviewed. The prevalence of any psychiatric disorders other than ND and NA was 26.3% (n=85). Students who had psychiatric disorders had a higher relative risk than those who did not have psychiatric disorders (30.6% versus 12.2%, odds ratio: 3.2, 95% CI 1.7-5.8; p<0.001). ND was also observed more commonly in students who were diagnosed with any of these disorders than in those free of these disorders: alcohol dependence or abuse (72.7% versus 15.1%), any mood disorder (36.0% versus 15.4%) and any anxiety disorder (29.3% versus 13.9%). CONCLUSION: This study suggests that ND in young adults is associated with a higher rate of psychiatric disorders.

[Body dysmorphic disorder in psychiatric outpatients: diagnosis, other psychiatric diagnosis, demographic and clinical correlates]. / Ayaktan psikiyatrik hastalarda vücut dismorfik bozuklugu: tani, yasam boyu baska ruhsal hastalik varligi, demografik ve klinik ozellikler.

OBJECTIVE: We assessed the clinical and demographic properties and comorbidity of 47 patients with body dysmorphic disorder (BDD). METHOD: Fifty-four patients with BDD among 4768 consecutive outpatients over a 5-year period were reviewed and invited for comprehensive re-examination. A total 47 patients (male female=26:21) were rediagnosed according to DSM-IV criteria for BDD and comorbid lifetime psychiatric disorders using SCID-I. RESULTS: The mean age of BDD patients was 23.1 +/- 5.5 years and the mean age at onset of BDD was 17.6 +/- 2.4 years. The face (27.7%) and nose (25.5%) were the most common areas of concern, followed by hair loss/thinning, legs/knees, hands, and thinness. Obsessive-compulsive disorder (31.9%), major depression (21.3%), and social phobia (17.0%) were the most frequent additional lifetime DSM-IV diagnoses. Eleven patients (23.4%) had ideas of reference and 9 patients (19.1%) had delusions of deformity or reference. Four patients (8.5%) had made suicide attempts. CONCLUSION: BDD may be related to obsessive-compulsive disorder in several aspects, including patterns of comorbidity and symptom profile. These findings also support the idea that BDD has a psychotic subtype that is closely related to the primary disorder. BDD patients among the Turkish population have a symptom profile similar to those in western countries except for lower suicide attempts.