Evaluation of Executive Functions With Functional Near-Infrared Spectroscopy in Euthymic Bipolar and Borderline Personality Disorders.

Introduction: Bipolar disorder (BD) and borderline personality disorder (BPD) are often indistinguishable, given both the key features of impulsivity and emotional dysregulation. This indicates widespread comorbidity and potential misdiagnosis in both groups. Therefore, this study aimed to differentiate BD and BPD by using alterations of brain hemodynamics under the influence of executive tests. Methods: Twenty patients with the euthymic phase of BD and 20 patients with BPD, and 20 healthy control subjects were included in this study. The prefrontal cortex (PFC) hemodynamic responses were evaluated using functional near-infrared spectroscopy (fNIRS) during the Stroop Test and Wisconsin Card Sorting Test (WCST). Results: Left dorsolateral prefrontal cortex (DLPFC) activation was significantly decreased in BPD during both tests. On the other hand, the BD group showed medial PFC hypoactivation during both tests, and this finding is distinct from BPD (p<0.05). Conclusion: Our results indicate that brain hemodynamics during the executive test can highlight differences between BP and BPD. While medial PFC hypoactivation was more prominent in the BP group, DLPFC hypoactivation was more pronounced in the BPD group.

Doxylamine Addiction: A Case Report. / Doksilamin Bagimliligi: Bir Olgu Sunumu.

Doxylamine succinate, one of the antihistamines available without a prescription for patients suffering from insomnia, is also an antihistamine with the potential for abuse. Although there are case reports about the addictive potential of antihistamines, there are not many studies on doxylamine succinate addiction in the literature. To our knowledge, there have been no case reports on doxylamine succinate addiction in Turkey. This case report presents a patient (43, M), who started using over-the-counter doxylamine succinate at 25 mg/day due to insomnia, gradually increased to 125 mg/day for the last 3 years continuing his doxylamine succinate intake for 5 years uninterrupted, as well as his treatment process. In addition, possible causes and consequences of doxylamine succinate and the potential for abuse of antihistaminic drugs are discussed through the case. Keywords: Antihistamines, drug dependence, doxylamine.

A Self-Management App for Patients with Schizophrenia: A Pilot Study.

We aimed to observe the effects of a self-management mobile app for patients with schizophrenia. A mobile app was designed to record and remind users to take medication and some daily activities. The patients were asked to use the app for one month. Before starting to use the app, and after completion of one month, the patients were assessed by some psychiatric scales. Twelve patients completed the study. The mean number of automatic reminders per patient was 918/month or 29.6/day. The mean entry number per patient was 158.4/month or 5.1/day. The numbers of daily recorded activities showed a decreasing tendency over time. The pre-study PANSS score was 16.2±5.8 (meanÂsSD) and the post-study score was 14.9±6.9 (p=0.040). The pre-study FROGS daily life skills score was 20.3±3.8 and the post-study score was 19.7Âs4.1 (p=0.012). The results suggest that a mobile app may be helpful for patients with schizophrenia.

Comparison of naltrexone implant and oral buprenorphine-naloxone in the treatment of opiate use disorder.

OBJECTIVE: We aimed to compare the effectiveness of extended-release naltrexone (XR-NTX) implant and sublingual buprenorphine-naloxone (BUP-NX) in relapse prevention in opiate use disorder (OUD). METHODS: Medical records of 400 patients who were treated for OUD between 2016 and 2020 were retrospectively evaluated concerning sociodemographic and clinical characteristics and abstinence duration with either BUP-NX (192 patients) or XR-NTX (208 patients) as maintenance treatments. RESULTS: The median age of patients using BUP-NX was 25.00, and the median age of patients using XR-NTX was 25.50 (p = .785). The ratio of female patients in the BUP-NX group and the XR-NTX group was 7.3% (n = 14) and 6.7% (n = 14), respectively. A significantly higher abstinence time was observed in the BUP-NX group (median = 4 months) than in the XR-NTX group (median = 3 months) (p = .015). Liver function tests were within the normal ranges at the three time points, which were just before the beginning and in the first and third months of treatment. CONCLUSIONS: These findings suggest that BUP-NX might be more effective than XR-NTX in preventing relapse in OUD and both drugs are safe for the liver. Prospective randomized studies are needed to replicate our results.

Levels of TNF alpha, Soluble TNF Receptors (sTNF-R1, sTNF-R2) in Bipolar Disorder.

INTRODUCTION: Current evidence suggests that pro-inflammatory cytokines, particularly tumor necrosis factor alpha (TNF-α) may play an important role in the pathophysiology of bipolar disorder (BD). Our study aims to compare BD patients and controls in terms of serum TNF-α, soluble tumor necrosis factor receptor 1 and soluble tumor necrosis factor receptor 2 (sTNF-R1, sTNF-R2) levels in different phases of BD. METHODS: Eighty-three patients with BD type 1 (27 manic, 22 depressive and 34 euthymic) and twenty-nine healthy controls were included in the study. Serum levels of TNF-α, sTNF-R1, sTNF-R2 levels were evaluated with ELISA kit. RESULTS: Levels of sTNF-R1 were showed a statistically significant difference between groups. Levels of sTNF-R1 were higher in depression or mania patients than euthymia patients and control subjects. A statistically significant difference in the serum level of sTNF-R1 between patients in acute episode (mania and depression) group and stabile (patients in euthymic episode and controls) group was found in logistic regression analysis. The probability of having acute episode increased threefold for each unit increase in serum level of sTNF-R1. There was no statistically significant difference between the mean serum values of TNF-α and sTNF-R2 between the groups. CONCLUSIONS: sTNF-R1 production was different between acute episode patients and controls or stable BD patients. The result of this study confirms that TNF-R1 may be a state marker representing disease activity for BD.

A Web-based Game for Teaching Facial Expressions to Schizophrenic Patients.

BACKGROUND: Recognizing facial expressions is an important social skill. In some psychological disorders such as schizophrenia, loss of this skill may complicate the patient's daily life. Prior research has shown that information technology may help to develop facial expression recognition skills through educational software and games. OBJECTIVES: To examine if a computer game designed for teaching facial expressions would improve facial expression recognition skills of patients with schizophrenia. METHODS: We developed a website composed of eight serious games. Thirty-two patients were given a pre-test composed of 21 facial expression photographs. Eighteen patients were in the study group while 14 were in the control group. Patients in the study group were asked to play the games on the website. After a period of one month, we performed a post-test for all patients. RESULTS: The median score of the correct answers was 17.5 in the control group whereas it was 16.5 in the study group (of 21) in pretest. The median post-test score was 18 in the control group (p=0.052) whereas it was 20 in the study group (p<0.001). CONCLUSIONS: Computer games may be used for the purpose of educating people who have difficulty in recognizing facial expressions.

Epilepsy and stigmatization in Turkey.

Patients with epilepsy experience stigmatization quite often. Studies investigating stigmatization perceived by patients with epilepsy in Turkey are limited in number. In this study, we aimed to understand the relationship between stigmatization and psychopathology and also to identify the effects of stigmatization on the quality of life in epilepsy. Patients completed a socio-demographical data form and epilepsy information form. They were evaluated in terms of psychiatric diagnosis using SCID I and they were asked to complete SCL-90 R, Epilepsy Stigmatization Scale and SF 36. The percentages of patients who did and did not report perception of stigmatization were similar in the study group. Depression was the most common diagnosis followed by anxiety disorder. In comparison to patients who did not feel stigmatized, patients who reported perceived stigmatization had a higher frequency of generalized tonic clonic seizures and injuries during seizures and more frequently missed taking their medication. They also showed higher rates of both suicide attempts and psychopathology as evidenced by a higher rate of psychiatric diagnosis and higher score in all the subscales of SCL 90. With regard to their quality of life they were observed to be more disabled in the physical functioning, general health perception, vitality, social role functioning and mental health dimensions. A logistic regression analysis revealed that stigmatization was best predicted by three variables: history of suicide attempts, receiving a psychiatric diagnosis and higher score in SCL90PST. Our study has shown that psychopathology is a more significant predictor of stigmatization than the other variables related with seizure control.

Evaluation of the usability of a serious game aiming to teach facial expressions to schizophrenic patients.

In some psychological disorders such as autism and schizophrenia, loss of facial expression recognition skill may complicate patient's daily life. Information technology may help to develop facial expression recognition skill by educational software and games. We designed and developed an interactive web-based educational program with which we performed a usability study before investigating its effectiveness on the schizophrenia patients' ability of emotion perception. The purpose of this study is to describe the usability evaluation for a web-based game set that has been designed to teach facial expressions to schizophrenic patients. The usability study was done at two steps; first, we applied heuristic evaluation and the violations were rated in a scale from most to least severe and the major problems were solved. In the second step, think-aloud method was used and the web site was assessed by five schizophrenic patients. Eight experts participated in the heuristic evaluation, in which a total of 60 violations were identified with a mean severity of 2.77 (range: 0-4). All of the major problems (severity over 2.5) were listed and the usability problems were solved by the development team. After solving the problems, five users with a diagnosis of schizophrenia used the web site with the same scenario. They reported to have experienced minor, but different problems. In conclusion, we suggest that a combination of heuristic evaluation and think-aloud method may be an effective and efficient way for usability evaluations for the serious games that have been designed for special patient groups.

[Association of serum homocysteine and methionine levels with cognition and functioning in bipolar disorder]. / Bipolar Bozuklukta Serum Homosistein ve Metiyonin Düzeylerinin Bilissel Islevler ve Islevsellikle Iliskisi.

OBJECTIVE: The relationship between homocysteine (HCY) levels and cognitive impairments, particularly executive functions in bipolar disorder (BD), has recently been investigated. However, conflicting results were reported. The aim of the present study is to investigate changes in serum HCY, methionine, vitamine B12 and levels in BD patients are relative to controls and to investigate the relationship between HCY, methionine, vitamin B12, and folate levels and clinical features, cognitive functions and psychosocial functioning in euthymic BD patients and controls. METHODS: Sixty BD type I euthymic patients and twenty controls were assessed with Global Assessment of Functioning and a battery of neuropsychological tests including the Wisconsin card sorting test, the Rey's auditory verbal learning test, the Cancellation test, Trail making test A, Trail making test B, and the Stroop test. HCY, vitamin B12, methionine and folate levels were measured together after collecting blood samples from both patient and controls. RESULTS: Mean serum methionine concentration was different between groups. Low serum methionine was found to be a predictor of BD. However, a statistically significant difference was not detected between groups for mean serum values of HCY, folate, or vitamin B12. HCY levels showed a positive correlation with illness duration, the number of total episodes, and the number of manic episodes. A significant correlation was not found between HCY, methionine, folate, B12 levels with cognitive functions and functioning in the BD group. CONCLUSION: Low serum methionine was found to be a predictor of BD, a condition which can lead to a decrease in SAM synthesis and thus to a variety of complications in methylation reactions. Additional studies are needed to clarify the impact of single carbon metabolism on BD.

Levels of TNF-α, soluble TNF receptors (sTNFR1, sTNFR2), and cognition in bipolar disorder.

OBJECTIVE: Tumor necrosis factor-alpha (TNF-α) may play an important role in bipolar disorder (BD) pathogenesis. There is only one study about a relationship between TNF-α levels and cognitive impairments in BD. The aim of the present study was to see whether TNF-α, soluble P55 TNF receptor (sTNFR1), and soluble P75 TNF receptor (sTNFR2) levels in BD patients are different from controls and to investigate the relationships between the levels of TNF-α, sTNFR1, and sTNFR2 and the cognitive functions in euthymic BD patients and controls. METHODS: We assessed 54 BD type I patients and 18 controls by using a battery of neuropsychological tests. Serum TNF-α levels were measured using a commercially available enzyme-linked immunosorbent assay, whereas serum sTNFR1 and sTNFR2 levels were measured using a commercially enzyme-amplified sensitivity immunoassay kit. RESULTS: We found that levels of sTNFR1 and sTNFR2 in BD patients were different from controls. No difference was detected between the BD group and the control group for levels of TNF-α. TNF-α level was found to have a negative correlation with the delayed recall in RAVLT. CONCLUSIONS: High levels of sTNFR1 and sTNFR2 in euthymic patients showed that it may support that proinflammatory process continues in euthymic period. This is the first study which showed increased sTNFR2 levels in euthymic period, which could be interpreted as a compensatory mechanism and again the first which deals with verbal memory.

[Case report: comorbid anorexia nervosa and schizophrenia in a male patient]. / Olgu Sunumu: Bir Erkek Hastada Anoreksiya Nervoza ve Sizofreni Eshastalanimi

Anorexia nervosa is a rare psychiatric disorder and epidemiological studies have shown a female to male ratio of 10:1, suggesting it is a disorder predominantly seen among females. The prevalence of anorexia nervosa comorbid with other psychiatric disorders has been reported to be quite high. Whereas depression and anxiety disorders are the most common comorbid diagnoses in anorexic patients, the dual-diagnosis of anorexia and schizophrenia is a relatively rare condition. Based generally on the observations from single case reports or case series, several explanations have been made about the co-occurrence of anorexia and schizophrenia. Herein, we present a male patient who developed schizophrenia after an anorexic period of 4 years that began when he was 14 years old with the decision to lose weight, which then progressed to a pattern of disordered eating and body image. This case is rare because the patient is male and has a comorbid diagnosis of anorexia nervosa and schizophrenia. To the best of our knowledge, there is only one previous case report in the literature describing a male anorexic patient with comorbid schizophrenia. In this case presentation, the diagnosis of anorexia nervosa in males is addressed, the definition and significance of sub-threshold cases are discussed, and the comorbidity of anorexia nervosa and schizophrenia are reviewed in light of the literature.

[Is there any correlation between self-perception and psychopathology in adolescence?]. / Ergenlerde kendilik algisi ile psikopatoloji arasinda baginti var mi?

OBJECTIVE: In this study, the relation between self-perception and psychopathology is examined trying to answer the question of whether the self-perception profiles of the adolescents who have admitted to an outpatient unit of a psychiatry clinic are different from those of the adolescents who have not. METHOD: The study is a cross-sectional controlled study. There are two groups one of which is the group of adolescents who have admitted to the outpatient adolescent clinic of the Social Security Hospital of Ankara and the other is the control group. Self-Perception Profile for Adolescents (SPPA) and SCL-90-R were administered to the groups. DSM-IV diagnoses were made by two clinicians via interviews with adolescents. The differences in the domains of SPPA between two groups were assessed via multivariate and then univariate analysis. RESULTS AND CONCLUSION: In the domains of SPPA, the global self-worth and the behavior in the relationships, the adolescent group who has admitted to the psychiatry clinic was found to be significantly lower than that of the adolescent group who has not.