Adipocytokines and ghrelin level of bipolar patients from manic episode to euthymic episode.

PURPOSE: Obesity and metabolic syndrome (MeS) are more frequently observed in bipolar patients than the general population. This may result from the differences of adipocytokines and ghrelin levels in bipolar disorder. MATERIAL AND METHODS: We evaluated the leptin, adiponectin, resistin and ghrelin levels in bipolar patients (n = 30) in manic episode and in a control group (n = 30). After treatment, the same patients were evaluated again during the euthymic episode. We also measured the insulin, glucose, insulin resistance (HOMA), trygliceride (TG), total cholesterol (TCHOL), high density lipoprotein cholesterol (HDL) and low density lipoprotein cholesterol (LDL) in relation to the (MeS). RESULTS: When controlling for age, BMI and glucose, leptin levels were higher in the bipolar disorder manic episode group (BD-ME) and bipolar euthymic episode group (BD-EE) than the control group; resistin levels were higher in the BD-ME compared to the control group and it had a positive correlation with Young Mania Rating Scale (YMRS). After treatment, ghrelin levels were higher in the BD-EE compared to the BD-ME group. There was no difference among the groups with respect to adiponectin. CONCLUSIONS: The present results point that high leptin, resistin and ghrelin levels may be involved in the early pathophysiological process which can lead to later obesity and MeS in patients with bipolar disorder.

Student nurses' perceptions of aggression: An exploratory study of defensive styles, aggression experiences, and demographic factors.

Throughout the clinical learning process, nursing students' perception of aggression might have implications in terms of their future professional behavior toward patients. Using a descriptive cross-sectional design, we investigated the relationships between student nurses' perceptions of aggression and their personal characteristics, defense styles, and a convenience sample of 1539 experiences of aggressive behavior in clinical practice. Information about the students' personal features, their clinical practice, and experiences of aggressive behavior was obtained by questionnaire. The Turkish version of the Perception of Aggression Scale and Defense Styles Questionnaire-40 were also used. Students were frequently exposed to verbal aggression from patients and their relatives. And perceived patient aggression negatively, perception of aggression were associated with sex, defense styles, feelings of safety, and experiences of aggressions during clinical practice. Of interest is the reality that student nurses should be prepared for untoward events during their training.

Associations with violent and homicidal behaviour among men with schizophrenia.

Objective We aimed to assess the risk factors associated with homicidal behaviour in male patients diagnosed with schizophrenia. Methods In a period of 1 year, male schizophrenia cases between 18-65 years of age (n = 210) were included. The clinical evaluation included the Positive and Negative Syndrome Scale (PANSS) and Overt Aggression Scale (OAS). The patients were divided into three groups in terms of violent behaviour history: (1) homicide group (n = 30), (2) a violent act resulting in serious injury (n = 71), (3) control group (patients without a history of a violent act) (n = 109). Results Lower level of education, rural residence, being unemployed and living alone were found to be significantly more common in patients who had committed a violent act compared to the schizophrenia patients in the control group. In order to explore the predictive value of several factors associated with violent behaviour, a logistic regression model was used, and variables (shorter duration of education, living alone, and lack of insight) significantly predicted the presence of violent behaviour (murder and/or injury) (χ(2)=31.78, df = 12, p = 0.001). Conclusions In order to be able to determine causality of homicidal acts in schizophrenia patients, our significant findings between homicidal violence, non-homicidal violence and the control group would merit further attention and exploration in further studies.

Social Cognition in Schizophrenia Patients and Their First-Degree Relatives.

INTRODUCTION: Social cognition is a person's ability to configure the designs of relationships between themselves and others and to use these designs to guide social behaviors in a flexible manner. The models that are the most studied and describe social cognition are the theory of mind (ToM) and emotion recognition. This study was aimed to detect ToM and emotion recognition disorders in schizophrenia patients and their first-degree relatives. METHODS: Thirty schizophrenia patients in remission, the first-degree relatives of schizophrenia patients (n=30), and 30 healthy volunteers who were paired with the patients in terms of age and duration of education were included in the study. The Positive and Negative Symptom Scale (PANSS), Dokuz-Eylül Theory of Mind Scale (DEToMS), Reading the Mind in the Eyes test, Facial Emotion Identification Test (FEIT), and Facial Emotion Discrimination Test (FEDT) were performed by the patients participating in this study. RESULTS: ToM and emotion recognition were found to be defective in the schizophrenia patients and their relatives. The performances of ToM and emotion recognition were ranked as the schizophrenia group, family group, and control group, from the worst to the best. The schizophrenia group showed poor performance in all sub-components except irony. In the family group, the empathy subcomponent showed similar performance with the control group, whereas the subcomponents of the second-order false belief, metaphor, and faux pas tests showed similar performance with the patient group. There were differences among the three groups in the first-order false belief subscale as well as the total DEToMS. The patient and family groups showed the poorest performances, whereas the control group showed the best performance. CONCLUSION: The detection of ToM and emotion recognition disorders in the remission period, regardless of the attack period and asymptomatic first-degree relatives, may support the view that the period of schizophrenia is an independent continuous variable.

Oxidative stress in bipolar and schizophrenia patients.

Oxidative stress has an important place in studies investigating the pathophysiology of psychiatric diseases. In spite of this fact, longitudinal studies are required to clarify the subject. Therefore, in this study, we examined lipid peroxidation, protein oxidation, total oxidized guanine species, superoxide dismutase (SOD) and total glutathione (GSH) levels in blood collected from adult bipolar patients (n=18) during manic and euthymic episodes, schizophrenic patients (n=18) during acute psychotic attack and remission phases and the control group (n=18). There was a significant increase in the level of lipid peroxidation in the bipolar disorder manic episode group (BD-ME) compared to control group. The level of protein oxidation was significantly higher in the schizophrenia acute psychotic attack group (SZ-APA) compared to the control group. The level of total oxidized guanine species was statistically higher in all psychiatric groups compared to the control group. There was no significant difference among the groups with regard to SOD and GSH. Consequently, we believe that lipid peroxidation may be effective in the pathogenesis of bipolar patients; that protein oxidation may be of importance in the pathogenesis of schizophrenia and that total oxidized guanine species may be crucial in the pathogeneses of both psychiatric disorders.

Factor structure of the Subjective Well-being under Neuroleptic treatment Scale-short form in schizophrenic outpatients: five factors or only one?

UNLABELLED: BACKROUND AND AIM: The Subjective Well-Being under Neuroleptics Scale, short form (SWNS), is a self-report measure that evaluates the states of well-being of schizophrenia patients using antipsychotic drugs independently from psychopathology of disease. This study examined the factor structure of the Turkish version of the scale using high-level statistical analyses. METHODS: The SWNS was translated into Turkish and applied to 103 schizophrenic patients. A type of multi-trait-multi-method (MTMM) confirmatory factor analysis was conducted to determine the factor structure of the Turkish version of the scale. RESULTS: The results of factor analysis of the SWNS were incompatible with the factor structure of the original scale. A set of MTMM analyses showed distinct method effects for both positive and negative item wording in the scale. In light of these findings, the factor structure of the SWNS was determined as having a one-dimensional structure, with bias due to item wording. CONCLUSIONS: The results of the present investigation indicated that the sub-factors of the SWNS failed to emerge from the data. This study is the first to show that there is an urgent need for further examination of the factor structure of the SWNS with regard to method effects. This issue has important implications for the use of sub-factors by both researchers and practitioners.

Personality characteristics and body image in obese individuals.

INTRODUCTION: The aim of this study was to determine the personality characteristics of obese and morbidly obese individuals with no psychiatric disorder and the correlation between these characteristics and body image and self-esteem. METHODS: Sixty-nine obese individuals and 69 healthy controls, matched in age, sex and marital status, were included in the study. Psychiatric disorders were excluded for all participants using SCID-I and II. Obese and healthy volunteers were compared in terms of body image, self-esteem and personality characteristics. RESULTS: TCI harm avoidance scores were higher in obese individuals compared to healthy controls. Harm avoidance scores were also higher in individuals with morbid obesity compared to non-morbid individuals, while self-directedness and persistence scores were lower. Body image dissatisfaction was higher in obese individuals. There was a negative correlation in obese individuals between body image and self-esteem scale scores and harm avoidance scores, and a positive correlation with self-directedness scores. DISCUSSION: An elevated harm avoidance temperament characteristic may be correlated with obesity. Furthermore, high harm avoidance, low self-directedness and low persistence may be significant personality characteristics in a process leading to morbid obesity. In addition, harm avoidance temperament and self-directedness personality characteristics may be correlated with body image dissatisfaction and self-esteem in obese individuals.

Metacognitive beliefs in unipolar and bipolar depression: a comparative study.

AIMS: The purpose of this study was to perform a comparative investigation of metacognitive beliefs regarding pathological worry in patients with unipolar and bipolar depressive disorder. METHODS: Those subjects with acute depressive episodes among patients diagnosed with major depressive disorder (unipolar) or bipolar disorder on the basis of DSM-IV diagnostic criteria (unipolar n = 51, bipolar n = 45), and healthy controls (n = 60), were included in the study. Participants were administered the Meta-Cognitions Questionnaire (MCQ-30) in order to determine metacognitive beliefs. The relationship between metacognitive beliefs and anxiety severity, depression severity and self-esteem in the unipolar and bipolar patients groups was then examined. RESULTS: Scores for negative beliefs about worry concerning uncontrollability and danger and for beliefs about the need to control thoughts were higher in both the unipolar and bipolar depression groups than in the healthy controls (P < 0.05). Lack of cognitive confidence scores were higher in the bipolar group than in the healthy controls (P < 0.05). Metacognitive beliefs (to a greater extent in parameters in the bipolar group) were correlated with anxiety level, depression level and self-esteem in both patient groups. CONCLUSION: In addition to metacognitive beliefs known to be associated with ruminations in unipolar and bipolar depression, metacognitive beliefs can also be seen in association with worry. Worry-associated metacognitive beliefs should be the subject of focus in the identification of metacognitive beliefs in depression patients and in metacognitive therapy in these patients.

The relationship between the presence of ADHD and certain candidate gene polymorphisms in a Turkish sample.

Due to the high heritability of attention-deficit hyperactivity disorder (ADHD), parents of children with ADHD appear to represent a good sample group for investigating the genetics of the disorder. The aim of this study was to investigate the association between ADHD and six polymorphisms in five candidate genes [5-HT2A (rs6311), NET1 (rs2242447), COMT (rs4818), NTF3 (rs6332), SNAP-25 (rs3746544) and (rs1051312)]. We included 228 parents of children diagnosed with ADHD and 109 healthy parents as the control group. The polymorphisms were genotyped using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) assays and analyzed using the chi-square test and the multinomial logit model. SNAP-25 (rs3746544) polymorphism was associated with loading for ADHD, while 5-HT2A (rs6311) and NET1 (rs2242447) polymorphisms were associated with ADHD. On the other hand, there was no significant association between the SNAP-25 (rs1051312), NTF3 (rs6332), or COMT (rs4818) gene polymorphisms and ADHD. In addition, we found that even if variation in the SNAP-25 gene alone does not affect the phenotype, it may nevertheless lead to the emergence of a clinical ADHD picture in the presence of other genetic factors. Our findings suggest that a combination of NET1 (rs2242447) and SNAP-25 (rs3746544) is a risk factor for ADHD. Problems associated with the noradrenergic and serotonergic systems and SNAP-25 may play a role, both alone and in interaction with one another, in the pathophysiological mechanisms of ADHD.

Internalized stigma and intimate relations in bipolar and schizophrenic patients: a comparative study.

OBJECTIVE: The aim of this study was to determine characteristics of internalized stigma and intimate relations in bipolar and schizophrenia patients and to compare characteristics of intimate relations in bipolar and schizophrenia patients with or without internalized stigma. METHOD: A total of 228 volunteers were included, 119 patients with bipolar disorder and 109 with schizophrenia. Schizophrenic and bipolar disorder patients were compared in terms of internalized stigma and intimate relations characteristics. Bipolar and schizophrenia patients with and without internalized stigma were compared in terms of characteristics of intimate relations. RESULTS: Internalized stigma was determined in one in three schizophrenia and one in five bipolar patients. Stigma resistance and relational esteem in intimate relations scores were higher in bipolar patients. Relational anxiety/fear of relationship, relational monitoring and external relational control scores were higher in schizophrenia patients with internalized stigma compared to those without, while their relational satisfaction, relational esteem and relational assertiveness scores were lower. Relational anxiety/fear of relationship and relational monitoring scores were higher in bipolar patients with internalized stigma compared to those without, while their relational satisfaction scores were lower. CONCLUSION: Internalized stigma in schizophrenia patients is a well-known subject that has been investigated previously. The results of our study are significant in terms of showing that internalized stigma is also frequent in bipolar disorder patients, and not solely in schizophrenia patients. Stigma resistance is higher in bipolar disorder patients. Internalized stigma is correlated with intimate relations in both bipolar and schizophrenia patients.

Psychiatric symptoms in patients with multiple sclerosis.

OBJECTIVES: This study was intended to identify general psychiatric symptoms in multiple sclerosis (MS) patients and to determine the distribution of these psychiatric symptoms by type of MS and degree of disability. METHODS: One hundred fifty-two volunteers, 76 MS patients and 76 healthy controls, matched in terms of age, gender, marital status, years spent in education and income, were included. Psychiatric symptoms were measured using the Symptom Checklist-90-R, Beck Depression Inventory, State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, Padua Inventory, Rosenberg Self-Esteem Scale and Eating Attitude Test. Degree of disability was determined using the Expanded Disability Status Scale (EDSS). In addition to being compared between the patient and control groups, scale scores were also compared between groups established on the basis of relapsing-remitting or progressive forms of MS, neurological disability and ambulatory ability. Correlations were determined between EDSS scores and psychiatric scale scores. RESULTS: In addition to symptoms of depression, anxiety and sleep impairment in MS patients, we also determined that less studied symptoms such as somatization, obsession, compulsion, interpersonal sensitivity, anger-hostility, phobic anxiety, paranoid ideation, psychoticism, low self-esteem and distorted eating attitudes were also more frequent compared to the healthy controls. Some symptoms were also more prevalent in progressive MS patients compared to relapsing-remitting subjects. Symptoms increase as degree of disability rises and ambulatory capacity declines. CONCLUSION: Depressive, anxious and sleep impairment symptoms are not the only ones seen in MS patients; other psychiatric symptoms are also common. Further studies are needed to investigate the frequency and causes of these little-investigated symptoms. As seen in patients with a progressive course and greater neurological disability, more psychiatric symptoms develop in patients with more severe disease.

Neuropsychological weaknesses in adult ADHD; cognitive functions as core deficit and roles of them in persistence to adulthood.

Prior investigations have shown that individuals with attention deficit hyperactivity disorder (ADHD) have impaired neuropsychological functions. This study had two aims, first to investigate weakened cognitive functions in adult ADHD (aADHD), and second, to investigate difference between persisters (those having persistently ongoing ADHD diagnosis in adulthood), and remitters (those having ADHD diagnosis only in childhood and not in adulthood), in terms of cognitive deficits. We evaluated performance on a comprehensive neuropsychological battery in three groups including 34 persisters, 35 remitters, and 35 healthy control group (absence of childhood and adulthood ADHD diagnosis). Our findings showed that adults with ADHD have inefficient attention, interference control and set-shifting functions, which may be revealed on neuropsychological tests that require greater cognitive demand. Given the finding that interference control deficit exists across the lifespan in people with ADHD, we suggest that interference control-associated functional weakness may be a core deficit for ADHD. (JINS, 2012, 18, 1-8).

Temperament and character traits in patients with bipolar disorder and associations with attempted suicide.

OBJECTIVE: This study was intended to investigate temperament and character traits in bipolar disorder patients with or without a history of attempted suicide. METHODS: One hundred nineteen patients diagnosed with euthymic bipolar disorder based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and with no accompanying Axis I and II comorbidity, and 103 healthy controls were included. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I and II disorders were used to exclude Axis I and II comorbidity. Temperament and character traits of bipolar patients with a history attempted suicide (25.2%, n = 30) or without (74.8%, n = 89) and of the healthy volunteers were determined using the Temperament and Character Inventory. The association between current suicide ideation and temperament and character traits was also examined. RESULTS: Bipolar patients with or without a history of attempted suicide had higher harm avoidance (HA) scores compared with the healthy controls. Persistence scores of bipolar patients with no history of attempted suicide were lower than those of the healthy controls. Self-directedness (SD) scores of the bipolar patients with a history of attempted suicide were lower than those of patients with no such history. Self-transcendence scores of bipolar patients with no history of attempted suicide were lower than those of both the healthy controls and of those patients with a history of attempted suicide. A positive correlation was determined between current suicidal ideation scale scores and HA, and a negative correlation between SD and cooperativeness was determined. CONCLUSIONS: High harm avoidance may be a temperament trait specific to bipolar disorder patients. However, it may not be correlated with attempted suicide in such patients. These may have low persistence, high SD and low self-transcendence temperament and character traits that protect against attempted suicide. Harm avoidance, SD, and cooperativeness may be correlated with current suicidal ideation.

Perception of patient aggression among nurses working in a university hospital in Turkey.

The way patient aggression is perceived influences nurses' attitudes and behaviour towards patients. The aim of this cross-sectional, descriptive study was to investigate how nurses working in a university hospital perceive aggression and whether certain variables (sociodemographic and professional characteristics, exposure to aggressive behaviour) affect that perception. Two hundred and eighteen nurses (response rate 68.1%) from different departments were administered the Perception of Aggression Scale, a self-reported scale measuring perception of patient aggression towards nurses. The nurses in this study generally perceived patient aggression as dysfunctional. Nurses exposed to patient aggression in their professional lives regarded patient aggression more as dysfunctional. In addition, the oldest nurses, the most professionally experienced and those with the longest tenure in their departments had less perception of aggression as functional than others. Professional fatigue and burn-out might play a role in this.

Oxidative mechanisms in schizophrenia and their relationship with illness subtype and symptom profile.

AIM: The aim of the present study was to investigate the differences in the antioxidant-oxidant balance (AO-OB) between schizophrenic patients and healthy individuals and to explore the relationship of AO-OB with illness subtypes and symptom profiles. METHODS: After a 15-day drug-free period, schizophrenia patients (n = 50) in a clinical sample, and age- and sex-matched healthy subjects (n = 49) were enrolled. Total antioxidant potentials (TAOP) and total peroxide levels (TPEROX) of all participants were measured and the oxidative stress index (OSI) was calculated. The assessment included structured measurements, including the Positive and Negative Syndrome Scale (PANSS), and the Brief Psychiatric Rating Scale (BPRS). RESULTS: TAOP had a significant positive correlation with age at onset of schizophrenia (P = 0.013), a negative correlation with the PANSS negative subscale scores (P = 0.008), a negative correlation with the PANSS total scores (P < 0.001), and a significant negative correlation with BPRS scores (P = 0.001). OSI had a significant negative correlation with age at onset (P = 0.046) and a significant positive correlation with PANSS negative subscale (P = 0.015). A multiple regression model indicated a significant linear combination of age, gender, duration of illness, subtype of schizophrenia, and PANSS scores, in which only the subtype of schizophrenia made a statistically significant contribution to predicting mean OSI (F[5,35] = 2.44, P = 0.04). CONCLUSION: Several parameters in the pathogenesis of schizophrenia, such as age of onset, level of negative symptoms, and subtype of illness, but not the presence of the illness itself, are associated with the level of oxidative stress.

Cognitive and emotional changes in neurobrucellosis.

OBJECTIVE: To determine cognitive and emotional changes among neurobrucellosis patients. METHODS: The patients with neurobrucellosis and controls with brucellosis without neurologic involvement were included in the study. Neurobrucellosis was diagnosed by the following criteria: (i) symptoms or clinical findings compatible with neurobrucellosis, including headache, confusion, mental and emotional changes; (ii) isolation of Brucella spp. from CSF and/or demonstration of antibodies to Brucella > or = 1/4 in the CSF; (iii) the presence of lymphocytosis, increased protein and decreased glucose levels in the CSF; and (iv) clinical improvement with appropriate treatment. Two psychiatrists interviewed the patients, and performed the Hamilton Depression Rating Scale (HDRS) tests and Mini-Mental State Examination (MMSE) tests. RESULTS: Thirty-four neurobrucellosis cases and 30 patients with brucellosis without neurological involvement were studied. The mean age was 41 years, 12 (41%) patients were female, 13 (46%) patients were farmers, and 7 (25%) patients were housewives. Among the neurobrucellosis cases, before the antibiotic therapy, the mean MMSE test score was 21.6, one week after the therapy 22.7, and two weeks after the therapy 24.3 (p=0.024, and p<0.001, respectively). At the day of admission before therapy, the mean of HDRS test was 9.9, one week after therapy it was 7.8, and two weeks after therapy it was 5 (p=0.014, and p<0.001, respectively). CONCLUSION: The cognitive and emotional disturbances among neurobrucellosis patients were documented by MMSE and HDRS tests. These disorders improve by antibiotic therapy, without any anti-depressive or anti-psychotic therapy.