Comparison of microRNA expression levels in patients with schizophrenia before and after electroconvulsive therapy.

OBJECTIVE: Exploring the role of microRNAs in the antipsychotic efficacy of electroconvulsive therapy (ECT) will contribute to understanding the underlying mechanism through which ECT exerts its therapeutic effects. The primary objective of this study was to identify microRNA alterations before and after ECT in patients with schizophrenia. METHODS: We compared microarray-based microRNA profiles in peripheral blood from eight patients with schizophrenia before and after ECT and eight healthy controls. Then, we aimed to validate selected differentially expressed microRNAs in 30 patients with schizophrenia following a course of ECT, alongside 30 healthy controls by using quantitative reverse-transcription PCR. RESULTS: Microarray-based expression profiling revealed alterations in 681 microRNAs when comparing pre- and post-ECT samples. Subsequent quantitative reverse-transcription PCR analysis of the selected microRNAs (miR-20a-5p and miR-598) did not reveal any statistical differences between pre- and post-ECT samples nor between pre-ECT samples and those of healthy controls. CONCLUSION: As neuroepigenetic studies on ECT are still in their infancy, the results reported in this study are best interpreted as exploratory outcomes. Additional studies are required to explore the potential epigenetic mechanisms underlying the therapeutic efficacy of ECT.

Disordered eating behaviors in gender-affirmative treatment seeking transgender people.

This study aimed to explore disordered eating behaviors in gender-affirming treatment (GAT)-seeking transgender (TG) adults and cisgender people, in addition to analyzing the association between gender dysphoria intensity, body mass index, and disordered eating behaviors. Data were collected from 132 GAT-seeking TG people with gender dysphoria who had never received GAT (91 TG men, 41 TG women), and 153 cisgender (99 cisgender men, 54 cisgender women) participants from Turkey. The Utrecht Gender Dysphoria Scale was used to evaluate the intensity of gender dysphoria. Eating Disorder Examination Questionnaire and Questionnaire on Eating and Weight Patterns-5 were utilized to assess disordered eating. There was no difference between TG women and TG men in terms of ED psychopathology. The most prominent characteristic in all four groups was shape concern, which was significantly higher in TG men and TG women when compared to cisgender men and cisgender women. Binge eating was notably more frequent in TG men and TG women compared to cisgender men, with 11% of the TG men and 7.3% of the TG women meeting the criteria for possible binge eating disorder. Screening for disordered eating behaviors, particularly binge eating, may be recommended in routine care for TG people.

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.

Suicidal ideation, post-traumatic stress disorder, and depression in traumatic spinal cord injury: What resilience tells us.

OBJECTIVE: Identification of unmet psychiatric needs, protective and risk factors for suicide are crucial for people with traumatic spinal cord injury (SCI). In this study, we aimed to explore depression, post-traumatic stress disorder (PTSD) status (non-PTSD, partial-PTSD, full-PTSD), resilience, suicidal ideation (SI) and to examine predictors and clinical correlates of current SI in traumatic SCI. METHOD: Sixty-three individuals with traumatic SCI who were at least 3 months post-injury were included in the study. The participants were evaluated in terms of PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5), depression, SI, and resilience using the PCL-5, the Patient Health Questionnaire-9, the Brief Resilience Scale, and sociodemographic measures. RESULTS: 33% of our sample (n = 21) had SI over the past two weeks. 71.4% of the patients with SI (n = 15) had depression. A total of 52.4% of the patients with SI (n = 11) were diagnosed with full PTSD. Resilience was found to be significantly lower in individuals with depression and individuals with SI. While depression predicted SI in traumatic SCI, resilience stands as a protective factor against SI. CONCLUSION: SI is quite common in individuals with traumatic SCI and is accompanied by substantial psychiatric comorbidities such as depression and PTSD. Along with depression and PTSD, resilience - which has protective and predictive values and is inversely associated with SI - constitutes a significant psychotherapeutic intervention and screening area.

The Impact of Coping Strategies on Suicide Attempts and Suicidal Ideation in Bipolar Disorder.

ABSTRACT: The stress coping strategies of patients with bipolar disorder (BD) may affect their suicide risk. We examined coping behaviors and impact of coping strategies and clinical characteristics on suicide attempts and lifetime suicidal ideation in patients with BD I, compared with a healthy control group. We recruited 185 euthymic patients with BD and 94 healthy controls. Participants completed the Coping Orientation to Problems Experienced Inventory. Suicide attempt prevalence in patients with BD was around 34%, and frequency of lifetime suicide ideation was around 60%. Binary logistic regression analysis revealed greater use of behavioral disengagement and religious coping strategies among patients with BD, compared with controls. Patients with previous suicide attempts presented a more severe illness course, notably early onset, with more depressive and mixed episodes and a more dysfunctional coping style than nonsuicidal patients. Behavioral interventions can target avoidant coping behavior, such as denial, especially in patients with suicide attempts.

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.

Levels of Depression and Anxiety, Sexual Functions, and Affective Temperaments in Women With Lifelong Vaginismus and Their Male Partners.

BACKGROUND: Depression and anxiety levels, sexual dysfunctions, and affective temperament characteristics of women with lifelong vaginismus (LLV) and their male partners may have important effects on the development, maintenance, and exacerbation of LLV. AIM: We aimed to investigate depression and anxiety levels, sexual dysfunctions, and affective temperament characteristics of both women with LLV and their male partners. METHODS: 56 women with LLV, their 56 male partners, and 44 couples with no complaints of any sexual function as a control group were included in this study. Dyadic data were analyzed using the Actor-Partner Interdependence Model. OUTCOMES: The Beck Depression Inventory, Beck Anxiety Inventory, Golombok Rust Inventory of Sexual Satisfaction, and Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire Scale were completed by all participants. RESULTS: Women with LLV had higher levels of anxiety and depression and had more sexual dysfunctions except for avoidance than those of female controls. Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto Questionnaire Scale scores were significantly higher in women with LLV for depressive (odds ratio [OR] = 1.27, 95% CI = 1.09-1.49), cyclothymic (OR = 1.31, 95% CI = 1.15-1.49), anxious (OR = 1.22, 95% CI = 1.09-1.38), and irritable (OR = 1.22, 95% CI = 1.04-1.42) temperament than in female controls. It was found that anxiety levels of male partners of women with LLV were higher than those of male controls and that they experienced less sexual satisfaction. Depressive (OR = 1.31, 95% CI = 1.07-1.61) and cyclothymic (OR = 1.18, 95% CI = 1.04-1.34) temperament scores were significantly higher in male partners of women with LLV than in male controls. The Actor-Partner Interdependence Model analyses show that hyperthymic temperament in male partners of women with LLV and anxious and depressive temperament in women with LLV have a negative effect on their own sexual functions. In terms of partner effect, it was found that men with hyperthymic temperament had a negative effect on the sexual functions of women with LLV and men with depressive temperament had a positive effect. CLINICAL IMPLICATIONS: The individual characteristics of both the women and their male partners have an impact on LLV. STRENGTHS & LIMITATIONS: The sample size was relatively small to assess affective temperaments. The inclusion of male partners in the study contributed to our understanding of couples with LLV. CONCLUSION: Our results indicate that affective temperaments detected in women with LLV (depressive, cyclothymic, anxious and irritable) and their male partners (depressive and cyclothymic) have an effect on the development, maintenance, and exacerbation of LLV, and affective temperaments have an effect on both their own and partner's sexual functions. Turan S, Usta Saglam NG, Bakay H, et al. Levels of Depression and Anxiety, Sexual Functions, and Affective Temperaments in Women With Lifelong Vaginismus and Their Male Partners. J Sex Med 2020;17:2434-2445.

ECT augmentation of antipsychotics in severely ill schizophrenia: a naturalistic, observational study.

OBJECTIVES: There is positive evidence to support the role of electroconvulsive therapy (ECT) in the treatment of schizophrenia; however, it is unclear to what extent this growing evidence reflects the actual situation in clinical practice. The aim of this study was to explore the efficacy of ECT augmentation to antipsychotics in individuals with schizophrenia in a naturalistic-observational environment. METHODS: Eighty-one patients diagnosed with schizophrenia, hospitalised due to acute psychotic exacerbation were included in the study. We compared changes in Positive and Negative Symptom Rating Scale (PANSS) scores between patients treated only with APs and those in the ECT augmentation group. RESULTS: A statistically significant decrease in symptom severity was observed in all PANSS subscales in both groups. In the ECT group, 95% of the patients (n = 39) responded to treatment compared to 75% of the non-ECT group (n = 30) (χ2=6.496, df = 1, p = 0.011). We found that combining ECT with AP significantly increased treatment response, which was defined as at least 25% PANSS symptom reduction, in patients with acute exacerbation of schizophrenia, compared to AP alone. CONCLUSIONS: Augmentation of ECT seems to increase responsiveness during acute treatment of severely ill schizophrenia patients. The mean percentage reduction in PANSS scores by 25% following antipsychotic treatment can help identify patients that will benefit from ECT after psychotic relapse in future. Key points There is positive evidence to support the role of ECT in the treatment of schizophrenia; however, it remains unclear to what extent this growing evidence reflects the actual situation in clinical practice. Augmentation of ECT seems to increase responsiveness during acute treatment of severely ill schizophrenia patients. The addition of ECT to antipsychotic treatment may only be beneficial in patients with antipsychotic responses below 50%. The mean percentage reduction in PANSS scores by 25% following antipsychotic treatment can help identify patients that will benefit from ECT after psychotic relapses in the future.

Alterations in Body Uneasiness, Eating Attitudes, and Psychopathology Before and After Cross-Sex Hormonal Treatment in Patients with Female-to-Male Gender Dysphoria.

Body dissatisfaction plays an important role in the development of psychiatric problems such as eating disorders as well as gender dysphoria (GD). Cross-sex hormonal treatment (CHT) alleviates the dissatisfaction by making various changes in the body. We examined the alteration of body uneasiness, eating attitudes and behaviors, and psychological symptoms longitudinally in Turkish participants with female-to-male gender dysphoria (FtM GD) after CHT. Thirty-seven participants with FtM GD and 40 female controls were asked to complete the Body Uneasiness Test to explore different areas of body-related psychopathology, the Eating Attitudes Test to assess eating disturbances, and the Symptom Checklist-90 Revised to measure psychological state, both before CHT and after 6 months of CHT administration. The baseline mean body weight, BMI scores, body uneasiness scores, and general psychopathological symptoms of participants with FtM GD were significantly higher than female controls, whereas baseline eating attitudes and behaviors were not significantly different. Over time, FtM GD participants' mean body weight and BMI scores increased, body uneasiness and general psychopathological symptoms decreased, and eating attitudes and behaviors had not changed at 24th weeks following CHT administration compared to baseline. CHT may have a positive impact on body uneasiness and general psychopathological symptoms in participants with FtM GD. However, CHT does not have an impact on eating attitudes and behaviors.

Effectiveness of ultra-rapid dose titration of clozapine for treatment-resistant bipolar mania: case series.

Treatment of severe and refractory manic episodes in hospital settings can occasionally be very difficult. In particular, severely excited patients showing aggressive, hostile, impulsive behaviours frequently require physical restraint and seclusion, high doses of antipsychotics and benzodiazepines, and sometimes, electroconvulsive therapy. Hospital stay is generally prolonged and such patients cause great emotional distress for other patients in the ward and clinical staff involved in their care. Here we report on three patients with a diagnosis of bipolar disorder and one patient with a diagnosis of schizoaffective disorder bipolar subtype, all of whom were hospitalized for severe manic episodes with psychotic features. These patients were extremely difficult to manage in the ward as no response could be obtained in the first week of treatment despite high doses of antipsychotics and benzodiazepine administration. The introduction and rapid titration of clozapine proved remarkably effective and was well tolerated in the acute management of these patients. We observed that clozapine had a superior and fast mood stabilization effect with rapid titration and could be extremely helpful in the management of such patients.