Psychological outcomes of COVID-19 survivors at sixth months after diagnose: the role of kynurenine pathway metabolites in depression, anxiety, and stress.

Coronavirus disease 2019 (COVID-19) has resulted in long-term psychiatric symptoms because of the immunologic response to the virus itself as well as fundamental life changes related to the pandemic. This immune response leads to altered tryptophan (TRP)-kynurenine (KYN) pathway (TKP) metabolism, which plays an essential role in the pathophysiology of mental illnesses. We aimed to define TKP changes as a potential underlying mechanism of psychiatric disorders in post-COVID-19 patients. We measured plasma levels of several TKP markers, including KYN, TRP, kynurenic acid (KYNA), 3-hydroxykynurenine (3-HK), and quinolinic acid (QUIN), as well as the TRP/KYN, KYNA/3-HK, and KYNA/QUIN ratios, in 90 post-COVID-19 patients (on the first day of hospitalization) and 59 healthy controls (on the first admission to the Check-Up Center). An online questionnaire that included the Depression, Anxiety and Stress Scale-21 (DASS-21) was used 6 months after the initial assessment in both groups. A total of 32.2% of participants with COVID-19 showed depressive symptoms, 21.1% exhibited anxiety, and 33.3% had signs of stress at follow-up, while 6.6% of healthy controls exhibited depressive and anxiety symptoms and 18.6% had signs of stress. TRP and 3-HK were negative predictors of anxiety and stress, but KYN positively predicted anxiety and stress. Moreover, TRP negatively predicted depression, while KYNA/3-HK was a negative predictor of anxiety. The correlation between depression, anxiety, and stress and TKP activation in COVID-19 could provide prospective biomarkers, especially the reduction in TRP and 3HK levels and the increase in KYN. Our results suggest that the alteration of TKP is not only a potential biomarker of viral infection-related long-term psychiatric disorders but also that the therapy targets future viral infections related to depression and anxiety.

Revisiting Jerusalem Syndrome: A Case Displaying Similar Symptoms to Jerusalem Syndrome During Mecca Visit. / Kudüs Sendromuna Tekrar Bakis: Mekke Ziyareti Sirasinda Kudüs Sendromuna Benzer Belirtilerle Basvuran Bir Olgu.

Jerusalem syndrome is a mental illness rarely seen in people who visit Jerusalem, manifests itself with obsessive religious thoughts, delusions, psychotic symptoms, and some characteristic features. In clinical practice, it's uncommon to encounter patients displaying symptoms of the Jerusalem syndrome. In this paper, we report a case of a middle-aged woman who manifested psychiatric symptoms similar to the Jerusalem syndrome after a Mecca visit without any previous psychiatric history. After careful examination, religious delusions, auditory and visual hallucinations, racing thoughts, disorganized speech, and confusion were denoted, therefore the patient was hospitalized. Brain imaging and laboratory examination was unremarkable. After nine days of antipsychotic treatment, the patient's symptoms completely dissolved, and she was discharged. Antipsychotic treatment was ceased entirely after two months. The patient and her family members reported that the patient was symptom-free for the following two years. Keywords: Brief reactive psychosis, religion, travel, differential diagnosis.

Behavioral and Neurodevelopmental Effects of Early Interventions in Adult Wistar Rats.

INTRODUCTION: Interventions performed in the early period of life are associated with cognitive and behavioral changes in adulthood. The effects of interventions such as exposure to an early stressful life event or environmental enrichment on cognitive and behavioral development are studied. The aim of this study is to develop a new intervention method, to investigate the effects of early interventions on social interaction, memory anxiety levels and NR2B levels in prefrontal and hippocampus in adulthood. The hypothesis of the study is that exposure to the ambivalent mother will affect the behavioral performance of rats at least as much as one hour apart from the mother in the adult period and cause changes in the prefrontal cortex and hippocampus in the NR2B levels. METHOD: In the study, the Wistar rats were divided into four groups as control group (12), group that remained 15 minutes apart from mother (Mild Stress) (12), group that remained 60 minutes apart from mother (Severe Stress) (14) and ambivalent mother group (13). In adulthood, the social interaction test, elevated plus maze and new object recognition test performances of rats were evaluated. ELISA method was used to evaluate the effect of interventions on the prefrontal cortex and hippocampus NMDA R2B levels. RESULTS: The important findings of the study were that in the new object recognition test, separation from the mother did not affect the recognition memory regardless of gender, while the short-term recognition memory of the females of the ambivalent mothers' group was better than the females in the other groups and the long-term memory performance of the mild stress groups men was better than the man in the other groups. In addition, in the social interaction test, the males of the ambivalent group and the mild stress group showed more aggressive behavior. It was determined that the prefrontal cortex NR2B level was higher in the mild stress and ambivalent mother group compared to the severe stress group, and NR2B level was increased in all intervention groups compared to the control group. CONCLUSION: In contrast to the hypothesis, the results of this study support that the ambivalent mother's group rats are not more adversely affected than the severe group rats and that the model created may be an environmental enrichment model rather than an early stressful life event exposure.

Revolving Door Phenomenon and Related Factors in Schizophrenia, Bipolar Affective Disorder and Other Psychotic Disorders.

BACKGROUND: Patients with chronic mental illness are frequently hospitalized and discharged from psychiatry wards. This situation is referred to as the "revolving door phenomenon" (RDP). In addition to factors related to the patient and the disease, limited number of beds leading to shortened hospital stay are among the reasons associated with frequent hospitalization. This study aims to compare patients with RDP and patients with single hospitalization in terms of clinical, sociodemographic, and treatment-oriented characteristics in order to evaluate the risk factors causing frequent hospitalization. SUBJECTS AND METHODS: In this study, patients who were admitted and hospitalized between May 1, 2011 - May 1, 2016 were retrospectively evaluated from patient records. The RDP group consisted of 74 patients and the single-hospitalization group consisted of 59 patients who met inclusion criteria. RESULTS: The RDP group had significantly higher rates of male gender, ECT history, past suicide attempts, multiple drug treatment, clozapine use, legal incidents, and noncompliance to follow up following discharge compared to the single-hospitalization group (p<0.05). CONCLUSION: This study demonstrates that Turkey also has RDP patients with characteristics and hospitalization patterns similar to patients in countries with different cultural, social, and economic conditions. It is important to identify and correct factors that cause frequent hospitalization as it will reduce the burden of the health system as well as provide benefit to the patient.

Treatment Outcomes of Gamma-Knife Radio Surgery in Refractory Obsessive-Compulsive Disorder.

Background: Obsessive-compulsive disorder (OCD) is a common disease that has negative effects on functionality, and 10% of the patients do not respond to first-line treatments. Gamma-knife radiosurgery (GKRS) has been used in patients with treatment-resistant OCD, but the data on long-term outcomes are still unsatisfactory. Methods: In this study, 12 patients who underwent GKRS between 2005 and 2020 were evaluated retrospectively. Anterior capsulotomy was performed using two 4-mm isocenters at the midputaminal point of the anterior limb of the internal capsule on each side with a maximum radiation dose of 140-180 Gy. Patients were followed up with the Yale-Brown Obsession and Compulsion Scale (Y-BOCS), Montgomery-Asberg Depression Rating Scale (MADRS), and Brief Psychiatric Rating Scale (BPRS) on the first, third, and sixth months. Results: After the procedure, a 35% reduction was observed in the overall Y-BOCS scores, and full response rate was 50%. There was a 49.5% decrease in the MADRS scores and a 57.8% decrease in the BPRS. Conclusion: GKRS is an effective and non-invasive procedure with favorable side effects in treatment-resistant OCD with selected patients.

Homophobia in Health Professionals in Ankara, Turkey: Developing a Scale.

The aims of this study were to develop a sexual orientation attitude scale and use it to investigate the attitudes of psychiatrists, other physicians and first year medical students toward homosexuals and homosexuality in Ankara, Turkey. A cross-sectional study was performed with three groups including psychiatrists (n = 147), non-psychiatric physicians (n = 224) and first year medical students (n = 280). A scale with 43 items consisting of four subscales (heterosexism, homophobia, homonegativity, neutrality) was developed which showed high internal consistency, validity and reliability in this sample of Turkish individuals. The internal consistency coefficients (Cronbach's alpha) for the subscales were 0.85-0.86, 0.95-0.95, 0.95-0.95, and 0.85-0.86, respectively. Being male, single, a graduate of a religious (Imam Hatip) or vocational high school, of rural origin, a student, more religious, heterosexual and studying at university hospitals were found to be related to higher scores (indicating more negative attitudes) on all subscales and the total scale and these differences were significant. Students had the highest scores and psychiatrists had the lowest scores in all subscales and the total scale. The results of this study indicate that physicians and medical students have negative attitudes toward homosexuals and that medical training on sexual health issues should be improved in Turkey.

How Game Addiction Rates and Related Psychosocial Risk Factors Change Within 2-Years: A Follow-Up Study.

OBJECTIVE: Prospective data of risky online gamers in Turkey is missing. Therefore, we aimed to investigate the change in gaming behaviors and addiction rates of Travian players within two years to search diagnostic stability of internet gaming disorder and some psychosocial risk factors. METHODS: 110 responders completed the whole questionnaire package including 21-item Game Addiction Scale (GAS), Satisfaction with Life Scale (SLS), Rosenberg Self-Esteem Scale (RSES), and Multi-dimensional Scale of Perceived Social Support (MSPSS). A hierarchical linear modeling approach was followed to test the linear change in game addiction scores of the participants from 2013 to 2015. RESULTS: GAS scores of gamers significantly decreased within two years (p=0.026). MSPSS scores significantly and negatively associated with GAS scores (p<0.001) and the negative association of time remained significant (p=0.035). Decrement in the MSPSS scores in two years was associated with increment in GAS scores. 9 (90%) of 10 participants with internet gaming disorder according to monothetic format and 26 (52%) of 50 participants with internet gaming disorder according to polythetic format were found to not to meet the diagnosis in the follow-up. 33 out of all participants reported that they were not playing any online games for at least last 6 months. CONCLUSION: Social support seems to be a protective factor for game addiction and diagnosis of internet gaming disorder has low temporal stability among Travian players in Turkey.

Femicide: Psychosocial Characteristics of the Perpetrators in Turkey.

Female homicides are widely prevalent in Turkey with rising trend. The aim of this study is to identify gender role attitudes, childhood trauma histories, and individual characteristics of men who have been involved in the femicide, and to compare them with men who do not exercise violence against women. Participants completed a Sociodemographic and Clinical Information form, Semistructured Interview form, and the Childhood Trauma Questionnaire. Case group was not significantly different than the control group in terms of any measured individual characteristics including childhood traumas, psychopathology, and gender attitudes. Our data indicate that only migration history may be linked to femicide. A unique psychopathology that could be related to being a femicide perpetrator was not identified. Migration and perception of gender roles stand out as factors that separate men who exercise violence from men who do not.

Adulthood behavioral and neurodevelopmental effects of being raised byan ambivalent mother in rats: what does not kill you makes you stronger.

BACKGROUND/AIM: This study aimed to investigate the effects of early adverse life events and being raised by an ambivalent mother on rats. MATERIALS AND METHODS: The rats were separated into four groups: 1) the control group (n = 12), which was raised under standard care; 2) the early handling (EH) group, which was raised using an EH model (n = 16); 3) the early deprivation (ED) group, which was raised using an ED model (n = 13), and 4) the ambivalent mother (AM) group, which spent 3 h/day with a "fake mother" (n = 17). When they became adults, their anxiety levels, depressive-like behaviors, and memory functions were measured using the elevated plus maze test, the forced swim test, and the novel object recognition test, respectively. Their neurodevelopment was evaluated by measuring the brain-derived neurotrophic factor (BDNF) levels in the prefrontal cortex, the dentate gyrus, and the cerebellum via ELISA. RESULTS: The rats in the ED and AM groups exhibited less anxiety and depressive-like behavior than those in the control and EH groups, particularly in females. There was no significant difference between the groups in memory function or brain BDNF levels. CONCLUSION: Severe and ambivalent early adverse life events may decrease anxiety and depressive-like behavior in adult rats.

Systematizing cultural awareness: Toward a model for modification of trauma therapy and an application in Turkey.

A cross-cultural team including a U.S.-trained clinical cross-cultural psychologist and two Turkish psychiatrists conducted research on a set of five trauma treatment psychotherapy groups for adult women survivors of sexual abuse in Ankara, Turkey. Based upon observational comparisons between trauma treatment groups in U.S. and Turkish settings, the team developed an approach to assist in adaptation of treatment methods from one cultural setting to another. This is a preliminary effort to develop a conceptual tool to focus the attention of therapists on salient dimensions of culture that may influence the psychotherapy process. This article describes six possible dimensions: (a) relational/individual self; (b) situationalism/universalism; (c) high/low power differential; (cc) high/low gender differential; (d) internal/external control; (e) emotional expressivity/containment; and (f) short-term/long-term time orientation. Comparative cultural examples from trauma psychotherapy group field notes illustrate the use of the tool.

Behavioural and neurobiological consequences of 2 different chronic stressors in rats.

BACKGROUND/AIM: To compare the behavioural and neurobiological consequences of chronic headache and chronic mild stress (CMS) in rats. MATERIALS AND METHODS: Forty-eight male Wistar rats were divided into 4 groups: 1) control group, 2) chronic headache group, 3) CMS group, and 4) sham group. Their behaviour prior to (D0) and after (D14) chronic stress was analysed. Afterwards, they were exposed to the Elevated Plus Maze (EPM) in order to evaluate anxiety-like behaviour and the Forced Swim Test (FST) for observation of depressive-like behaviour. Ultrasonic vocalisations (USVs) were recorded by a USV detector system at DO and D14 and during the FST. The c-fos expressions in various brain regions were analysed 2 h after the EPM and FST. RESULTS: The control group showed significantly more sleeping behaviour at D14 (χ2 = 8.213, P = 0.042), emitted more negative and positive affect USVs at D14 (χ2 = 9.853, P = 0.020) and during FST (χ2 = 4.000, P = 0.046) than the chronic headache and CMS groups, and showed significantly less anxiety-like behaviour in the EPM than the CMS group (P = 0.021). CONCLUSION: These results suggest that CMS increases anxiety-like behaviour but not depressive-like behaviour, while chronic headache does not have a significant effect on these behaviours in rats.

Group psychotherapy in women with a history of sexual abuse: what did they find helpful?

AIMS AND OBJECTIVES: To define the effects of group psychotherapy in women with a history of sexual abuse, to find possible predictors for dropout and treatment outcome rates and to find which therapeutic factors of group psychotherapy are perceived by group members to be most helpful. BACKGROUND: Sexual abuse of women is a global concern and causes many psychiatric and psychological sequelae. Group psychotherapy is one of the preferred treatment modalities. DESIGN: Prospective cohort study. METHODS: Forty-seven women with a history of childhood and/or adulthood sexual abuse were recruited for weekly 12-session group psychotherapy. Subjects were given the Hamilton Depression Rating Scale, the Hamilton Anxiety Rating Scale, the Clinician Administered Post-traumatic Stress Disorder Scale, the Dissociative Experiences Scale, the Childhood Trauma Questionnaire and the Group Therapeutic Factors Questionnaire. Re-evaluations were made after the 6th and 12th session and also at a six-month follow-up session. RESULTS: Group psychotherapy significantly reduced participants' levels of depression (screening/12th session mean scores, 22.45/11.10), anxiety (15.45/4.32) and symptoms of post-traumatic stress disorder (42.27/9.32), and this decline became statistically significant at the 6th session and tended to persist at the six-month follow-up. Higher levels of dissociative symptoms at baseline were associated with less response to treatment, but higher levels of attendance at group sessions. Group members rated existential factors (41.40 ± 12.39), cohesiveness (37.42 ± 8.32) and universalism (37.56 ± 7.11) as the most helpful therapeutic factors. CONCLUSION: Group psychotherapy was significantly effective in reducing levels of depression, anxiety and posttraumatic stress disorder symptoms in this sample of women. Dissociation had a significant effect on both treatment outcome and treatment adherence. For this sample of women, group psychotherapy was most helpful for reducing feelings of stigma, isolation and shame. RELEVANCE TO CLINICAL PRACTICE: Group psychotherapy can be used as a preferred treatment method for women from different cultural backgrounds with a history of sexual abuse.

Investigation of serotonin transporter gene promoter (5-HTTLPR) and intron 2 (variable number of tandem repeats) polymorphisms with suicidal behavior in a Turkish population.

The serotonin (5-hydroxytryptamine) transporter (5HTt) gene has been reported to be associated with suicidal behavior. In this study, we have investigated the 5' promoter region (i.e., 5HTt gene-linked polymorphic region [5-HTTLPR]) and a 17-base pair variable number of tandem repeats polymorphism in the 5HTt gene for potential association with suicidal behavior in a Turkish population. Genotypes were determined for 182 subjects of suicide (86 attempted suicide and 96 completed suicide) and 181 healthy control subjects. Our results showed that allele frequencies at individual loci were not significantly different in the two groups. This absence of altered individual locus haplotype (allele) frequency suggests the lack of a significant genetic contribution by the 5-HTTLPR or variable number of tandem repeats variations to the expression of suicidal tendencies. However, our linkage disequilibrium analyses indicated that there may be a greater risk for suicidal behavior in carriers of the S10 and L12 alleles of 5-HTTLPR.

A prospective study of serotonin transporter gene promoter (5-HTT gene linked polymorphic region) and intron 2 (variable number of tandem repeats) polymorphisms as predictors of trauma response to mild physical injury.

The aim of this study was to examine the effect of both promoter and intron polymorphisms of the serotonin transporter (5HTT) gene on posttraumatic stress disorder (PTSD) development. For this purpose, two polymorphisms of the 5-HTT gene, which are found in the promoter (5-HTT gene-linked polymorphic region) and second intron (variable number of tandem repeats) of the gene, were analyzed in 100 patients who were admitted to the Emergency Department after a mild physical trauma. None of the 5-HTT polymorphisms studied have an effect on PTSD development after a mild physical injury, but having L allele for 5-HTT gene-linked polymorphic region may cause milder hyperarousal symptoms in those patients who have developed PTSD.

Perceptions of Turkish psychiatric inpatients about therapeutic factors of group psychotherapy.

Many studies on therapeutic factors in group psychotherapy were done during the 1970s and 1980s, primarily with Western samples, The present study was carried out in a psychiatric inpatient clinic in Turkey. Using Yalom's (1975) therapeutic factor questionnaire administered at discharge, patients rated existential factor, instillation of hope and self-understanding as the most helpful factors and identification as the least helpful. There were significant differences among patients with regard to gender, age, education, comorbid personality disorder, but not with Axis I diagnosis or number of attended sessions. Patients' and psychiatrist's rating showed significant differences. Differences between this Turkish sample and those reported in common Western literature are discussed under the light of relatedness psychology, which is an important concept of cross-cultural psychology.

Farewell to the world: suicide notes from Turkey.

There has been limited study of suicide in Islamic countries. This paper marks the first study of suicide notes in Turkey, an Islamic country. Using a classification scheme, 49 suicide notes (a rate of 34.5%) were studied. The results show that note writers do not differ greatly from other suicides. Further analysis of younger (<40) and older (>40) suicide note writers reveal few significant differences. Our results, together with the results of classification studies in different countries, suggest that caution is in order in transposing findings from one country to other countries. Future study of suicide notes should, in fact, focus on cross-cultural investigation.

Comparison of clozapine-amisulpride and clozapine-quetiapine combinations for patients with schizophrenia who are partially responsive to clozapine: a single-blind randomized study.

Schizophrenia is a devastating psychiatric disorder. Clozapine has long been the gold standard for treatment of patients with treatment-resistant schizophrenia; however, some patients are only partially responsive to clozapine treatment. Augmentation of clozapine treatment might enhance its effectiveness in partial responders, but only a few studies have investigated possible augmentation strategies. This study compared the effectiveness and tolerability of the combination of amisulpride and clozapine with the combination of quetiapine and clozapine in patients who were only partially responsive to clozapine monotherapy. Fifty-six treatment-resistant patients who were partially responsive to clozapine were randomly assigned to receive amisulpride or quetiapine along with an ongoing stable dose of clozapine. Fifty patients completed the study. Patients were evaluated at baseline and at the first, third, sixth, and eighth weeks. Efficacy measures consisted of the Brief Psychiatric Rating Scale (BPRS), the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS), and the Clinical Global Impression (CGI) scale. Tolerability and adverse effects were assessed with the Udvalg for Kliniske Undersogelser (UKU) Side Effect Rating Scale and the Simpson Angus Scale (SAS). A substantial improvement occurred in both groups by the end of the eighth week; however, the improvement associated with amisulpride was significantly greater than that seen with quetiapine. This difference was noted as early as the third week of follow-up in terms of CGI scores, and by the sixth week with regard to BPRS, SANS, and SAPS scores. Both drugs were well tolerated, as measured by UKU and SAS. Improvement favoring clozapine+amisulpride could be attributed to the selective D2/D3 binding property of amisulpride, which had an additional effect in improving symptoms of schizophrenia. The authors concluded that amisulpride seems to be effective and well tolerated for augmentation purposes in clozapine-resistant patients.

Cerebrovascular dynamics in patients with migraine: near-infrared spectroscopy study.

Migraine is hypothesized to be a neurovascular coupling disorder where the cerebral vascular reactivity is malfunctioning and measuring hemodynamic changes during migraine without causing more disturbance has always been a challenge. Functional near infrared spectroscopy system (fNIRS) is being proposed as an inexpensive, rapid, safe and accurate alternative to fMRI, transcranial doppler sonography (TCD). We have developed NIROXCOPE 201, a novel device for fNIRS which offers 16 source-detector pairs distributed on a probe that is placed on the forehead. Measuring hemodynamic changes during migraine without causing more disturbance has always been a challenge. Using NIROXCOPE 201, we have attempted to investigate the cerebrovascular reactivity of migraine patients to a breath hold task which produces a metabolic perturbation. Six normals and six migraine patients performed four consecutive breath holding task. We calculated the peak and latencies of the initial dip and recovery phases for [Hb], [HbO(2)], [tHb], and [OXY] signals. [Hb], [tHb], and [OXY] ID and R amplitudes of normals are approximately a magnitude higher than migraine patients (P<0.01), while latencies showed no significant differences. Data suggests an altered neurovascular coupling in frontal cortex of migraine patients interictally. The application of NIROXCOPE 201 to patients suffering from other primary headache disorders will reveal diagnostic as well as therapeutic implications of the presented study.

Prognosis of postpartum psychiatric disorders in a Turkish sample.

Objective The postpartum period represents a time of increased risk for psychiatric disorders. Postpartum depression is especially very common. Many aetiological risk factors have been reported for postpartum psychiatric disorders. The purpose of this study was to evaluate the postpartum psychiatric disorders in a Turkish sample and discuss their course. Methods The files of 6000 inpatients who were admitted to Gazi University School of Medicine Psychiatry Department were evaluated retrospectively, and 67 patients were chosen whose psychiatric illness had began puerperally. These patients were grouped according to age of onset of the illness, number of episodes and the type of these episodes, their postpartum psychiatric diagnoses and illness prognosis. Results Of 6000 patients, 67 (1.11%) were diagnosed as having a postpartum psychiatric disorder: 56.7% (n=38) were diagnosed as having a postpartum psychotic disorder, while 35.8% (n=24) as having an affective disorder. Forty-seven patients (70.1%) received a diagnosis of major psychiatric disorder during their follow-up. Conclusion These results show that postpartum diagnoses may show a chronic course and cause a life-time psychiatric illness and therefore patients should be monitored carefully for psychotic symptoms even after the acute period is over.

Psychiatric findings related to neurological complications in Behcet's disease: A short review and a case presentation.

Behcet's disease affects the skin, mucosa, joints, vascular system, eyes, the central nervous system (CNS) and gastrointestinal system. In Behcet's disease, the obvious illness mechanism in all organ systems is occlusive vasculitis of unknown etiology. CNS involvement in Behcet's disease sometimes causes psychiatric disorders. In this paper we discuss a case with neurobehcet disease who was admitted with psychotic symptoms. This 29-year-old male patient had symptoms of Behcet's disease and concomitant psychiatric symptoms. An advanced evaluation of the CNS was performed following unresponsiveness to antipsychotic treatment. It was concluded that the psychotic picture was a result of CNS involvement related to Behcet's disease. Colchicine was added to the treatment and upon discharge the case was in remission. Differences in treatment and prognosis between psychiatric disorder due to Behcet's disease and psychiatric disorders comorbid to Behcet's disease are discussed.