CORRELATION AMONG EXPERIENTIAL AVOIDANCE, ANXIETY SENSITIVITY AND BEHAVIORAL INHIBITION SYSTEM IN GENERALIZED ANXIETY DISORDER AND PANIC DISORDER PATIENTS.

PURPOSE: This study aimed to analyze the concepts of experiential avoidance, anxiety sensitivity and behavioral inhibition system through healthy volunteers and patients diagnosed with anxiety disorder. It was planned to analyze and evaluate the correlation among the levels of experiential avoidance, anxiety sensitivity and behavioral inhibition system in various anxiety groups. METHOD: Within the scope of this study, clinical interviews were carried out with patients who sought treatment at the Psychiatry Department of the Hospital of Balikesir University Medical Faculty. The study included 50 Generalized Anxiety Disorder (GAD) patients and 50 Panic Disorder (PD) patients who fulfilled the study criteria and accepted to participate in the study. A voluntary control group of 50 individuals with similar age and gender with the patients was formed. The participants were evaluated through the Acceptance and Action Questionnaire-II (AAQ-II), Behavioral Inhibition System/Behavioral Approach System Scale (BIS/BAS Scale), and Anxiety Sensitivity Index-3 (ASI-3). RESULTS: In this study, the anxiety sensitivity, behavioral inhibition system sensitivity and experiential avoidance levels were all found to be higher in both the GAD and PD patients than the controls. On the other hand, the scale scores did not significantly differ between the GAD patients and PD patients. Positive correlations were determined among anxiety sensitivity, experiential avoidance and behavioral inhibition system. Our data provided findings supporting that the development of anxiety disorders entails increased anxiety sensitivity, behavioral inhibition system sensitivity and experiential avoidance levels. DISCUSSION: The literature has shown, through separate studies, a correlation among experiential avoidance, anxiety sensitivity and behavioral inhibition system as well as a correlation between these concepts and anxiety disorders, and this study handled them altogether to reveal their correlation with anxiety in a clinical environment.

The Prevalence of Postpartum Depression and the Correlation of Perceived Social Support and Quality of Life with Postpartum Depression: A Longitudinal Study.

OBJECTIVE: Postpartum depression (PPD) has negative effects on the mothers who experience it. The aims of the study described herein were to determine the prevalence of PPD and to determine the correlations between PPD and perceived social support, quality of life, and the risk factors for PPD. METHODS: Data were collected using a questionnaire prepared by the researchers and that included the Edinburgh Postnatal Depression Scale, the Beck Depression Scale, the Quality of Life scale, the Multidimensional Scale of Perceived Social Support, and questions regarding the sociodemographic characteristics and PPD risk factors of the mother. RESULTS: The prevalences of PPD were found to be 3.9% in the 4th week postpartum and 5.9% in the 6th week postpartum. Being a primary school (and no higher) graduate, being stressed in daily life, experiencing health problems during the delivery and the postpartum period, and not thinking of oneself as a good mother were all determined to be risk factors for PPD. Although the mean score for social support was higher in women with low PPD risks, this difference was not significant. According to a linear regression model, PPD negatively affected the social and psychological qualities of life of the mothers in the 4th week postpartum. CONCLUSION: Along with a trend suggesting a correlation between high social support and low PPD risk in women, a correlation between low PPD risk and high quality of life was also found.

Plasma Neuropeptide-S Levels in Populations Diagnosed with Generalized Anxiety Disorder: A Controlled Study.

INTRODUCTION: Neuropeptide S (NPS) is a novel neuropeptide reported to be involved in fear-and stress-related conditions and their corresponding neuroendocrine processes. The aim of this study was to compare the plasma NPS levels in patients suffering from generalized anxiety disorder (GAD) and those of healthy controls. METHODS: A total of 40 subjects diagnosed with GAD and 40 healthy controls were recruited in the study. The Hamilton Anxiety Scale (HAM-A), Generalized Anxiety Disorder-7 (GAD-7), and Hamilton Depression Scale (HAM-D) were administered to all participants to determine the severity of participants' anxiety and concomitant depressive symptoms. The plasma NPS levels were measured from the fasting venous blood samples obtained from each participant. RESULTS: The median plasma NPS level was found to be significantly higher in the GAD group in comparison to the control group (28.8 pg/mL as against 19.1 pg/mL, p=0.01). A significant positive correlation was observed between the plasma NPS levels and HAM-A scores (rs=0.23, p=0.04) as well as the GAD-7 scores (rs=0.28, p=0.01). The p-value obtained from the correlation analysis between the plasma NPS levels and HAM-D scores was 0.052. A receiver operating characteristic (ROC) analysis revealed that the plasma NPS levels could enable the identification of GAD with 67.5% sensitivity and 62.5% specificity, when the cut-off value was determined as 25.06 pg/mL. CONCLUSIONS: Our results support the view that plasma NPS levels, which has demonstrated anxiolytic effects on the central nervous system, is related to the severity of anxiety in GAD and could be considered as a candidate marker for the identification of GAD.

Relationship between panic disorder and plasma neuropeptide-S level

Abstract Background: Panic disorder has long been associated with the changes in various neurotransmitters, such as Neuropeptide-S (NPS). Objective: In this study we aimed to determine whether there is a relationship between blood NPS levels and panic disorder. Methods: Twenty nine patients with panic disorder and thirty two healthy control subjects who were age and gender matched were enrolled to the study. Blood samples were taken from participants and plasma NPS levels were quantified by using an ELISA kit. Results: In the study group, median NPS blood level was 16.7 pg/mL and in the control group it was 32.5 pg/mL. There was a statistically significant difference (p = 0.021). Using receiver operating characteristics (ROC) curve, sensitivity and specificity of NPS blood level, for diagnosing panic disorder was calculated, and it was found 79.3% and 56.25% respectively (AUC:0.672, 95% CI: 0.540-0.787). Discussion: Malfunction at the NPS modulatory system in the cortical areas (which is causing excitations in brain areas, such as amygdala and hypothalamus) does not only increase anxiety symptoms and risk of panic disorder but also causes panic disorder patients to have lower plasma NPS levels than the control group. Therefore it can be argued that such malfunction can be treated with a systemic treatment. Baykan H et al. / Arch Clin Psychiatry. 2018;45(4):79-81

Investigating the relationship between plasma neuropeptide-S levels and clinical depression.

PURPOSE: Neuropeptide-S (NPS) is a novel 20-amino acid peptide, mainly expressed in the central nervous system and endocrine tissues. NPS has been linked to anxiety and fear-related behaviors. The association of NPS with depression in a human population has not been previously examined. The aim of the current study was to explore the potential association of NPS with clinical depression and comorbid anxiety. MATERIALS AND METHODS: Seventy-nine patients diagnosed with major depressive disorder and seventy-eight controls were included in the study. The Hamilton Depression Scale (HAM-D) and Hamilton Anxiety Scale (HAM-A) were used to measure depression and anxiety levels, respectively. Venous blood samples were obtained to measure plasma NPS levels. RESULTS: There were no statistically significant differences between the patients and controls in terms of sex, marital status, and smoking status. Plasma NPS levels were also not significantly different between the patients and controls. In patients with major depressive disorder, HAM-A and HAM-D scores were significantly higher than those of controls. No correlation was found between plasma NPS levels and age, body mass index (BMI), median HAM-A scores, and median HAM-D scores. CONCLUSIONS: Despite a significantly high level of comorbid anxiety among the patient group, we found no relationship between plasma NPS levels and depressive symptomatology.

Vitamin D Levels and Vitamin D Receptor Gene Polymorphism in Major Depression.

BACKGROUND: The aim of this study is to evaluate vitamin D levels and rs2228570 (FokI) polymorphism of vitamin D in patients with established diagnosis of major depressive disorder in order to investigate the impact of vitamin D levels and genetic polymorphisms on etiology and/or severity of the disease. SUBJECTS AND METHODS: The study included 86 patients who were diagnosed with major depressive disorder in Hospital of Balikesir University Faculty of Medicine, Department of Psychiatry, and 89 healthy volunteers with similar age, sex, education level and BMI. Psychiatric diagnosis was established by using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). For clinical evaluation, sociodemographic data form, Hamilton Depression Rating Scale, Hamilton Anxiety Scale were used. Blood samples were drawn after 12 hours of fasting from the patients volunteered and the control group who were given their informed consent for participation in the study. Vitamin D levels were determined by using the method of ECLIA (Electrochemiluminescent immunoassay). Genotype analysis was performed using the method of Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). RESULTS: In our study, median vitamin D levels (min-max) of the patient and control groups were 10.3 ng/mL (3.0-42.1) and 11.4 ng/mL (3.0-38.8), respectively. Statistically significant differences as for vitamin D levels between groups were not detected (p=0.729). Similiarly no statistically significant difference between groups in genotype distribution was observed (p=0.396). CONCLUSION: In conclusion, our findings do not support the relationship between depression, vitamin D levels and Fok 1 polymorphism of vitamin D receptor. To test these hypotheses in the light of literature we need further studies to be performed with large number of patients.

Dry Eye Disease in Patients with Newly Diagnosed Depressive Disorder.

PURPOSE: Psychiatric conditions and not just the treatments themselves might be involved in the pathophysiology of dry eye disease (DED). The aim of our study was to evaluate the association between depression and DED using objective and subjective tests in patients with newly diagnosed depressive disorder who were not using any medication which may help us to determine the sole effect of depression on dry eye. METHODS: Thirty-six patients from the psychiatry clinic with a new diagnosis of depressive disorder and 32 controls were included in the study. All met the Diagnostic and Statistical Manual IV criteria for depression. Beck Depression Inventory (BDI) was used to measure depression severity and the State-Trait Anxiety Inventory (Stai1, Stai2) for concomitant anxiety symptoms. The Ocular Surface Disease Index (OSDI) and Visual Functioning Questionnaires (VFQ25) were completed and used to confirm diagnosis of DED in conjunction with the tear break up time (TBUT), ocular surface vital dye staining, and Schirmer's test. RESULTS: The comparison of depressive and control groups revealed significantly lower Schirmer (20.3 ± 9.9 vs. 25.7 ± 9.3 mm) and TBUT (7.8 ± 5.7 vs. 12.5 ± 7.8 s) scores with a consistently higher Oxford score (1.8 ± 3.2 vs. 0.2 ± 0.4) in the depressive group. Although the parameters were affected in the depressive group, this did not influence OSDI (86.1 ± 13.6 vs. 86.6 ± 13.3) and VFQ25 (30.8 ± 21.6 vs. 38.5 ± 29.1) scores. In both groups, the three psychological test scores (Stai1-2 and BDI) were correlated to each other but none of these tests were correlated to OSDI, VRQL, Schirmer, TBUT, and Oxford staining scores. CONCLUSION: Our study shows a definite association between depression and DED. We feel that it is important that psychiatrists take this into account especially while prescribing antidepressants which may aggravate dry eye signs.

The influence of emotional distress on the outcome of in-vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) treatment among infertile Turkish women.

BACKGROUND: To determine whether the emotional distress of infertile Turkish women is related to social support and influences the outcome of their IVF and/or ICSI treatment. METHODS: The Beck Depression Inventory, State- Trait Anxiety Inventory, and Social Support scales were administered to 104 primary infertile Turkish women before the date of their embryo transfer. Comparisons were made between the women who became pregnant and those who did not following the embryo transfer. RESULTS: Compared to the pregnant women, the non-pregnant women had a greater number of emotional symptoms despite similar levels of social support. Also, the increased severity of depressive symptoms and higher levels of anxiety were predictive of low pregnancy rates. CONCLUSION: The pregnancy rate of infertile Turkish women was associated with emotional distress and low levels of social support were associated with increased emotional distress. Further research is needed to determine the factors and mechanisms that contribute to emotional distress in the treatment of infertility.

Mirtazapine augmentation in depressed patients with sexual dysfunction due to selective serotonin reuptake inhibitors.

OBJECTIVE: To evaluate the effect of mirtazapine augmentation in patients with sexual dysfunction induced by current selective serotonin reuptake inhibitor (SSRI) treatment. METHODS: Forty-nine outpatients in remission from major depressive disorder with SSRI treatment and experiencing treatment-emergent sexual dysfunction were invited to participate and 33 (25 women and 8 men) were included in this 8-week open-label study. All patients continued her/his current SSRI treatment (dosages unchanged) and started on mirtazapine augmentation of 15 mg/day during the first week and 30 mg/day throughout the rest of the study. The Hamilton rating scale for depression (HAM-D), the psychotropic-related sexual dysfunction questionnaire (PRSexDQ), and the Golombok and Rust Inventory of Sexual Satisfaction (GRISS) were given to all patients at baseline and at each follow-up (end of the first, second, fourth, sixth, and eight weeks). RESULTS: Mirtazapine augmentation led to significant reductions in HAM-D, PRSexDQ, and GRISS scores throughout the study especially after week 4 and 48.5% of patients (n = 16) reported that they had no overall sexual dysfunction at the end of the study. CONCLUSIONS: Mirtazapine augmentation is a good choice for the treatment of SSRI-induced sexual dysfunction, and the results are typically seen later after 4-8 weeks.

[Is there gender difference in infertile couples with no axis one psychiatric disorder in context of emotional symptoms, social support and sexual function?]. / Psikiyatrik Birinci Eksen Tanisi Almayan Infertil Ciftlerde Emosyonel Semptomlar, Sosyal Destek ve Cinsel Islev Baglaminda Cinsiyet Farki Var Mi?

OBJECTIVE: It was aimed to evaluate the levels of emotional distress, social support and sexual function of infertile couples with no psychiatric Axis-I disorder according to gender differences. METHOD: The study sample of 103 primary infertile couples with no psychiatric Axis-I disorder according to DSM-IV were given Beck Depression Inventory, State and Trait Anxiety Inventory, Inventory of Perceived Social Support and Golombok Rust Inventory of Sexual Satisfaction (GRISS). RESULTS: The sample's depressive symptom severity did not indicate clinical depression, state anxiety was within normal range, and trait anxiety was high according to the scales. Compared to men, women had more severe depressive symptoms when they were the cause of couple's infertility whether alone or with their husbands, and higher trait anxiety in all infertility groups, and more perceived social support of family whether they or their husbands are the cause of infertility. According to sexual functioning profile obtained by the subscale scores of GRISS, more frequently defined problems of sexual relationship were non-communication and non-sensuality for men and avoidance for women in all infertility groups. The emotional distress of woman and man were correlated negatively with their perceived social support and positively with their sexual functioning. CONCLUSION: It was concluded that women had more social support and emotional distress and men had more problems of sexual function, however, satisfactory social support might decrease the emotional symptoms of both genders.

Acute and maintenance electroconvulsive therapy for treatment of psychotic depression in a pregnant patient.

Depression may relapse during pregnancy in women with a history of depression. Treatments which may be effective for mothers may be harmful to the fetus. Electroconvulsive therapy (ECT) has been widely used in patients with different medical illnesses. It is safe, and its efficacy is well established. In our example, the patient was a 34-year-old white woman who was at 13 weeks' gestation at the time of admission to our hospital. Over a 1-month period, the patient underwent a total of 13 ECTs (3 times a week) and 3 more ECTs monthly until the birth of her child. After 10th ECT, the Hamilton Depression Rating Scale score was reduced from 33 before ECT to 7. After 3 more weekly ECTs, the patient was discharged from the hospital with a Hamilton Depression Rating Scale score of 3. The patient was instructed to continue maintenance treatment with ECT sessions monthly. Except for pelvic pain and transient fetal arrhythmias, no complications were reported. Thus, acute and maintenance ECT may be the choice of treatment in severely depressed or psychotic pregnant patients.

Factitious disorders encountered in patients with the diagnosis of reflex sympathetic dystrophy.

Reflex sympathetic dystrophy (RSD) may be a misdiagnosis or at least not descriptive enough in patients with atypical hand posture and atypical edema. Seven patients with the previous diagnosis of RSD were investigated further because of inconsistent clinical picture with the underlying pathology and bizarre course of the disease. Four patients had clenched fist and three had factitious edema. These seven patients underwent psychological examination, and MMPI was applied to all. In two of these no psychological disorder was obtained according to DSM-IV. One patient could not adapt to MMPI. In two anxiety disorders, in one depression, and in one patient conversion disorder was diagnosed. We suggest that these patients are not motivated enough to improve their conditions and expectations of such patients may show some differences depending on the environment.