Childhood Trauma as an Environmental Determinant of Risk of Violence in Bipolar Disorder.

Introduction: The complex interaction of violent behavior, childhood trauma and bipolar disorder (BD) is unclear. Therefore, we aimed to investigate the risk factors of violence in BD and studied the relationship between different types of childhood trauma and violence. Methods: We assessed 105 remitted patients diagnosed with BD I (n=91) or BD II (n=14). All patients were evaluated with the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Childhood Trauma Questionnaire (CTQ), Buss-Perry Aggression Questionnaire (BPAQ) and Violence Tendency Scale (VTS). Uni- and Multivariable Linear Regression Analyses were conducted to predict violent behavior. Results: All patients scored high points on CTQ and violence scales. In the univariate regression analysis, CTQ total and subscale scores (except physical neglect), age and presence of lifetime suicide attempts were correlated with both VTS and BPAQ. Emotional and sexual abuse subtypes had a significant correlation with violence. In the multivariate analysis, only CTQ total score and age were significantly correlated with violence. There was a negative relationship between age and violence. Conclusion: All types of childhood traumas seem to be correlated with violent behavior in patients with BD. Childhood trauma and younger age are significant determinants of violence in BD. The VTS, which emerged in Turkey, may assist clinicians to detect potentially aggressive behavior before it becomes obvious.

Is co-occurrence of adult adhd with bipolar disorder a risk factor for violent behavior?

Research has shown that individuals with psychiatric disorders such as bipolar disorder (BD) and attention deficit and hyperactivity disorder (ADHD) have a higher likelihood of violent behavior. This study investigated the frequency of comorbid BD and ADHD in adultpatients and the relationship between this comorbidity and violent behavior. We assessed 105 remitted patients diagnosed with BD I (n = 91) or BD II (n = 14). The patients were administered the Sociodemographic Data Scale, the Wender-Utah Rating Scale (WURS), the Adult ADHD Self-Report Scale (ASRS), the Buss-Perry Aggression Questionnaire (BPAQ), and theViolence Tendency Scale (VTS) as self-reports. The same clinician administered the Diagnostic Interview for ADHD in adults (DIVA 2.0) to patients who scored≥36 on the WURS. Comorbid ADHD was diagnosed in 15.2% of patients according to the DIVA 2.0. In the multiple linear regression analysis, there was a statistically significant positive effect of the ASRS total score on the VTS and the BPAQ total score. Furthermore, it was found that male gender had a statistically significant positive effect on VTS total score and young age had a statistically significant positive effect on BPQA total score. These findings demonstrate an association between BD, comorbid ADHD, and violent behavior.

Paliperidone Palmitate-induced Urinary Incontinence: A Case Report.

Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients' compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia.

The distinction between unipolar and bipolar depression: a cognitive theory perspective.

BACKGROUND: There is very limited data about the cognitive structure of bipolar depression when compared to unipolar depression. The aim of the study was to look into the differences between unipolar and bipolar depressed patients regarding their cognitive structure in view of Beck's cognitive theory. METHODS: In this study, 70 bipolar patients during a depressive episode, 189 unipolar depressed patients and 120 healthy subjects were recruited. The participants were interviewed by using a structured clinical diagnostic scale. To evaluate the cognitive structure differences, the Automatic Thoughts Questionnaire (ATQ) and the Dysfunctional Attitude Scale (DAS) were used. RESULTS: We found that on the mean ATQ total score, the unipolar depressed patients scored significantly higher (92.9±22.7) than both the bipolar depressed patients (73.2±24.7) and the healthy subjects (47.1±19.6), even after controlling for all confounding factors, e.g. gender, marital status, depressive symptom severity (F = 157.872, p<0.001). The bipolar depressed patients also scored significantly higher on the mean ATQ total score than the healthy controls. On the mean DAS total score, and on the mean score of its subscale of need for approval, the bipolar depressed patients scored (152.8±21.2 and 48.2±7.4, respectively) significantly higher than both the unipolar depressed patients (160.9±29.0 and 51.9±9.7, respectively) and the healthy subjects (127.9±32.8 and 40.2±12.2, respectively), even after controlling for any confounding factor (F=45.803 [p<0.001] and F=43.206 [p<0.001], respectively). On the mean score of the perfectionistic attitude subscale of the DAS, the depressed groups scored significantly higher than the healthy subjects, but they did not seem to separate from each other (F=41.599, p<0.001). CONCLUSIONS: These results may help enhance the understanding of the potentially unique psychotherapeutic targets and the underlying cognitive theory of bipolar depression.

The factors contributing to death anxiety in cancer patients.

Suffering comes in many ways for patients confronting cancer. One of these is an unspecifiable fear about death, which is an existential issue. The aim of this study was to investigate the relationship between death anxiety and its correlates in cancer patients. Seventy cancer patients were assessed using SCID-I, Templer's Death Anxiety Scale, the Hospital Anxiety (A) and Depression (D) Scale, the Distress Thermometer, the Visual Analogue Scale for pain (VAS), the Global Assessment of Functioning, and Glock and Stark's Dimensions of Religious Commitment scales, and these assessments were compared between cancer patients with and without death anxiety. Multiple regression analysis was conducted after correlation analysis between death anxiety and sociodemographic and clinical variables. Axis I psychiatric diagnosis, pain scores, and negative believes about what will happen after death were found to be higher in patients having death anxiety than patients not having death anxiety. Also life expectancy was perceived as shortened in patients with death anxiety. Death anxiety was associated with anxiety, depressive symptoms, and beliefs about what will happen after death. In conclusion, death anxiety could not be regarded as a natural consequence of having cancer; it is associated with the unresolved psychological and physical distress.

[The genetics of suicidal behavior]. / Intihar Davranisinin Genetigi.

There is consistent evidence suggesting that genetic factors play an important role in predisposition to suicidal behavior. Family, twin, and adoption studies have demonstrated that there is a genetic dimension to suicide. Although there is some overlap between suicide and mood disorders, even among psychiatric groups with the highest risk, some patients never attempt suicide, indicating the importance of a diathesis or genetic link to suicide that is independent of the underlying psychiatric disorder. Over the last 3 decades research has shown that there is a relationship between suicide, aggressiveness, and impulsivity. It is possible that genetic factors may be related to personality traits such as impulsiveness and aggressiveness, which in turn may lead to suicide attempts. An increasing number of molecular genetic studies have been carried out among cases involving suicidal behavior and candidate genes thought to be related to suicide. The most important candidate genes include the serotonin transporters (SERTs), tryptophan hydroxylase (TPH), some serotonin receptors (5HT1A, 5HT1B, and 5HT2A), catechol-O-methyltransferase (COMT), monoamine oxidase-A (MAO-A), and tyrosine hydroxylase (TH). The aim of this review was to assess the genetic dimension of suicide behavior, both current and historical.

Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine.

GOALS OF THE WORK: This study aimed to compare the effectiveness of mirtazapine and imipramine on not only the distressing symptoms of cancer patients such as pain, nausea, vomiting, appetite loss, and sleep disturbances but also depressive and anxiety symptoms. MATERIALS AND METHODS: Fifty-three patients with cancer who were diagnosed with major depressive disorder, anxiety disorder, or adjustment disorder were included. Twenty patients on mirtazapine, 13 patients on imipramine, and 20 patients in the control group without medication were interviewed during three visits (baseline, third week, and sixth week). Pain, nausea, vomiting, appetite loss, and sleep disturbances were evaluated with self-assessment single-symptom scales during each visit. The patients were also asked to complete the Hospital Anxiety Depression Scale (HADS) during each visit. MAIN RESULTS: There were no significant differences among the three visits in the mirtazapine, imipramine, or control groups in terms of pain, nausea, vomiting, or appetite loss. For the initial, middle, and late insomnia, only the mirtazapine group showed improvements (p = 0.001, p = 0.001, p = 0.003). There were also significant differences in the mean total (p = 0.03), anxiety (p = 0.003), and depression (p = 0.025) scores of HADS among the three visits for patients taking mirtazapine. There were no significant differences for HADS scores from the baseline to the end point for patients taking imipramine or control group patients. CONCLUSION: Our findings suggest that mirtazapine is effective for resolving insomnia as well as anxiety and depressive symptoms in cancer patients. However, more systematic research, such as placebo-controlled studies, is needed.

Psychiatric morbidity and its screening in Turkish women with breast cancer: a comparison between the HADS and SCID tests.

OBJECTIVE: Adjustment disorders (ADs) and major depressive disorder (MDD) are often the most prevalent psychiatric disorders among cancer patients. This study's objective was to determine the overall performance of Hospital Anxiety and Depression Scale (HADS) as a screening instrument in identifying cases of psychiatric morbidity such as ADs and MDD. METHODS: Two hundred and four consecutive patients completed a questionnaire including a demographic and clinical data form, HADS, and were examined with the Structured Clinical Interview for DSM-IV (SCID). The screening performance of HADS was investigated by calculating the area under the receiver operating characteristics curves (AUC), rates of specificity, and sensitivity. RESULTS: For MDD; the AUC was 0.77 on the HADS total, the AUC was 0.79 on the HADS depression subscale, and was 0.72 on the anxiety subscale. For ADs; the results were 0.74, 0.74, and 0.70 respectively. Findings indicated that a HADS total cut-off score of > or =17 to be optimal in identifying cases of MDD. This cut-off score offered a sensitivity of 0.70 and a specificity of 0.80. Findings suggested that a HADS total cut-off score of 10 was the optimal combination of sensitivity (0.84) and specificity (0.55) for ADs. When compared with SCID, the percentage of cases identified by HADS was 28% for MDD and 22% for ADs. CONCLUSIONS: Compared with SCID, HADS was found to have acceptable levels of sensitivity and specificity in detecting psychiatric morbidity especially for MDD and HADS can be recommended with reservations as a screening tool for breast cancer patients.

Interleukin-6 levels and HPA axis activation in breast cancer patients with major depressive disorder.

An association or a casual link has been proposed between the neuroendocrinological and neuroimmunological changes attributed to either depression or cancer. This study investigated whether breast cancer patients with and without major depression exhibit plasma interleukin-6 abnormalities and dexamethasone suppression test results. Four groups, each consisting of 30 women (1--healthy women, 2--patients with major depression, 3--breast cancer patients without major depression, 4--breast cancer patients with major depression), were compared to each other. Psychiatric evaluations were made by structured clinical interview for DSM-IV. Severity of depression was measured with the Hamilton Depression Rating Scale. Plasma levels of interleukin-6 were measured. A dexamethasone suppression test was applied. Breast cancer patients with major depression had markedly higher plasma levels of interleukin-6 than the other group. All breast cancer patients with depression had abnormal dexamethasone suppression test results. These findings suggest a hypothalamo-pituitary-adrenal axis activation and plasma levels of interleukin-6 and plasma interleukin-6 elevation and plasma levels if interleukin-6 and plasma levels of post cortisol concentrations. Evidence for a casual link or association of major depression with immune and endocrinological activation needs to be investigated further.

Screening for psychological distress in Turkish cancer patients.

The distress thermometer (DT) is a useful measure of psychological distress in cancer patients. Our objective was to investigate distress impact on oncology patients in Turkey and determine the optimal cut-off score on the DT for identifying clinically significant distress. One hundred and eighty two cancer patients completed the DT, Problem List (PL), and Hospital Anxiety and Depression scale (HADS), The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 version 3.0). The receiver operating characteristic (ROC) curve analyses of DT scores yielded an estimated area under the curve of 0.66 when compared to the HADS cut-off score, suggesting the DT is an effective scale to discriminate between classified cancer patients both with and without clinically significant distress. The DT cut-off score of 4 yielded the optimal combination of sensitivity and specificity. Scores on the DT were moderately correlated to the HADS (p<0.01) and EORTC QLQ-C30. Based on the significant correlations, we conclude that the DT has acceptable criterion validity.

Clinical experience with risperidone and memantine in the treatment of Huntington's disease.

We described a 32-year-old woman with Huntington's disease (HD) who presented with severe chorea, psychosis and cognitive abnormalities. We started risperidone at 2 mg p.o./d and increased to 4 mg p.o./d after six weeks. Psychotic and motor symptoms were markedly improved. Since there was no change in cognitive functions, we added memantine at 5 mg p.o./d and gradually increased the dose to 20 mg p.o/d after five weeks. We continued risperidone and memantine for nearly six months. The patient did not show any progression of cognitive symptoms or motor abnormalities. We did not observe any psychotic symptoms.

Sertraline, escitalopram and tianeptine related abnormal movements but not with bupropion: a case report.

It is not scarce that patients experience various extrapyramidal symptoms (EPS) during antidepressant drug therapy. Thus, choice of an antidepressant drug in case of extrapyramidal side effects, at present, is a dilemma. Escitalopram, which is a recently marketed selective serotonin reuptake inhibitors (SSRI), has no such reputation. There is just one case reported for tianeptine that induced abnormal involuntary movements/extrapyramidal side effects. We would like to present a case that was successfully managed with bupropion which had developed EPS during 2 different SSRI (sertraline and escitalopram) and tianeptine therapy.