Early and late contingent negative variation (CNV) reflect different aspects of deficits in schizophrenia.

Abnormal reward processing and psychomotor slowing are well-known in schizophrenia (SZ). As a slow frontocentral potential, contingent negative variation (CNV) is associated with anticipatory attention, motivation and motor planning. The present study aims to evaluate the early and late amplitude and latencies of CNV in patients with SZ compared to healthy controls during a reward processing task and to show its association with clinical symptoms. We recruited 21 patients with SZ and 22 healthy controls to compare early and late CNV amplitude and latency values during a Monetary Incentive Delay (MID) Task between groups. Patients' symptom severity, levels of negative symptoms and depressive symptoms were assessed. Clinical features of the patients were further examined for their relation with CNV components. In conclusion, we found decreased early CNV amplitudes in SZ during the reward condition. They also displayed diminished and shortened late CNV responses for incentive cues, specifically at the central location. Furthermore, early CNV amplitudes exhibited a significant correlation with positive symptoms. Both CNV latencies were linked with medication dosage and the behavioural outcomes of the MID task. We revealed that early and late CNV exhibit different functions in neurophysiology and correspond to various facets of the deficits observed in patients. Our findings also emphasized that slow cortical potentials are indicative of deficient motivational processes as well as impaired reaction preparation in SZ. To gain a deeper understanding of the cognitive and motor impairments associated with psychosis, future studies must compare the effects of CNV in the early and late phases.

Enhanced Punishment Responses in Patients With Schizophrenia: An Event-Related Potential Study.

It is well known that abnormal reward processing is a characteristic feature of various psychopathologies including schizophrenia. Reduced reward anticipation has been suggested as a core symptom of schizophrenia. The Monetary Incentive Delay Task (MID) is frequently used to detect reward anticipation. The present study aims to evaluate the amplitude and latency of event-related potential (ERP) P300 in patients with schizophrenia (SCH) compared to healthy controls during the MID task. Twenty patients with SCH and 21 demographically matched healthy controls (HC) were included in the study. ERP P300 amplitude and latency values were compared between groups using an MID task in which reward and loss cues were presented. Relations between P300 and clinical facets were investigated in the patient group. SCH group had enhanced mean P300 amplitudes and delayed peak latency in the punishment condition compared with HC. These higher responses were also associated with negative symptoms. SCH group showed altered reward processing as being more sensitive to loss of reward conditions as firstly evidenced by electrophysiological methods, possibly due to abnormality in various systems including social withdrawal, social defeat, and behavioral inhibition system.

Reduced Reward Processing in Schizophrenia: A Comprehensive EEG Event-Related Oscillation Study.

It is well known that abnormal reward processing is a characteristic feature of various psychopathologies including schizophrenia (SZ). Reduced reward anticipation has been suggested as a core symptom of SZ. The present study aims to evaluate the event-related oscillations (EROs) delta, theta, alpha, beta, and gamma in patients with SZ during the Monetary Incentive Delay (MID) task, which elicits the neural activity of reward processing. Twenty-one patients with SZ and twenty-two demographically matched healthy controls were included in the study. EROs were compared between groups and correlation analyses were conducted to determine a possible relationship between clinical scores and ERO values. Compared with healthy controls, the SZ group had reduced (1) delta and theta amplitudes in the reward condition (2) total beta and non-incentive cue-related beta amplitudes, and (3) incentive cue-related frontal gamma amplitudes. These reductions can be interpreted as impaired dopaminergic neurotransmission and disrupted cognitive functioning in the reward processing of SZ. In contrast, SZ patients showed higher incentive cue-related theta and occipital gamma amplitudes compared to controls. These increments may reflect negative symptoms in SZ. Moreover, theta amplitudes showed a negative correlation with Calgary Depression Scale for Schizophrenia scores and a positive correlation with attentional impulsivity. This is the first study showing the impairments of SZ patients in EROs from delta to gamma frequency bands compared with healthy controls during reward anticipation. Being the first comprehensive study, our results can be interpreted as providing evidence for disrupted brain dynamics in the reward processing of SZ studied by EROs. It may become possible to help patients' wellness by improving our understanding of reward processing in schizophrenia and developing innovative rehabilitation treatments based on these findings.

Deficits in Analytic and Common-Sense Reasoning in Schizophrenia.

ABSTRACT: Human rationality has a dual nature including analytic and common-sense thinking. Symptoms of schizophrenia have been suggested to be related to deficits in these aspects of logical reasoning. However, empirical studies investigating logical reasoning errors in schizophrenia and their clinical and neurocognitive correlates are scarce. Formal thought disorder and theory of mind (ToM) might be particularly important for understanding logical reasoning errors in schizophrenia. The current study compared the performances of 80 patients with schizophrenia with those of 49 healthy controls on syllogistic and counterfactual reasoning tasks and investigated clinical, neuropsychological, and social cognitive correlates of logical reasoning in schizophrenia. Patients with schizophrenia were impaired in both analytic and common-sense thinking. ToM impairment was a significant predictor of analytic reasoning abilities in schizophrenia. Executive functions and verbal memory were also significantly associated with analytic reasoning in schizophrenia. Further studies investigating logical reasoning errors in the early phases of the illness are needed.

Clinical and developmental characteristics of cognitive subgroups in a transdiagnostic sample of schizophrenia spectrum disorders and bipolar disorder.

Evidence suggests that neurocognitive dysfunction is a transdiagnostic feature of individuals across the continuum between schizophrenia and bipolar disorder. However, there is significant heterogeneity of neuropsychological and social-cognitive abilities in schizophrenia, schizoaffective disorder, and bipolar disorder. The current study aimed to investigate the clinical and developmental characteristics of cognitive subgroups within the schizo-bipolar spectrum. 147 clinically stable patients with schizophrenia, schizoaffective or bipolar disorder were assessed using clinical rating scales for current psychotic and affective symptoms, and a comprehensive neuropsychological battery including measures of social cognition (Hinting and Reading the mind from the Eyes (RMET) task)). Developmental history and premorbid academic functioning were also evaluated. The study also included 36 healthy controls. Neurocognitive subgroups were investigated using latent class analysis (LCA). The optimal number of clusters was determined based on the Bayesian information criterion. A logistic regression analysis was conducted to investigate the predictors of membership to the globally impaired subgroup. LCA revealed two neurocognitive clusters including globally impaired (n = 89, 60.5%) and near-normal cognitive functioning (n = 58, 39.5%) subgroups. The near-normal cognitive functioning subgroup was not significantly different from healthy controls. The globally impaired subgroup had a higher score of developmental abnormalities (p<0.001), poorer premorbid academic functioning, mothers who were less educated and more severe disorganized speech (p = 0.001) and negative symptoms (p = 0.004) compared to the near-normal cognitive functioning group. History of developmental abnormalities and persistent disorganization rather than diagnosis are significant predictors of the subgroup of individuals with global cognitive impairment in the schizophrenia-bipolar disorder continuum.

A Real Environment Based Virtual Reality Psychosocial Treatment May Help Patients with Schizophrenia to Increase Social Functioning: A Preliminary Study. / Gerçek Çevre Temelli Sanal Gerçeklik Psikososyal Tedavisi Sizofreni Hastalarinin Sosyal Islevlerinin Artmasina Yardimci Olabilir: Bir Ön Çalisma.

disorders. The aim of the study is to investigate the impact of the VR Psychosocial Treatment Program (PTP) on psychosocial functioning and symptoms in people with schizophrenia. METHOD: Seven schizophrenia patients who have been admitted to the Schizophrenia Outpatient Unit of Dokuz Eylül University School of Medicine and met the diagnosis of schizophrenia according to DSM-V diagnostic criteria were included in the study. Psychosocial functionality level was assessed by PSP (Personal and Social Performance Scale), positive and negative symptom severity with PANSS (Positive and Negative Syndrome Scale), and social skills with SSC (Social Skills Checklist). VRPTP was continued for a total of 10 sessions and twice a week during five weeks. In this study, a real-environment-based VR-PTP for schizophrenia patients was developed. In the sessions, there were different realenvironment- based VR contents including social interaction components such as cafe, market, bazaar, public transportation. RESULTS: There was a statistically significant difference between the PSP scores before and after the VR application (p=0.018). None of the patients reported motion sickness during VR sessions due to the immersive nature of VR. There was no significant difference between pre and post VR PANSS total and subscale scores. CONCLUSION: In this preliminary study, we discovered that realenvironment- based VR-PTP is effective for improving the social skills of patients with schizophrenia. Cognitive enhancement programs and psychosocial functionality therapies may be carried out using virtual reality in the near future. VR can assist patients in coping with their symptoms and day-to-day challenges.

Quality of Life of Individuals with Bipolar Disorder and Schizophrenia.

Introduction: Quality of life (QoL) is a concept defined as a subjective perception of one's position in life and is negatively affected in many psychiatric illnesses such as bipolar disorder (BD) and schizophrenia (SCZ). It is hypothesized that therapeutic approaches based on QoL can increase the patient's adherence to treatment and contribute to a satisfactory life. This study aimed to compare the QoL of individuals having BD and schizophrenia with that of healthy controls (HCs) and to investigate the impact of the state of remission on QoL. Method: The World Health Organization QoL Scale-Short Form (WHOQOL-Bref) was administered to individuals with BD (n=124) and SCZ (n=74) and to HCs (n=81) to evaluate QoL. The WHOQOL-Bref subscale and total scores were compared between the groups using multifactor analysis of covariance (MANCOVA) by considering age and education level as the covariates. Then, the patient groups were compared using MANCOVA based on the state of remission by taking age, level of education, and Global Assessment of Functioning scores as the covariates. The relationship between clinical features and QoL scores was evaluated using correlation analysis, and linear regression analysis was applied for the variables that were found to be significant. Results: It was found that individuals with SCZ or BD had lower WHOQOL-Bref psychological, social, and total scores than HCs. Those with SCZ additionally had lower physical and environmental subscale scores than HCs. Furthermore, those with SCZ had lower WHOQOL-Bref physical, psychological, social, and total scores than individuals with BD. There was no significant difference in WHOQOL-Bref scores between individuals with BD and SCZ in the remission period. WHOQOL-Bref physical, psychological, and total scores were found to be significantly lower in unremitted BD patients when compared with remitted BD patients. Unremitted BD patients were found to have significantly lower WHOQOL-Bref psychological, environmental, and total scale scores than unremitted SCZ patients. Conclusion: It can be concluded that the QoL of individuals with BD is between that of healthy individuals and those with SCZ. However, unremitted BD patients have lower QoL than unremitted SCZ patients. Both patient groups display similar features during remission. Identifying the similarities and differences in terms of QoL in both patient groups is of great importance to develop the best type of treatment for the patients.

Neurocognitive functioning during symptomatic states and remission in bipolar disorder and schizophrenia: A comparative study.

Aims Patients with bipolar disorder present milder cognitive impairment in comparison to patients with schizophrenia. Psychotic symptoms are associated with poorer cognitive functioning in both disorders. We aim to compare cognitive dysfunction between bipolar disorder and schizophrenia across symptomatic and remitted states. Methods An extensive cognitive battery was used to assess bipolar disorder patients (32 in manic episodes with psychotic features, 44 in euthymia), patients with schizophrenia (41 symptomatic, 39 remitted), and 55 healthy controls. A global cognitive factor and six neurocognitive domain factors were identified using principal component analyses. Results Global cognition components differed according to both illness and remission status; working memory differed according to remission status regardless of diagnosis; verbal fluency differed according to diagnosis regardless of remission status. An omnibus F test revealed that the remission state had a significant impact on processing speed in schizophrenia. Conclusion Our data suggest that both disorders are associated with state dependent (i.e., global cognition and working memory) and diagnosis dependent (i.e., global cognition and verbal fluency) neurocognitive dysfunctions. Processing speed was exclusively influenced by symptomatic states of schizophrenia.

Neurocognitive and linguistic correlates of positive and negative formal thought disorder: A meta-analysis.

Executive dysfunction and language impairment are the most prominent neuropsychological models of formal thought disorder (FTD) in schizophrenia. However, available studies have provided contradictory findings regarding the accuracy of these models. Furthermore, specific neurocognitive underpinnings of positive FTD (PosFTD) and negative FTD (NegFTD) are not clear. Following the systematic review of schizophrenia studies, a random-effects meta-analysis of the relationship between FTD and neurocognition/language in schizophrenia was conducted in 52 reports including 2805 patients. Neurocognition was significantly associated with both PosFTD (r = -0.21, CI = -0.14 to -0.27) and NegFTD (r = -0.24, CI = -0.18 to -0.30). Both PosFTD (r = ranged from -0.18 to -0.27) and NegFTD (r = ranged from -0.19 to -0.23) were significantly correlated with verbal memory, visual memory, attention, and processing speed. In meta-analyses of executive functions, PosFTD was significantly associated with working memory (r = -0.21), planning (r = -0.19), and inhibition (r = -0.21) and NegFTD was significantly associated with planning (r = -0.27), fluency (r = -0.27), and working memory (r = -0.24). In meta-analyses of linguistic variables, PosFTD was associated with deficits in syntactic comprehension (r = -0.27) and semantic processing (r = -0.18). In contrast, NegFTD was associated only with semantic comprehension (r = -0.21). Both PosFTD and NegFTD were significantly associated with executive dysfunction, neurocognitive deficits and semantic dysfunction but syntactic deficits were more specific to PosFTD. There were also some distinct patterns of relationships between the pattern of executive dysfunction and types of FTD. Fluency deficit was associated more strongly with NegFTD and poor inhibition was more specifically related to PosFTD. Current findings suggest that neurocognitive and linguistic correlates of PosFTD and NegFTD might be partly different.

Association of Wider Social Environment with Relapse in Schizophrenia: Registry Based Six-Year Follow-Up Study.

INTRODUCTON: The impact of social environment on the frequency and prevalence of schizophrenia is well known. However, in schizophrenia and other psychotic disorders, there are few studies which investigate the effect of social environment on disease prognosis and relapse. The aim of this study was to investigate the effect of neighborhood social capital level and address change on relapse in schizophrenia and similar psychotic disorders. METHODS: The research sample consisted of 147 patients (schizophrenia, 76.1%; n=112), who were being followed up at regular intervals of at most six months at the Psychotic Disorders Unit outpatient clinic. Patients were followed-up for relapse indicators between January 1, 2009 and December 31, 2013. During the follow-up, relapse criteria including hospitalization, increased need for help, self-harm, suicidal thoughts, violent behavior, suicide attempts, antipsychotic dose increase and electroconvulsive therapy were used. At least one of these criteria was accepted as a relapse for that period. Neighborhood social capital levels were obtained from a general public survey conducted in Izmir city center in 2008 and the voting rates in the neighborhood during the follow-up period. In addition, during the follow-up period, any change in the address of the patient was recorded. RESULTS: While there was no correlation between the neighborhood social environment and relapse, a significant relationship was found between relapse and address changes. The probability of relapse was 1.3 times higher in patients with change of address (95%CI: 1.0-1.6; p<0.05), and decreased likelihood of relapse was found as the duration of residence in the same neighborhood shortened (ß: (-0.05) 95%CI: [(-0.10)-(-0.003)]; p<0.05). CONCLUSION: In schizophrenia, relapse appears to be related with the narrow social environment (family, home address) in which the person lives, not with the wider social environment (social capital of the neighborhood). The need for adaptation to a new social environment that arises with a change of address, albeit narrowly, can lead to an increase in symptoms of schizophrenia as a psychosocial stressor.

[The Validity and Reliability Study of the Dokuz Eylül Theory of Mind Index (DEZIKÖ) in Patients with Schizophrenia]. / Sizofreni Hastalarinda Dokuz Eylül Zihin Kurami Ölçegi'nin (DEZIKÖ) Geçerlilik ve Güvenilirlik Çalismasi.

OBJECTIVE: Although a lack of a comprehensive theory of mind (ToM) index has been indicated frequently in studies of schizophrenia spectrum disorders, there is no valid and reliable index to assess ToM, which represents the ability to attribute mental states to other people. The purpose of this study is to examine the validity and reliability of the "Dokuz Eylul Theory of Mind Index" (DEZIKÖ) in healthy volunteers and in patients with schizophrenia, which is the first Turkish-language ToM index, developed using examples in the ToM literature. METHOD: The study sample consisted of a total of 286 participants, including 89 patients with schizophrenia who had been diagnosed by DSM-IV and 197 healthy volunteers. Sociodemographic data form and DEZIKÖ were administered to all participants. Empathic Skill Index-B Form (EBÖ-B) and Positive and Negative Syndrome Scale (PANSS) were administered to the patients. RESULTS: In healthy volunteers, internal consistency coefficient of DEZIKÖ was 0.64; inter-rater reliability was 0.99 (p<0.0001) and testretest reliability was 0.90 (p<0.01). The patient group had a positive significant correlation between DEZIKÖ and EBÖ-B (r=0.43, p<0.05). Furthermore, it was shown that healthy volunteers and patients with schizophrenia can be distinguished by using DEZIKÖ (t(285)=8.74, p<0.01). The results of factor analysis with principal components analysis in the healthy volunteer group verified that DEZIKÖ has 3 factor groups. CONCLUSION: These findings indicated that DEZIKÖ, the first ToM index in the Turkish language, has acceptable validity and reliability values in healthy volunteers and in patients with schizophrenia.

Relationship between social-cognitive and social-perceptual aspects of theory of mind and neurocognitive deficits, insight level and schizotypal traits in obsessive-compulsive disorder.

OBJECTIVE: The primary aim of the current study was to investigate different aspects of theory of mind (ToM), including social-cognitive (ToM-reasoning) and social-perceptual (ToM-decoding) in obsessive-compulsive disorder (OCD). We also aimed to investigate the relationship between ToM, neurocognition and a number of clinical variables including overvalued ideas, schizotypal personality traits, level of insight, and disease severity. METHOD: Thirty-four patients who have been diagnosed with OCD according to DSM-IV and 30 healthy controls were included in the study. All participants were given a neuropsychological battery including tasks measuring ToM-reasoning, ToM-decoding and other neurocognitive functions. Schizotypal Personality Questionnaire (SPQ), Yale Brown Obsession and Compulsion Scale (YBOC-S) and Overvalued Ideas Scale (OVIS) were also administered to the participants. RESULTS: Patients with OCD showed significant deficits in both aspects of ToM. ToM performances of patients showed a significant positive correlation with neurocognitive functions. When controlled for general cognition factor, patient-control difference for ToM-reasoning (F = 3,917; p = 0,05), but not ToM-decoding, remained statistically significant. ToM-reasoning impairment of patients was significantly related to the severity of OCD symptoms and poor insight (p = 0,026 and p = 0,045, respectively). On the other hand, general cognitive factor (ß = 0,778; t = 3,146; p = 0,04) was found to be the only significant predictor of ToM-reasoning in OCD patients in the multiple linear regression model. CONCLUSION: OCD is associated with ToM impairment, which is related to schizotypal traits, disease severity and poor insight, yet neurocognitive deficits also significantly contribute to this finding. However, ToM-reasoning impairment could be considered as a relatively distinct feature of OCD, which is partly separate from general cognitive deficits.

Out-of-pocket health expenditures in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders: findings from a study in a psychiatry outpatient clinic in Turkey.

PURPOSE: The aim of this study is to explore the amount of OOP health expenditures and their determinants in patients with bipolar disorder, anxiety, schizophrenia and other psychotic disorders in a psychiatry outpatient clinic of Turkey. METHODS: The study group was 191 patients who attended to the Psychiatry Outpatient Clinic in June 2014. All patients were previously diagnosed with either 'bipolar disorder', 'anxiety disorder' or 'schizophrenia and other psychotic disorders'. The dependent variable was OOP expenditures for prescription, medical tests and examinations. Independent variables were age, gender, education, occupation, existence of social and/or private health insurance, equivalent household income and the financial resources. Student's t test, Mann-Whitney U test, ANOVA and logistic regression methods were applied with SPSS 15.0 for analysis. RESULTS: OOP expenditures per admission were higher in patients with schizophrenia and other psychotic disorders ($8.4) than those with anxiety disorders ($4.8) (p = 0.02). OOP expenditures were higher in patients paying with debit ($9.8) than paying with monthly income ($6.2) (p = 0.04). OOP expenditures were higher in patients without social health insurance ($45.8) than others ($4.8) (p = 0.003). There was not a difference in OOP expenditures with respect to equivalent household income level, occupational class or education level of the patients (respectively p: 0.90, p: 0.09, p: 0.52). CONCLUSIONS: Patients who were diagnosed with 'schizophrenia and other psychotic disorders' were disadvantaged in paying significantly higher amounts for their treatment. A substantial group of these patients compulsorily payed with debit. Considering this financial burden, diagnosis of the patient should be prioritized in health insurance coverage.

Duration of untreated psychosis and neurocognition in first-episode psychosis: A meta-analysis.

Neurocognitive impairment is a well-established feature of first-episode psychosis (FEP). Neurotoxicity hypothesis of psychosis suggests that untreated psychosis before the initiation of first effective treatment is associated with loss of acquired cognitive abilities. However, the outcome of the studies investigating the relationship between duration of untreated psychosis (DUP) and cognitive impairment in FEP remains inconclusive. No previous meta-analysis investigating the relationship between DUP and cognitive impairment in FEP has been published. Following the systematic review of FEP studies, a random-effects meta-analysis of the relationship between DUP and neurocognition in schizophrenia was conducted. Current meta-analysis included 27 studies including 3127 patients with first-episode psychosis. Overall, DUP and cognitive abilities were not significantly related, with the exception of evidence for a weak relationship with a single cognitive domain. There was a very small but significant association between longer DUP and reduced performance in planning/problem-solving ability (r=-0.09, CI=-0.14 to -0.03). Current findings do not provide support for the neurotoxicity hypothesis of psychosis.

Formal thought disorder in schizophrenia and bipolar disorder: A systematic review and meta-analysis.

Historically, formal thought disorder has been considered as one of the distinctive symptoms of schizophrenia. However, research in last few decades suggested that there is a considerable clinical and neurobiological overlap between schizophrenia and bipolar disorder (BP). We conducted a meta-analysis of studies comparing positive (PTD) and negative formal thought disorder (NTD) in schizophrenia and BP. We included 19 studies comparing 715 schizophrenia and 474 BP patients. In the acute inpatient samples, there was no significant difference in the severity of PTD (d=-0.07, CI=-0.22-0.09) between schizophrenia and BP. In stable patients, schizophrenia was associated with increased PTD compared to BP (d=1.02, CI=0.35-1.70). NTD was significantly more severe (d=0.80, CI=0.52-0.1.08) in schizophrenia compared to BP. Our findings suggest that PTD is a shared feature of both schizophrenia and BP but persistent PTD or NTD can distinguish subgroups of schizophrenia from BP and schizophrenia patients with better clinical outcomes.

Relation of formal thought disorder to symptomatic remission and social functioning in schizophrenia.

OBJECTIVE: The aim of this cross-sectional study is to examine the relation of formal thought disorder (FTD) with symptomatic remission (SR) and social functioning in patients with schizophrenia. METHOD: The study was carried out with a sample consisting of 117 patients diagnosed with schizophrenia according to DSM-IV. The patients were assessed with the Positive and Negative Syndrome Scale (PANSS), the Thought and Language Index (TLI), and the Personal and Social Performance Scale (PSP). We used logistic regression in order to determine the relation between FTD and SR and linear regression to identify the strength of association between FTD and social functioning. RESULTS: Logistic regression analysis revealed that poverty of speech (odds ratio: 1.47, p<0.01) and peculiar logic (odds ratio: 1.66, p=0.01) differentiated the remitted patients from the non-remitted ones. Linear regression analysis showed that the PSP total score was associated with poverty of speech and peculiar logic items of the TLI (B=-0.23, p<0.01, B=-0.24, p=0.01, respectively). CONCLUSION: Our findings suggest that poverty of speech and peculiar logic are the specific domains of FTD which are related to both SR status and social functioning in patients with schizophrenia.

Formal thought disorder in first-episode psychosis.

Formal thought disorder (FTD) is one of the fundamental symptom clusters of schizophrenia and it was found to be the strongest predictor determining conversion from first-episode acute transient psychotic disorder to schizophrenia. Our goal in the present study was to compare a first-episode psychosis (FEP) sample to a healthy control group in relation to subtypes of FTD. Fifty six patients aged between 15 and 45years with FEP and forty five control subjects were included in the study. All the patients were under medication for less than six weeks or drug-naive. FTD was assessed using the Thought and Language Index (TLI), which is composed of impoverishment of thought and disorganization of thought subscales. FEP patients showed significantly higher scores on the items of poverty of speech, weakening of goal, perseveration, looseness, peculiar word use, peculiar sentence construction and peculiar logic compared to controls. Poverty of speech, perseveration and peculiar word use were the significant factors differentiating FEP patients from controls when controlling for years of education, family history of psychosis and drug abuse.

Impact of panic attacks on quality of life among patients with schizophrenia.

OBJECTIVE: Schizophrenia patients had decreased levels of quality of life compared to normal population. The aim of this study was to investigate the impact of panic attacks on quality of life in patients with schizophrenia. METHODS: Eighty-eight patients with schizophrenia and 85 healthy subjects were included in the study. World Health Organization Quality of Life Instrument-Short Form (WHOQOL-Bref) was given to patients and healthy subjects to assess quality of life. Panic module of Structured Clinical Interview for DSM-IV (SCID) was administered to patients for diagnosis of panic attacks and panic disorder. Positive and Negative Syndrome Scale (PANSS) for symptom severity and Calgary Depression Scale (CDS) for depressive symptoms were administered to the patients. RESULTS: Patients with schizophrenia demonstrated significantly lower scores compared to healthy controls in all domains of WHOQOL-Bref. Twenty-five patients (28.4%) with schizophrenia had panic attacks (PA) and 10 patients (11.4%) met criteria for panic disorder (PD). Schizophrenia patients with PA had significantly lower scores on psychological domain of WHOQOL-Bref compared to the patients without PA. Schizophrenic patients with panic attacks had higher CDS scores than patients without PA. In the multivariate regression analyses the variance in psychological domain of WHOQOL-Bref was explained by depression rather than panic attack. CONCLUSION: In patients with schizophrenia comorbid panic attacks may have a negative impact on quality of life, which is associated with depression significantly. Panic attacks and depressive symptomatology must be examined comprehensively in order to improve quality of life in patients with schizophrenia.

Prevalence and risk factors of psychotic symptoms: in the city of Izmir, Turkey.

BACKGROUND: Psychotic symptoms, psychotic-like experiences and schizotypal signs can emerge in different socio-cultural circumstances and cause clinical or non-clinical pictures. Transient or self-limiting psychotic-like experiences are more prevalent than clinical psychotic disorders. The aim of this study is to determine the prevalence and sociodemographic correlates of psychotic symptoms in an urban area. METHODS: A cross-sectional study was conducted among the residents of two districts in the urban area of Izmir, Turkey. Among the systematically selected 1,500 residents of 85,212-study population, a total of 1,268 individuals (response rate: 84.5%) were screened for any lifetime psychotic symptoms. RESULTS: Composite International Diagnostic Interview (CIDI) was used to assess psychotic symptoms. CIDI (+) psychotic symptoms were found in 3.6% of the screened sample. Logistic regression analysis showed that being a female (OR=2.4, 95% CI=1.2-5.1), having a first degree family history of any mental disorders (OR=13.9, 95% CI=5.7-34.3), lack of social support (OR=4.5, 95% CI=2.3-8.6) and alcohol use (OR=4.9, 95% CI=2.3-10.6) were all related to psychotic symptoms. CONCLUSION: Prevalence of any psychotic symptom is lower compared to European studies. Alcohol might be considered as a risk factor for developing psychotic symptoms in the Turkish cultural setting.