The relationship between separation anxiety and intolerance of uncertainty in pregnant women.

Background and aim: Pregnancy is a risky period to develop Adult Separation Anxiety Disorder (ASAD). The aim of this study was to investigate the frequency of separation anxiety in pregnant women, and the relationship of separation anxiety with sociodemographic variables and intolerance of uncertainty.Methods: This study included 310 pregnant women and used the Adult Separation Anxiety Questionnaire (ASAQ) and Intolerance of Uncertainty Scale-Short Form (IUS-12).Results: The average age in pregnant women with ASAD was lower. IUS-12 total score, prospective anxiety, and inhibitory anxiety subscale scores were significantly higher in the ASAD group. There were moderate and statistically significant positive correlations between the ASAD score and the IUS-12 total, prospective anxiety and inhibitory anxiety subscale scores.Conclusion: Intolerance of uncertainty may be an important factor in the mental processes of individuals with separation anxiety. Pregnancy period can be a risky period for developing ASAD. Cognitive behavioral treatments including intolerance of uncertainty may be effective in the treatment of ASAD. There is a need for follow-up studies on the effects of separation anxiety during pregnancy on maternal-fetal health.

The Relationship Between Obsessive Belief Level and Cognitive Flexibility in Patients with Obsessive Compulsive Disorder.

INTRODUCTION: It is known that dysfunctional beliefs are important in the onset and maintenance of symptoms of Obsessive Compulsive Disorder (OCD) according to the cognitive model of OCD. OCD patients with higher obsessive beliefs would be expected to have greater deficits in cognitive flexibility. In this study, we aimed to examine the relationship between obsessive belief levels and cognitive flexibility in OCD patients. METHODS: Patients with OCD (50) and Panic Disorder (30) as a control group were evaluated and diagnosed using Structured Clinical Interview for DSM-IV Axis I Disorders. A socio-demographic data form, Beck Depression Inventory, Beck Anxiety Inventory and Wisconsin Card Sorting Test (WCST) were administered to all the patients. The Yale-Brown Obsessive Compulsive Scale and Obsessive Beliefs Questionnaire-44 (OBQ-44) were administered to the OCD group. The OCD group was divided into two subgroups as higher obsessive beliefs (OCD-H) (n=29) and lower obsessive beliefs (OCD-L) (n=21) according to a cluster analytic approach. RESULTS: When the subgroups were compared according to WCST; the number of completed categories was statistically significantly lower, and the numbers of total errors, perseverative errors and non-perseverative errors were significantly higher in the OCD-H group. CONCLUSION: The results of our study show that cognitive flexibility is impaired in OCD patients with higher obsessive beliefs.

Relationship between dysfunctional attitudes and childhood traumas in women with depression.

AIM: Psychological traumas in childhood could lead to dysfunctional attitudes causing negative cognitive structuring and mistakes in data processing. In this study, we aimed to research the relation of childhood traumas with dysfunctional attitudes in female patients with depressive disorder. METHOD: Seventy female patients diagnosed with depressive disorder and 50 healthy volunteers participated in the study, and the participants were administered a socio-demographic form, the Beck Depression Inventory (BDI), the Childhood Trauma Questionnaire (CTQ) and the Dysfunctional Attitudes Scale (DAS). RESULTS: Comparing the two groups by median values of CTQ, total CTQ, sexual abuse, physical abuse, emotional abuse, physical neglect and emotional neglect, median values of the patient group were significantly higher compared to the control group, and comparison by median values of DAS revealed that median values of the patient group was significantly lower compared to the control group. In the correlation analysis carried out for finding the relation between CTQ and DAS, there was a significant negative correlation between DAS score and emotional abuse score. In the patient group, all kinds of abuses and neglects except for sexual abuse were at a higher rate in those with a history of depression in the family. CONCLUSION: In our study, a negative correlation was determined between DAS and only emotional abuse leading us to the finding that one of the factors mediating childhood traumas to cause depression could lead to dysfunctional attitudes.

Relationship Suicide, Cognitive Functions, and Depression in Patients with Schizophrenia.

INTRODUCTION: The aim of this study was to compare schizophrenic patients with and without a suicide attempt history in terms of sociodemographic and clinical features and cognitive functions and to determine the predictive factors for suicide attempt history. METHODS: In this study, we assessed and compared 70 patients with schizophrenia, 27 patients with a suicide attempt history, and 43 patients without a suicide attempt history. The cognitive functions of patients were assessed by the Stroop test, Wisconsin Card Sorting Test (WCST), and Rey Auditory Verbal Learning Test. In order to evaluate clinical symptoms, the Positive and Negative Syndrome Scale (PANSS) and Calgary Depression Scale for Schizophrenia (CDSS) were used. RESULTS: In this study, the number of hospitalizations, PANSS general psychopathology subscale score, CDSS total score, suicide item score, and WCST total number of responses (WCST1) were significantly higher among the patients with a suicide attempt history. The WCST1 and CDSS total scores were predicted using the suicide attempt history. CONCLUSION: Revealing the factors related to suicidal behavior in patients with schizophrenia contributes to the prevention of suicide. Studies with long-term follow-up and with a larger sample group are required for the investigation of relationship suicide, cognitive impairment, which is one of the core symptoms of schizophrenia, and depression.

The relationship between insight and the level of expressed emotion in patients with obsessive-compulsive disorder.

AIM: The aim of this study is firstly to compare the obsessive-compulsive disorder (OCD) patients with good insight and OCD patients with poor insight in terms of socio-demographic and clinical features; to investigate the relation between insight and the level of the expressed emotion (EE) in the patients; and lastly to specify the factors that predict level of insight. METHODS: OCD patients with good insight and patients with poor insight were compared in terms of clinical features and the perceived EE level of the patients and the individuals that they live with in order to specify the factors that predict the insight level, and to investigate the relationship between insight level and EE. RESULTS: It was found that the total Expressed Emotion Scale, total Level of Expressed Emotion (LEE), LEE-Emotional Response and LEE-Tolerance/Expectation subscale scores of the group comprised of patients with poor insight are higher than the other group. The results also show that the duration of illness and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) total score predict insight level. CONCLUSIONS: This study shows that the level of EE perceived by the patients with poor insight and the person that he/she lives with, is higher than the group with good insight. The studies that investigate the relationship between the factors of insight level and EE level, which are indicated to determine the level of the illness severity and its chronicity, will enable the researchers to understand the importance of the role of the family on the treatment processes of OCD.

[Insight and social functioning in deficit and nondeficit schizophrenia]. / Eksiklik sendromu olan ve olmayan sizofreni tanili hastalarda içgörü ve sosyal islevsellik düzeyleri.

OBJECTIVE: Deficit syndrome is a symptom complex characterized by primary and enduring negative symptoms, therefore it is difficult to diagnose. Poorer social functioning and insight are serious issues of Schizophrenia. Both of them seems to be related with deficit schizophrenia. The present study aimed to compare insight and social functioning in patients with deficit and nondeficit schizophrenia. MATERIALS AND METHODS: Our study involved 71 patients with Schizophrenia recruited from the out patient clinic of psychiatry, Eskisehir Osmangazi University, Faculty of Medicine. Patients were diagnosed as schizophrenia by using Structured Clinical Interview for DSM-IV (SCID-I). Participants were evaluated by The Schedule for the Deficit Syndrome (SDS) and separated to two groups: Deficit (n=30) and nondeficit (n=41) Schizophrenia. All participants were administered Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Schedule for Assessing the Three Components of Insight (SAI) and Personal and Social Performance Scale (PSP). RESULTS: Compared to patients with nondeficit group, non-paranoid subtype ratio was significantly higher in deficit group. The mean SAI and PSP scores were significantly lower in the deficit group than in the nondeficit group. The mean SAPS and SANS scores were significantly higher in the deficit group than in the nondeficit group. CONCLUSION: Our study emphasizes the importance of lack of insight and poorer social functioning in deficit schizophrenia.

The estimation of cerebral asymmetries in schizophrenia by the Cavalieri principle.

OBJECTIVE: To demonstrate hemispheric asymmetry in patients with schizophrenia using a cheap, simple stereologic method on the basis of standard CT scans of the brain. METHODS: To demonstrate hemispheric asymmetry, standard CT scans of 30 schizophrenic patients (14 males, 16 females) were compared with 39 (13 male, 26 female) control subjects at Eskisehir Osmangazi University, Eskisehir, Turkey in 2005. Brain volumes were investigated by using a cheap, simple stereologic method, namely, Cavalieri. RESULTS: In patients with schizophrenia, we found that as age increases, right and left hemisphere volumes decrease. However, in the control group there was no relationship found between age and hemisphere volumes. In the control group, the left hemisphere was significantly bigger in males compared to females. There was a significant difference in both right and left hemisphere volumes between the control group and the schizophrenic group. In the schizophrenic group, a significant difference was observed in right hemisphere volumes between genders (p=0.002), while there was no difference in the control group. There was a difference in left hemisphere volumes between genders in both groups. Right and left hemispheric volumes of the schizophrenic group were smaller than those of control group. CONCLUSION: Cerebral asymmetry is an arguable subject for the diagnosis of schizophrenia. The method that we used in this study will be useful in estimating hemispheric volumes.

Absence and size of massa intermedia in patients with schizophrenia and bipolar disorder.

OBJECTIVE: To evaluate the absence and size of massa intermedia (MI), a midline thalamic structure, and its gender-specific alteration in patients with schizophrenia and bipolar disorder. METHODS: Thirty-five patients with schizophrenia (17 females and 18 males), 21 patients with bipolar disorder (15 females and 6 males) and 89 healthy controls (50 females and 39 males) were evaluated by magnetic resonance imaging. Thin-slice magnetic resonance images of the brain were evaluated. MI was determined in coronal and sagittal images, and area of the MI was measured on the sagittal plane. RESULTS: Females had a significantly lower incidence of absent MI compared with males in the healthy control group. The absence of MI in schizophrenia and bipolar patients was not higher than the incidence in healthy controls. The size of MI showed a gender difference. The mean MI area size was smaller in female schizophrenia patients than in female controls, while no significant difference was observed between male schizophrenia patients and their controls. CONCLUSIONS: The size of MI, a gender difference midline structure, is smaller in females with schizophrenia, and the results of this study support other studies of structural aberration of the thalamus and other midline structures in the brains of patients with schizophrenia.

A gender-oriented comparison between the mental health profiles of Bulgarian immigrants forcibly migrated to Turkey and the native population 15 years after migration.

UNLABELLED: Background. The considerable problem of the migration of people, mainly from developing or undeveloped countries to developed countries, is a worldwide issue. The aims of this study were to compare, according to gender, scores obtained pertaining to mental symptom distributions of Bulgarian immigrants arriving in one city of west Turkey in 1989 with those of native-born citizens, as well as to the scores obtained from the scales of anxiety, hopelessness, job and life satisfaction. Methods. During the period of study between 1 February and 31 April 2003, short symptom inventory, state and trait anxiety scales, and hopelessness, job, and life satisfaction scales were collected from 85 immigrants living in a district where immigrants are prevalent. The results of 98 of the native population living in the same district were also collected during the same period. Data were analyzed using chi-square, t, Mann-Whitney U-tests, and percent ratios. RESULTS: Upon comparison of the scores of both immigrant women and native women, and immigrant men and native men, no differences were found between scores obtained from the subscales of short symptom inventory, state and trait anxiety scales, and hopelessness and job satisfaction scales (p>0.05). The only observable difference was between scores obtained from the life satisfaction scale (p<0.01 and p<0.05, respectively). The depression subscale of the short symptom inventory revealed a difference in the scores of immigrant women compared to immigrant men, as did the somatization subscale for native-born women when compared to native men (p<0.05 and p<0.05, respectively). CONCLUSIONS: That both male and female immigrants had low scores for life satisfaction forces us to draw the conclusion that their expectations, necessities, desires and wishes were not entirely fulfilled. The reason for their being no observable differences between the other scale scores may be attributed to the fact that the immigrant women and men share not only the same ethnic origin, but also historical and cultural ties with those in Turkey. An alternative view could be that those entering the country may have adapted to the environment after the passage of 15 years. Furthermore, the significant difference seen between immigrant women and men, and native women and men in terms of symptoms of depression and somatization, respectively, may be explained through the notion that women perceived migration to be more different, and that native women more readily accepted the thought of physical illness according to mental disorders. Further studies are needed to better explain some of these results.

Gender differences in psychological effect of the August 1999 earthquake in Turkey.

Disasters traumatically expose normal populations to severe threats to life, deaths of relatives and massive environmental destruction. Epidemiological studies found that women would be more vulnerable to disaster than men. In this study, we examined gender differences in short-term psychological effect of the 1999 earthquake in Turkey on adult survivors. A total of 184 subjects (79 males and 105 females) who used a psychiatric service were interviewed within 6-10 weeks after the earthquake. All subjects were assessed using a modified version of the Mississippi Scale for Posttraumatic Stress Disorder, the Beck Depression Inventory, the Beck Hopelessness Scale, and four subscales (depression, anxiety, hostility and somatization) of the Symptom Check List (SCL-90-R). Women had higher mean total Mississippi Scale scores than men (84.29 vs. 78.72; P<0.05). Women scored higher on the Beck Depression Inventory and the Beck Hopelessness Scale than men (respectively 16.3 vs. 10.4; P<0.001 and 7.5 vs. 6.0; P<0.05). Women had significantly higher depression (1.40 vs. 0.94; P<0.001), anxiety (1.46 vs. 1.12; P<0.05) and somatization (1.31 vs. 0.84; P<0.001) subscale scores of the SCL-90-R than men. These findings indicate that women may experience more severe psychological reactions than men after a disastrous earthquake.

[Acute stress disorder and posttraumatic stress disorder after motor vehicle accidents]. / Motorlu araç kazalarindan sonra görülen Akut Stres Bozuklugu ve Travma Sonrasi Stres Bozuklugu.

OBJECTIVE: We examined the rates of and factors associated with the development of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) after motor vehicle accidents (MVAs). METHOD: Forty hospitalized patients who had orthopedic injuries after MVAs and 26 hospitalized patients who had orthopedic injuries without a MVA were included in the study. One month after the MVA, the General Health Questionnare (GHQ) Hamilton Depression Rating Scale (HDRS), Multidimensional Scale of Perceived Social Support (MSPSS), Peritraumatic Dissociative Experiences Questionnare (PDEQ) and sociodemographic data questionnaire were given to all patients. At 3 and 6 months follow-up the Clinician Administered PTSD Scale (CAPS), HDRS, GHQ, and a questionnaire concerning medical problems caused by the accident along with economic and legal problems were applied. RESULTS: 20% of the inpatients in the MVA group developed ASD in the 1st month, 30% developed PTSD in the 3rd month and 17% developed PTSD in the 6th month, while in the control group none of the patients developed either ASD or PTSD. The MVA group had higher mean GHQ, HDRS and CAPS scores than the controls at the 1st, 3rd and the 6th months of follow-up. CONCLUSION: Serious and long-term psychiatric problems are seen after MVAs. Early intervention and rehabilitation are needed for the risk groups determined.

Neurocognitive deficits and quality of life in outpatients with schizophrenia.

The purpose of this cross-sectional study was to examine the relationships between neurocognitive deficits and quality of life for patient with schizophrenia. Fifty-seven schizophrenic outpatients (38 men and 19 women) were assessed for neurocognitive deficits using the Wisconsin Card Sorting Test (WCST) and all patients completed the PCASEE (P=physical, C=cognitive, A=affective, S=social, E=economic-social, and E=ego functions) questionnaire to assess their quality of life. We assessed psychiatric symptoms using the Schedule for the Assessment of Positive Symptoms (SAPS) and the Schedule for the Assessment of Negative Symptoms (SANS). We rated the Abnormal Involuntary Movement Scale (AIMS) for extrapyramidal side effects. Pearson correlational analyses were conducted to assess the relationships among measures of quality of life, neurocognitive functioning, symptoms, and extrapyramidal side effects. There were significant relationships among the total score of the PCASEE questionnaire and the SANS total score and the AIMS total score (P<.001). Small but significant associations were found among the total score of the PCASEE questionnaire and the SAPS total score and a number of nonperseverative errors (P<.05). Negative symptoms and extrapyramidal side effects in schizophrenia appear to have direct impact on the patient's perceived quality of life.