Optimized short-forms of the Cognitive Distortions Questionnaire.

INTRODUCTION: The Cognitive Distortions Questionnaire (CD-Quest) is a self-report questionnaire that assesses common cognitive distortions. Although the CD-Quest has excellent psychometric properties, its length may limit its use. METHODS: We attempted to develop short-forms of the CD-Quest using RiskSLIM - a machine learning method to build short-form scales that can be scored by hand. Each short-form was fit to maximize concordance with the total CD-Quest score for a specified number of items based on an objective function, in this case R2, by selecting an optimal subset of items and an optimal set of small integer weights. The models were trained in a sample of US undergraduate students (N = 906). We then validated each short-form on five independent samples: two samples of undergraduate students in Brazil (Ns = 182, 183); patients with depression in Brazil (N = 62); patients with social anxiety disorder in the US (N = 198); and psychiatric outpatients in Turkey (N = 269). RESULTS: A 9-item short-form with integer scoring was created that reproduced the total 15-item CD-Quest score in all validation samples with excellent accuracy (R2 = 90.4-93.6%). A 5-item ultra-short-form had good accuracy (R2 = 78.2-85.5%). DISCUSSION: A 9-item short-form and a 5-item ultra-short-form of the CD-Quest both reproduced full CD-Quest scores with excellent to good accuracy. These shorter versions of the full CD-Quest could facilitate measurement of cognitive distortions for users with limited time and resources.

Does the clerkship/internship in psychiatry affect medical students' level of knowledge about schizophrenia, attitudes, and beliefs toward schizophrenia and other mental disorders?

Undergraduate medical students' attitudes and beliefs toward mental illnesses are a crucial phenomenon as these students will be care providers of the future. The current study aimed to analyze whether the psychiatry clerkship/internship affects these students' level of knowledge about schizophrenia as well as their attitudes and beliefs toward schizophrenia and other mental illnesses. A total of 158 medical students, 92 in their fifth year and 66 in their sixth year, were included in the study. The participants completed the Knowledge About Schizophrenia Questionnaire (KASQ), Beliefs toward Mental Illness Scale (BMI), and Attitudes toward People with Mental Disorders Scale (APMDS) before and after the psychiatry clerkship/internship. The KASQ and APMDS total scores were significantly higher whereas BMI and BMI-Dangerousness subscale scores were significantly lower after the clerkship/internship in psychiatry. Postclerkship/internship KASQ total scores were negatively correlated with BMI total scores and BMI-Dangerousness subscale scores. Additionally, BMI total scores and APMDS total scores were also negatively correlated. Although the change in KASQ scores was significantly associated with the decrease in BMI total scores after the clerkship/internship, it was not associated with the increase in APMDS total score in the hierarchical multiple linear regression analysis. In conclusion, the present study revealed that knowledge about schizophrenia and attitudes and beliefs toward mental illnesses improved significantly after the clerkship/internship in psychiatry. While improvement in medical students' knowledge about schizophrenia and mental illnesses is a predictor of the decrease in negative beliefs about mental illnesses, a similar relationship was not found regarding attitudes. This study not only provides information about the relationship between knowledge about schizophrenia and attitudes and beliefs about mental illness but also highlights the need to consider the multifactorial nature of attitudes when developing intervention programs for medical students.

Validity and Reliability of the Turkish Version of Mahony Psychological Assessment for Bariatric Surgery.

Background: The aim of this study was to determine the validity and reliability of the Turkish version of Mahony Psychological Assessment for Bariatric Surgery which can be easily administered and used as a guide by health professionals who will be included in the treatment of patients who are potential candidates for bariatric surgery. Methods: A total of 310 patients who were admitted to health institutions for bariatric surgery in 3 different provinces of Turkey answered these questions in the Turkish translation of Mahony Psychological Assessment for Bariatric Surgery. Eating disorder examination questionnaire was also administered to the patients in addition to Mahony Psychological Assessment for Bariatric Surgery. Results: Early life problems due to weight scores of women were significantly higher than men (P = .001). Among the age groups, both the early life problems due to weight scores (P = .008) and dysphoric feelings about weight scores (P < .001) of the 18-44 age group were significantly higher than the participants who are over the age of 45. There is a weak-to-medium and positive correlation between the total Mahony Psychological Assessment for Bariatric Surgery total scores and all the subscale and total scores of the Eating Disorder Examination Questionnaire (P < .05 for all). These correlation results support the co-validity of Mahony Psychological Assessment for Bariatric Surgery and Eating Disorder Examination Questionnaire. Internal consistency of the Mahony Psychological Assessment for Bariatric Surgery was at a high level except for the subscale of positive treatment attitude and supportive environment. Cronbach's ɑ values were calculated to be 0.902 for the subscale of emotional and binge eating, 0.820 for the early life problems due to weight, 0.856 for the dysphoric feelings about weight, 0.539 for the positive treatment attitude and supportive environment, and 0.919 for the whole scale. Conclusion: The analyses have shown that the Turkish version of Mahony Psychological Assessment for Bariatric Surgery may be used in clinical interviews and psychiatric evaluation of bariatric surgery patients in Turkey.

Cognitive attentional syndrome and metacognitive beliefs as potential treatment targets for metacognitive therapy in bipolar disorder.

Most treatment guidelines emphasize the use of psychotropic drugs for both the acute and maintenance treatment of bipolar disorder (BD). However, relying only on psychotropics without adjunctive psychosocial interventions may be insufficient in treating patients with BD. Given its unique view in the explanation of psychopathological states, metacognitive therapy (MCT) might be helpful for BD. Metacognitive theory posits that psychopathology is a result of the cognitive attentional syndrome (CAS) and that it is influenced and maintained by dysfunctional metacognitive beliefs, perseverative thinking, attentional biases, and dysfunctional coping strategies. In this review, literature data regarding these areas in BD are examined. Studies suggest that perseverative thinking might be among the emotion regulation strategies endorsed in individuals with BD. Regarding attentional biases, literature data show that state-dependent, mood-changing attentional biases and a ruminative self-focused attention are present. Studies also suggest that cognitive self-consciousness is higher in BD compared to controls. It is seen that maladaptive coping strategies are frequently reported in BD, and that these strategies are associated with depression severity, negative affect and relapse risk. Studies focusing on dysfunctional metacognitive beliefs in BD reported that individuals with BD had higher scores for negative metacognitive beliefs, self-consciousness, need to control thoughts, and a lack of cognitive confidence. Also, dysfunctional metacognitive beliefs were associated with depressive symptomatology. These findings suggest that the components of CAS and dysfunctional metacognitive beliefs are evident in BD. For a subgroup of patients with BD who fail to respond to evidence-based psychopharmacological and adjunctive psychotherapeutic interventions, MCT might be an alternative way to consider as a treatment option. In conclusion, taken the available data together, we propose a sequential treatment protocol for BD, mainly based on the MCT treatment plan of depressive disorders.

Impact of metabolic syndrome and clinical features on functioning in patients with bipolar disorder: a cross-sectional study

Objective: The metabolic syndrome (MS) is highly prevalent among patients with bipolar disorder (BD), and may affect progression, functioning, and comorbid conditions in BD. The aim of this study was to investigate the effect of clinical variables and MS on overall functioning and specific areas of functioning in patients with BD. Methods: A total of 210 participants (140 participants with BD I and BD II in remission and 70 non-psychiatric control subjects) were included. The investigators administered the Young Mania Rating Scale (YMRS), the Bipolar Depression Rating Scale (BDRS), the Global Assessment of Functioning Scale (GAF), and the Bipolar Disorder Functioning Scale (BDFS). The participants completed the Beck Depression Scale (BDS) and the Beck Anxiety Scale (BAS). MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Hierarchical regression analysis was used to investigate potential correlations of comorbid MS with clinical variables and level of functioning. Results: Level of functioning did not differ between patients with and without MS. However, there were significant correlations between the level of functioning subscales and the number of depressive episodes (p = 0.033), level of general functioning (p = 0.012), duration of illness (p = 0.012), BDS (p = 0.005), BDRS (p = 0.021), BAS total scores (p = 0.021), number of hypomanic episodes (p = 0.022), number of hospitalizations (p = 0.003), employment status (p = 0.032), and diagnosis of BD I (p = 0.007) and BD II (p = 0.044). Conclusion: Our findings suggest that clinical variables had a greater effect on functioning than MS in BD patients.

Impact of metabolic syndrome and clinical features on functioning in patients with bipolar disorder: a cross-sectional study.

OBJECTIVE: The metabolic syndrome (MS) is highly prevalent among patients with bipolar disorder (BD), and may affect progression, functioning, and comorbid conditions in BD. The aim of this study was to investigate the effect of clinical variables and MS on overall functioning and specific areas of functioning in patients with BD. METHODS: A total of 210 participants (140 participants with BD I and BD II in remission and 70 non-psychiatric control subjects) were included. The investigators administered the Young Mania Rating Scale (YMRS), the Bipolar Depression Rating Scale (BDRS), the Global Assessment of Functioning Scale (GAF), and the Bipolar Disorder Functioning Scale (BDFS). The participants completed the Beck Depression Scale (BDS) and the Beck Anxiety Scale (BAS). MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Hierarchical regression analysis was used to investigate potential correlations of comorbid MS with clinical variables and level of functioning. RESULTS: Level of functioning did not differ between patients with and without MS. However, there were significant correlations between the level of functioning subscales and the number of depressive episodes (p = 0.033), level of general functioning (p = 0.012), duration of illness (p = 0.012), BDS (p = 0.005), BDRS (p = 0.021), BAS total scores (p = 0.021), number of hypomanic episodes (p = 0.022), number of hospitalizations (p = 0.003), employment status (p = 0.032), and diagnosis of BD I (p = 0.007) and BD II (p = 0.044). CONCLUSION: Our findings suggest that clinical variables had a greater effect on functioning than MS in BD patients.

Metabolic syndrome in bipolar disorder: prevalence, demographics and clinical correlates in individuals with bipolar I, bipolar II, and healthy controls

Abstract Background: The metabolic syndrome is a growing global public health problem and highly prevalent in patiens with bipolar disorder. There are a few studies about relationship between metabolic syndrome and bipolar disorder subtypes. Objective: The aim of this study was to investigate the prevalence of metabolic syndrome (MS) and its individual components in subjects with bipolar I (BD I) and bipolar II (BD II) disorder compared with non-psychiatric controls, and to determine the variables affecting MS. Methods: A total of 210 individuals (mean age 42.5 ± 11.87, 58.1% female) of whom 70 had BD I, 70 BD II, and 70 controls, were included in this study. MS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), the adapted ATP III (ATP III-A) and the International Diabetes Federation (IDF) criteria. Results: Participants with BD I had a significantly higher prevalence of MS when compared to individuals BD II and non-psychiatric controls according to the NCEP-ATP III, ATP III-A, and IDF criteria (ps < 0.01). In individuals with MS, increased waist circumference was the most common abnormality. Logistic regression analysis revealed that the presence of physical illness, age and number of cigarettes smoked significantly predicted the presence of MS. Discussion: This study showed that MS was more prevalent among BD I individuals compared to BD II and controls, and highlighted the importance of regular screening for MS in individuals with BD.

Association of mindfulness and impulsivity with obesity

Abstract Background: The prevalence of obesity has more than doubled over the past three decades. Impulsivity is a multidimensional personality trait that potentially contributes to the development and maintenance of obesity. Mindful awareness can potentially minimize the automatic and inattentive reactions around food. Objectives: In our study, we aimed to research the relationship between impulsivity and mindful attention. Methods: The study population consisted of 60 outpatients aged 18 and older, with a body mass index (BMI) of at least 30 kg/m2 presenting to the psychiatry clinics of a secondary health care facility. The participants completed the Barratt Impulsiveness Scale (BIS), and the Mindful Attention Awareness Scale (MAAS). Results: The average age of participants was 39 years, BMI was 35.70 ± 4.54 kg/m2. BMI was not statistically significantly correlated with any of the scales, and the MAAS total score was negatively correlated with the impulsiveness scores, except for the motor impulsiveness subscale score. Dispositional mindfulness was negatively associated with impulsiveness scores, except for motor impulsiveness. Discussion: This study showed that there was a negative relationship between impulsivity and mindfulness. Therefore, using mindfulness techniques may decrease impulsivity, and may be extremely helpful in promoting better eating behaviors and weight regulation.

Cognitive distortions mediate the relationship between defense styles and depression in female outpatients

Background and Objectives: Some clinicians use different psychotherapeutic methods in combination in their practice. These combinations reflect the need for more rigorous research on the common pathways which these different therapy orientations may be utilizing, and one way to identify these pathways would be to investigate some core assessment tools or conceptual foundations of these two different approaches. Aim: The aim of the present study was to evaluate the relationship between defense mechanisms and cognitive distortions, and to identify the mediating role of cognitive distortions between defense styles and depression. Methods: A total of 342 female psychiatric outpatients aged 18 and older were recruited. A diagnostic interview and rating of the depression severity were undertaken, and the Cognitive Distortion Scales and the Defense Style Questionnaire were completed by the participants. Hierarchical regression analyses were conducted to test for the direct and indirect effects of the defense styles. Results: Cognitive distortions and defense mechanisms were both correlated with the severity of depression, but the correlations were stronger for the former. Conclusions: The findings are suggestive of the mediating effect of cognitive distortions between defense mechanisms and the severity of depression (AU)

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Simple markers for subclinical inflammation in the different phases of bipolar affective disorder

Abstract Background: Recently, a growing number of publications have suggested that the immune-inflammatory system may be involved in the etiology of bipolar disorder (BD). Objective: The aim of this study was to investigate neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) in the three different phases of BD patients compared to each other and controls. Methods: One hundred eighty-seven bipolar patients (78 euthymic, 53 manic/hypomanic and 56 depressed), and 62 age and sex matched controls were enrolled. Sociodemographic variables and complete blood count parameters of the patients and the control group were recorded. Results: The groups did not differ from each other on the hematological parameters, except for NLR and RDW. Post-hoc analyses revealed that NLR values were significantly higher in the euthymic and manic/hypomanic bipolar groups compared to control group. In addition, post-hoc analyses revealed that RDW values were significantly higher in the manic/hypomanic bipolar group relative to the control group. Discussion: Longitudinal studies evaluating the levels of inflammatory markers in the early phases of the disorder, and their relationship with the development of different episodes and medical comorbidities may be useful to understand the role of inflammation in BD.

Expressed emotion in panic disorder: Relationship with demographic and clinical variables and quality of life.

OBJECTIVE: Expressed emotion (EE) predicts the outcome of treatment in patients with anxiety disorders. We aimed to investigate the relationship between EE and demographic and clinical characteristics of patients with panic disorder (PD), to determine whether there is a difference between PD, major depressive disorder (MDD) patients and healthy controls (HC) in terms of EE and to investigate the effect of EE on quality of life (QOL) in patients with PD. METHODS: Our study involved a total of 150 participants (50 patients in each group). All participants were given the Level of Expressed Emotion (LEE) scale and the short-form health survey (SF)-36 . Furthermore, the EE scale was completed by the participant's key relatives. RESULTS: EE was associated with some sociodemographic and clinical variables in patients with PD. There was no significant difference between PD and MDD and between PD and HC in terms of the LEE and the EE and their subscale scores. It was also demonstrated that EE had no effect on the QOL in patients with PD. CONCLUSION: EE was not different in PD compared to MDD and HC. Additionally, EE was not related to QOL in PD.

Duration of the depressive episode is correlated with ganglion cell inner plexifrom layer and nasal retinal fiber layer thicknesses: Optical coherence tomography findings in major depression.

Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has been used increasingly to diagnose and manage a variety of retinal diseases. Since the axons in retinal nerve fiber layer (RNFL) are nonmyelinated within the retina, OCT has been used in various neurodegenerative diseases to visualize the process of neurodegeneration. Decreases in RNFL and ganglion cell inner plexiform layer (GCIPL) thicknesses were observed in patients with schizophrenia. To date, there is no clinical research investigating OCT parameters in patients with MD. We compared the RNFL thickness, GCIPL thickness in 58 MD patients and 57 healthy controls, and investigated their correlation with clinical variables of depression. Depressed patients were not different from the healthy controls with regard to OCT parameters. GCIPL and nasal RNFL were correlated with the duration of the latest depressive episode. Some measures of OCT were negatively associated with clinical variables like a family history of psychiatric diagnosis and the duration of the latest episode. Larger studies including depressed patients of different severity, including structured interviews and controlling for the effect of antidepressant treatment will provide better results.

State of the art psychopharmacological treatment options in seasonal affective disorder.

Seasonal affective disorder (SAD) is defined as a subtype of mood disorders in DSM 5, and it is characterized by a seasonal onset. SAD is proposed to be related to the seasonal changes in naturally occurring light, and the use of bright light therapy for depressive symptoms has been shown to reduce them in placebo controlled trials. Cognitive behavioral therapy has also been demonstrated to be effective in SAD. This review article aims to focus on the psychopharmacological treatment options for SAD. According to clinical trial results, first line treatment options seem to be sertraline and fluoxetine, and are well tolerated by the patients. There is some evidence that other antidepressants (e.g. bupropion) might be effective as well. Although clinical trials have shown that some of these antidepressants may be of benefit, a recent review has concluded that there is not enough evidence to support the use of any of these agents for the treatment of SAD yet. Moreover, more studies are still needed to evaluate the effectiveness of other treatment options, e.g., propranolol, melatonin, hypericum, etc. In addition to the above proposed treatments, patients with seasonal depressive symptoms should thoroughly be evaluated for any cues of bipolarity, and their treatment should be planned accordingly.

The role of tumour necrosis factor alpha and soluble tumour necrosis factor alpha receptors in the symptomatology of schizophrenia.

Background Immunological mechanisms may be responsible for the development and maintenance of schizophrenia symptoms. Aim The aim of this study is to measure tumour necrosis factor-alpha (TNF-α), soluble tumour necrosis factor-alpha receptor I (sTNF-αRI), and soluble tumour necrosis factor-alpha receptor II (sTNF-αRII) levels in patients with schizophrenia and healthy individuals, and to determine their relationship with the symptoms of schizophrenia. Methods Serum TNF-α, sTNF-αRI and sTNF-αRII levels were measured. The Positive and Negative Syndrome Scale (PANSS) was administered for patients with schizophrenia (n = 35), and the results were compared with healthy controls (n = 30). Hierarchical regression analyses were undertaken to predict the levels of TNF-α, sTNF-αRI and sTNF-αRII. Results No significant difference was observed in TNF-α levels, but sTNF-αRI and sTNF-αRII levels were lower in patients with schizophrenia. Serum sTNF-αRI and sTNF-αRII levels were found to be negatively correlated with the negative subscale score of the PANSS, and sTNF-αRI levels were also negatively correlated with the total score of the PANSS. Smoking, gender, body mass index were not correlated with TNF-α and sTNF-α receptor levels. Conclusions These results suggest that there may be a change in anti-inflammatory response in patients with schizophrenia due to sTNF-αRI and sTNF-αRII levels. The study also supports low levels of TNF activity in schizophrenia patients with negative symptoms.

Psychopharmacological treatment differences in autogenous and reactive obsessions: A retrospective chart review.

BACKGROUND: Identification of homogeneous subgroups of obsessive compulsive disorder (OCD) patients may have important implications for improving effective treatment options. It has been proposed that obsessive thoughts can be classified into two subtypes, i.e. autogenous and reactive obsessions. Although it has been shown that patients with autogenous obsessions may display a worse response to treatment, no studies have yet addressed whether there is a different need for the psychopharmacological treatment options in the subtypes of OCD patients. AIM: To investigate the clinical characteristics and treatment differences between autogenous (A-OCD) and reactive (R-OCD) subtypes of OCD patients. METHODS: Both OCD subgroups (n = 50 for A-OCD, n = 130 for R-OCD) were compared with each other in terms of their demographic and clinical parameters. Odds ratio values for gender, treatment options, co-morbidity, severity of OCD, and response to treatment were computed. Multivariate hierarchical regression analyses were performed to identify any predictors for treatment options, severity of OCD, and response to treatment. RESULTS: Our results indicated that the A-OCD and R-OCD groups differed from each other on some demographic and clinical variables in addition to their psychopharmacological treatment needs. Patients in the A-OCD group were found to be prescribed an atypical antipsychotic 2.3 times more likely than the R-OCD group. The odds for a combination treatment, or the improvement of OCD symptoms from baseline levels did not differ between the two subtypes of obsession groups. CONCLUSIONS: Autogenous and reactive subtypes of obsessions may need to be offered different psychopharmacological treatment options.

A Case in the Bipolar Spectrum.

It has been reported that the correct diagnosis and treatment are delayed when subsyndromal bipolar mood disorder symptoms are overlooked. Patients in this spectrum are reported to have a diminished level of functioning, and these patients fail to accept their diagnosis; therefore, there is a low level of treatment adherence. This case report focuses on the diagnosis and treatment of a patient in the bipolar spectrum.

Psychometric Properties of the Revised and Abbreviated form of the Turkish Version of the Dysfunctional Attitude Scale.

Dysfunctional attitudes are considered to be important risk factors in the onset and maintenance of depression. Thus, a psychometrically reliable and valid measure is necessary for understanding depression. The Dysfunctional Attitude Scale (DAS) is widely used and has good psychometric properties, but there is no consensus about its factor structure. To examine its psychometric properties and factor structure, a total of 885 individuals consisting of patients with depression and healthy controls were evaluated. After the sample was randomly divided into two subsets, exploratory and confirmatory factor analyses were performed. Then the DAS was abbreviated according to the factor profiles and theoretical background. Analyses indicated two factors, named Perfectionism/Achievement and Need for Approval/Dependency for the revised DAS . Reliability analyses revealed a good internal consistency, and the concurrent validity indicated significant correlations with the Beck Depression Inventory and the Automatic Thoughts Questionnaire.

Turkish Version of the Cognitive Distortions Questionnaire: Psychometric Properties.

Cognitive distortions are interrelated with all layers of cognitions, and they may be part of the treatment once they are accessed, identified, labeled, and changed. From both a research and a clinical perspective, it is of utmost importance to disentangle cognitive distortions from similar constructs. Recently, the Cognitive Distortions Questionnaire (CD-Quest), a brief and comprehensive measure, was developed to assess both the frequency and the intensity of cognitive distortions. The aim of the present study was to assess the psychometric properties of the Turkish version of the CD-Quest in a psychiatric outpatient sample. Demographic and clinical data of the participants were analyzed by descriptive statistics. For group comparisons, Student's t-test was applied. An exploratory principal components factor analysis was performed, followed by an oblique rotation. To assess the internal consistency of the scale Cronbach's α was computed. The correlation coefficient was calculated for test-retest reliability over a 4-week period. For concurrent validity, bivariate Pearson correlation analyses were conducted with the measures of mood severity and negatively biased cognitions. The results revealed that the scale had excellent internal consistency, good test-retest reliability, unidimensional factor structure, and evidence of concurrent and discriminant validity.

Assessing Negative Automatic Thoughts: Psychometric Properties of the Turkish Version of the Cognition Checklist.

BACKGROUND: Beck's theory of emotional disorder suggests that negative automatic thoughts (NATs) and the underlying schemata affect one's way of interpreting situations and result in maladaptive coping strategies. Depending on their content and meaning, NATs are associated with specific emotions, and since they are usually quite brief, patients are often more aware of the emotion they feel. This relationship between cognition and emotion, therefore, is thought to form the background of the cognitive content specificity hypothesis. Researchers focusing on this hypothesis have suggested that instruments like the cognition checklist (CCL) might be an alternative to make a diagnostic distinction between depression and anxiety. OBJECTIVES: The aim of the present study was to assess the psychometric properties of the Turkish version of the CCL in a psychiatric outpatient sample. PATIENTS AND METHODS: A total of 425 psychiatric outpatients 18 years of age and older were recruited. After a structured diagnostic interview, the participants completed the hospital anxiety depression scale (HADS), the automatic thoughts questionnaire (ATQ), and the CCL. An exploratory factor analysis was performed, followed by an oblique rotation. The internal consistency, test-retest reliability, and concurrent and discriminant validity analyses were undertaken. RESULTS: The internal consistency of the CCL was excellent (Cronbach's α = 0.95). The test-retest correlation coefficients were satisfactory (r = 0.80, P < 0.001 for CCL-D, and r = 0.79, P < 0.001 for CCL-A). The exploratory factor analysis revealed that a two-factor solution best fit the data. This bidimensional factor structure explained 51.27 % of the variance of the scale. The first factor consisted of items related to anxious cognitions, and the second factor of depressive cognitions. The CCL subscales significantly correlated with the ATQ (rs 0.44 for the CCL-D, and 0.32 for the CCL-A) as well as the other measures of mood severity (all Ps < 0.01). To a great extent, all items of the CCL were able to distinguish the clinical and non-clinical groups, suggesting the scale has high discriminating validity. CONCLUSIONS: The current study has provided evidence that the Turkish version of the CCL is a reliable and valid instrument to assess NATs in a clinical outpatient sample.

Metacognitions and emotional schemas: a new cognitive perspective for the distinction between unipolar and bipolar depression.

INTRODUCTION: Clinicians need to make the differential diagnosis of unipolar and bipolar depression to guide their treatment choices. Looking at the differences observed in the metacognitions, and the emotional schemas, might help with this differentiation, and might provide information about the distinct psychotherapeutical targets. METHODS: Three groups of subjects (166 unipolar depressed, 140 bipolar depressed, and 151 healthy controls) were asked to fill out the Metacognitions Questionnaire-30 (MCQ-30), and the Leahy Emotional Schema Scale (LESS). The clinicians diagnosed the volunteers according to the criteria of DSM-IV-TR with a structured clinical interview (MINI), and rated the moods of the subjects with the Montgomery Asberg Depression Rating Scale (MADRS), and the Young Mania Rating Scale (YMRS). Statistical analyses were undertaken to identify the group differences on the MCQ-30, and the LESS. RESULTS: The bipolar and unipolar depressed patients' scores on the MCQ-30 were significantly different from the healthy controls, but not from each other. On the LESS dimensions of guilt, duration, blame, validation, and acceptance of feelings, all three groups significantly differed from each other. There were no statistically different results on the LESS dimensions of comprehensibility, consensus, and expression. The mood disordered groups scored significantly different than the healthy controls on the LESS dimensions of simplistic view of emotions, numbness, rationality, rumination, higher values, and control. CONCLUSIONS: These results suggest that the metacognitive model of unipolar depression might be extrapolated for patients with bipolar depression. These results are also compatible to a great extent with the emotional schema theory of depression.