Dimensional characteristics of persistent negative symptoms in schizophrenia and their relationships with schizotypy in first-degree relatives.

PURPOSE OF THE ARTICLE: Schizophrenia with persistent negative symptoms (PNS) may have different characteristics regarding negative symptom dimensions and heritability patterns. This study aimed to investigate the dimensional characteristics of PNS and their relationships with schizotypal features in first-degree relatives (FDRs). MATERIALS AND METHODS: The study included 142 patients, 142 FDRs, and 71 healthy controls (HC). Patients were evaluated with the Positive and Negative Symptom Scale (PANSS), Brief Negative Symptom Scale (BNSS), Calgary Depression Scale for Schizophrenia (CDSS), and Simpson-Angus Scale (SAS). Schizotypy Personality Questionnaire was applied to FDR and HC groups. Clinical symptoms were compared between primary-PNS, secondary-PNS, and non-PNS groups. In addition, schizotypy scores were compared between FDRs and HCs. Then, the relationship between the symptoms of the patients in the PNS group and the schizotypy scores of their relatives was evaluated by multiple regression analysis. RESULTS: All negative symptom dimension scores were similar in primary-PNS and secondary-PNS and lowest in non-PNS. PNS-FDR had higher in all schizotypy scores than non-PNS-FDR and HC, except for lack of close friends and social anxiety. In the PNS group, positive symptom severity and PANSS experiential deficit scores significantly predicted positive and negative schizotypy scores in relatives. Negative schizotypy was associated with asociality. CONCLUSIONS: The PNS is likely a subtype in which the genetic basis of negative symptoms is stronger and is associated with genetic abnormalities shared by positive and negative schizotypy dimensions in relatives. Family-based genetic studies will be beneficial in enlightening the genetic etiology of PNS.

Efficacy and Safety of Paliperidone Palmitate Treatment in Patients With Schizophrenia: A Real-World Multicenter, Retrospective, Mirror-Image Study.

PURPOSE: The aim of the study was to assess efficacy and safety of paliperidone palmitate (PP) in schizophrenic patients using real-life data. METHODS: This national, multicenter, retrospective, and mirror-image study was performed reviewing the medical records of patients in 18 centers. Adult schizophrenic patients receiving PP treatment (n = 205) were enrolled. Patients' data covering the last 12 months before the initial PP injection and the period until the end of study with at least 12 months after the initial PP injection were evaluated. Patients' characteristics, scale scores, and adverse events were recorded. RESULTS: Nonadherence to prior medication was the most frequent reason for switching to PP treatment. Comparing with the period before PP treatment, the rate of patients visiting the hospital for relapse (79.5% vs 28.9%, P < 0.001) and the median number of hospitalizations (2 vs 0, P < 0.001) were lower during PP treatment. During PP treatment, the Positive and Negative Syndrome Scale score decreased by 20% or more (response to treatment) in 75.7% of the patients. The frequency of adverse events did not differ between the period before and during PP treatment. Improvement in functionality was higher in those with disease duration of 5 years or less. CONCLUSIONS: Paliperidone palmitate is effective and safe in treatment of schizophrenic patients and in switching to PP treatment in patients with schizophrenia, which reduced the percentage of patients admitted to the hospital for relapse and the median number hospitalization, and has positive effects on functionality.

The Effect of Medical Education on Attitudes Towards Schizophrenia: A Five-Year follow-Up Study. / Tip Egitiminin Sizofreniye Yönelik Tutumlar Üzerine Etkisi; 5 Yillik Izlem Çalismasi.

OBJECTIVE: It has been widely acknowledged that the community and health professionals hold negative attitudes toward patients with impaired mental health. This constitutes a majör obstacle for those patients in coping with their disease, managing their care, and hence regulating their lives. Although studies carried out in Turkey document the presence of stigma, they provide limited information about the ways for solving this problem. Drawing on the litrature, the present study investigated the effect of medical education on stigmatization. METHOD: During 2008/2009 academic year, 106 freshmen who were majoring in the Medical School at Celal Bayar University volunteered to participate in the present study. Participants have not yet received any theoretical or practical training on psychiatry. At the beginning of the study, they were informed about the purpose of the study and accordingly requested to fill a consent form. The 32-item schizophrenia subscale of the Attitude Questionnaire developed by Psychiatric Investigations and Education Center (PAREM) was administered to the participants. Along with the questionnaire, they were also requested demographic information. After 5 years, the participants who completed their psychiatry internship were reassessed with the same instrument. RESULTS: 106 volunteers participated in the present study. The majority of the participants were females (54.7%) with equal balance of income and expidentures (65.1%) having a mental disease percentage of 5.6%. Findings showed that students' attitudes towards schizophrenic patients changed significantly positive as they proceed from first year to the fifth year. Results demonstrated that as students move through the years they report more positive attitudes in the areas of etiology of schizophrenia (p<0.01), treatment options (p<0.01), approach to schizophrenic patients (p<0.01), and social interactions (p<0.01). CONCLUSION: We claim that the development of positive attitudes should be integrated in to the mental health curriculum not only in particular years but also throughout the whole years of education. Along this continuum, we believe that students would become more aware of the needs of the schizophrenic patients and gain an on going intuition toward the difficulties that the patients encounter. Viewed together, at the stage of acquiring medical/psychological skills students should be given the opportunity to have direct contact with patients in order to give adequate response to patients' needs and thus observe the improvement at the end of the treatment.

Effects of Depression on Treatment Motivation in Male Alcohol Dependence.

INTRODUCTION: Treatment motivation in alcohol dependents is usually viewed as a strong predictor of seeking treatment and treatment success. The conditions affecting motivation in alcohol dependence, however, has not been clarified. In this study, it is aimed to determine the effects of depression on treatment motivation in male alcohol dependence. METHODS: The present study included 34 male alcohol dependents presenting to outpatient clinics in Manisa Hospital of Mental Disorders and Hospital of Celal Bayar University. The patients underwent evaluation using the socio-demographic and clinical information form, DSM-IV SCID-I Clinical Version, Treatment Motivation Questionnaire (TMQ), and Hamilton Depression Rating Scale (HDRS). RESULTS: A significant relationship was found between the total score of TMQ and HDRS (p=.039). CONCLUSION: We believe that the present study, in which we examined the relationship between treatment motivation in male alcohol dependence and depression, would provide a significant contribution to literature. It is also important to investigate other factors that may affect treatment motivation in male alcohol dependence. Studies with larger samples are needed on this topic.

Alterations in BDNF (brain derived neurotrophic factor) and GDNF (glial cell line-derived neurotrophic factor) serum levels in bipolar disorder: The role of lithium.

OBJECTIVE: Brain-derived neurotrophic factor (BDNF) has been consistently reported to be decreased in mania or depression in bipolar disorders. Evidence suggests that Glial cell line-derived neurotrophic factor (GDNF) has a role in the pathogenesis of mood disorders. Whether GDNF and BDNF act in the same way across different episodes in bipolar disorders is unclear. METHOD: BDNF and GDNF serum levels were measured simultaneously by enzyme-linked immunosorbent assay (ELISA) method in 96 patients diagnosed with bipolar disorder according to DSM-IV (37 euthymic, 33 manic, 26 depressed) in comparison to 61 healthy volunteers. SCID- I and SCID-non patient version were used for clinical evaluation of the patients and healthy volunteers respectively. Correlations between the two trophic factor levels, and medication dose, duration and serum levels of lithium or valproate were studied across different episodes of illness. RESULTS: Patients had significantly lower BDNF levels during mania and depression compared to euthymic patients and healthy controls. GDNF levels were not distinctive. However GDNF/BDNF ratio was higher in manic state compared to euthymia and healthy controls. Significant negative correlation was observed between BDNF and GDNF levels in euthymic patients. While BDNF levels correlated positively, GDNF levels correlated negatively with lithium levels. Regression analysis confirmed that lithium levels predicted only GDNF levels positively in mania, and negatively in euthymia. LIMITATIONS: Small sample size in different episodes and drug-free patients was the limitation of thestudy. CONCLUSION: Current data suggests that lithium exerts its therapeutic action by an inverse effect on BDNF and GDNF levels, possibly by up-regulating BDNF and down-regulating GDNF to achieve euthymia.

Reliability and Validity of the Turkish Version of the Health Anxiety Inventory.

INTRODUCTION: Health anxiety is seen in the clinical presentation of both somatoform disorders, especially hypochondriasis and anxiety disorders. In this study, we aimed to perform the reliability and validity analyses of the Turkish version of the Health Anxiety Inventory which is used in the assessment of health anxiety. METHOD: Translation and back-translation of the Health Anxiety Inventory was done. Study groups consisted of in- or out-patients with somatoform disorder (n=65), panic disorder (n=55), major depressive disorder (n=22), and healthy volunteers (n=114). In the assessment, beside the Health Anxiety Inventory, the Hamilton Rating Scale for Depression, Somatosensory Amplification Scale and the Trait Anxiety Inventory were used. RESULTS: In reliability analyses, Cronbach's alpha internal consistency coefficient was 0.918 and item-total score correlation coefficients were between 0.405 and 0.769. Test-retest correlation coefficient was r=0.572. In construct validity, two factors that representing 54.5 percent of the total variance were obtained and they represented sensitivity to somatic symptoms and anxiety towards organic diseases. In concurrent validity, it had moderate to good correlation with the other study scales. In the comparison of study groups, the groups of somatoform disorder and anxiety disorder had significantly higher level of health anxiety than the groups with major depressive disorder and of healthy controls. CONCLUSION: The Turkish version of the Health Anxiety Inventory can be reliably and validly used both in clinical practice and in research.