The Relationship between 10 Years Risk of Cardiovascular Disease and Schizophrenia Symptoms: Preliminary Results.

OBJECTIVE: Previous research shows that patients with schizophrenia have increased cardiovascular disease risk than general population. Increased cardiovascular risk in schizophrenia patients have been associated with many reasons such as antipsychotic drugs, genetic predisposition, andlifestyle. In this study, we aimed to investigate the relationship between the risk of heart disease and schizophrenia symptomatology. METHODS: The 10-year cardiovascular risk was assessed by the Framingham Risk Score (FRS) in 103 patients with schizophrenia and in 39 healthy controls. Sociodemographic characteristics, age at schizophrenia onset, duration of illness, number of hospitalizations, the course of the disease and antipsychotic medications were recorded. Patients' symptoms were evaluated via The Scale for the Assessment of Negative Symptoms (SANS), The Scale for the Assessment of Positive Symptoms (SAPS), and Calgary Depression Scale for Schizophrenia (CDSS). RESULTS: Ten-year cardiovascular risk was 5.16% inpatients with schizophrenia, and 3.02% in control group (p=0.030). No significant correlation was found between FRS scores, SANS, SAPS, and CDSS scores. However, FRS scores were significantly correlated with age, number of hospitalizations and duration of disease (r=0.300, 0.261, 0.252, respectively). Moreover FRS scores were higher (p=0.008) and high-density lipoprotein (HDL) levels were lower (p=0.048) in patients using multiple antipsychotics. CONCLUSION: Our findings suggest a relationship between the risk of cardiovascular disease and the duration and overall severity of schizophrenia and also highlights the role of antipsychotics in this relationship.

Sex hormones in alcohol consumption: a systematic review of evidence.

Sex hormones play an important role in establishing sex-distinctive brain structural and functional variations that could contribute to the sex differences in alcohol consumption behavior. Here, we systematically reviewed articles that studied sex hormone impacts on alcohol consumption and alcohol use disorder (AUD). An extensive literature search conducted in MEDLINE, PubMed, Scopus and CINAHL databases identified 776 articles, which were then evaluated for pre-specified criteria for relevance and quality assurance. A total of 50 articles, including 19 human studies and 31 animal studies, were selected for this review. Existing evidence supports the association of increased testosterone level and increased risk for alcohol use and AUD in males but results are inconclusive in females. In contrast, the evidence supports the association of increased estrogen level and increased alcohol use in females, with mixed findings reported in males. Much less is known about the impact of progestins on alcohol use and misuse in human subjects. Future observational and experimental studies conducted in both sexes with a comprehensive hormone panel are needed to elucidate the impact of the interplay between various sex hormone levels during various developmental stages on alcohol use-related phenotypes and AUD.

Empathy, and its relationship with cognitive and emotional functions in alcohol dependency.

BACKGROUND: Empathy can be defined as the ability to understand the other's thoughts and feelings. It contains both cognitive and emotional components. AIMS: The aim of this study was to investigate the empathy ability of patients with alcohol dependency in association with cognitive and emotional functions, after acute detoxification and during long-term abstinence. METHODS: Thirty-three alcohol dependent inpatients that completed a detoxification process and stayed abstinent throughout the study, and 33 healthy comparison subjects that matched the patients for age, gender, and education level were included in the study. All the participants were administered the Facial Emotion Identification Test (FEIT), Facial Emotion Discrimination Test (FEDT), Trail Making Test (TMT), Digit Span Test (DST), Auditory Consonant Trigram Test (ACT), and Empathy Quotient Scale (EQS). All the tests were repeated after 3 months of abstinence. RESULTS: At the first evaluation conducted after detoxification, patients performed significantly worse than healthy comparisons in almost all tests. At the second evaluation, which was conducted after 3 months of abstinence, the patients improved significantly in all measures, and no significant differences were detected between the patient and comparison groups. There were significant correlations between the test scores and EQS score. CONCLUSIONS: Alcohol dependency has deleterious effects on empathy ability, and cognitive and emotional functions. Those impairments can improve with abstinence. Empathy ability has strong relationships with cognitive and emotional functions.

Alexithymia and somatisation in patients with remitted major depression and their impact on social functioning.

OBJECTIVES: The aim of the present study is to investigate the level of social functioning, alexithymia and somatisation in patients with major depressive disorder who achieved full remission and to examine the impact of alexithymia and somatisation on social functioning in patients with major depression who are in full remission. METHODS: A total of 117 outpatients with major depression and full remission and 42 healthy controls were included in the study. The participants were administrated Affect Underpinned by Severity and Social Impairment Questionnaire (AUSSI) to evaluate social functioning and depressive symptoms, Toronto Alexithymia Scale (TAS) to evaluate alexithymia and Somatosensory Amplification Scale (SSAS) to evaluate somatisation. Forty-one patients who scored higher or equal to the cut-off score of 5 on the social impairment subscale of AUSSI were classified as having impaired social functioning, whereas 76 patients who scored less than 5 were classified as having unimpaired social functioning. RESULTS: There were no significant differences between the groups for AUSSI mood symptoms subscale score. Patients with impaired social functioning scored higher than controls on TAS score. Patients with both impaired and unimpaired social functioning scored higher than controls on SSAS scores. The only significant predictor of social impairment in patients with major depression who were in full remission was AUSSI mood symptoms subscale score. CONCLUSION: Patients with major depression may still have social impairment after remission. Depressive symptoms are the most important predictors of social functioning in patients with remitted depression. Maximum precautions should be taken to treat depression without leaving any residual symptoms.

Sex differences in the risk of rapid cycling and other indicators of adverse illness course in patients with bipolar I and II disorder.

OBJECTIVES: To examine the independent effects of sex on the risk of rapid cycling and other indicators of adverse illness course in patients with bipolar I disorder (BP-I) or bipolar II disorder (BP-II). METHODS: We analyzed data from the first 1,225 patients enrolled in the Mayo Clinic Individualized Medicine Biobank for Bipolar Disorder. Demographic and clinical variables were ascertained using standardized questionnaires; height and weight were assessed to determine body mass index (BMI). Rates of rapid cycling, cycle acceleration, and increased severity of mood episodes over time were compared between women and men overall and within subgroups defined by bipolar disorder subtype (BP-I or BP-II). Multiple logistic regression analysis was used to assess the independent effect of sex on the risk of these indicators of adverse illness course. RESULTS: Women had significantly higher rates of rapid cycling than men. Overall rates of rapid cycling were higher in patients with BP-II than BP-I; and sex differences in the rate of rapid cycling were more pronounced in patients with BP-II than BP-I, although the power to detect statistically significant differences was reduced due to the lower sample size of subjects with BP-II. Female sex was a significant predictor of rapid cycling, cycle acceleration, and increased severity of mood episodes over time after adjusting for age, bipolar disorder subtype, BMI, having any comorbid psychiatric disorder, and current antidepressant use. CONCLUSIONS: Female sex was associated with significantly higher risk of rapid cycling, cycle acceleration, and increased severity of mood episodes over time in a sample of 1,225 patients with bipolar disorders.

Sex and gender-related differences in alcohol use and its consequences: Contemporary knowledge and future research considerations.

AIMS: To review the contemporary evidence reflecting male/female differences in alcohol use and its consequences along with the biological (sex-related) and psycho-socio-cultural (gender-related) factors associated with those differences. METHODS: MEDLINE, PubMed, Web of Science, SCOPUS, PsycINFO, and CINAHL databases were searched for relevant publications, which were subsequently screened for the presence/absence of pre-specified criteria for high quality evidence. RESULTS: Compared to men, more women are lifetime abstainers, drink less, and are less likely to engage in problem drinking, develop alcohol-related disorders or alcohol withdrawal symptoms. However, women drinking excessively develop more medical problems. Biological (sex-related) factors, including differences in alcohol pharmacokinetics as well as its effect on brain function and the levels of sex hormones may contribute to some of those differences. In addition, differences in alcohol effects on behavior may also be driven by psycho-socio-cultural (gender-related) factors. This is evident by variation in the magnitude of differences in alcohol use between countries, decreasing difference in the rates of alcohol consumption in recent generations and other findings. Evidence indicates that both sex and gender-related factors are interacting with alcohol use in complex manner, which differentially impacts the risk for development of the behavioral or medical problems and alcohol use disorders in men and women. CONCLUSIONS: Discovery of the mechanisms underlying biological (sex-related) as well as psycho-socio-cultural (gender-related) differences in alcohol use and related disorders is needed for development of personalized recommendations for prevention and treatment of alcohol use disorders and related problems in men and women.

Facial emotion recognition deficits in abstinent cannabis dependent patients.

BACKGROUND: Cannabis is clearly the most popular illicit drug in North America, Europe and in other parts of the world. Evidence is accumulating for the involvement of the endocannabinoid system in emotional processing. However, only few studies examined emotional processing in chronic, heavy cannabis users and these studies were performed in cannabis dependent patients who were abstinent for 12-48 hours. The aim of this study was to investigate facial emotion identification and discrimination abilities in patients with cannabis dependence who were abstinent for at least 1 month. METHODS: The study included 30 males with cannabis dependency according to DSM-IV criteria and who had been abstinent for at least 1 month and 30 healthy controls. All the subjects were evaluated with Facial Emotion Identification Test (FEIT) and Facial Emotion Discrimination Test (FEDT). RESULTS: The main finding of this study was the presence of deficits in both identification and discrimination of facial emotions in cannabis dependent patients during abstinence. In addition, when we examined negative and positive emotions separately, we found out that abstinent cannabis dependent patients performed significantly worse than controls in the identification of negative emotions but not positive emotions. CONCLUSIONS: Our findings indicate that facial emotion recognition deficits which have previously been observed in current cannabis users are still detectable in abstinent cannabis dependent patients and do not improve quickly with abstinence (an average of 3.2 months).

The impact of insight on social functioning in patients with schizophrenia.

BACKGROUND: It is still unclear whether insight has a direct association with social functioning in schizophrenia, independent of its association with symptoms. AIM: This study aimed to investigate the relationship of insight and its dimensions with social functioning in schizophrenia. METHODS: A total of 170 outpatients with schizophrenia were included in this study. All patients were evaluated with the Scale to Assess Unawareness of Mental Disorder (SUMD), Positive and Negative Syndrome Scale (PANSS) and Personal and Social Performance Scale (PSP). Patients with impaired insight and patients with unimpaired insight were compared for PSP score through independent samples t test. Pearson's correlation analysis was used to determine the correlations between study variables. Multiple stepwise linear regression analysis was used in order to determine the variables that predict social performance. RESULTS: The PSP score of patients with impaired insight was significantly lower than that of patients with unimpaired insight. There were significant correlations between insight dimensions and PSP score. PANSS negative scale score, awareness of achieved effects of medication and awareness of anhedonia/asociality were significant predictors of social performance. CONCLUSION: Insight has a significant impact on social functioning in schizophrenia, and some, but not all, insight dimensions have direct impact on social performance, independent of their association with symptoms.

[The Relationship of Deficit Syndrome with Clinical Symptoms, Summer Births and Heritability in Patients with Schizophrenia]. / Sizofreni Tanili Hastalarda Eksiklik Sendromu ile Klinik Belirtiler, Yaz Dogumlari ve Ailesellik Arasindaki Iliski.

AIM: The aim of this study was to compare deficit schizophrenia patients with non-deficit schizophrenia patients for negative and positive symptome scores, rate of summer births, and rate of familial history of psychosis. METHOD: 110 patients with schizophrenia diagnosed via Structured Clinical Interview for DSM-IV (SCID-I) aged between 18-65 were included in the study. All the patients were evaluated using the Scale for the Assessment of Negative Symptoms (SANS), Scale for the Assessment of Positive Symptoms (SAPS), and The Schedule for the Deficit Syndrome (SDS), and sociodemographic information was obtained. RESULTS: The deficit syndrome group had higher negative and positive scores compared to the non-deficit group. The rate of summer births were higher in the deficit group. Although the rate of positive family history for psychosis was higher in deficit group compared with the non-deficit group, the difference did not achieve statistical significance. CONCLUSION: Our results that depict higher severity of negative and positive symptom scores and higher rate of summer births with deficit schizophrenia, provides more evidence that deficit and non-deficit schizophrenia are different subtypes having different pathophysiologies. But statistically nonsignificant difference of positive familial history between two groups suggests that the thesis of deficit schizophrenia may be related to genetic factors more than enviromental factors needs to be invesigated further.

Ventral prefrontal executive function impairment as a potential endophenotypic marker for bipolar disorder.

BACKGROUND: Patients with remitted bipolar disorder have cognitive impairments, particularly in executive functions. However, the findings of studies that investigated cognitive functions in unaffected relatives of patients with bipolar disorder are conflicting. AIMS: The aim of this study is to investigate executive functions in healthy parents of patients with bipolar I disorder, along with bipolar I disorder patients and matched controls. It has been hypothesized that both patients with bipolar I disorder and their parents would have executive function impairments compared with controls. METHODS: 25 patients with bipolar I disorder, in full remission, 25 healthy controls that matched the patients with respect to age, gender and education, 50 healthy parents of those patients and 50 healthy controls that matched the parents for age, gender and education were included in the study. All the participants were interviewed with Structured Clinical Interview for DSM-IV-Axis I (SCID-I). Executive functions were assessed using the Verbal Fluency Test (VFT), Trail Making Test (TMT), Wisconsin Card Sorting Test (WCST) and Stroop Test. RESULTS: Patients performed significantly worse than their matched controls on the VFT, TMT and Stroop tests, but not on the WCST. Parents performed significantly worse than their matched controls on the TMT and Stroop tests, but not on the VFT and WCST. CONCLUSIONS: Our results bring more evidence that deficits in ventral, but not dorsal prefrontal executive functions are associated with familial vulnerability to bipolar disorder and ventral prefrontal executive function impairments may represent a potential endophenotype for bipolar disorder.

Association Between Age at Onset of Schizophrenia and Age at Menarche.

INTRODUCTION: Increasing evidence from clinical practice, as well as from epidemiological and basic research shows that there are gender differences in clinical features of schizophrenia, and this may be related to estrogens. There may be a relationship between earlier puberty and later onset of the disease, because of the protective effects of estrogens in women with schizophrenia. In this study, our aim was to analyze the correlation between age of menarche and age of onset of schizophrenia and to investigate the protective effects of estrogens in schizophrenia. METHOD: In this study, we included 289 patients who were diagnosed with schizophrenia. Those with mental deficiency or organic brain disorders were excluded from the study. All subjects were given a socio-demographic form to determine their personal information, age at menarche, age at first odd behavior, age at onset of the disease and first hospitalization. Data on factors which may affect the association between age at onset of schizophrenia and age at menarche such as family history, head or birth trauma etc. were recorded on the information form. RESULTS: We found out that age at menarche was negatively associated with age at first odd behavior and age at first psychotic symptoms. CONCLUSION: Our study verifies the protective effects of estrogens and shows that the earlier puberty may be the cause of later onset of schizophrenia. A gender-sensitive approach in psychiatry improves our understanding of mental illness and our therapeutic strategies.

Childhood Traumatic Experiences, Anxiety, and Depression Levels in Fibromyalgia and Rheumatoid Arthritis.

INTRODUCTION: The close relationship between chronic pain, anxiety, depression, and childhood traumatic experiences is well known. The aim of this study is to investigate childhood traumatic experiences, anxiety, and depression levels in patients with fibromyalgia and rheumatoid arthritis, which are diseases that cause chronic pain. METHOD: A total of 30 patients with fibromyalgia, 30 patients with rheumatoid arthritis, and 30 healthy controls, matched with patients with respect to gender, age, and education, were included in the study (90 participants in total). All participants were given a form for sociodemographic characteristics, the Childhood Trauma Questionnaire (CTQ), and Hospital Anxiety and Depression Scale (HAD). Patients were also asked to complete a numeric pain scale (NPS). RESULTS: Patients with fibromyalgia reported significantly higher scores for CTQ emotional abuse and HAD depression compared with healthy controls. Patients with fibromyalgia reported significantly higher scores for HAD anxiety than both healthy controls and patients with rheumatoid arthritis. Patients with rheumatoid arthritis reported significantly higher scores for CTQ emotional abuse and HAD depression compared with healthy controls. Pain scores of patients with fibromyalgia were higher than in patients with rheumatoid arthritis. Participants who had scores over the threshold on HAD anxiety and depression had significantly higher scores on CTQ sexual abuse. CONCLUSION: Both patients with fibromyalgia and patients with rheumatoid arthritis have high levels of childhood traumatic experiences and depression. Patients with pain-related disorders should be examined for childhood traumatic experiences, anxiety, and depression for better treatment outcomes.

[Clozapine-associated neuroleptic malignant syndrome followed by catatonia: a case report]. / Klozapin kullanimina bagli nöroleptik malign sendrom ve ardisik katatoni: olgu sunumu.

OBJECTIVE: Neuroleptic malignant syndrome (NMS) is a rare life-threatening condition associated with the use of antipsychotics and other drugs that influence dopaminergic transmission. Although NMS is typically associated with classical antipsychotics, it can also be induced by atypical antipsychotics. In this paper, we report a case of NMS associated with clozapine use. CASE: A 27-year-old male was diagnosed as schizophrenia in 2006 and zuclopenthixol depot was administered parenterally. Following the second injection, NMS was diagnosed and he was switched to clozapine. After 4 years of clozapine use, one day, he suddenly stopped eating, stayed in bed all day, and had incontinence. Upon examination at our hospital the patient had muscle rigidity, high fever, leukocytosis, and a high creatine phosphokinase level, and NMS was diagnosed. He was put on bromocriptine. NMS resolved, but psychotic relapse and catatonia developed. 10 sessions of electro convulsive treatment (ECT) were administered. Quetiapine 25 mg/day was introduced and titrated up to 600 mg/day afterwards. He has been using quetiapine 600 mg/day for 18 months and at the time this manuscript was written has not had any signs of psychosis or NMS. CONCLUSION: NMS is usually induced by the use of agents with high dopaminergic affinity. Incomplete or extraordinary NMS cases have been reported due to clozapine and atypical antipsychotics. The presented case is noteworthy due to the complete and typical presentation of NMS. It should always be kept in mind that all atypical antipsychotics including clozapine have the probability to induce NMS although not common.

[Association of suicide attempts with childhood traumatic experiences in patients with major depression]. / Majör Depresyonda Özkiyim Girisimi ile Çocukluk Çagi Örselenmeleri Arasindaki Iliski.

OBJECTIVE: Childhood traumatic experiences are widely known risk factors in the development of various psychiatric disorders and unfavorable behavior patterns, including suicide attempts. Moreover, in the course of some psychiatric disorders, suicide attempts are more frequent in patients with childhood traumatic experiences. This study explores the influence of childhood traumatic experiences on suicide attempts in patients with major depression. METHOD: Our study involved 30 patients with major depressive disorder in full remission who had attempted suicide, and 30 patients with major depressive disorder in full remission who had never attempted suicide, as well as 30 healthy controls matched with patients for age, gender, and education. All the subjects were interviewed with Structural Clinical Interview for DSM-IV (SCID-I). Subsequently, all subjects were administered Childhood Trauma Questionnaire (CTQ). RESULTS: Patients who had attempted suicide reported significantly higher CTQ scores for emotional abuse and emotional neglect, physical abuse, and sexual abuse than healthy controls. Moreover, patients who had attempted suicide reported significantly higher CTQ scores for each three subdomains than patients who had never attempted suicide. There were no significant difference between patients who had never attempted suicide and healthy controls in any of the CTQ subdomains. CONCLUSION: Childhood trauma may be a risk factor for suicide attempts in patients with depression. Inquiring childhood traumatic experiences could make an important contribution to predict suicide risk in patients with depression.

Facial emotion recognition in schizophrenia: the impact of gender.

OBJECTIVE: Previous studies reported gender differences for facial emotion recognition in healthy people, with women performing better than men. Few studies that examined gender differences for facial emotion recognition in schizophrenia brought out inconsistent findings. The aim of this study is to investigate gender differences for facial emotion identification and discrimination abilities in patients with schizophrenia. METHODS: 35 female and 35 male patients with schizophrenia, along with 35 female and 35 male healthy controls were included in the study. All the subjects were evaluated with Facial Emotion Identification Test (FEIT), Facial Emotion Discrimination Test (FEDT), and Benton Facial Recognition Test (BFRT). Patients' psychopathological symptoms were rated by means of the Positive and Negative Syndrome Scale (PANSS). RESULTS: Male patients performed significantly worse than female patients on FEIT total, and negative scores. Male controls performed significantly worse than female controls on FEIT total and negative scores. On all tasks, female patients performed comparable with controls. Male patients performed significantly worse than controls on FEIT, and FEDT. CONCLUSION: Women with schizophrenia outperformed men for facial emotion recognition ability in a pattern that is similar with the healthy controls. It could be claimed that male patients with schizophrenia need special consideration for emotion perception deficits.