Evaluation of Catatonia with Different Assessment Scales in Psychiatry and Neurology. / Psikiyatri ve Nörolojide Katatoninin Farkli Ölçeklerle Degerlendirilmesi.

OBJECTIVE: Catatonia is a syndrome that can be missed in clinical settings. Diagnosis of catatonia is important because the condition can be reversible and is associated with severe complications. This study aims to screen patients with catatonia admitted to a university hospital's psychiatry and neurology services, examine their characteristics, and compare the coverage of different catatonia scales. METHOD: During a consecutive 20 months study period, the Turkish adaptations of the Bush-Francis Catatonia Rating and the KANNER scales were administered in psychiatry and neurology inpatient units and patients on the waiting list for psychiatric hospitalization. The participants were also evaluated with DSM-5 criteria. In addition, the sociodemographic and clinical characteristics of the patients in the psychiatric group were compared. RESULTS: A total of 214 patients were evaluated. Twenty-eight (13.1%) screened positive for catatonia, and 23 (82.1%) were diagnosed with catatonia according to DSM-5 criteria. KANNER and Bush- Francis identified the same patients as having catatonia. In addition to schizophrenia and mood disorders; neurodevelopmental disorder, encephalitis, postpartum psychosis, obsessive-compulsive disorder, delirium, cerebrovascular disease, functional neurological symptom disorder have also been found to be associated with catatonia. The most common complication was urinary tract infection. Life-threatening complications were also observed. CONCLUSION: Overlooking catatonia may have dire consequences. Adhering solely to the DSM-5 criteria may miss some patients with catatonia. Widely and efficiently using standardized catatonia scales can improve detection capacity and enhance the management of morbidity and mortality.

Efficacy and tolerability of antipsychotic polypharmacy for schizophrenia spectrum disorders. A systematic review and meta-analysis of individual patient data.

BACKGROUND: Antipsychotic polypharmacy (APP) is frequently prescribed for schizophrenia-spectrum disorders. Despite the inconsistent findings on efficacy, APP may be beneficial for subgroups of psychotic patients. This meta-analysis of individual patient data investigated moderators of efficacy and tolerability of APP in adult patients with schizophrenia-spectrum disorders. DESIGN: We searched PubMed, EMBASE, and the Cochrane Central Register of Randomized Trials until September 1, 2022, for randomized controlled trials comparing APP with antipsychotic monotherapy. We estimated the effects with a one-stage approach for patient-level moderators and a two-stage approach for study-level moderators, using (generalized) linear mixed-effects models. Primary outcome was treatment response, defined as a reduction of 25 % or more in the Positive and Negative Syndrome Scale (PANSS) score. Secondary outcomes were study discontinuation, and changes from baseline on the PANSS total score, its positive and negative symptom subscale scores, the Clinical Global Impressions Scale (CGI), and adverse effects. RESULTS: We obtained individual patient data from 10 studies (602 patients; 31 % of all possible patients) and included 599 patients in our analysis. A higher baseline PANSS total score increased the chance of a response to APP (OR = 1.41, 95 % CI 1.02; 1.94, p = 0.037 per 10-point increase in baseline PANSS total), mainly driven by baseline positive symptoms. The same applied to changes on the PANSS positive symptom subscale and the CGI severity scale. Extrapyramidal side effects increased significantly where first and second-generation antipsychotics were co-prescribed. Study discontinuation was comparable between both treatment arms. CONCLUSIONS: APP was effective in severely psychotic patients with high baseline PANSS total scores and predominantly positive symptoms. This effect must be weighed against potential adverse effects.

Catatonia Due to Lithium Neurotoxicity: A Case Report. / Lityum Nörotoksisitesine Ikincil Gelisen Katatoni Vakasi: Bir Olgu Sunumu.

Lithium may cause toxicity as it has a narrow therapeutic range. Lithium intoxication may manifest in the form of acute, acute on chronic and chronic intoxication. Neurotoxicity is a common component of chronic lithium intoxication and the symptoms include tremor, ataxia, dysarthria, extrapyramidal symptoms, hyperreflexia, seizures and status epilepticus. Although rare, catatonia could as a manifestation of lithium neurotoxicity. In this report, we present a patient with bipolar disorder presenting with catatonic symptoms secondary to lithium intoxication. We will discuss the risk factors, differential diagnosis and the treatment of catatonic symptoms. Lithium neurotoxicity may present with various clinical symptoms including catatonia, and differential diagnosis should be made well in such cases. If lithium neurotoxicity is suspected, rapid and appropriate intervention is required to prevent permanent neurological damage. Keywords: Lithium, Neurotoxicity, Catatonia.

Natural language processing for defining linguistic features in schizophrenia: A sample from Turkish speakers.

Natural language processing (NLP) provides fast and accurate extraction of features related to the language of schizophrenia. We utilized NLP methods to test the hypothesis that schizophrenia is associated with altered linguistic features in Turkish, a non-Indo-European language, compared to controls. We also explored whether these possible altered linguistic features were language-dependent or -independent. We extracted and compared speech in schizophrenia (SZ, N = 38) and healthy well-matched control (HC, N = 38) participants using NLP. The analysis was conducted in two parts. In the first one, mean sentence length, total completed words, moving average type-token ratio to measure the lexical diversity, and first-person singular pronoun usage were calculated. In the second one, we used parts-of-speech tagging (POS) and Word2Vec in schizophrenia and control. We found that SZ had lower mean sentence length and moving average type-token ratio but higher use of first-person singular pronoun. All these significant results were correlated with the Thought and Language Disorder Scale score. The POS approach demonstrated that SZ used fewer coordinating conjunctions. Our methodology using Word2Vec detected that SZ had higher semantic similarity than HC and K-Means could differentiate between SZ and HC into two distinct groups with high accuracy, 86.84 %. Our findings showed that altered linguistic features in SZ are mostly language-independent. They are promising to describe language patterns in schizophrenia which proposes that NLP measurements may allow for rapid and objective measurements of linguistic features.

Investigation of hemorheological parameters in patients with major depressive disorder.

BACKGROUND: Hemorheological parameters have been reported to be altered in cardiovascular disease. Major depression has been associated with increased risk of cardiovascular disease. OBJECTIVE: Our hypothesis is that hemorheological parameters are disturbed in major depressive disorder. METHODS: Major depressive disorder and control groups consisted of 50 subjects. Plasma viscosity, erythrocyte aggregation, erythrocyte deformability, hematological parameters and hematological parameters were examined. RESULTS: Plasma viscosity was statistically significantly higher, erythrocyte elongation index at 0.53 Pa and 0.95 Pa was lower, and MCV, MCH, and MCHC values were also lower in the major depression group (P < 0.05). Elongation index and plasma viscosity were correlated with depressive symptomatology. CONCLUSIONS: The increased plasma viscosity and decreased elongation index of erythrocytes indicate an unfavorable hemorheological situation in patients with major depressive disorder compared with healthy controls. The results of this study confirm the findings of studies finding a potential threat to cardiovascular health from major depressive disorder. Increased plasma viscosity and decreased erythrocyte elongation index in depressed patients may be risk factors for cardiovascular events and provide data on the causality of the association between depression and cardiovascular disease.

Turkish Adaptation, Validity and Reliability Study of the Bush Francis Catatonia Rating and KANNER Scales. / Bush Francis Katatoni Degerlendirme ve KANNER Katatoni Ölçeklerinin Türkçe Uyarlama, Geçerlik ve Güvenirlik Çalismasi.

OBJECTIVE: Catatonia is a common syndrome which can be lifethreatening due to its complications. The aims of the study were to translate the Bush Francis Catatonia Rating Scale (BFCRS) and the KANNER Scale into Turkish, conduct the validity and reliability analyses and to compare the two scales. METHOD: During the study period extending over 20 consecutive months, the Turkish versions of the scales were administered to 84 patients who were hospitalized in the psychiatry ward or who were admitted to the hospitalization list. The clinical and sociodemographic characteristics of all patients were evaluated. The scales were administered to the patients by two raters, one of whom was permanently involved. RESULTS: Convergent and criterion validities revealed a high correlation between the screening instruments of both scales and between the BFCRS total score and 2nd and 3rd part scores of the KANNER Scale. BFCRS total score of ≥6, KANNER Scale 2nd part score of ≥15, or 3rd part score of ≥1 can be used with high accuracy in diagnosing catatonia according to DSM-5. Internal consistency for both scales was found to be high (Cronbach's alpha 0.902 for BFCRS and 0.9, 0.891, 0.806 for KANNER Scale subsections). Inter-rater reliability was also high for most of the scale items (mean Kappa coefficient: 0.885 for BFCRS and 0.904 for KANNER Scale). CONCLUSION: In conclusion, the Turkish adaptations of both scales were found to be valid and reliable, showing strong psychometric properties. This study is the first validity and reliability study for the KANNER Scale.

Comparison of Formal Thought Disorder in the Acute Episode of Schizophrenia and Manic Episode of Bipolar Affective Disorder. / Sizofreni ve Ikiuçlu Duygudurum Bozuklugunun Akut Hastalik Döneminde Düsünce Süreci Bozukluklarinin Karsilastirilmasi.

OBJECTIVE: The aim of this study was to compare the formal thought disorder (FTD) in the acute episode of schizophrenia (SCHZ) and bipolar affective disorder (BPAD), and to determine the FTD dimensions associated with BPAD. METHOD: The study included a total of 34 SCHZ patients not meeting the standardized remission criteria and 20 patients in BPAD manic episode. The patients completed the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression Scale (CGI), the Young Mania Rating Scale (YMRS), the Hamilton Depression Rating Scale (HAM-D) and the Thought and Language Disorder Scale (TALD) in order to assess FTD. The association of FTD with the diagnoses was analyzed by a logistic regression model including the TALD factors and the SCHZ and BPAD groups. RESULTS: Statistically significant differences were not determined between the demographic features, the CGI scores and the TALD objective positive factor scores of the SCHZ and BPAD groups. The objective negative and subjective negative factors (p<0.001 for all) were higher in SCHZ group and the subjective positive factor were significantly higher in BPAD group (p=0.028). In the logistic regression model, the TALD subjective positive factor was associated with BPAD diagnosis, and the objective negative factor was associated with SCHZ diagnosis. In the BPAD group, the TALD total score correlated positively with the manic episode severity, and the scores on the subjective negative and subjective positive factors correlated negatively with disease duration. CONCLUSION: The study results show that FTD is common to the acute episodes of both SCHZ and BPAD and that assessment of the subjective positive FTD symptoms and objective negative FTD symptoms may be useful to differentiate the acute episode of SCHZ from the BPAD manic episode.

The cognitive aspect of formal thought disorder and its relationship with global social functioning and the quality of life in schizophrenia.

PURPOSE: It was expected that using a comprehensive scale like the Thought and Language Disorder Scale (TALD) for measurement of FTD would enable assessing its heterogeneity and its associations with cognitive impairment and functionality. This study has aimed to analyze the relationship between formal thought disorder (FTD) and cognitive functions, functionality, and quality of life in schizophrenia. METHODS: This cross-sectional exploratory study included 46 clinical participants meeting the DSM-5 diagnostic criteria for schizophrenia and 35 healthy individuals as the control groups. Data were acquired by means of the Turkish language version of the TALD, the Positive and Negative Syndrome Scale, the Clinical Global Impression Scale, the Functioning Assessment Short Test, the Social Functioning Scale, the World Health Organization Quality of Life Instrument-Short Form, and a neuropsychological test battery on executive functions, working memory, verbal fluency, abstract thinking, and response inhibition. Correlation analyses were conducted to detect significant relationships. RESULTS: The clinical group scored failures in all cognitive tests. The objective positive FTD was associated with deficits in executive functions and social functioning. The objective negative FTD was associated with poor performance in all cognitive domains, physical quality of life, and social and global functioning. The subjective negative FTD was negatively correlated with psychological quality of life. CONCLUSION: This study demonstrated that objective FTD factors reflect different underlying cognitive deficits and correlate with different functioning domains. Significant correlation was determined between subjective negative FTD and psychological quality of life. Given the close relationship of FTD with functioning and quality of life, the FTD-related cognitive deficits should be the key treatment goal in schizophrenia.

Clinical risk factors, phenomenology and the impact of clozapine induced obsessive compulsive symptoms.

The aim of this study was to investigate the clinical risk factors, phenomenology and the impact of clozapine induced obsessive-compulsive symptoms (OCS) in patients with schizophrenia. One hundred twenty-two patients receiving clozapine treatment for at least 6 weeks were assessed with Structured Clinical Interview for Axis-I Disorders for DSM-IV, Positive and Negative Syndrome Scale, Yale-Brown Obsessive Compulsive Scale and Checklist, Calgary Depression Scale, Clinical Global Impression Scale and WHO-Disability Assessment Schedule-II. Information about past and current clinical status were gathered through clinical interviews and medical records. With clozapine 44.3% of the patients had de novo OCS, 33.6% had OCS both before and after clozapine, 21.3% didn't report any OCS. Clozapine doses, clozapine and norclozapine plasma levels were not significantly different. Severity of OCS was affected by clozapine and norclozapine plasma levels, and correlated with increased disability. Obsessions were less in clozapine induced OCS group, and compulsions, especially of checking subtypes, were predominant, compared to the group with prior history of OCS, who reported a significant increase in checking compulsion after clozapine treatment. Clozapine induced OCS should be considered during cost/benefit assessment of clozapine treatment, and understanding the risk factors and its different phenomenology may shed light into the underlying mechanisms.

Examination of formal thought disorder and its clinical correlates with the Turkish Version of the Thought and Language Disorder Scale (TALD-TR) in schizophrenia.

BACKGROUND: Formal thought disorder (FTD) is considered to be a fundamental feature of schizophrenia. This study aims to analyze psychometric properties of the Turkish version of "Thought and Language Disorder Scale (TALD)" and investigate the relationship between FTD and various clinical characteristics in patients with schizophrenia. METHODS: TALD was adapted into Turkish and applied to a total of 149 participants of which 114 had DSM-5 psychiatric diagnoses (schizophrenia N = 70, mania N = 20, depression N = 24) and 35 were healthy controls. Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale, Young Mania Rating Scale, and Clinical Global Impression were administered to detect illness severity. RESULTS: The principal component analyses revealed that the Turkish version of TALD (TALD-TR) consisted of four factors including the Objective Positive (OP), Subjective Negative (SN), Objective Negative (ON) and Subjective Positive (SP) symptom dimensions which were in line with the original TALD factorial structure. It was concluded that TALD-TR shows strong construct validity and high interrater reliability. The correlation analyses with TALD-TR and PANSS showed that there are positive correlations between the TALD-TR total score and the PANSS total and subscale scores. Each diagnostic group showed the distinct pattern of FTD. The mania group exhibited the highest mean total score in the OP, whereas the schizophrenia group exhibited the highest mean total score in the ON factor. In the schizophrenia group, the severity of FTD correlated positively with duration of illness and negatively with age at onset of illness. CONCLUSION: Adaptation of TALD into different languages seems to be possible, bringing in an international tool for research on FTD.