The effect of chronotypes on follow-up outcomes of patients with substance use disorder.

Substance use disorder (SUD) can have circadian characteristics and individuals with evening chronotype are more prone to addiction. In this study, the effect of chronotypes on the treatment outcomes of SUD was investigated. The study included 66 patients who were diagnosed with SUD according to DSM-5. Two clinical interviews were conducted at 6-month intervals, and remission/relapse status was evaluated at the second interview. The Structured Clinical Interview Form for DSM-IV Axis I Disorders (SCID-I), Addiction Profile Index Practitioner Form, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Pittsburg Sleep Quality Index and Morningness-Eveningness Questionnaire (MEQ) were applied to the patients. MEQ scores of relapsed patients were found to be different in terms of eveningness than those in remission (45.62 ± 8.70 versus 49.75 ± 7.60, p = 0.045). As the craving and addiction profile index total scores (addiction severity) increased, eveningness chronotype scores also increased (r = - 0.387 and r = - 0.286, respectively). The mean scores of craving and BDI were higher in relapsed patients compared to those in remission (p = 0.003 and p = 0.015, respectively). Our results suggest that patients with SUD had a lower morningness chronotype than the general population; additionally, more relapsed patients had an eveningness chronotype. Thus, chronotypes may play a role in the onset, prevention, and treatment outcome of SUD.

Development of stigma scale for women with mental illness in perinatal period, validity and reliability study.

AIM: Although there are many scales that measure stigma, there is no scale with the necessary adequacy to measure stigma in the perinatal period. The study aims to develop the stigma scale for women with mental illness in the perinatal period and test its validity and reliability. MATERIALS AND METHODS: Participants were reached via patients, visitors, and hospital staff who applied to Sakarya Training and Research Hospital between 01/06/2022 and 01/12/2022. Two hundred people (female n = 134, male n = 66) aged 18-65 participated in the study and "Sociodemographic data form," "Perinatal Mental Illness Stigma Scale (PMISS)," "Social Distance Scale," and "Beliefs Towards Mental Illness Scale" were used to collect data. Data were analyzed using SPSS 22 and the AMOS 26 program. RESULTS: The Content Validity Index of the scale items was between 0.80-1. Cronbach's alpha coefficient score of the general scale was 0.94, the "Discrimination and Prejudice" sub-dimension was 0.93, and the "Labeling" sub-dimension was 0.88. It was determined that item-total score correlations varied between 0.410 and 0.799. P value calculated < 0.05 in Barlett's test and 0.94 in the Kaiser-Meyer Olkin test. These values show that factor analysis can be applied to the scale. According to the Exploratory Factor Analysis result, the scale has a 2-factor structure, explaining 60% of the total variance. The Guttman Split-Half coefficient of the scale was 0.882, and the Spearman-Brown coefficient was 0.883. The scale was reapplied to 30 participants with an interval of three weeks. The correlation coefficient between the two measurements was 0.91, indicating that the scale satisfies the invariance principle over time. CONCLUSION: The PMISS is a reliable measurement tool that can be used to investigate stigma towards mental illness during the perinatal period in the Turkish population.

Development of a mobile monitoring program for anxiety and depression in pregnancy and evaluation of 3-month results.

BACKGROUND: The aims of this study were to develop a mobile mental health application (app) to scan the symptoms of anxiety, depression, and related factors during pregnancy; examine the effect of the app on pregnant women; and determine the factors related to using such an app. METHODS: A software platform called Perinatal Anxiety Depression Monitoring Platform (PADIP) was developed. This study included 320 pregnant women: 160 in the PADIP group and 160 in the control group. The PADIP group was screened monthly for 3 months for depression, anxiety, and sleep quality, and instant feedback was provided on scale scores. RESULTS: During the follow-up period, there was a significant decrease in depression and anxiety scale scores in the PADIP group but no significant difference in scale scores in the control group. The interface used for the app was important for scale scores. It was preferred by pregnant women with a high education level, higher Perinatal Anxiety Screening Scale scores, and lower sleep quality scores. CONCLUSIONS: PADIP use was associated with a decrease in depression and anxiety scores of pregnant women. It was more useful for patients with higher education levels and a history of a psychiatric disorder, but further research is needed to develop a more comprehensive model.

Investigating associations between appetite-regulating hormones, aggression and craving in males with cannabis use disorder.

BACKGROUND: Aggression and craving are common and important withdrawal symptoms in cannabis use disorder. The present study investigated the association between appetite-regulating hormones, aggression, and craving during cannabis withdrawal syndrome (CWS). METHODS: Fifty-six male subjects diagnosed with cannabis withdrawal and 45 healthy males were included in the study. The Substance Craving Scale, the Buss-Perry Aggression Questionnaire, and the State-Trait Anxiety Inventory were implemented at baseline. Blood samples were drawn to measure ghrelin, leptin, adiponectin, and resistin levels in the serum. Then, the Point Subtraction Aggression Paradigm (PSAP) was applied. Bloodwork and psychometric assessment procedures were re-implemented after the PSAP. At the 7-day follow-up, psychometric assessments and hormone measurements were repeated in the CWS group. RESULTS: Baseline serum ghrelin and adiponectin levels were lower in the CWS group than controls at baseline. After PSAP, there was a significant increase in ghrelin levels of patients with CWS compared to controls. Patients yielded higher aggression scores, while there was no significant correlation between hormonal changes and PSAP findings. At 7-day follow, ghrelin and resistin levels significantly increased, while serum leptin decreased in patients with CWS. Finally, there was a positive association between craving and resistin levels. CONCLUSIONS: Our results present the changes in appetite-regulating hormones. Long-term follow-up studies are needed to shed light on neuroendocrinological aspects of cannabis withdrawal.

Klotho, BDNF, NGF, GDNF Levels and Related Factors in Withdrawal Period in Chronic Cannabinoid Users.

Klotho and neurotropic factors have recently been shown to be related to some psychiatric disorders and neurocognitive disorders, but there is no study on this issue within substance users. In this study, brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), glial derived neurotrophic factor (GDNF) and klotho serum levels of a patient group consisting of 27 chronic cannabis users according to the DSM-V and 27 healthy volunteers were compared, and their relationships with other the clinical features of other patients were evaluated. Clinical scales, the Buss-Perry Aggression Scale, and the Substance Craving Scale were repeated on the first day of hospitalisation and on the seventh day of withdrawal. BDNF, GDNF, NGF and klotho levels were analysed using the ELISA method. There was no differences between the cannabinoid use disorder group and the control group regarding their klotho and other neurotrophic levels, but initiation age of cannabis use was negatively correlated with these levels. In addition, there was a relationship between verbal aggression scores and BDNF and NGF levels. There was a positive correlation between klotho and neurotrophic factors in all groups (patient group Day 1, patient group Day 7, control group) (p < 0.01). When comparing the difference between the correlations using the cocor (a comprehensive solution for the statistical comparison of correlations), the klotho-GDNF and klotho-NGF correlations for the first day of the patient group and the control group were different. In this study, rather than a difference in klotho levels and neurotropic factors, a significant relationship between these markers and each other and clinical parameters was demonstrated; further studies are needed to understand the exact mechanism.

Mega cisterna magna in bipolar mood disorder: a case report.

Mega cisterna magna (MCM), one of the members of the Dandy-Walker complex, is a developmental malformation of the posterior fossa that is larger than 10 mm but morphologically does not affect the vermis and cerebellar hemispheres. Reports of psychiatric disorders associated with this anomaly are rare. We present the case of a patient with MCM who presented with a psychotic manic attack and was diagnosed with bipolar disorder. A 28-year-old female, single housewife, university graduate, presented with irritability, decreased sleep and appetite, distraction, and agitation. The patient also had a delusion of reference. In the clinical follow-up, an increase in energy and an increase in the amount of speech were observed. Her neurological examination was normal, and cranial magnetic resonance imaging revealed an MCM. The relationship and clinical significance of MCM with psychosis and mood disorders have not yet been fully elucidated. It is not known whether this association is accidental or based on etiological commonality. The purpose of this case report is to review the relationship between the cerebellum and psychiatric symptoms and to contribute to the literature.

Outbreak anxiety scale: Development, validity, and reliability.

OBJECTIVE: Epidemic and pandemic outbreak periods are as stressful for psychiatric symptoms as well as the physical symptoms of the epidemic disease and can trigger and aggravate psychiatric symptoms, especially anxiety. There is no scale specific to the outbreak period and which can be used in other outbreaks. In this study, it was planned to develop a scale to evaluate the anxiety associated with epidemic disease, especially during the epidemic period. METHODS: In this study, a Likert type scale with 15 items was developed by our research team to evaluate outbreak disease anxiety, and the scale form created was transferred to online use and the reliability of validity was evaluated by obtaining the results of 311 participants in the online environment. The internal consistency of the scale was assessed with Cronbach's Alpha coefficients. Split-half reliability was estimated using Spearman-Brown coefficients unequel length. Explanatory factor analysis, confirmatory factor analysis in AMOS, correlation analysis, and construct validity analysis (convergent validity and discriminant validity) were conducted. Beck Anxiety Inventory and Health Anxiety Inventory was used to evaluate concurrent and discriminant validity. RESULTS: The Cronbach Alpha coefficient calculated for the evaluation of the internal consistency (homogeneity) of the outbreak anxiety scale was determined as 0.94 and this value shows that the scale has high reliability. With the results of this study, the scale's content validity and construct validity, discrimination, and criterion validity were evaluated and it was shown to have acceptable valid features in all. CONCLUSION: Outbreak anxiety scale is a valid and reliable tool to evaluate anxiety related with outbreak of epidemic and pandemic disease.

BDNF, GDNF, NGF and Klotho levels and neurocognitive functions in acute term of schizophrenia.

BACKGROUND: Klotho and its relationship with neurotrophic factors and cognition in schizophrenia has not yet been investigated. In this study, the hypothesis that the blood serum levels of BDNF, GDNF, NGF and Klotho in schizophrenia patients and healthy controls would be related to cognitive functions was investigated. METHODS: In this study, two groups were assessed: schizophrenia patients (case group) who were hospitalised in the Psychiatry Clinic of Sakarya University Training and Research Hospital and healthy volunteers (control group). The patients were evaluated on the 1st and 20th days of their hospitalisation with the Positive and Negative Syndrome Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), the General Assessment of Functioning Scale (GAF) and the Clinical Global Impression Scale (CGI). For cognitive assessment, both groups were evaluated with the Wechsler Memory Scale-Visual Production Subtest (Wechsler Memory Scale III-Visual Reproduction Subtest) and the Stroop test. RESULTS: BDNF, GDNF, NGF and Klotho levels were lower in schizophrenia patients than in healthy controls. In the schizophrenia patients, on the 20th day of treatment, there was a statistically significant increase in BDNF compared to the 1st day of treatment. BDNF, GDNF and Klotho showed positive correlations with some cognitive functions in the healthy controls. BDNF, GDNF, NGF and Klotho levels were intercorrelated and predictive of each other in both groups. CONCLUSION: This study suggests a relationship between cognitive functions, neurotrophic factors and Klotho. Most of the results are the first of their kind in the extant literature, while other results are either similar to or divergent from those generated in previous studies. Therefore, new, enhanced studies are needed to clarify the role of Klotho and neurotrophic factors in schizophrenia.

The relationship between expressed emotion, personality traits and prognosis of alcohol and substance addiction: 6-month follow-up study.

AIM: Preventing relapses in addiction and related factors are still being investigated. There is inadequate data, specifically, on the effects of expressed emotion (EE) among key relatives of patients with alcohol and substance use disorder (ASUD), the personality traits of patients, and the clinical features of addiction on relapses. MATERIAL AND METHOD: This study was conducted with patients with ASUD (n = 102, 98 male) and their relatives (n = 102, 44 male). The Dependency Profile Index, and the Temperament and Character Inventory were applied to the patients, while the EE scale was applied to key relatives. Relapse rates were evaluated six months later. RESULTS: EE levels among key relatives of patients were found to be associated with early relapse rates (p = 0.002). In addition, the individuals the patients lived with (p = 0.041), income level (p = 0.048), working status (p = 0.039), time spent in profession (p = 0.007), and severity of addiction (p = 0.016) were all found to be significantly associated with relapses. The personality traits of patients were not related to early relapses. In logistic regression analysis, EE and time spent in a profession were found to be significantly associated with relapses (p = 0.014, 0.043 respectively), while other variables were not significant. CONCLUSION: The relationship between relapse in the early period of abstaining from substance use and EE levels of key relatives seems to be a greater determinant for ongoing success than several other variables in patients with ASUD, including addiction severity. The research suggests that families be involved in programs that help prevent relapses.

Development, validity and reliability study of a compliance scale for the COVID-19 outbreak prevention recommendations

Background/aim: During the intense periods of the COVID-19 pandemic, legal measures were taken for its containment. However, since legal precautions cannot be implemented continuously, hand washing, mask usage and obeying social distance rules are important in combating the pandemic. Complying with these rules is mostly individual decisions. The behavior of individuals has a prominent place in the course of the pandemic. In this study, we aimed to develop a scale which could measure compliance with outbreak measures. Materials and methods: This study was conducted in two stages after evaluation of the content validity of the item pool formed by the research group by experts. For construct validity, the scale subdimensions were determined in 250 people between the ages of 18-70 years at the first stage and the definitive version of the 20-item scale was constructed. In the second stage, exploratory factor analysis was repeated in a group of 484 people, and confirmatory factor analysis was performed. Cronbach's alpha coefficients, Spearman-Brown coefficients, test-retest methods were used to determine reliability. Results: The variance explanation of the scale consisting of 20 items and two subdimensions in the explanatory factor analysis is 63.434% (n = 484). Confirmatory factor analysis resulted in CMIN/DF = 3.540, RMR = 0.043, NFI Delta 1 = 0.928, TLI rho 2 = 0.939, CFI = 0.947, RMSEA = 0.072, SRMR = 0.0368. Cronbach's alpha value of the scale is 0.95; and the Spearman Brown coefficient equal length analysis resulted in 0.928. The temporal consistency of the scale was evaluated with the test-retest method (P = 0.893). The structure, content validity, temporal consistency, item discrimination, and internal consistency were evaluated and found to have acceptable valid, reliable properties. Conclusion: The outbreak prevention recommendation compliance scale is a valid and reliable tool with which compliance with the prevention plans can be evaluated.

Comparison of vitamin B12, vitamin D and folic acid blood levels in patients with schizophrenia, drug addiction and controls.

Schizophrenia (SCH) and drug addiction are chronic disorders that are frequently accompanied by physical diseases, poor nutrition and reduced self-care, all of which are likely to result in vitamin deficiencies. The objective of this study was to compare vitamin levels in SCH patients, substance use disorder (SUD) patients and healthy controls (HCs). The study included 189 SCH patients, 119 SUD patients and 109 HCs. Information on vitamin B12, folic acid and vitamin D levels were retrieved from the hospital's database, and mean values and deficiency/insufficiency were evaluated. Vitamin D deficiency (<30 ng/ml) was more common in the SCH group than in the SUD and HC groups (88.4%, 74.8% and 86.4%, respectively). Although there were no significant differences in folic acid deficiency (<3.0 ng/ml) in the SUD and SCH groups (15.1% and 8.5%, respectively), the incidence of folic acid deficiency was significantly higher in both groups as compared with that in the HC group (5.8%). Significantly higher numbers of patients in the SCH group than in the SUD group had vitamin B12 deficiency (45.5% vs. 28.3%). The prevalence of vitamin B12 deficiency in the SUD group was significantly higher than that the HC group (28.3% vs.11.5%). As compared with the HC group, vitamin D and B12 levels were significantly lower in SCH group, and folic acid and B12 levels were significantly lower in the SUD group. Several vitamin deficiencies appear to be common in both SCH and SUD. Possible reasons should be investigated.

How often do women use non-drug treatment methods for psyschiatric symptoms during pregnancy and postpartum periods?

The aim of this study was to determine the prevalence of complementary and alternative medical applications (CAM) and non-drug treatments of women during their pregnancies, postpartum periods and the changes between these periods. The Screening Form for Non-pharmacologic Methods Used during Pregnancy and Postpartum period was administered to the participants. Passiflora (Incarnata), Hypericum perforatum (St. John's Wort), omega 3 supplements, bright light treatment, transmagnetic stimulation, S-adenosyl- methionine, herbal teas, biofeedback/neurofeedback, amulets, exercise, acupuncture and psychotherapy were investigated. The ratio of the use of one of the CAM methods for psychiatric complaints during people's lifetime was found to be 33.3% (n=162). Herbal teas were the main practice used during pregnancy (58.8%) and the postpartum. The use of CAM according to the utilization periods of the participants statistically significantly decreased in those who were currently pregnant (Cochran's Q=298.007; P<0.05). The use of participants' non-drug treatments in the periodical follow-up decreased in those who are currently pregnant and increased during the postpartum period.

Klotho, vitamin D and homocysteine levels during acute episode and remission periods in schizophrenia patients.

AIM: Neurodegenerative processes are effective in schizophrenia. However, the underlying causes of the symptoms and associated factors have not yet been fully elucidated. Recent research has focused on the relationship between neurodegeneration and vitamin D, Klotho and homocysteine levels. In this study, we aimed to investigate this relationship in schizophrenia. METHOD: This study included 30 schizophrenic inpatients, 30 schizophrenic outpatients in remission and 28 healthy volunteers as the control group. The psychiatric diagnoses of our patients were evaluated according to DSM-IV criteria. The Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF) scale and the Clinical Global Impression (CGI) scale were used for clinical measurements. Serum Klotho, homocysteine, vitamin D, vitamin B12 and folic acid levels were analyzed using ELISA and compared with clinical properties. RESULTS: The PANSS scores and CGI scores were higher in schizophrenic inpatients than outpatients, and the GAF scores were lower (p < 0.05). Three groups were compared for Klotho, homocysteine and vitamin D serum levels; Klotho levels were elevated but the difference was not statistically significant (p > 0.05). However, vitamin B12, folic acid and homocysteine levels were higher in schizophrenic patients than the control group (p < 0.05). CONCLUSIONS: Higher levels of homocysteine with concomitant higher levels of vitamin B12 and folic acid suggest a relationship of this pathway with schizophrenia. Differences in Klotho levels were elevated but it was not significant. Replication studies to investigate probable associations with larger samples are needed.

Depressive Temperament in Relatives of Patients with Schizophrenia Is Associated with Suicidality in Patients with Schizophrenia.

OBJECTIVE: Suicide is a major cause of death in patients with schizophrenia; thus, predicting and preventing suicide in patients with schizophrenia is examined in various studies. Affective temperaments which are accepted as precursors of mood disorders may be an important factor in predicting suicidality. This study investigated the relationship between affective temperaments of relatives of schizophrenia patients and suicidal thoughts and other clinical correlates of patients with schizophrenia. METHODS: Patients with schizophrenia and their first degree relatives are included to the study. All of the participants were evaluated with Structured Clinical Interview for DSM-IV axis I disorders and relatives with active psychiatric diagnosis were excluded. Positive and Negative Symptom Scale, Clinical Global Impression Scale, Turkish version of cognitive assessment interview were administered congruently to the patients. Relatives of the patients were evaluated with Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Auto-questionnaire. RESULTS: Depressive temperament scores of relatives of schizophrenic patients who had suicidal thoughts were higher than the scores of the relatives of the patients who did not have suicidal thoughts. Depressive temperament also predicted number of suicide attempts in regression analysis. Number of suicide attempts was also related with number of hospitalization and functionality of the patient. CONCLUSION: Suicidality in schizophrenia is related with relatives' affective temperaments and patients' own positive symptom scores. The relationship between suicidal thoughts and depressive temperament is high lightened in this study.

Atrial natriuretic peptide and posterior pituitary neurohormone changes in patients with acute schizophrenia.

OBJECTIVES: Interactions between neuropeptides and psychiatric disorders have been investigated for many years. The aim of this study was to evaluate oxytocin (OXT), arginine-vasopressin (AVP), and atrial natriuretic peptide (ANP) and assess their interactions with each other, as well as investigate these changes with the manifestations of schizophrenia. PARTICIPANTS AND METHODS: Thirty-four individuals having acute schizophrenia and 24 healthy individuals as the control group were included in the study. Positive and Negative Syndrome Scales, Global Assessment of Functionality score, and Clinical Global Impression (CGI) scores were measured. Serum hormone levels were analyzed using enzyme-linked immunosorbent assay and were compared with the clinical findings. RESULTS: OXT levels were significantly lower and AVP levels were significantly higher in patients having acute schizophrenia than the control group. OXT was negatively correlated with Positive and Negative Syndrome Scales positive score and CGI score, while it was positively correlated with Global Assessment of Functionality score. AVP was negatively correlated with CGI score. ANP levels of the patients having schizophrenia were lower than the control group; however, there was no significant correlation with clinical findings. CONCLUSION: The obtained data indicate that the AVP level was higher, but OXT and ANP levels were lower in the patients having acute schizophrenia. Specifically OXT is related with reduced disease severity and increased functionality.

Temperament and Character Traits of Parents of Children With ADHD.

OBJECTIVE: This study investigates the relationship between ADHD and the personalities of parents of children with ADHD. METHOD: Personality traits of parents of children with ADHD (study group; n = 135) and parents of children without ADHD (control group; n = 122) were compared. Psychiatric comorbidities were excluded with Structured Clinical Interview for DSM-IV Axis I Disorders, Clinical Version [SCID-I-CV]. Personality is assessed with Temperament and Character Inventory, and inattention (IA) and hyperactivity (HI) are assessed with Turgay Scale. RESULTS: Harm avoidance and persistence scores were higher, and self-directedness (SD) scores were lower in the study group than the control group. Being in ADHD group predicted lower SD scores. Positive correlations were found between harm avoidance and IA and HI, and between persistence and HI. Negative correlations were found between SD and both IA and HI. CONCLUSION: Our data suggest that there is relationship between ADHD in children's and parents' personalities. Common etiologic properties and personalized psychoeducation and treatment options for families should be discussed.

Affective temperaments during pregnancy and postpartum period: a click to hyperthymic temperament.

BACKGROUND: Pregnancy and postpartum periods are the main reproductive periods during which women experience mood disorders. Affective temperaments are known antecedents of mood disorders and their importance is increasing in time for early diagnosis and determining risky groups. But data about affective temperaments during perinatal period is limited. METHODS: Women during pregnancy and perinatal period and healthy controls who are not in perinatal period are included in the study. 83 pregnant women in 1st trimester, 94 pregnant women in 2nd trimester and 115 pregnant women in 3rd trimester; 32 women in 1st month postpartum and 89 women in 2nd month postpartum; and 88 healthy non-pregnant women with similar ages were evaluated regarding their temperament evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire (TEMPS-A) scores. RESULTS: Women in perinatal period had higher scores of hyperthymic temperaments than the control group. Women in the 2nd month of postpartum period had also higher anxious temperament scores. And women in the second trimester had the highest hyperthymic temperament scores. CONCLUSION: Pregnancy and postpartum periods correlate with hyperthymic temperament characteristics in women without active psychiatric diagnosis. Future studies will help to understand if this is a mental quietness or increased risk for bipolarity.

Evaluation of Immunomodulatory and Hematologic Cell Outcome in Heroin/Opioid Addicts.

The long-term use of opioids leads alternations in both innate-adaptive immune systems and other diagnostic hematologic cells. The purpose of this study is to evaluate the alterations of these parameters in patients with heroin/opioid addictions. Adults, meeting the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria of the American Psychiatric Association regarding opioid use disorder (Heroin Group or HG, n = 51) and healthy controls (Control Group or CG, n = 50), were included in the study. All hematological parameters, inflammation indexes (neutrophil-lymphocyte ratio and platelet-lymphocyte ratio), and iron panel were compared with the controls. Mean corpuscular volume, red blood cell distribution width, mean corpuscular hemoglobin content, unsaturated iron-binding capacity, and total iron-binding capacity were significantly higher in HG compared to CG, while red blood cell count, hemoglobin, hematocrit, and serum iron levels were significantly lower. Additionally, platelet and platelet distribution width were significantly high while mean platelet volume was low in HG. Regarding the parameters related to immunity, white blood cell, neutrophil count, and neutrophil percentage were significantly high while lymphocyte percentage and basophils count were significantly low. Besides, inflammatory indexes were significantly higher in HG compared to CG. Intravenous administration of heroin resulted in lower levels of hemoglobin, hematocrit, and mean corpuscular volume than inhalation and intranasal administration. Our data demonstrated that chronic use of opioids is related to all of the hematologic series. The chronic use of opioid alters the immunologic balance in favor of innate immunity cells and changes the hematometric/morphometric characteristics of erythrocytes. What is more, the route of heroin administration should be taken into consideration as well. This study may lead to a better understanding of the hematological effects of heroin/opioid use in patients with relevant addictions.

Affective Temperaments in Parents of Children with Attention Deficit Hyperactivity Disorder.

INTRODUCTION: The objective of this study was to investigate affective temperaments of parents of children with ADHD and the relationship between ADHD and affective temperaments. METHODS: The children diagnosed with ADHD were evaluated with a structured interview and the Turgay DSM-IV-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S) was filled by parents. Then parents were evaluated by a structured clinical interview for DSM-IV (SCID-I), and those with no diagnosis of psychiatric disorder (in the past and at the time of the study) were included to the study. The Turkish version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire was used to evaluate affective temperaments of parents. A control group of parents who has no children with ADHD was applied the same evaluation protocol. RESULTS: The study was conducted with 123 parents (66 mothers, 57 fathers) of 66 children with ADHD and 119 control parents (65 mothers, 54 fathers) of 71 children without ADHD. Affective temperament scores of parents of children with ADHD were significantly higher than those of the control group. When the scores of mothers and fathers were compared separately, mothers had higher scores in all temperaments except hyperthymic temperament, and fathers had higher scores in all temperaments except anxious temperament in the ADHD group. Additionally, the T-DSM-IV-S attention deficit and hyperactivity/impulsivity scores of children were moderately correlated with most of the affective temperaments scores of their parents. CONCLUSION: There is a relationship between ADHD and affective temperaments. Further studies are needed to understand the etiology, strength, and nature of this relationship.

Delirium and High Creatine Kinase and Myoglobin Levels Related to Synthetic Cannabinoid Withdrawal.

Synthetic cannabinoids (SCs) are included in a group of drugs called new psychoactive substances. Effects of SCs on the central nervous system are similar to other cannabinoids, but 2-100 times more potent than marijuana. Thus, addiction and withdrawal symptoms are more severe than natural cannabinoids. Withdrawal symptoms of SCs were reported in the literature previously. But there is no report about SC withdrawal delirium and its treatment. Several studies reported that agonists of CB1 receptors play a role in GABA and glutamatergic neurotransmission, which is similar to the effects of alcohol on GABA and glutamatergic receptors. Previous studies on alcohol delirium cases suggested that elevated creatine kinase (CK) can be a marker of progress. This study reports delirium and high serum CK levels related to SC withdrawal and offers a treatment with benzodiazepine for them. We described two cases treated in our inpatient clinic about SC withdrawal with increase of serum CK level and other laboratory parameters. One of them demonstrated delirium symptoms and the other did not with early rapid treatment.