Psychache and Suicidal History in Patients with Obsessive-Compulsive Disorder

PURPOSE

Suicide is an important cause of death in patients diagnosed with obsessive-compulsive disorder (OCD) as well as other psychiatric disorders. Early determining of risk factors provides an opportunity for intervention. The mediating effect of psychological pain (also known as psychache) on suicide has been shown in various disorders but has not been investigated in patients with OCD. In this study, we aimed to show the relationship between psychological pain and other clinical variables and suicide in OCD patients.

PATIENTS AND METHODS

This cross-sectional study consisted of 67 patients diagnosed with OCD according to DSM-5 criteria with no comorbid psychiatric diagnosis who applied to the psychiatric outpatient clinic of Çukurova University Faculty of Medicine and 63 healthy controls. Among the OCD patients, 12 had previous suicide attempts. In addition to the sociodemographic data form, participants filled out the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Psychache Scale (PS), the Beck Scale for Suicidal Ideation (BSIS), and the Hamilton Depression Scale (HDS).

RESULTS

OCD group's median obsession, compulsion, and the total scores of YBOCS, and the mean PS scores were higher than the control group. There was no difference between the sociodemographic variables of OCD patients with and without previous suicide attempts such as age, gender, years of education, place of residence, marital, and occupational status. The median scores of obsession, avoidance, global severity, and indecisiveness subdimensions of YBOCS, the mean BSIS and PS scores, the rates of current aggressive, current contamination, and the past religious obsessions were higher in the suicidal group. There were moderately significant relationships in the same direction between the PS, BSIS, and total YBOCS scores. Multivariate regression analysis demonstrated that only the PS scores predicted previous suicide attempts.

CONCLUSION

Our results demonstrated that current aggressive, current contamination, past religious obsessions, and the higher psychological pain are related to previous suicide attempts in OCD patients. Our regression analysis supports Shneidman's hypothesis: there would be no suicide without psychache. Relieving psychache in OCD patients may reduce suicide attempts even if there is no diagnosis of comorbid depression.

A Case of Simultaneous Mania and Idiopathic Normal Pressure Hydrocephalus: Etiology or Comorbidity?

Normal pressure hydrocephalus (NPH), typically associated with the triad of gait disturbance, dementia and urinary incontinence, rarely presents with symptoms of mania, depression or psychosis and psychiatric disorders may complicate the diagnosis. Few cases of NPH and psychiatric disease comorbidity have been reported so far. In most of these cases, NPH was associated with depression and psychotic symptoms. Mania symptoms were also reported in a few cases those of which were associated with a history of bipolar disorder (BPD) or subthreshold BPD symptoms. In this paper, we present a case of late-onset mania symptoms simultaneously presenting with NPH in a healthy individual without a history of psychiatric disorder.

Assessment of Dyadic Adjustment and Sexual Functions in Patients with Bipolar Disorder

Introduciton

There are limited studies investigating the relation between dyadic adjustment, and sexual functions. The aim of this study was to compare patients with bipolar disorder (BD) in euthymic phase with healthy controls, and confirm our hypothesis which we expect to find that dyadic adjustment is negatively affected in bipolar patients with sexual dysfunctions (SDs).

Methods

A total of 50 euthymic bipolar patients (32 female, 18 male), and 50 healthy individuals as a control group (27 female, 23 male) were included in the study. A data form for socio-demographic features and two other forms for clinical characteristics of bipolar disorder and sexual functions have been filled by clinician. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-4) Axis I was used to determine axis I psychiatric disorders. All patients completed Golombok Rust Inventory of Sexual Satisfaction (GRISS), and Dyadic Adjustment Scale (DAS).

Results

Twenty-five (50%) of bipolar patients, and 13 (48.8%) of healthy controls were found to have SDs. There was a significant difference between bipolar patients, and healthy controls in regard to the presence of SDs (p=0.013). Dissatisfaction, communication, and anorgasmia subscale scores, and total scores of GRISS was found to be higher in female patients with BD. Intercourse frequency, impotence and premature ejaculation subscale scores and total scores of GRISS were higher in male patient group than healthy controls. When bipolar patients and healthy controls were compared, there was a significant difference between dyadic cohesion and affectional expression scores as measured by DAS. As a result of the univariate and regression analyzes, it was determined that the variable affecting the dyadic adjustment in bipolar patients was affected by sexual dysfunction rather than disease presence.

Conclusion

The results of this study have shown that the prevalence rate of SDs is higher in bipolar patients than healthy individuals. It was determined that the variable affecting the dyadic adjustment of patients with BB was affected by sexual function rather than disease presence. The presence of SDs in bipolar patients have negative effects on dyadic adjustment.

Attention-deficit hyperactivity disorder and impulsivity in female patients with fibromyalgia

OBJECTIVE

Data which indicate a greater role of the central nervous system in the etiology of fibromyalgia are increasing. The goal of the present study is to determine the link between fibromyalgia and attention-deficit hyperactivity disorder (ADHD) and, in addition, to reveal the relevance of impulsivity dimension.

METHODS

The study included 78 females with fibromyalgia who applied to a physical medicine and rehabilitation polyclinic in Ceyhan State Hospital and 54 healthy females. The diagnosis of fibromyalgia was made by an experienced specialist of physical medicine and rehabilitation based on the American Rheumatology Association Diagnostic Criteria (2010). The diagnosis of ADHD was by an experienced psychiatrist using Diagnostic and Statistical Manual of Mental Disorders-5. The following inventories were used: adult ADHD self-report scale, Wender Utah rating scale, and Barratt impulsivity scale short form.

RESULTS

Adult ADHD was detected in 29.5% of the fibromyalgia group and 7.4% of the control group; childhood and adolescent attention hyperactivity disorder ratios in these groups were 33.3% and 11.1%, respectively. The differences were statistically significant (P=0.002, P=0.003). Scores of the fibromyalgia group on the Wender Utah rating scale, adult ADHD self-report scale, attention subscale, hyperactivity-impulsivity subscale, and the Barratt impulsivity scale for non-planning and attentional impulsivity were found to be significantly higher than the control group (P<0.05, P<0.01, P<0.01, P<0.05, P<0.01, P<0.05, respectively).

CONCLUSION

The present study has shown that both adult and childhood ADHD are quite common in female fibromyalgia patients. There was a link between fibromyalgia and impulsivity. Certain subtypes of fibromyalgia and attention-deficit hyperactivity deficit disorder could be sharing the common etiological pathways.

Prevalence and clinical correlates of intermittent explosive disorder in Turkish psychiatric outpatients

OBJECTIVE

Intermittent explosive disorder (IED) is defined as the failure to resist aggressive impulses resulting in repeated acts of verbal and/or physical aggression. Although it is frequently encountered in clinical psychiatric practice, there is a paucity of data concerning IED in the scientific literature both internationally and in Turkey. The aim of this study was to evaluate the prevalence of IED and associated sociodemographic and clinical features in a clinical setting.

METHODS

A total of 406 patients who were referred to our psychiatry outpatient clinic for the first time in a six-month period were included in the study. The diagnosis of IED was made using both Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) and DSM-5 criteria. Axis I disorder and personality disorder diagnoses were made according to DSM-5 criteria. Diagnoses were based on information from the Structured Clinical Interview for DSM-IV (SCID I) and the Structured Clinical Interview for DSM-IV personality disorders (SCID II), Symptom Checklist-90 (SCL-90), Wender Utah Rating Scale, Adult Attention Deficit Hyperactivity Disorder (ADHD) DSM-IV Based Diagnostic Screening and Rating Scale, a clinical interview conducted by the researcher, and a sociodemographic data form. In addition, participants were administered the Buss-Perry Aggression Scale and Barratt Impulsiveness Scale Version 11 (BIS-11) to assess aggression and impulsivity.

RESULTS

Lifetime and 12-month prevalence of IED according to DSM-5 were 16.7% and 11.3%, respectively. Mean age at onset was 16.4 years. The prevalence of lifetime IED was 3.8 times higher in males than females (95% CI = 1.9-7.5); twice as high in individuals living in rural areas compared to those living in urban centers (95% CI = 1.1-3.7); 2.7 times higher among those with lifetime suicide attempt versus those without (95% CI = 1.3-5.6); 4.5 times higher in those with lifetime self-injurious behavior compared to those without (95% CI = 2.3-8.7); and 3 times higher in individuals reporting aggression/anger problems in the family compared to those without (95% CI = 1.5-5.9). The prevalences of childhood ADHD, conduct disorder, and oppositional defiant disorder were significantly higher in the IED group.

CONCLUSION

The result of the current study has revealed that approximately one-sixth of respondents experienced lifetime IED according to DSM-5 diagnostic criteria. Statistically significant sociodemographic correlates of IED include gender, urbanicity, history of suicide attempt, history of self-injurious behavior, and family history of aggression/anger problems.

Assessment of sleep quality in bipolar euthymic patients

OBJECTIVE

Sleep quality is affected in bipolar disorder even in euthymic episodes. The aim of this study was to assess sleep quality in bipolar euthymic patients, determine related clinical characteristics and evaluate its effects on functionality.

METHODS

A total of 122 outpatients were included. Scales were used to confirm that patients were euthymic. Mini Mental Test was performed to exclude patients with a diagnosis of dementia. A data form for socio-demographic features and clinical characteristics of bipolar disorder have been completed. SCID-I and SCID II were used. The general features of sleep were investigated by General Sleep Questionnaire. All patients completed Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and Bipolar Disorder Functioning Questionnaire.

RESULTS

56.5% of our sample had poor sleep quality. Patients with poor sleep had a longer time to fall asleep and more frequent waking after sleep onset. Caffeine use and smoking, history of suicide attempts, seasonality, comorbidity of lifetime anxiety, somatoform and impulse control disorders, using antidepressant medication and administration of electroconvulsive therapy were significantly higher; emotional and intellectual functioning, household relations, taking initiative, self-sufficiency and total functionality were lower in bipolar patients with poor sleep quality (p<0.05). The strongest predictor of sleep quality problem was seasonality, recording an odds ratio of 3.91.

CONCLUSIONS

Sleep quality is closely related with clinical features of bipolar disorder. Sleep quality is affected negatively in euthymic episodes of bipolar disorder and poor sleep quality cause loss in functionality. Assessment of sleep disturbances routinely in psychiatric interviews and dealing with sleep problems regardless mood episodes may improve sleep quality, thereby functionality and quality of life.

The Effects of Occupational Therapy and Psychosocial Interventions on Interpersonal Functioning and Personal and Social Performance Levels of Corresponding Patients

INTRODUCTION

In this study, we aimed to investigate the effects of occupational therapy and psychosocial interventions on the interpersonal functioning and individual and social performance levels of corresponding patients under the heading of psychosocial treatment approaches in psychiatry clinics as well as the attitudes of the patients in regard to those interventions.

METHODS

In 2013, out of psychotic (schizophrenia, bipolar disorder/mania) and nonpsychotic (depression, obsessive compulsive disorder, alcohol dependence) inpatients in our clinic, 48 patients who participated in occupational activities were included in the study group and 43 patients who did not participate in these activities were included in the control group. We prepared and implemented a 3-item questionnaire constructed by our team, which probed the patients' thoughts on these occupational activities. The Interpersonal Functioning Scale (IFS) and Personal and Social Performance Scale (PSP) were applied to both groups on hospital admission and discharge; variations in scale scores were evaluated on par with sociodemographic variables, and the study and control groups were compared.

RESULTS

In total, 91% of the study group provided positive feedback regarding the aforementioned interventions. When comparing the study and control groups, the IFS variance score of the study group did not show a significant difference with respect to that of the control group. A statistically significant difference (p<0.0001) was observed in the PSP scores. Evaluation of the PSP of the occupational activities, focusing on sociodemographics and diagnostic labels, revealed a significant improvement in nonpsychotic patients (p=0.002) compared with psychotic patients, in females (p=0.001) compared with males, in unemployed patients (p=0.0001) compared with employed patients, in single patients (p=0.002) compared with married patients, in less-educated patients (p=0.004) compared with high school graduates, and in patients younger than 45 years (p=0.002) compared with those older than 45 years.

CONCLUSION

The findings of our study showed coherence with the literature regarding similar studies conducted on psychotic subgroups. The results demonstrated significantly positive repercussions, specifically in the treatment of nonpsychotic patients; both groups benefited from occupational activities, as shown by improvements in all psychiatric inpatients' PSP scores in comparison with scores of the control group. We concluded that the recruitment of psychosocial treatment approaches enhanced personal and social performance in the patient groups, thereby leading to additional clinical benefits.