The effects of psychological flexibility and resilience on psychopharmacological treatment response in patients with obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a challenging psychiatric condition to treat. Previous research has explored various aspects of treatment response, but limited attention has been given to the significance of psychological flexibility and resilience. This study aimed to investigate the correlation between psychological flexibility, resilience, and different dimensions of OCD, as well as their role in treatment response specifically concerning OCD symptom sub-dimensions. The study involved 50 OCD patients and 42 healthy individuals as controls. Participants completed the Dimensional Obsessive-Compulsive Scale (DOCS), Acceptance and Action Questionnaire (AAQ-2), and Resilience Scale for Adults (RS). Initial scale scores were compared to post-treatment scores obtained after a 3-month follow-up using pharmacotherapy. The patient group exhibited significantly higher AAQ-2 scores and lower RS scores compared to the control group. During the post-treatment follow-up, a reduction in DOCS and AAQ-2 scores was observed, along with an increase in RS scores. The impact of differences in AAQ-2 and RS scores on the change in DOCS total scores was analyzed using mixed model linear regression analysis. The results showed a statistically significant effect of changes in AAQ-2 and RS sub-dimension scores on the change in DOCS total scores. The findings highlight the importance of flexibility and resilience in influencing treatment response among patients with OCD. When conventional pharmacotherapy and psychotherapy approaches prove insufficient, interventions focused on enhancing flexibility and resilience may contribute to improved treatment outcomes.

The effect of early or late initiation of long-acting antipsychotics on the caregiver burden in schizophrenia

The effective treatment in the early stages of schizophrenia is of critical importance to improve the prognosis. Schizophrenia affects patients' relatives too. The effects of early or late initiation of long-acting injectable antipsychotics (LAI-APs) on the patient have been shown, yet their effects on the caregiver are still unknown. We aimed to determine how the time of initiation of LAI-APs affects the caregiver burden by comparing the patients who were started on LAI-APs in the first 5 years of diagnosis and those who were started at a later period. Patients were classified as 'early-LAI' and 'late-LAI' according to the time of initiation of a LAI-AP. Their caregivers were also classified as the same way, as 'caregiver-early' and 'caregiver-late' and were compared in terms of caregiver burden. The quality of life, depression, anxiety, and caregiver burden scores of the caregiver-late group were significantly worse. The time of initiation of LAI-APs and the functioning levels of the patients were found to be determinant factors for the caregiver burden. This is the first study to investigate the effects of LAI-AP's initiation time on the caregivers to our knowledge. The use of LAI-APs in the early stages is associated with better outcomes for the caregiver.

Is co-occurrence of adult adhd with bipolar disorder a risk factor for violent behavior?

Research has shown that individuals with psychiatric disorders such as bipolar disorder (BD) and attention deficit and hyperactivity disorder (ADHD) have a higher likelihood of violent behavior. This study investigated the frequency of comorbid BD and ADHD in adultpatients and the relationship between this comorbidity and violent behavior. We assessed 105 remitted patients diagnosed with BD I (n = 91) or BD II (n = 14). The patients were administered the Sociodemographic Data Scale, the Wender-Utah Rating Scale (WURS), the Adult ADHD Self-Report Scale (ASRS), the Buss-Perry Aggression Questionnaire (BPAQ), and theViolence Tendency Scale (VTS) as self-reports. The same clinician administered the Diagnostic Interview for ADHD in adults (DIVA 2.0) to patients who scored≥36 on the WURS. Comorbid ADHD was diagnosed in 15.2% of patients according to the DIVA 2.0. In the multiple linear regression analysis, there was a statistically significant positive effect of the ASRS total score on the VTS and the BPAQ total score. Furthermore, it was found that male gender had a statistically significant positive effect on VTS total score and young age had a statistically significant positive effect on BPQA total score. These findings demonstrate an association between BD, comorbid ADHD, and violent behavior.

Internalized Stigma and Resistance Against Stigma as Risk Factors for Suicide in Individuals with Schizophrenia: A Cross-Sectional Study

Introduction

Identifying the relationship between internalized stigma and suicide is critical in dealing with schizophrenia. We aimed to examine how internalized stigma and its subcomponents affect suicidality in patients with schizophrenia. The second aim of this study was to identify the risk factors for internalized stigma in schizophrenia.

Methods

We assessed 114 patients diagnosed with schizophrenia. Structured Clinical Interview for the DSM-5 (SCID-5), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS), Internalized Stigma of Mental Illness (ISMI), and Suicide Probability Scale (SPS) were applied to the sample. Multivariable linear regression analysis was conducted to determine the risk factors of internalized stigma.

Results

Statistically significant correlation between stigma resistance and all SPS scores was found. The correlation between stigma resistance and suicidal thought was independent of the CDS and PANSS scores of the sample. Stigma resistance and depressive situation were the predictive factors for SPS. Only depressive state of the group predicted the level of internalized stigma in the regression analysis.

Conclusions

Stigma resistance is an important risk factor for suicide in schizophrenia. Clinicians should focus on interventions to increase resistance against stigma and to determine the depressive situation of patients with schizophrenia.

Prospective analysis of serum prolactin levels, clinical symptomatology and sexual functions in patients with schizophrenia switched to paliperidone palmitate 3-monthly from paliperidone palmitate 1-monthly: Preliminary findings of the first 3 months

OBJECTIVE

Long-acting injectable (LAI) antipsychotics were developed to improve adherence to schizophrenia treatment. Paliperidone palmitate (PP) has two LAI forms: Monthly (PP1M) and three-monthly (PP3M). PP3M shows less difference in Peak-to-Trough drug concentration levels. This could be related to a lower incidence of hyperprolactinemia, which may negatively affect adherence. We aimed to compare prolactin levels and investigate relationships between prolactin levels, symptomatology and sexual function in patients with schizophrenia after switching from PP1M to PP3M.

METHODS

Twenty-five patients were enrolled. The sociodemographic data form, the Positive and Negative Syndromes Scale (PANSS) and the Arizona Sexual Experience Scale (ASEX) were used. Morning blood samples were drawn to determine prolactin levels.

RESULTS

Prolactin level (p < 0.001), the total score and arousal sub-score of ASEX (respectively; p = 0.015, p = 0.020) and the total score and positive scale of PANSS (respectively; p = 0.017, p = 0.021) were decreased on the 90th day (±15 days).

CONCLUSIONS

After switching to PP3M, the decreases in prolactin levels and potentially related sexual side effects was statistically significant. There may be a difference between two formulations of the same drug in terms of side effects, and there is a need for prospective follow-up studies with larger samples.

Neurochemical differences between bipolar disorder type I and II in superior temporal cortices: A proton magnetic resonance spectroscopy study

BACKGROUND

Despite the diagnostic challenges in categorizing bipolar disorder subtypes, bipolar I and II disorders (BD-I and BD-II respectively) are valid indices for researchers. Subtle neurobiological differences may underlie clinical differences between mood disorder subtypes. The aims of this study were to investigate neurochemical differences between bipolar disorder subtypes.

METHODS

Euthymic BD-II patients (n = 21) are compared with BD-I (n = 28) and healthy comparison subjects (HCs, n = 30). Magnetic Resonance Imaging (MRI) and proton spectroscopy (¹H MRS) were performed on a 3T Siemens Tim Trio system. MRS voxels were located in the left/right superior temporal cortices, and spectra acquired with the single voxel Point REsolved Spectroscopy Sequence (PRESS). The spectroscopic data were analyzed with LCModel (Version 6.3.0) software.

RESULTS

There were significant differences between groups in terms of glutamate [F = 6.27, p = 0.003], glutamate + glutamine [F = 6.08, p = 0.004], inositol containing compounds (Ino) (F = 9.25, p < 0.001), NAA [F = 7.63, p = 0.001] and creatine + phosphocreatine [F = 11.06, p < 0.001] in the left hemisphere and Ino [F = 5.65, p = 0.005] in the right hemisphere. Post-hoc comparisons showed that the BD-I disorder group had significantly lower metabolite levels in comparison to the BD-II and the HC groups.

LIMITATIONS

This was a cross-sectional study with a small sample size. In addition, patients were on various psychotropic medications, which may have impacted the results.

CONCLUSIONS

Neurochemical levels, in the superior temporal cortices, measured with ¹H-MRS discriminated between BD-II and BD-I. Although further studies are needed, one may speculate that the superior temporal cortices (particularly left hemispheric) play a critical role, whose pathology may be related to subtyping bipolar disorder.

Hypersexuality associated with paliperidone

We report a case of unusual sexual symptoms in a 43-year-old female patient with schizophrenia (according to Diagnostic and Statistical Manual of Mental Disorders, fifth edition), who was being treated with a depot formulation of paliperidone palmitate, an atypical antipsychotic medication. The symptoms included increased sexual desire, sexual preoccupation, constant drive for intercourse, and sexual arousal with unrelated stimuli such as urination. Potential neurochemical mechanisms have been elucidated for this symptomatology. Paliperidone palmitate has broad neuropharmacological effects, which might have contributed to the development of this rare clinical condition. (PsycINFO Database Record

Explanatory Models of Illness, Help Seeking Behaviours and Related Factors in Patients with Schizophrenia: A Comparative Study from Two Different Provinces of Turkey

This study aims to identify the help seeking behaviours of patients from two geographically distinct provinces of Turkey. A questionnaire about sociodemographic characteristics and help seeking ways was applied to 49 schizophrenia patients from Van, 99 from Ankara. The ratio of patients seeking psychiatric help at the beginning of their illness was 76% in Ankara, the capital city, in contrast to 54% in Van (p = 0.01). Twenty-two percent of patients from Ankara and 69% from Van reported that non-psychiatric help seeking was the choice of their families (p < 0.001). Thirty-five percent of all patients sought religious support when their symptoms started. Patients with lower education levels sought more religious help (p = 0.002). Help seeking behaviours show regional variations. Religious help seeking behaviour is a major way of dealing with the illness. Psychoeducation is a crucial need both for patients and families.

Effect of familial Mediterranean fever on sexual and reproductive health in women

BACKGROUND/AIM

The aim of this study was to investigate the relationship between familial Mediterranean fever and female sexual dysfunction and premenstrual syndrome.

MATERIALS AND METHODS

This study included 36 patients with familial Mediterranean fever and 33 healthy volunteers. Familial Mediterranean fever was diagnosed according to the Tel Hashomer criteria and familial Mediterranean fever mutations were identified in all of the patients. The patients and healthy volunteers were compared in terms of anxiety, depression, sexual dysfunction, and premenstrual syndrome, and a model was created that describes the relationships among these variables.

RESULTS

We found statistically significant differences between the groups in terms of anxiety, premenstrual syndrome, and Golombok Rust Inventory of Sexual Satisfaction frequency and vaginismus subscale scores. There was no difference in depression scores between the groups.

CONCLUSION

Familial Mediterranean fever is a rheumatic disease that predisposes patients to sexual dysfunction and premenstrual syndrome, which emerges as direct and indirect psychological factors.

Situs Inversus Totalis and Schizophrenia Comorbidity

The comorbidity of structural or genetic diseases with schizophrenia is seen as an opportunity to understand the formation of schizophrenia. This case report presents a patient with comorbidity of schizophrenia, tetralogy of Fallot (TOF) and total situs inversus. TOF is a cyanotic heart disease, which can be linked to 22q11 deletion and trisomy 21. Situs inversus totalis (SIT) is a congenital condition in which the major visceral organs, including the heart, are positioned in a mirror image from normal conditions. The comorbidity of TOF and SIT is quite rare. In our case report, schizophrenia is added to this rare comorbidity. This case report discussed the comorbidity and probable causal relationships. Furthermore, the research method of how transposition in internal organs is reflected in brain lateralization is also presented.

Total white blood cell count, liver enzymes, and metabolic syndrome in schizophrenia

BACKGROUND/AIM

Metabolic syndrome (MetS) is an important clinical issue in patients with schizophrenia, but its associated factors are still ambiguous. The aim of the present study was to test whether there are any associations between MetS and white blood cell (WBC) levels, liver enzymes, or sociodemographic variables.

MATERIALS AND METHODS

The study included 91 patients with a diagnosis of schizophrenia. We used the National Cholesterol Education Program's Third Adult Treatment Protocol criteria to evaluate MetS in patients. Schizophrenia patients with MetS were compared with those without MetS on the basis of demographic and clinical characteristics and total WBC counts. We conducted Spearman's correlation and binary logistic regression analyses to achieve the best prediction of MetS in schizophrenia.

RESULTS

Compared with schizophrenia patients without MetS, those with MetS were older, less educated, and more likely to be smokers. They were also more likely to have a longer duration of the illness, a longer untreated period, and higher alanine aminotransferase (ALT) and WBC levels. MetS was correlated with age, duration of illness, income, ALT, gamma-glutamyl transpeptidase, WBC, and hemoglobin values. Age and WBC levels were found to be the best predictors of MetS.

CONCLUSION

Hemograms and liver tests should be conducted to test for MetS in schizophrenia.

Paliperidone Palmitate-induced Urinary Incontinence: A Case Report

Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients’ compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia.

Could psychiatric assessment before hematopoietic stem cell transplantation predict the need for psychiatric consultation during transplantation period?

Psychiatric morbidity seems to be a significant concern associated with all stages of hematopoietic stem cell transplantation (HSCT). We aimed to understand whether psychiatric consultation before HSCT procedure could predict the need for psychiatric support during isolation period. Seventy-eight patients undergoing HSCT were included in the study. Patients were diagnosed according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). Standard anxiety and depression scores were performed. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and State and Trait Anxiety Inventory (STAI) were performed. Psychiatric consultation was required for 45 (58%) patients during hospitalization. Only pre-HSCT STAI trait scores were higher in patients who were found to have psychopathology at consultation during hospitalization compared to patients without established psychopathology. Sixteen (76%) and 29 (51%) patients needed consultation with and without pre-HSCT psychopathology, respectively. Our study showed that the psychiatric consultation request rate during the transplantation process was higher for cases previously diagnosed with psychopathology and who had high trait anxiety scale scores before HSCT.

The relationship between metacognitions and insight in obsessive-compulsive disorder

This study aimed to determine the relationship between metacognitions and insight in obsessive compulsive disorder. One hundred individuals who had been diagnosed according to "Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision" criteria as having obsessive compulsive disorder and 50 healthy controls are included in the study. A sociodemographic and clinical data form, the Yale-Brown Obsession and Compulsion Scale and the Beck Depression Inventory were given to the participants. Insight is assessed by the 11th item of the Yale-Brown Obsession and Compulsion Scale. The Metacognition Questionnaire-30 was administered to both the obsessive compulsive disorder and the control groups to assess metacognitions. We found that the metacognition scores were statistically different in all groups and that the metacognition scores were higher in the obsessive compulsive disorder with good insight group than in the obsessive compulsive disorder with poor insight and control groups. In the obsessive compulsive disorder with poor insight group, all of the metacognition subscale scores were lower than those in the obsessive compulsive disorder with good insight group. Our findings elucidate the relationship between metacognitions and insight in obsessive compulsive disorder.

Acute dystonia after using single dose duloxetine: case report

Duloxetine is a balanced and potent serotonin and noradrenaline reuptake inhibitor which is known to be effective in depression and anxiety disorders. The common adverse effects include dry mouth, nausea, insomnia, somnolence, dizziness and constipation. Reported adverse effects of the extra pyramidal symptoms (EPS) are rare. In this case, a patient who suffered from acute dystonia, after only one dose of 30 mg duloxetine is presented.