The association of social inequality with the onset, persistence, and progression of psychotic experiences along the extended psychosis phenotype: a 6-year follow-up study in a community-based sample

PURPOSE

This paper aims to investigate associations between early childhood and current indicators of socioeconomic inequality and the onset (incident), persistence and progression (increase in severity) of psychotic experiences (PEs) in a longitudinal follow-up of a community-based population.

METHODS

Households in the metropolitan area of Izmir, Turkey were contacted in a multistage clustered probability sampling frame, at baseline (T1, n = 4011) and at 6-year follow-up (T2, n = 2185). Both at baseline and follow-up, PEs were assessed using Composite International Diagnostic Interview 2.1. The associations between baseline socioeconomic features and follow-up PEs were analysed using logistic regression models. Indicators of social inequality included income, educational level, current socioeconomic status (SES), social insurance, the area resided, ethnicity, parental educational level, and SES at birth.

RESULTS

The risk of onset of PEs was significantly higher in lower education, lower SES, and slum-semi-urban areas. The persistence of PEs was significantly associated with the lowest levels of education and current SES, and rural residency. Persistent PEs were significantly and negatively associated with paternal SES at birth. Progression of PEs was significantly higher among respondents with educational achievements lower than university level and lower levels of SES, who have no social insurance and who reside in slum-semi-urban areas. Parental education and paternal SES at birth were not associated with the persistence of PEs.

CONCLUSION

Indicators of social inequality (low education, low SES, low income, and poverty in the neighbourhood) were associated with the onset and persistence of PEs and progression along the extended psychosis phenotype. The early indicators seem to have a modest life-long impact on the psychosis phenotype.

A 6-year follow-up study in a community-based population: Is neighbourhood-level social capital associated with the risk of emergence and persistence of psychotic experiences and transition to psychotic disorder?

BACKGROUND

Social capital is thought to represent an environmental factor associated with the risk of psychotic disorder (PD). This study aims to investigate the association between neighbourhood-level social capital and clinical transitions within the spectrum of psychosis.

METHODS

In total, 2175 participants, representative of a community-based population, were assessed twice (6 years apart) to determine their position within an extended psychosis spectrum: no symptoms, subclinical psychotic experiences (PE), clinical PE, PD. A variable representing change between baseline (T1) and follow-up (T2) assessment was constructed. Four dimensions of social capital (informal social control, social disorganisation, social cohesion and trust, cognitive social capital) were assessed at baseline in an independent sample, and the measures were aggregated to the neighbourhood level. Associations between the variable representing psychosis spectrum change from T1 to T2 and the social capital variables were investigated.

RESULTS

Lower levels of neighbourhood-level social disorganisation, meaning higher levels of social capital, reduced the risk of clinical PE onset (OR 0.300; z = -2.75; p = 0.006), persistence of clinical PE (OR 0.314; z = -2.36; p = 0.018) and also the transition to PD (OR 0.136; z = -2.12; p = 0.034). The other social capital variables were not associated with changes from T1 to T2.

CONCLUSIONS

Neighbourhood-level social disorganisation may be associated with the risk of psychosis expression. Whilst replication of this finding is required, it may point to level of social disorganisation as a public health target moderating population psychosis risk.

The relationship between severity of overactive bladder symptoms and cognitive dysfunction, anxiety and depression in female patients with multiple sclerosis: Running head: OAB-V8, BICAMS and HAD scale in MS

BACKGROUND

Overactive bladder (OAB), cognitive dysfunction, depression and anxiety are common problems encountered in MS. This study was planned to investigate the relationship between the severity of OAB symptoms and cognitive function, anxiety and depression in MS.

METHODS

100 patients with MS diagnosis with OAB symptoms were recruited. OAB symptoms was assessed with the OAB-V8 questionnaire. Symbol Digit Modalites Test (SDMT), California Verbal Learning Test II (CVLT-II) and Brief Vasospatial Memory Test-Revised (BVMT-R) in BICAMS Battery were used to evaluate cognitive function. Depression and anxiety were assessed with the Hospital Anxiety Depression (HAD) Scale.

RESULTS

The mean age of the patients was 40.9±12.3, the duration of the disease was 9.03±6.89 years, and the mean OAB-V8 score was 17.6±8.9. SDMT test (r=-0.299, p<0.01) showed a moderately significant, CVLT-II (r= -0.219, p<0.05) and BVMT-R (r=-0.218, p<0.05) tests showed a weakly significant negative correlation with OAB-V8 score. There was a moderate positive correlation between the OAB-V8 score and HAD-D (r=0.279, p=0.005) and HAD-A (r=0.318, p=0.001) scores. SDMT and BVMT-R scores were significantly lower in anticholinergic (Ach) drug users (especially oxybutynin users) compared to those who did not use Ach drugs.

CONCLUSIONS

It has been observed that the severity of OAB symptoms is related to worsening of information processing speed and an increase in depression and anxiety. It has been determined that there is a significant effect on information processing speed, visual learning and memory in patients using Ach drugs, especially in those using oxybutynin, compared to those who do not use Ach drugs.

Relationship Between Serum Agouti-Related Peptide Levels and Metabolic Syndrome in Euthymic Bipolar Patients

INTRODUCTION

Agouti-Related Peptide (AgRP) is expressed primarily in the hypothalamic arcuate nucleus, stimulates appetite and decreases metabolism and energy expenditure. The aim of our study is to evaluate the relationship between serum Agouti-Related Peptide (AgRP) levels and metabolic syndrome in euthymic bipolar patients.

METHODS

Forty euthymic bipolar patients who used only mood stabilizer for at least three months and 40 healthy volunteers as control group were included in the study. We measured fasting blood glucose levels and serum levels of AgRP, total cholesterol, triglyceride, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) of all participants. The main outcome measure was the difference between patients and control groups in terms of metabolic syndrome frequency and the relationship between serum AgRP level and metabolic syndrome is also investigated.

RESULTS

The metabolic syndrome was significantly more common in euthymic bipolar patients than in control group (p=0.039). Additionally, levels of blood glucose and triglyceride were significantly higher in the patient group than in the control group (p=0.006 and 0.01 respectively). Serum AgRP levels did not differ between the patient and control groups (p=0.35). Also, in euthymic bipolar patients, there was no significant difference in serum AgRP levels between patients with metabolic syndrome and those without (p=0.754).

CONCLUSION

We found significantly higher frequency of metabolic syndrome in euthymic bipolar patients than in the control group. However, there was no significant difference in the levels of serum AgRP between bipolar patients with and without metabolic syndrome in either study groups.

The Relationship between Alcohol-Cannabis Use and Stressful Events with the Development of Incident Clinical Psychosis in a Community-Based Prospective Cohort

OBJECTIVE

The aim of this study is to evaluate the associations between alcohol-cannabis use and forensic/stressful events with the risk of incident clinical psychosis during follow-up.

METHOD

A community-based sample (n: 2142) was screened for clinical psychosis (schizophrenia and other psychotic disorders, affective disorders with psychotic features) at baseline and follow-up. Thus, incident clinical psychosis cases to develop during follow-up (individuals with no clinical psychosis at the baseline assessment and with clinical psychosis at the follow-up assessment) were detected (n: 27). These cases and the controls who did not report any psychotic symptoms at the follow-up assessment (n: 1691) were compared for exposure to environmental risk factors during follow-up (total n: 1718).

RESULTS

Individuals reporting heavy alcohol drinking or cannabis use during follow-up had significantly higher risk of incident clinical psychosis. The monthly frequency of drinking and cannabis use was also associated with the risk. Higher number of stressful life events exposed predicted higher risk of incident clinical psychosis. The risk of incident clinical psychosis was significantly higher in case of coexistence of two risk factors (heavy drinking, cannabis use, ≥3 stressful events), in comparison with the existence of a single risk factor (17.7 vs. 1.6%, p<0.001).

CONCLUSION

Heavy drinking, cannabis use, forensic events and stressful events were associated with the risk of incident clinical psychosis. The coexistence of multiple stressful events and disorders related to abuse of alcohol/cannabis should be considered as a warning for the development of clinical psychosis.

The effect of Attention Deficit and Hyperactivity Disorder on Antiretroviral Treatment and Appointment Adherence among adults living with HIV

INTRODUCTION

The most prominent characteristic of adult attention deficit hyperactivity disorder (ADHD) is impulsive behavior and deficits in executive functions, which require long-term organization and discipline. This may have serious implications in terms of adherence to treatment among adults living with HIV (PLWH). This study aimed to determine the prevalence of ADHD among non-perinatally infected PLWH and its effect on adherence to antiretroviral treatment (ART) and scheduled appointments.

METHODOLOGY

The PLWH admitted to our centers between January 2012 and February 2016 were invited to the study. ADHD diagnosis was made according to the novel criteria guided interviews. The first ART interruption for ≥ 6 days per month (≤ 80%) was defined as ''ART-event'' and the first non-attendance of any scheduled appointment was defined as ''appointment-event''. Kaplan-Meier plot with a Log-rank test was used for event-free adherence (EFA).

RESULTS

Twenty-five patients out of 85 were diagnosed with ADHD (29.4 %) which was significantly higher than the highest percentage reported (7.3 %) for the general population (p < 0.0001). Both ART-event (p = 0.0002) and appointment-event (p = 0.02) were significantly higher among ADHD participants compared to those without. Additionally, both ART-EFA (p = 0.00014) and appointment-EFA (p = 0.023) were significantly shorter among ADHD participants compared to those without.

CONCLUSION

ADHD is significantly higher in adult PLWH and people with ADHD had a significant tendency for non-adherence to ART and follow-up. Screening for ADHD as well as providing treatment when required would be beneficial to achieve and maintain virologic success.

Testing an Internet-Based Turkish Obesity Behavioral Therapy Program: A Randomized Study

OBJECTIVE

Behavioral treatment is recommended as the first line intervention for the prevention of health problems pertaining to obesity. Internet-based programs are used to provide cognitive behavioral therapy for psychiatric disorders and systemic diseases to a large number of patients at low cost. The aim of this study is to develop the first internet based Turkish obesity behavioral therapy program and test its short-term effectiveness.

METHOD

A Turkish web-based behavioral therapy program based on the behavioral strategies employed in the Diabetes Prevention Program was generated. In order to test the effectiveness of this internet-based program an eight week randomized study was conducted. A total of 101 overweight participants with body mass index in the 25-40 range were randomly assigned to an eight-week weight loss program using either the Internet Behavior Therapy (IBT, n=51) or e-mail education (EE, n=50). The participants in the IBT group were provided access to an Internet program that provided videos teaching behavioral weight-loss skills as well as a self-monitoring platform to calculate the daily calorie balance. The participants in the EE group received weekly e-mails with information on healthy eating, physical exercises and weight loss for eight weeks. The primary outcome measure was the observed weight change at the end of the 8 weeks.

RESULTS

In the analyses wherein baseline weight was carried forward for missing data, the IBT produced significantly larger mean weight loss in comparison to the EE at the end of the 8 weeks [2.28 kg (2.11) vs. 0.74 kg (1.57), p=0.001]. The participants in the IBT group, when compared to the EE group, were also more likely to achieve a clinically significant weight loss of 5% of their initial body weight at the end of the 8-week study period (17.6% vs. 2%, p=0.016).

CONCLUSION

The participants who received a structured IBT intervention lost significantly more weight after two months, compared to those who received weekly informational emails regarding weight loss. Internet-based behavioral therapy programs may have the potential to serve as a low-cost alternative for obese patients.

DSM outcomes of psychotic experiences and associated risk factors: 6-year follow-up study in a community-based sample

BACKGROUND

Psychotic experiences (PEs) may predict a range of common, non-psychotic disorders as well as psychotic disorders. In this representative, general population-based cohort study, both psychotic and non-psychotic disorder outcomes of PE were analysed, as were potential moderators.

METHODS

Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011). Participants were interviewed with the Composite International Diagnostic Interview (CIDI) both at baseline and at 6-year follow-up. Participants with PE at baseline were clinically re-interviewed with the SCID-I at follow-up. The role of socio-demographics, characteristics of PE, co-occurrence of mood disorders and family history of mental disorders were tested in the association between baseline PE and follow-up diagnosis.

RESULTS

In the participants with baseline PE, the psychotic disorder diagnosis rate at follow up was 7.0% - much lower than the rates of DSM-IV mood disorders without psychotic features (42.8%) and other non-psychotic disorders (24.1%). Within the group with baseline PE, female sex, lower socio-economic status, co-occurrence of mood disorders, family history of a mental disorder and persistence of PE predicted any follow-up DSM diagnosis. Furthermore, onset of psychotic v. non-psychotic disorder was predicted by younger age (15-30 years), co-presence of delusional and hallucinatory PE and family history of severe mental illness.

CONCLUSION

The outcome of PE appears to be a consequence of baseline severity of multidimensional psychopathology and familial risk. It may be useful to consider PE as a risk indicator that has trans-diagnostic value.

Is BDNF-Val66Met polymorphism associated with psychotic experiences and psychotic disorder outcome? Evidence from a 6 years prospective population-based cohort study

There is little research on genetic risk for the extended psychosis phenotype ranging from psychotic experiences (PEs) to psychotic disorders (PDs). In this general population-based prospective cohort study, the longitudinal associations between BDNF-Val66Met polymorphism and the different levels of the extended psychosis phenotype were investigated. Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighborhoods at baseline (n = 4011). A nested case-control study (n = 366) recruited individuals with PEs and PDs as well as individuals with no psychotic symptoms. In this subgroup, blood sampling for genetic analysis and assessment of environmental exposures were carried out, followed by clinical re-appraisal at follow-up 6 years later (n = 254). The BDNF-Val66Met polymorphism was significantly associated with the extended psychosis phenotype. The pattern of the association was that the BDNF-Val66Met polymorphism impacted in a dose-response but extra-linear fashion, with stronger impact at the PD end of the extended psychosis phenotype. Associations were still significant after adjusting for sociodemographic factors and environmental exposures including life events, childhood adversity, socioeconomic status, urbanicity, and cannabis use. The BDNF-Val66Met polymorphism may index susceptibility to expression of psychosis along a spectrum.

Psychotic experiences and mood episodes predict each other bidirectionally: a 6-year follow-up study in a community-based population

BACKGROUND

Psychotic experiences (PEs) are not exclusive to psychotic disorders and highly correlated with mood episodes. In this representative general population-based study, longitudinal bidirectional associations between the extended psychosis phenotype and mood episodes were investigated, accounting for other possible causes.

METHODS

Households were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011) and at 6-year follow-up (n = 2185). Participants were interviewed with the relevant sections of the composite international diagnostic interview both at baseline and at follow-up. Sociodemographic, familial and environmental risk factors associated with the extended psychosis phenotype and mood episodes were assessed. Logistic regression and cross-lagged panel correlation models were used for the associations between the extended psychosis phenotype and mood episodes.

RESULTS

PEs were associated with subsequent depressive and manic episodes. There was bidirectionality in that mood episodes were associated with subsequent PEs, and PEs were associated with subsequent mood episodes. The associations occurred in a sub-additive pattern. There were substantial synchronous and cross-lagged correlations between these psychopathology domains, with reciprocally similar cross-lagged correlations. Familial risk and adverse life events were associated with both psychopathology domains, whereas some sociodemographic risk factors and alcohol/cannabis use were associated with only one domain.

CONCLUSION

The sub-additive bidirectional associations between PEs and mood episodes over time and the similarity of cross-lagged correlations are suggestive of mutually causal connections between affective and psychotic domains of psychopathology.

Izmir Mental Health Cohort for Gene-Environment Interaction in Psychosis (TürkSch): Assessment of the Extended and Transdiagnostic Psychosis Phenotype and Analysis of Attrition in a 6-Year Follow-Up of a Community-Based Sample

Objective: TürkSch is a prospective, longitudinal study in a representative community sample (İzmir, Turkey), consisting of several data collection stages, to screen and follow-up mental health outcomes, with a special focus on the extended and transdiagnostic psychosis phenotype. The aim of the present paper is to describe the research methodology, data collection results, and associations with noncontact and refusal in the longitudinal arm. Methods: Households were contacted in a multistage clustered probability sampling frame, covering 11 districts and 302 neighborhoods at baseline (n = 4,011) and at 6-year follow-up (n = 2,185). Both at baseline and at follow-up, participants were interviewed with the Composite International Diagnostic Interview. Participants with probable psychotic disorder were reinterviewed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID)-I either at the hospital or at the participant's residence. Relevant neighborhood-level measures were assessed in a separate sample (n = 5,124) in addition to individual-level measures. Candidate gene-by-environment interactions were investigated using two nested case-control studies. Results: Individuals with a mental health problem had lower refusal rates. Older and lower educated individuals had a lower probability of noncontact. Discussion: The TürkSch study has an advanced design to meet the challenges of evaluating the multidimensional etiological and phenomenological nature of the extended and transdiagnostic psychosis phenotype.

[The Association between the Extended Psychosis Phenotype and COMT val158met and BDNF val66met polymorphisms]

OBJECTIVE

Psychotic disorders were previously associated with catechol- O-methyltransferase (COMT) val158met (rs4680) and brain-derived neurotrophic factor (BDNF) val66met (rs6265) polymorphisms. This article evaluates the association between COMT/BDNF polymorphisms and the extended psychosis phenotype which covers not only schizophrenia but also subclinical expressions of psychotic experiences.

METHOD

The participants of this study were part of the TürkSch (Izmir Mental Health Survey for Gene-Environment Interaction in Psychoses), a longitudinal study Psychotic experiences and disorders were screened 437. The extended psychosis phenotype was grouped into four: (1) no psychotic experiences (n: 194), (2) subclinical psychotic experiences (n: 87), (3) clinically relevant psychotic experiences (n: 104), and (4) schizophrenia-like disorders (n: 52). BDNF rs6265 was genotyped occurred in every participant whereas COMT rs4680 genotyping could be done on 366 individuals.

RESULTS

There was no association between the extended psychosis phenotype and BDNF rs6265/COMT rs4680 polymorphisms. The frequency of met carriers in the BDNF rs6265genotype was slightly higher in individuals with subclinical psychotic experiences than in the group with no psychotic experiences, which was just below the significance level (p=0.08).

CONCLUSION

The lack of an association between different expression levels of the extended psychosis phenotype and the BDNF rs6265/ COMT rs4680 polymorphism might be related to sample characteristics, underlying gene-gene, gene-environment and gene-environment-gene interactions.

Psychotic experiences, alcohol–cannabis abuse, stressful events and familial risk is associated with onset of clinical psychosis: Evidence from a 6-year longitudinal population-based cohort

Introduction

Both clinical and subclinical psychosis is probably a consequence of underlying genetic and environmental interactions.

Objectives

Defining differential impact of environmental/familial risk factors and psychotic experiences across the onset of clinical psychosis.

Aims

To assess mental health outcomes in a 6-year follow-up of a representative general population sample with a special focus on extended psychosis phenotype.

Methods

Addresses were contacted in multistage clustered area probability sampling frame covering 9 districts and 302 neighbourhoods (n: 4011) at baseline (T1) and 6 years after (n: 2142) (T2). Psychotic experiences were screened with Composite International Diagnostic Interview and probable cases were re-interviewed with SCID-I. Relations were tested using logistic regression models.

Results

Of subclinical psychotic symptoms at baseline, 6.4% transitioned to clinical psychosis; 44.4% persisted, 90.2% transitioned to any DSM disorder. Of newly onset clinical psychosis at T2, 62.8% had subclinical psychotic expressions at baseline. The risk of developing clinical psychosis was greater in those with baseline subclinical psychotic experiences, alcohol–cannabis abuse, stressful-forensic event history and family history of mental disorders. Most of risk factors associated with psychosis proneness at T1 were also associated with clinical psychotic outcome at T2 (Table 1).

Conclusions

Psychotic experiences takes attention for the risk to develop psychosis due to underlying genetic and environmental interactions; also may be an important risk factor to develop any mental disorder.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Healthy living and smart choices - A project for developing a web-based Turkish obesity treatment program

Introduction

Obesity is a major public health problem in the world and getting obesity under control is one of the most important goals of the World Health Organization. Cognitive behavioral therapy techniques are helpful for adjusting lifestyle to stay at a healthy weight range. Success of web-based programs which designed with evidence-based behavioral strategies has been proven with different studies. However, a web-based program suitable for Turkish culture and eating habits is still missing.

Objectives

Primary objective of this project is to develop and test a web-based obesity behavioral treatment program in collaboration with experienced academicians from different disciplines.

Aims

The aim of this project is to develop a program which will help Turkish primary care physicians in treating and tracking obesity patients.

Method

The web-based program will include a 12-week-long core behavioral program. Participants will be asked to record their daily dietary intakes and automatic feedback will be given by the system. Weekly behavioral training videos will be available during the core program. As participants watch the videos and record their daily intakes, they will get instant awards such as virtual diet-coin which they will be able to spend for gifts such as low calorie recipes. One hundred obese patients (with body mass index greater than 30 kg/m2) will be recruited to evaluate the effectiveness of the program. The changes in their blood pressures, body weights and waist circumferences will be recorded.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The epidemiology of major depressive disorder and subthreshold depression in Izmir, Turkey: Prevalence, socioeconomic differences, impairment and help-seeking

BACKGROUND

Subclinical and clinical depression is common, widely distributed in the general population, and usually associated with role impairment and help-seeking. Reliable information at the population level is needed to estimate the disease burden of depression and associated care needs in Turkey.

METHOD

The cross-sectional study aimed to assess the prevalence of subthreshold (SubD) and clinical major depressive disorder (MDD) in Izmir, Turkey. In the 5242 eligible households, a total of 4011 individuals were successfully interviewed, yielding a response rate of 76.5%. Prevalence estimates of MDD and SubD depression were formed by using the responses to the questions of the CIDI section E. Short Form 36 (SF-36) to assess health status and functional impairments in eight scaled scores during the last four weeks. All respondents were questioned about receiving 12-month treatment for any psychological complaints, the route of help-seeking, as well as prescribed medicines and any hospitalization.

RESULTS

The one year prevalence estimate for CIDI/DSM IV MDD was 8.2% (95% CI, 7.4-9.1). Less educated, low income, uninsured, low SES, unemployed/disabled and housewives, slum area residents had higher one year MDD prevalence. Determined prevalence of help seeking from mental health services of SubD and MDD cases were 23.6%, 30.6% respectively. Only 24.8% of clinically depressive patients received minimally adequate treatment.

LIMITATIONS

Cross sectional design.

CONCLUSION

Higher MDD prevalence correlates with younger ages, female gender, unemployment, less education, lower monthly income, lower SES and uninsurance. Help seeking from mental health services were low. There are treatment gap and impairment in depressive group.

[Case management based multidiscıplinary care protocol in the palliative care of cancer patients]

Today, multifaceted approach is needed for the palliative care of advanced stage cancer patients. The main objective for these patients, elimination of pain and other symptoms, psychosocial and spiritual needs are met and to increase the quality of life. We are also faced with the challenge of meeting the physical and psychosocial needs of family members. The purpose of a holistic approach to patient and family who provide effective and quality care, care coordination and case management of a multidisciplinary team approach is based on cooperation. Care protocols specified patient care activities to be carried by the related disciplines to achieve results on a timeline that shows a certain, a multidisciplinary clinical management tool. A lot of care guidelines and protocols developed by a team of experts to contribute to the palliative care activities, and this is thought to be a guiding team members, working with patients.

The impact of physical and psychological comorbid conditions on the quality of life of patients with acute myocardial infarction: a multi-center, cross-sectional observational study from Turkey

OBJECTIVE

Acute myocardial infarction (MI) has significant and detrimental effects on the lifestyles of the patients. It has been shown that quality of life (QoL) in patients with MI is impaired in every aspect. This study aims to evaluate the impact of depression and physical comorbidity on QoL in Turkish patients with acute first MI.

METHOD

This multi-center cross-sectional study was carried out in 15 centers with 998 patients hospitalized for acute first MI. For detection of depression, Beck Depression Inventory (BDI) was used. For evaluation of QoL, World Health Organization Quality of Life Questionnaire (WHOQOL) was applied.

RESULTS

The mean age of the patients was 57.5 +/- 10.1 years and 79.2 % (n = 792) of the patients were men. Patients with comorbid depression (BDI > or = 10) and comorbid medical conditions, and female patients had significantly lower scores in every domain of WHOQOL. In the regression analysis model, female gender, low education, comorbid medical conditions, especially comorbid hypertension, and BDI score were found to have a significant effect on the domains of WHOQOL.

CONCLUSIONS

Female patients are more prone to impairment in quality of life after myocardial infarction. Both comorbid medical conditions and depression have a significant impact on the impairment of QoL in Turkish patients with acute MI. In order to improve the subjective wellbeing of post MI patients, both psychiatric and physical comorbidities must be detected and managed even in the short-term.

Evidence that the wider social environment moderates the association between familial liability and psychosis spectrum outcome

BACKGROUND

Familial liability to both severe and common mental disorder predicts psychotic disorder and psychotic symptoms, and may be used as a proxy in models examining interaction between genetic risk and the environment at individual and contextual levels.

METHOD

In a representative general population sample (n=4011) in Izmir, Turkey, the full spectrum of expression of psychosis representing (0) no symptoms, (1) subclinical psychotic experiences, (2) low-impact psychotic symptoms, (3) high-impact psychotic symptoms and (4) full-blown clinical psychotic disorder was assessed in relation to mental health problems in the family (proxy for familial liability) and the wider social environment. Quality of the wider social environment was assessed in an independent sample using contextual measures of informal social control, social disorganization, unemployment and low income, aggregated to the neighbourhood level.

RESULTS

The association between familial liability to severe mental illness and expression of psychosis spectrum was stronger in more deprived neighbourhoods [e.g. this association increased from β=0.33 (p=0.01) in low-unemployment neighbourhoods to β=0.92 (p<0.001) in high-unemployment neighbourhoods] and in neighbourhoods high in social control, while neighbourhood variables did not modify the association between familial liability to common mental disorder and the psychosis outcome. Neighbourhood variables mediated urbanicity effects.

CONCLUSIONS

Contextual effects may be important in moderating the expression of psychosis liability in populations, representing a specific pathway independent of the link between common mental disorder and psychosis.

Testing the psychosis continuum: differential impact of genetic and nongenetic risk factors and comorbid psychopathology across the entire spectrum of psychosis

A growing number of studies demonstrate high rates of subthreshold psychotic experiences, but there is considerable heterogeneity in rates due to study cohort and design factors, obscuring how prevalent psychotic experiences may or may not relate to rare psychotic disorders. In a representative general population sample (n = 4011) in Izmir, Turkey, the full spectrum of expression of psychosis was categorized across 5 groups representing (1) absence of psychosis, (2) subclinical psychotic experiences, (3) low-impact psychotic symptoms, (4) high-impact psychotic symptoms, and (5) full-blown clinical psychotic disorder and analyzed for continuity and discontinuity in relation to (1) other symptom dimensions associated with psychotic disorder and (2) proxies of genetic and nongenetic etiology. Results were tested for linear and extralinear contrasts between clinical and nonclinical and between disorder and nondisorder expression of psychosis. Demographic variables, indexing premorbid social adjustment and socioeconomic status, impacted mostly linearly; proxy variables of genetic loading (more or more severely affected relatives) impacted in a positive extralinear fashion; environmental risk factors sometimes impacted linearly (urbanicity and childhood adversity) and sometimes extralinearly (cannabis), occasioning a disproportional shift in risk at the clinical disorder end of the spectrum. Affective symptoms were associated with a disproportionally higher risk below the disorder threshold, whereas a disproportionally higher risk above the threshold was associated with psychotic symptom load, negative symptoms, disorganization, and visible signs of mental illness. Liability associated with respectively affective and nonaffective symptom domains, in interaction with environmental risks, may operate by impacting differentially over a quasi-continuous extended psychosis phenotype in the population.

Irritable bowel syndrome in renal transplant patients: prevalence, link with quality of life, anxiety, and depression

BACKGROUND

Gastrointestinal complications are common in renal transplant recipients and may arise from any part of the gastrointestinal tract. Irritable bowel syndrome (IBS) is highly common in the general population, but the status is not known in renal transplant patients. In this study, we evaluated the prevalence of IBS and its association with health-related quality of life (HRQOL), anxiety, and depression in renal transplant patients.

METHODS

One hundred and ninety-eight patients were enrolled in this study. Sociodemographic and laboratory variables were recorded. Severity of depressive and anxiety symptoms and HRQOL were assessed by the Beck Depression Inventory, State-Trait Anxiety Inventory, and Short Form 36 (SF-36), respectively. Diagnosis of IBS was based on Rome III criteria.

RESULTS

The mean age was 38 ± 10 years and 61% were male. The mean transplant duration was 62 ± 54 months. Among 198 patients, 55 (27%) had IBS. Patients with IBS had lower SF-36 scores and had higher depressive and anxiety symptoms than patients without IBS.

CONCLUSIONS

IBS is highly prevalent in renal transplant patients. The presence of IBS is closely related with HRQOL anxiety and depression.

[Lifetime prevalence and correlates of schizophrenia and disorders with psychotic symptoms in the general population of Izmir, Turkey]

OBJECTIVE

To estimate the lifetime prevalence of 12 DSM-IV disorders with psychotic symptoms in a general population survey.

METHOD

Addresses were contacted in a multistage clustered area probability sampling frame of administrative neighbourhoods and households, covering 9 districts and 302 neighbourhoods in the Izmir metropolitan area between November 2007 and October 2008. One household member aged between 15 and 64 years and available to complete the interview was randomly selected using a within-household sampling method. The primary screening instrument was the Composite International Diagnostic Interview 2.1. A systematic screening procedure was implemented to detect probable cases with any psychotic disorder. Those selected by the screens were re-interviewed with the Structured Clinical Interview for DSM-IV. Diagnoses of individuals who were not available for re-interview were made by combining screening information with case register diagnoses and/or the telephone interviews with relatives or spouse.

RESULTS

A total of 4011 individuals were screened for disorders with psychotic symptoms. After screening, 499 respondents were selected as a probable case. 277 of screen positive respondents were available for clinical reappraisal. Initial screening interviews and additional material were used for best estimate diagnoses of the remaining 172 respondents. Total lifetime prevalence of 12 DSM-IV disorders with psychotic symptoms was 2.62%. Lifetime prevalence of each disorder separately were as follows: 0.74% for schizophrenia, 0.20% for schizoaffective disorder, 0.05% for schizophreniform disorder, 0.10% for delusional disorder, 0.12% for brief psychotic disorder, 0.55% for major depressive disorder with psychotic features, 0.37% for bipolar I disorder, 0.20% for substance induced psychotic disorder, and 0.07% for psychotic disorders due to a general medical condition.

CONCLUSION

Total lifetime prevalence of disorders with psychotic symptoms is higher than any previously reported estimates in Turkey; with a prevalence of approximately 2.5%, these disorders can be considered a major public health concern.

[Psychotic disorders among immigrants from Turkey in Western Europe: An overview of incidences, prevalence estimates, and admission rates]

OBJECTIVE

To provide an overview of incidence and prevalence estimates, admission rates, and related features of psychotic disorders among immigrants from Turkey in Western Europe.

METHOD

Articles published in all languages between 1990 and 2010 were included. In order to detect relevant studies, a string ([schizo* OR psych*] AND [Turk*] AND [migra* OR immigra*]) was used in MEDLINE and PsychINFO. Turkish indexes and abstracts books of national congresses were also screened to locate additional papers.

RESULTS

We included 21 studies which yielded 25 rates on psychotic disorders among immigrants from Turkey. Fifteen papers reported rates for the immigrants from Turkey in The Netherlands, four for Germany, one for Denmark and one for Switzerland. The incidence estimates of non-affective and affective psychosis among immigrants from Turkey were between 38.5 and 44.9 per 100,000 while incidence estimates of schizophrenia were between 12.4 and 63.8 per 100,000. The prevalence estimates of schizophrenia and other psychotic disorders were between 1.1 and 6.2 per 1,000. Rates and relative risks of psychotic disorders in immigrants from Turkey tended to be higher than the natives and lower than other immigrant groups with similar sociocultural background. In addition to other risk factors, social contextual factors including discrimination and neighbourhood characteristics were the key environmental factors that modulate rates of psychotic disorders among immigrants from Turkey. Males were under a higher risk of incidence, prevalence estimates, and admission rates.

CONCLUSION

Variations in rates and relative risks indicate a possible etiological role of social experiences in immigrants. Studies with a focus on comparing the rates and the social factors of psychotic disorders between immigrants from Turkey in Western Europe and their family members residing in Turkey may provide additional insight into the epidemiology of psychotic disorders.

Izmir mental health survey for gene-environment interaction in psychoses (TürkSch): objectives and methodology

OBJECTIVE

To describe the objectives and design of a multistage study on the prevalence and risk factors of mental health problems, in particular psychotic disorders and psychotic symptoms, by assessing a probabilistic sample of household residents in the Izmir Metropolitan Area, aged 15-64 years.

METHOD

The study included three different observation frames. In the first stage, of which methodology is in the focus of this paper, the primary screening instrument was the Composite International Diagnostic Interview 2.1, which assesses lifetime and/or last one year occurrence of several DSM-IV disorders. Second, a parallel survey of social capital of administrative wards was conducted in the same neighbourhoods. Third, a nested-case control study was performed to study effects of genetic and environmental risk factors on wide psychosis phenotype.

RESULTS

A total of 4011 males and females were contacted through a multistage clustered area probability sample of administrative neighbourhoods and households, covering 9 districts and 302 neighbourhoods. The response rate for the first stage was 76.5% in 5242 eligible households. Respondents were interviewed at home in 2008 for the screening of included mental health problems. The screened disorders were mood disorders (last 1 year), schizophrenia and other non-affective psychotic disorders (lifetime), and dependence and abuse of psychoactive substances (lifetime).

CONCLUSION

Although cross-sectional in nature, the TürkSch has a unique study design and yields data of high quality. This enables study of the prevalence, risk and higher-order interactions underlying ill-health in the Turkish population, with a specific focus on psychosis.

[The psychosis epidemiology in Turkey: a systematic review on prevalence estimates and admission rates]

OBJECTIVE

To provide prevalence estimate, admission rates and related features of psychotic disorders in Turkey.

METHOD

Studies with data on prevalence and/or rates in outpatient or inpatient admissions after 1990 were included. Strings of ([schizo*OR psych*] AND Turkey) were used in PubMed and PsychINFO to detect relevant studies. Turkish Medical and Psychiatry indexes were screened with Turkish keywords. Abstract books of national congresses, national index of thesis, and references of the included papers were searched for additional data. Results were presented as prevalence per 1000 and median values of admission rates.

RESULTS

A total of 56 studies were included, including 8 cross-sectional (4 core and 4 special group), 27 outpatient and 21 inpatient admission estimates or rates. The lifetime prevalence of schizophrenia in general population (pooled data, n: 6022) was 8.9 per 1000 (Standard error [SE]: 1.2; 95% confidence interval [CI]: 6.6-11.3). Psychosis prevalence is higher in subgroups including university students, prisoners and homeless people. Patients with a diagnosis of psychotic disorder constituted 7.6% and 26.9% of adult outpatient and inpatient psychiatry admissions. However, median rates vary depending on institutional, regional, temporal and residential features. Male gender was at higher risk in all kinds of estimates and rates for all age groups.

CONCLUSION

Prevalence of schizophrenia in Turkey is higher than the formerly reported estimates in different countries. Higher prevalence may be a consequence of sample properties, environmental risk exposures, and study design. However more research is needed to further elaborate the relatively higher prevalence. Nevertheless, a major part of the psychiatry services are devoted to psychotic outpatients and inpatients.

Planning a social activity to improve psychological well-being and quality of life of hemodialysis patients: a pilot study

We aimed to investigate the impact of social activity on anxiety-depression, self-esteem and quality of life in hemodialysis patients. Ninety-one patients were recruited to the current study. Of these, 31 patients wanted to take part in a theater play, while 60 patients (group C) did not. Thirty-one patients were randomly assigned to two groups: Group A (N = 15) started activities immediately and group B (N = 16) was assigned to a waiting list to be included in the activity of theater acting four months later. Beck Depression Inventory, Beck Anxiety Inventory, Rosenberg Self-esteem Scale and World Health Organization Quality of Life Scale short form (WHOQOL-BREF) were used to compare psychological parameters and quality of life of the groups before and after the social activity. The patients who were younger, more literate, and wealthier, had longer disease duration, and who were feeling physically and psychologically well, were willing to participate in social activity. The impact of social activity was evaluated between group A and C. After the social activity, there were significant differences in terms of depression (P = 0.008), self-esteem (P = 0.003), and physical (P = 0.04) and psychological (P = 0.05) sub-dimensions of quality of life between the groups. The depression score of the patients in group A decreased while their self-esteem increased, but the increase in the physical and psychological sub-dimension scores of quality of life scale did not reach statistical significance. This pilot study showed that social activity primarily improved depression and self-esteem in hemodialysis patients.

Body image and self-esteem in somatizing patients

AIM

The aim of the present study was to determine dissatisfaction with body appearance and bodily functions and to assess self-esteem in somatizing patients.

METHODS

Body image and self-esteem were investigated in 128 women; 34 of those had diagnosed somatoform disorders, 50 were breast cancer patients with total mastectomy surgery alone, and 44 were healthy subjects. Body image and self-esteem were assessed using the Body Cathexis Scale and Rosenberg Self-Esteem Scale.

RESULTS

The two clinical groups did not differ from one another (z = -1.832, P = 0.067), but differed from healthy controls in terms of body image (somatizing patients vs healthy controls, z = -3.628, P < 0.001; total mastectomy patients vs healthy controls, z = -3.172, P = 0.002). They also did not differ significantly in terms of self-esteem (z = -0.936, P = 0.349) when depressive symptoms were controlled. No statistically significant difference was observed between total mastectomy patients and healthy controls in terms of self-esteem (z = -1.727, P = 0.084). The lower levels of self-esteem in somatizing patients were largely mediated by depressive symptoms. Depressed and non-depressed somatizing patients differed significantly from healthy controls with respect to their self-esteem and body image.

CONCLUSIONS

Somatizing patients who were dissatisfied with their bodily functions and appearance had lower levels of self-esteem and high comorbidity of depression. In clinical practice it is suggested that clinicians should take into account psychiatric comorbidity, self-esteem, and body image in somatizing patients when planning treatment approaches.

Quality of life and its relation with disease severity in Behçet's disease

OBJECTIVE

Since Behçet's disease (BD) is a systemic vasculitis, it may deteriorate the quality of life of the patients. We aimed to investigate the relationship between the disease severity and the quality of life in patients with BD.

METHODS

We studied 195 BD patients and 195 healthy controls who were matched with regard to age, gender and socio-economic status. Krause score was calculated to assess disease severity, while Short-form-36 (SF-36) and The World Health Organization Quality of Life (WHOQOL-100) were used to evaluate the quality of life in BD.

RESULTS

The overall SF-36 and WHOQOL-100 scale scores, as well as their domains were significantly lower in BD patients. In BD patients, "general health", "role-physical", domains of SF-36, and "psychological", "level of independence", "environment", "environmental-public" domains of WHOQOL-100 showed significantly negative linear correlations with Krause scores. In BD patients with arthritis, the scores of "general health", "physical functioning", "role emotional" domains of SF-36, and the scores of "psychological", "level of independence" and "social relations" domains of WHOQOL-100 were significantly worse than without arthritis. The scores of "pain" domain of SF-36 and "level of independence" domain of WHOQOL-100 were significantly worse in BD patients with vascular involvement, while the scores of "mental health" domain of SF-36 and "psychological" domain of WHOQOL-100 were significantly worse in BD patients with eye involvement.

CONCLUSION

Based on the evaluation of SF-36 and WHOQOL-100 scores, quality of life is impaired and related with disease severity in BD. Arthritis, eye involvement and vascular involvement seem to contribute to this impairment.

Variables affecting patient satisfaction in breast surgery: a cross-sectional sample of Turkish women with breast cancer

OBJECTIVE

In Turkey, despite the fact that breast cancer accounts for 24.1% of all cancer in women, a very small number of these patients receive breast reconstruction. This low percentage would seem to indicate that there are several factors affecting the decision of which surgical procedure should be selected. The aim of this study was to establish the demographical, medical, and psychological factors associated with the breast cancer patient's decision-making process, and assess their satisfaction with the type of surgery received.

METHOD

We assessed long-term satisfaction with the type of surgery received; satisfaction with the information process by which the surgery decision is taken; feelings of ambivalence or regret regarding the type of surgery received in both mastectomy (n = 50) and breast reconstruction patients (n = 25). Additionally, breast cancer survivors were compared with age-matched healthy control volunteers (n = 50) in terms of demographics, body image and self-esteem, which could be expected to affect their preferences. We administered a demographical and medical information form, Structured Clinical Interview for DSM-IV, Clinical Version (SCID-I), the Body Cathexis Scale (BCS); and the Rosenberg Self-Esteem Scale (RSE).

RESULTS

In both groups, women with a low income and less education were more likely to experience decision regret or low satisfaction. Moreover, total mastectomy-alone patients had lower self-esteem compared to reconstructive surgery patients and healthy women.

CONCLUSION

Early stage breast cancer is a chronic disease and patients have to live with the consequences of their decision for many years. At the same time, the type of surgery is decided on when patients are in an acute phase and under intense pressure. Therefore, the decision making process needs to be explored more, especially breast cancer patients with less education and low income need better assistance and more detailed explanation of their options.

Donepezil for anticholinergic drug intoxication: a case report

We present a case of delirium due to amitriptyline overdose, which resolved rapidly following initiation of the cholinesterase inhibitor donepezil. The authors discuss the possibility of cholinesterase inhibitors being an effective choice in the management of anticholinergic drug induced delirium.

A preliminary open-label study of moclobemide treatment of pain disorder

Antidepressants appear to be useful in the treatment of pain disorders, although the exact underlying mechanisms are unknown. In this preliminary study, we examined the utility of moclobemide, a reversible inhibitor of monoamine oxidase, in the treatment of 14 patients with pain disorder. The drug was administered in doses up to 450 mg/day for 8 weeks. Assessments of perceived pain and psychological evaluations of patients were carried out weekly using visual assessment scores of pain, depression, anxiety, sleep, difficulty in concentration, dry mouth, sweating, and fatigue. The therapeutic effects of moclobemide on the sense of pain, depression, anxiety, sleepless, difficulty in concentration, dry mouth, sweating, and fatigue were analyzed using a repeated measures analysis of variance. Our findings suggest that moclobemide therapy may be an effective, useful option in the management of perceived pain, in addition to its beneficial effects on depression, somatization, and anxiety.

Seasonal affective disorder in eight groups in Turkey: a cross-national perspective

OBJECTIVE

Previous estimates of the prevalence of seasonal affective disorder (SAD) in community-based samples generally originated from western countries. We report prevalence rates in eight groups from four latitudes in Turkey.

METHOD

Seasonal Pattern Assessment Questionnaire (SPAQ) was distributed to the community-based samples from eight different locations at four latitudes in Turkey. The prevalence rates of winter SAD and subsyndromal SAD (S-SAD) were estimated for the four groups at the same latitudes by using SPAQ responses.

RESULTS

We distributed 3229 SPAQs, had an overall response rate of 54.16% and 1749 SPAQs were included in the analyses. Seasonality was reported as a problem by 549 subjects (31.57%) of our 1749 respondents. Prevalence of winter SAD and S-SAD are estimated as 4.86 and 8.35%, respectively, for the whole group. Prevalence rates were determined for each center and for four latitudes (two centers at the same latitude were grouped as one). In Adana-Gaziantep (lt. 37), Izmir-Elaziğ (lt. 38), Eskişehir-Ankara (lt. 39) and Trabzon-Edirne (lt. 41), the prevalence rates for winter SAD were 6.66, 2.25, 8.00 and 3.76%, respectively.

CONCLUSIONS

Our prevalence estimates of winter SAD are similar to those found in previous community-based studies at the same latitudes; no correlation was found between latitude and prevalence of winter SAD, which could be related to the sampling methodology or to the fact that there were only 5 degrees of difference between the latitudes.

Derivation of Response Scales for WHOQOL TR

This study has two objectives: One is to demonstrate the Likert-type response scale generation for the Turkish version of the WHOQOL. The other is to show the effect of level of education of the subjects to translate their perception into a rating on a Visual Analog Scale (VAS). WHOQOL questions have four types of response scales: frequency, evaluation, capacity, and intensity. The WHOQOL cross-cultural response scale methodology is based on the VAS. Fifty-one low-level educated subjects from the initial study population (n = 228) were excluded by applying two special exclusion criteria, because of the reliability problems. Those subjects with 8 years and less education were more likely than those with 11 years' (OR = 0.25%; 95 CI 0.11-0.56) and 15 years' and more education (OR = 0.11; 95% CI 0.04-0.29) to be excluded from the study. After translating anchor points into Turkish, the VAS were prepared for each of the response scales (intensity, capacity, frequency, and evaluation). A list of descriptors—16 for frequency, 15 for capacity and intensity, 16 and 14 for evaluation scales—were compiled from dictionaries and the relevant literature. Each descriptor was placed on a 10 cm fresh line in a random order in every scale. The study subjects were asked to place a mark on a 10 cm line for each descriptor, according to where they think the descriptor lies in relation to the anchor points. In order to select the intermediate descriptors for each scale, mean distances for each descriptor were calculated and target intermediate descriptors were found for each scale by applying WHOQOL response scale methodology. The intra-class correlation coefficients (ICC), which indicate the interrater reliability in the current setting, were calculated in the included study population (n = 177) for each education category separately. ICCs were found as 0.39 for 5 years', 0.46 for 8 years', 0.66 for 11 years', and 0.79 for 15 years' and more education categories. Categories of at least 11 years' education were found to show sufficient interrater reliability. The mean and the variabilities of the target descriptors produced similar results with the initial 15 WHOQOL centers. On the other hand, the obtained results indicate that visual analog scale methodology should be used with caution on subjects educated less than 9 years in the Turkish context.