A pilot study examining hemomania behaviors in psychiatry outpatients engaged with nonsuicidal self-injury

BACKGROUND

This study aims to conduct the first-ever evaluation of our previously proposed behaviors of "hemomania" in individuals engaged with nonsuicidal self-injury (NSSI).

METHODS

The study encompassed 130 outpatients engaged with NSSI who applied at the psychiatry outpatient clinic. NSSI behaviors were assessed using the Inventory of Statements About Self-Injury, while psychiatric diagnoses were evaluated using the Structured Clinical Interview for DSM-5 Disorders-Clinician Version. Subsequently, participants completed the Depression Anxiety Stress Scale-21 and Short Form of Barratt Impulsiveness Scale.

RESULTS

The prevalence of at least one hemomania behavior including seeing blood, tasting blood, bloodletting, and blood-drinking was observed to be 43.1% in individuals with NSSI. When participants were divided into two groups, individuals with hemomania exhibited: (1) a higher incidence of psychiatric comorbidities, increased suicide attempts, and more severe symptoms of depression, anxiety, stress, and impulsivity, (2) higher comorbidity rates of borderline personality disorder, body-focused repetitive behaviors, and dissociative disorders, and (3) elevated frequencies of certain NSSI behaviors, including cutting, biting, needle-ticking, and carving, compared to those without.

CONCLUSION

Hemomania could be considered a specific impulse control disorder, characterized by heightened impulsivity and a persistent urge to obtain one's own blood. However, further studies are needed to validate this hypothesis.

Delayed Mid-Sleep Time Associated With Weight Gain While Controlling for Eating Behaviors and Attention Deficit Hyperactivity Disorder Symptoms During the COVID-19 Pandemic

OBJECTIVE

Society's sleep-wake cycle and eating behaviors have altered and are considered the psychological outcomes of the coronavirus disease-2019 (COVID-19) pandemic. Our aim was to examine the relationship between sleep-wake rhythms, eating behaviors (dieting, oral control, and bulimic behaviors), and attention deficit hyperactivity disorder (ADHD) symptoms with weight gain during the COVID-19 pandemic.

METHODS

The participants were 578 female university students divided into three groups based on weight change during COVID-19 who lost weight, whose weight did not change (nWC), and who gained weight (WG). The participants' information about weight change in the last year and responses to the Pittsburg Sleep Quality Index, Eating Attitudes Test, Adult ADHD Severity Rating Scale, and Wender Utah Rating Scale were collected via an online survey from January 8, 2021 to January 11, 2021.

RESULTS

The sleep-wake phase was more delayed in WGs than in the other two groups. The bulimic behavior score was higher and the oral control behavior score was lower in the WG group than in the nWC group. A hierarchical regression analysis model, in which weight change scores were dependent variables, showed that mid-sleep time in second step (β=4.71, t=2.18, p=0.03), and oral control (β=-0.11, t=-3.24, p=0.001)/bulimic behaviors (β=0.20, t=3.20, p=0.001) in third step were associated with weight change after controlling for both current and childhood ADHD symptoms.

CONCLUSION

Chronotherapeutic approaches that regulate sleep-wake rhythm may facilitate weight control of individuals during stressful periods, such as the COVID-19 outbreak.

Decreased miR-15b-5p/miR-155-5p levels and increased miR-134-5p/miR-652-3p levels among BD patients under lithium treatment

BACKGROUND

There is an increasing interest about the role of miRNAs in the pathogenesis of bipolar disorder (BD). In this study, we aimed to examine the role of miRNAs as potential diagnostic and clinical biomarkers in BD.

METHODS

Fifteen miRNAs in plasmas obtained from BD patients (n = 66) and from the healthy control group (n = 66) were analyzed by a qPCR test. Clinical variables including lithium treatment response were assessed with various test batteries. The correlation of the miRNA levels with the clinical variables and scale scores was examined. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses were performed using the DIANA-miRPath v.3.0 software to identify the possible target genes.

RESULTS

The miR-132, miR-134, miR-152, miR-607, miR-633, and miR-652 levels were significantly increased, whereas the miR-15b and miR-155 levels were found to be significantly decreased in the patient group compared to the controls. The miR-15b-5p and miR-155-5p levels and increases in the miR-134-5p and miR-652-3p levels were calculated to have 83.3 % sensitivity and 78.8 % specificity in determining the risk of BD. miR-155-5p was associated with the disease burden and severity. Fatty acid biosynthesis and metabolism, viral carcinogenesis, the EBV infection, and extracellular matrix and adhesion pathways were highlighted as target pathways.

CONCLUSION

We can conclude that miRNAs may play a role in the pathophysiology of BD through various biological pathways and that miRNAs may be used as a screening test to distinguish bipolar patients from healthy controls. Our findings will provide a basis for long-term follow-up studies with larger samples.

Heterogeneity of associations between dissociation and attention deficit symptoms

Childhood trauma and dissociative experiences are suggested to be predisposing transdiagnostic factors for attention deficit /hyperactivity disorder (ADHD) as well as many psychiatric disorders. Trauma-related symptoms such as motor restlessness, emotional instability, and concentration problems can mimic, trigger, or exacerbate ADHD symptoms. Moreover, given the relationship between ADHD and trauma-induced distress, it has been suggested that dissociative experiences and attention problems may reveal overlapping characteristics. The aim of this study was to investigate the associations between dissociative experiences and attention deficits by carrying out mixture analysis. A thousand and thirty-seven participants volunteered to the online investigation. Participants completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale (ASRS), Wender Utah Rating Scale (WURS), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), and Somatoform Dissociation Questionnaire (SDQ). Item responses on the DES and attention deficit symptoms as indexed by the ASRS were subjected to latent class analysis. The three-latent-class model outperformed alternative mixture models. Mixture analysis classified the sample into three homogenous subgroups as follows: (1) No/low dissociation or attention problems; (2) Moderate dissociation with attention problems; and (3) High dissociation with attention problems. High dissociators with attention problems were characterized by heightened scores on somatoform dissociation and emotional neglect. No/low dissociation or attention problems latent class reported significantly lower scores on hyperactivity/impulsivity, depression, attention deficit in childhood, and sexual abuse than both moderate and high dissociation latent classes. High dissociators and moderate dissociators significantly differed on conduct problems and physical abuse. We concluded that impulsive hyperactivity, depression, and childhood sexual abuse were common features in heightened dissociation latent classes, as well as attention deficit.

Dissociative Experiences Associated With Internet Gaming Disorder After Controlling For Childhood Trauma And ADHD Diagnosis

The aim of this study was to investigate the relationships among childhood trauma, dissociative experiences, and internet gaming disorder (IGD) in young adults diagnosed with attention deficit hyperactivity disorder (ADHD) and age- and gender-matched controls. Forty participants diagnosed with ADHD at a university hospital psychiatric outpatient clinic and 40 healthy controls completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale (ASRS), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), and Internet Gaming Disorder Scale - Short Form (IGDS9-SF). The CTQ (t = -4.61, p < .01), DES (t = -4.71, p < .01), SDQ (t = -2.40, p < .01), and IGDS9-SF (t = -4.89, p < .01) scores were significantly higher in the ADHD group than in the control group. A hierarchical regression analysis that explained 50% of unique variance in internet gaming disorder (IGD) indicated that being male (β = 0.41, t = 4.61, p < .001) and having an ADHD diagnosis (β = 0.48, t = 5.49, p < .001) are robust predictors. Additionally, the DES score, which indicates the severity of psychoform dissociation (β = 0.34, t = 2.43, p = .017), was found to be significantly associated with IGD after controlling for ADHD diagnosis and childhood trauma. While excessive gaming may increase dissociative symptoms, the mental state of dissociative experiences may be a predisposing factor for IGD; however, further studies are needed to investigate these claims.

Feeding and Eating Disorders in the Context of Circadian Rhythms

A circadian rhythm is a 24-hour rhythm controlled by a master clock, the suprachiasmatic nucleus, and driven by synchronizing internal/external zeitgebers. Food intake is one of the most important external cues/zeitgebers. Studies in humans and animals have shown that misalignment of food intake leads to chronodisruption, which is associated with metabolic disruption, obesity, and disordered eating attitudes. The term chronotype, which expresses the circadian typology, has been classified into 3 main types that represent the differences in the reflection of circadian rhythms shown in human studies on daily behaviors. It has been reported that evening-type individuals are more prone to disrupted eating attitudes, such as skipping meals, eating at night, and consuming a calorie-rich diet. In addition, eating disorders up to the diagnostic level is associated with the evening type. The bidirectional relationship between impaired circadian rhythms and disordered eating attitudes has brought chronotherapeutic interventions, which are biological rhythm-oriented treatment approaches, to the agenda. Bright light therapy has been found to reduce bulimic eating behaviors and night eating symptoms. More evidence is needed regarding the effect of chronotherapeutic approaches on metabolic disorders, disordered eating attitudes, and eating disorders associated with obesity.

Feeding and Eating Disorders in the Context of Circadian Rhythms

A circadian rhythm is a 24-hour rhythm controlled by a master clock, the suprachiasmatic nucleus, and driven by synchronizing internal/external zeitgebers. Food intake is one of the most important external cues/zeitgebers. Studies in humans and animals have shown that misalignment of food intake leads to chronodisruption, which is associated with metabolic disruption, obesity, and disordered eating attitudes. The term chronotype, which expresses the circadian typology, has been classified into 3 main types that represent the differences in the reflection of circadian rhythms shown in human studies on daily behaviors. It has been reported that evening-type individuals are more prone to disrupted eating attitudes, such as skipping meals, eating at night, and consuming a calorie-rich diet. In addition, eating disorders up to the diagnostic level is associated with the evening type. The bidirectional relationship between impaired circadian rhythms and disordered eating attitudes has brought chronotherapeutic interventions, which are biological rhythm-oriented treatment approaches, to the agenda. Bright light therapy has been found to reduce bulimic eating behaviors and night eating symptoms. More evidence is needed regarding the effect of chronotherapeutic approaches on metabolic disorders, disordered eating attitudes, and eating disorders associated with obesity.

From the urge to see one's own blood to the urge to drink it: Can hemomania be specified as an impulse control disorder? Two case reports

At least half of self-mutilative individuals report that seeing their own blood is comforting, while a quarter report that they have tasted it. Bloodletting and blood-drinking behaviors have been discussed in case reports of disorders such as borderline personality disorder, bulimia nervosa, dissociative identity disorder, and psychotic disorder. The role of blood-drinking behavior, however, needs to be clarified in the psychiatric literature. This paper is the first to discuss blood-drinking behavior as a possible impulse control disorder that progresses from a desire to see or taste one's own blood. It presents the cases of two patients who report drawing blood from their own arms via syringe and drinking it. The first patient began to suck her own blood by removing scabs at age 8. The second started cutting his arm during his middle school years to reduce tension. Both eventually began to drink their own blood by draining it impulsively. This paper presents two cases with blood-drinking behavior diagnosed as impulse control disorder not otherwise specified according to the Diagnostic and Statistical Manual of Mental Disorders. We propose the term "hemomania" to describe an impulse control disorder characterized by impaired functioning due to at least one of the following urges: seeing one's own blood, self-bloodletting, and tasting/drinking one's own blood. We argue that hemomania progresses from an urge to see one's own blood to the urge to drink it, though randomized controlled studies are needed to support this claim.

Comparison of venlafaxine alone versus venlafaxine plus late partial sleep deprivation therapy combination for major depressive disorder

Treatment resistance, medication non-adherence, and side effects of pharmacotherapeutics make treatment difficult in major depressive disorder. Sleep deprivation is a fast-acting and tolerable reinforcement treatment method. In this study, we investigated the effects of late partial sleep deprivation (PSD) therapy added to venlafaxine treatment on symptoms of anxiety and depression, sleep quality and treatment process. This study was conducted in a sample of 40 patients who were admitted to our inpatient psychiatric unit with a diagnosis of major depressive disorder. While the venlafaxine (Ven) group received only venlafaxine treatment, the venlafaxine+partial sleep deprivation (Ven+PSD) group underwent late partial sleep deprivation therapy three times in the first week in addition to venlafaxine treatment. The Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D), Beck Depression Inventory, Pittsburgh Sleep Quality Index, and Insomnia Severity Index (ISI) were administered to both groups at the baseline and at the end of the 1st, 4th, and 6th weeks and, additionally, Profile of Mood State (POMS) was administered to the Ven+PSD group before and after each PSD. The Ven+PSD group had lower HAM-D and HAM-A scores than the Ven group at the end of the 1st and 6th week. Both anxiety and depression subscale scores on the POMS showed a significant decrease after PSD in the Ven+PSD group. The mean venlafaxine dose (mg/d) was significantly lower in the Ven+PSD group than in the Ven group. Late partial sleep deprivation is a fast-acting and tolerable therapy in major depressive disorder.

A case report of patient who had two manic episodes with psychotic features induced by nasal decongestant

Objective

Phenylephrine, pseudoephedrine and ephedrine are the sympathomimetic drugs that have been used most commonly in oral preparations for the relief of nasal congestion. These drugs stimulate the central nervous system that is affected by the alpha and beta adrenergic agonism. Sympathomimetic agents used in the treatment of flu and common cold with ephedrine and pseudoephedrine are case reports. That the manic and psychotic episodes are triggered. In this article, we would like to present a bipolar manic disorder with two manic episodes and both of them triggered by influenza drugs.

Case

A 25-year-old man patient was admitted to psychiatric outpatient clinic with increasing complaints such as increasing energy, speaking much, decreasing sleep, increasing the libido after using the flu drug that prescribed to him containing phenylephrine. Also, 2 years ago, he has manic attack triggered after the flu drug.

Discussion

In recent years the study of epilepsy and bipolar disorder in common suggests that bipolar disorder may affect the kindling phenomenon. In our case, two of reasons in the neurobiology of developing manic attacks the kindling phenomenon is likely to be effective. First, the possibility of using cold medicine containing ephedrine or pseudoephedrine in the first manic episode, in the second manic episode having spent the attack with FAQ stimulant effect of lower phenylephrine. Second, in the first episode after using the 5–6 tablets developing manic attacks. In the second attack to be triggered with just 2 doses may indicate the effect of kindling.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

The effects of individual circadian rhythm differences on insomnia, impulsivity, and food addiction

PURPOSE

Individuals can generally be divided into morning, neither and evening types according to behavioral, psychological, and biological variables including appetite levels, usual meal times, sleep times, and melatonin secretion. These factors together identify a person as being part of a certain chronotype, i.e., as feeling more efficient either in the morning (morning type) or later in the day (evening type). Food addiction is defined as addictive behavior toward palatable foods and is thought to be one of the underlying risk factors for obesity. Our aim in this study was to investigate the relationship between circadian rhythm differences and food addiction via insomnia and impulsivity in university students.

METHOD

Participants were 1323 university students, filled out a package of psychological tools, including the Morningness-Eveningness Questionnaire, Insomnia Severity Index, Barratt Impulsiveness Scale Short Form, and Yale Food Addiction Scale. Logistic regression analysis was used to investigate direct relation of food addiction with insomnia, impulsivity and obesity, and mediation regression analysis was used to investigate the indirect effect of circadian rhythm differences on food addiction.

RESULTS

Our findings indicated that evening types were more prone to insomnia and impulsivity, and also insomnia and impulsivity significantly contributed to the variance of food addiction. Although there was no significant linear relationship between circadian rhythm differences and food addiction, evening-type circadian preferences were indirectly associated with higher food addiction scores mediated by insomnia and impulsivity.

CONCLUSION

The most remarkable result of our work was that circadian rhythm differences seem to indirectly effect on food addiction through elevated insomnia and impulsivity.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional survey.

The relationship between night eating symptoms and disordered eating attitudes via insomnia and chronotype differences

Humans' sleep timing and the psychological construct "diurnal preference" determines their "chronotype" (i.e., morning or evening type). Diurnal preferences can affect sleep-awake rhythms and eating behaviors. Our aim in this study was to examine the relationship between night eating symptoms and disordered eating attitudes by evaluating insomnia and chronotype differences in university students. The participants, 383 university students, filled out a package of psychological tools, including the Morningness-Eveningness Questionnaire, the Insomnia Severity Index, the Night Eating Questionnaire, and the Eating Attitude Test. One way analysis of variance was used to investigate the relationship of chronotypes with scale scores, and mediation regression analysis was used to investigate the indirect effects of night eating symptoms on disordered eating attitudes. Insomnia and night eating scores of the participants varied statistically according to chronotypes, and both insomnia and night eating scores were associated with the evening type. Findings show that night eating symptoms have a direct effect on the chronotype differences and insomnia and an indirect effect on disordered eating attitudes, by increasing insomnia scores. In conclusion, night eating syndrome may represent the misalignment of food intake and may shift the circadian rhythm to delayed sleep phase, acting as a peripheral oscillator in human.

Heterogeneity of sleep quality in relation to circadian preferences and depressive symptomatology among major depressive patients

BACKGROUND

The current study aimed at investigating the latent dimensional structure of sleep quality as indexed by the seven components of the Pittsburgh Sleep Quality Index (PSQI), as well as latent covariance structure between sleep quality, circadian preferences and depressive symptoms.

METHODS

Two hundred twenty-five patients with major depressive disorder (MDD), with an average age of 29.92 ± 10.49 years (aged between 17 and 63), participated in the study. The PSQI, Morningness-Eveningness Questionnaire (MEQ) and Beck Depression Inventory (BDI) were administered to participants. Four sets of latent class analyses were subsequently run to obtain optimal number of latent classes best fit to the data.

RESULTS

Mixture models revealed that sleep quality is multifaceted in MDD. The data best fit to four-latent-class model: Poor Habitual Sleep Quality (PHSQ), Poor Subjective Sleep Quality (PSSQ), Intermediate Sleep Quality (ISQ), and Good Sleep Quality (GSQ). MDD patients classified into GSQ latent class (23.6%) reported the lowest depressive symptoms and were more prone to morningness diurnal preferences compared to other three homogenous sub-groups. Finally, the significant association between eveningness diurnal preferences and depressive symptomatology was significantly mediated by poor sleep quality.

LIMITATION

The cross-sectional nature of the study and the lack of an objective measurement of sleep such as polysomnography recordings was the most striking limitation of the study.

CONCLUSIONS

We concluded sleep quality in relation to circadian preferences and depressive symptoms has a heterogeneous nature in MDD.

The effects of individual biological rhythm differences on sleep quality, daytime sleepiness, and dissociative experiences

Individuals who differ markedly by sleep chronotype, i.e., morning-type or evening-type also differ on a number of psychological, behavioral, and biological variables. Among several other psychological functions, dissociation may also lead to disruption and alteration of consciousness, which may facilitate dream-like experiences. Our study was aimed at an inquiry into the effects of individual biological rhythm differences on sleep quality and daytime sleepiness in conjunction with dissociative experiences. Participants were 372 undergraduate college students, completed a package of psychological instruments, including the Morningness-Eveningness Questionnaire, Dissociative Experiences Scale, Insomnia Severity Index, and Epworth Sleepiness Scale. Using logistic regression models, direct relations of pathological dissociation with sleepiness, sleep quality and circadian preferences were investigated. Poor sleep quality and sleepiness significantly contributed to the variance of dissociative symptomatology. Although there was no substantial linear association between circadian preferences and pathological dissociation, having evening-type preferences of sleep was indirectly associated with higher dissociation mediated by poor sleep quality. Poor sleep quality and daytime sleepiness seems to be significant antecedents of pathological dissociation. Sleep chronotype preferences underlie this relational pattern that chronobiological characteristics seem to influence indirectly on dissociative tendency via sleep quality.

Investigation of Food Addiction and Impulsivity Relations Biological Rhythms Differences and Insomnia in University Students

Objective

Increasing prevalence of obesity in the world and increasing role of processed foods in daily life has led to become the focal point of food addiction. This study aims to investigation of food addiction and impulsivity relations biological rhythms differences and insomnia in university students.

Method

One thousand and five hundred students planned to participate who studies in Konya Selcuk University central campus. Participants were to fill out the test during their classes under physician supervision. The volunteers completed a package of psychological instruments including the Morningness–Eveningness Questionnaire, Yale Food Addiction Scale, Insomnia Severity Index, and Barratt Impulsiveness Scale administered by two investigators in their classrooms.

Results

In total, 1323 forms were suitable for statistical analysis. The mean age was 20.83, mean BMI was 22.02. Food addiction prevalence was 18.2%. Our study showed that association between the eveningness type and food addiction (P < 0.045). Also, the eveningness type and insomnia were in positive correlation in impulsivity (P < 0.001).

Conclusion

This study has explored the association between eveningness type of biological rhythms, food addiction, insomnia and impulsivity.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Evaluation of the Relationship between Major Depressive Disorder and Bereavement Symptoms in Elderly Patients Who Present Either to Psychiatry or Family Medicine

INTRODUCTION

We aimed to determine the level of bereavement and depression symptoms among elderly patients who experience the loss of a significant other and the relationship between depressive symptoms and bereavement symptoms.

METHODS

The study sample consisted of elderly adults who lost a significant other at least 6 months prior to the submission time. Participants were recruited from patients who presented to either the psychiatry or family medicine outpatient unit of a Training and Research Hospital. Cognitive functions were assessed using Standardized Mini Mental Examinations for Educated and Uneducated People (SMME/SMME-U). Participants were excluded from the study if their SMME or SMME-U scores were lower than 23 points. To assess the severity of depressive and bereavement symptoms, the Geriatric Depression Scale (GDS) and Core Bereavement Items (CBI) scales were used, respectively.

RESULTS

Overall, 33 out of 67 individuals (49.2%) who presented to the psychiatry unit and 7 out of the 43 individuals (16.3%) who presented to the family medicine unit were diagnosed with major depressive disorder (MDD). CBI scale score means were higher in the MDD groups than in the non-depressive groups (p=0.012 and p=0.001, respectively). CBI scores were significantly correlated to acute (p=0.047) and chronic stress (p=0.007) in the psychiatry group and to chronic stress in the family medicine group (p=0.001).

CONCLUSION

Probing loss experiences and reactions to them can be important to understand depression, to evaluate its symptoms, and to help manage the relevant symptoms. Considering the significant contributions of bereavement to depressive symptom severity in elders, interventions specific to bereavement symptoms should not be ignored.

Association between endocrinological, immunological and psychosocial variables in psoriasis patients

BACKGROUND

There is limited data concerning the relationship between psychosocial problems of psoriasis patients and the function of their hypothalamic-pituitary-adrenal (HPA) axis and immunologic markers. This study aimed to determine serum levels of basal cortisol and adrenocorticotropic hormone (ACTH) and circulating levels of various cytokines and chemokines and their association with psychological measures in psoriasis patients.

METHODS

Serum concentrations of endocrinological and immunological variables were quantified, and psychiatric questionnaires were completed.

RESULTS

In psoriasis patients, serum levels of ACTH, TNF-a, IL-6, IL-23, CCL-17, CCL-27, CCL-20 and CXCL-9, current psychiatric symptoms and childhood neglect scores were all higher than in controls. In addition, in psoriasis patients, physical neglect scores were related to lower basal cortisol, whereas recent stressful life events were related to higher IL-6, IL-23 and CCL-20 levels.

CONCLUSIONS

The exposure to stressful life events in childhood and just before a flare-up of psoriasis may be related to altered function of the HPA axis and an immune dysregulation in psoriasis.

Psychometric properties of the Turkish version of the Sleep Hygiene Index in clinical and non-clinical samples

OBJECTIVE

Sleep is one of the most significant of human behaviors, occupying roughly one third of human life. Sleep is a process the brain requires for proper functioning. Sleep hygiene can be described as practices to ease sleep and to avoid factors which decrease sleep quality. Inadequate sleep hygiene generally results in disturbance of daily life activities due to inability to sustain sleep quality and daytime wakefulness. Therefore, the importance of development and utilization of measures of sleep hygiene increases. The aim of the study was to assess psychometric properties of the Sleep Hygiene Index (SHI) in clinical and non-clinical Turkish samples.

METHOD

Data were collected from 106 patients with major depression consecutively admitted to the psychiatry clinic of Yüzüncü Yıl University School of Medicine and 200 were volunteers recruited from community sample who were enrolled at the university. The SHI, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI) and Epworth Sleepiness Scale (ESS) were administered to the subjects. Factor structure of the SHI was evaluated with explanatory and multi-sample confirmatory factor analyses. Pearson product-moment correlation coefficients of the SHI with the PSQI, ISI and ESS were computed. Item analyses, internal consistency coefficients and intra-class correlations between two repeated applications in both patient and healthy subjects were calculated.

RESULTS

The SHI revealed a unidimensional factor structure. Significant strong partial associations of the SHI with depression, insomnia and poor sleep quality and a modest partial association with sleepiness were detected. Cronbach's alphas for the SHI in community sample and patients with major depression were 0.70 and 0.71, respectively. Additionally, we found acceptable three-week temporal reliability in terms of intra-correlation coefficients of r=0.62, p<0.01 for the community sample and of r=0.67, p<0.01 among patients with major depression.

CONCLUSION

The SHI revealed adequate validity and reliability to be used by researchers in Turkish sample. Current results were discussed in light of previous findings and theoretical considerations.

Comparison of venlafaxine alone versus venlafaxine plus bright light therapy combination for severe major depressive disorder

OBJECTIVE

Phototherapy, ie, bright light therapy, is an effective and safe treatment of major depressive disorder (MDD). It exerts rapid mood-elevating activity, similar to antidepressant medications, most likely mediated through both monoaminergic and circadian system melatonergic mechanisms. We assessed the efficiency of bright light therapy as an adjuvant treatment to antidepressant pharmacotherapy in patients with severe MDD randomized by Hamilton Depression Rating Scale (HDRS) score to either (1) 150 mg venlafaxine hydrochloride daily at 7:00 AM or (2) 150 mg venlafaxine plus 60-minute light of 7000 lux the initial week of clinical management (venlafaxine + bright light therapy) daily at 7:00 AM.

METHOD

50 inpatients with severe MDD at the Psychiatry Clinic of Yüzüncü Yıl University Training and Education Hospital participated. The study, which was conducted from January 2013 through June 2014, entailed patients diagnosed with severe MDD based on DSM-IV-TR for the first time. Mood states were assessed by the HDRS, Profile of Mood States (POMS), and Beck Depression Inventory (BDI) before treatment and at 1, 2, 4, and 8 weeks of treatment.

RESULTS

On the basis of the HDRS score as the primary outcome variable, both strategies significantly improved depression and negative mood states already at the first treatment week (P < .001). Differences in therapeutic effects by treatment strategy were remarkable at the second and fourth weeks of clinical management (P = .018 and P = .011, respectively), with beneficial effects continuing until trial conclusion. Those treated with venlafaxine + bright light therapy evidenced significantly lower HDRS depression scores (P < .05) as well as BDI scores (P < .05) and POMS negative mood states scores (depression-dejection, tension-anxiety, anger-hostility, fatigue-inertia, and confusion-bewilderment subscales; all P < .05) after the second week. At week 4 of the trial, 19 (76%) of the 25 venlafaxine + bright light therapy patients versus just 11 (44%) of the 25 venlafaxine patients (P < .05) attained the target goal of treatment, a HDRS score ≤ 13, indicative of mild depression, and, although not statistically significant in our small sample study (P = .36), at week 8, 76% of venlafaxine + bright light therapy patients (n = 19) versus just 64% of the venlafaxine patients (n = 16) experienced complete remission of depression (HDRS score ≤ 7).

CONCLUSIONS

Both venlafaxine and venlafaxine + bright light therapy treatment strategies significantly reversed the depressive mood of patients with severe MDD; however, the latter induced significantly stronger and more rapid beneficial effects. Future longer-term studies with large sample sizes, nonetheless, are required to confirm and generalize these results to patients of diverse ethnicities and cultures with both severe and mild MDD.

TRIAL REGISTRATION

ANZCTR.org.au registration number: ACTRN12614001061628.

The Effects of Sleep Deprivation on Dissociation and Profiles of Mood, and Its Association with Biochemical Changes

INTRODUCTION

Sleep deprivation is a method, which has being used in order to comprehend the functions of sleep both in healthy individuals and for the patients of depression with in treatment, for a long time. The objective of our present study is to examine the relation between hormonal values, which are known for being related to the effects of these said changes determined in the mood, dissociation and thought suppression in healthy individuals after one night of sleep deprivation implementation.

METHODS

One night sleep deprivation was performed on a total of thirty-two healthy volunteers (16 males and 16 females) who were included in the study. Blood samples were taken from the individuals before and after sleep deprivation implementation in order to determine cortisol, dehydroepiandrosterone-sulfate (DHEA-S) and Thyroid Functions' Levels tests. In order to evaluate the effects of the sleep deprivation on moods, "White Bear Suppression Inventory (WBSI)" has been conducted, with an aim of evaluating thought suppression, "Profile of Mood States (POMS)", "Dissociative Experiences Scale (DES)" with a purpose of realizing any dissociation tendency.

RESULTS

On the individuals who have been implemented for sleep deprivation, a decrease on depression and vigor-activity sub-scales values was detected, and an increase was determined on fatigue sub-scales values of "POMS". While the values of DES were found to have been statistically increased after sleep deprivation, also a significant decrease was determined on WBSI values. Even if there hasn't been any significant statistical change determined on cortisol levels after sleep deprivation, yet there had been some significant changes detected on Thyroid Stimulating Hormone (TSH), fT3, fT4, and DHEA-S levels. Decrease in "POMS" depression sub-scale values and increase on fatigue sub-scale values were determined on the individuals whose sT4 levels were found to be increased significantly in statistic manner after the sleep deprivation.

CONCLUSION

According to the results of our study, sleep deprivation for one night was determined to cause decrease on depressive mood, increase on dissociative symptoms and to lower the tendency of suppressing the unwanted thoughts, consciously. The fact of being obtained lower depression values, on the individuals with the increased DHEA-S levels after the sleep deprivation meets with the information claiming that the high DHEA-S levels may be deemed as protectors against the negative effects of the stress.

Assessment of the effects of antihistamine drugs on mood, sleep quality, sleepiness, and dream anxiety

OBJECTIVE

There are limited comparative studies on classic and new-generation antihistamines that affect sleep quality and mood. The purpose of this study was to determine and compare the effects of classic and new-generation antihistamines on sleep quality, daytime sleepiness, dream anxiety, and mood.

METHODS

Ninety-two patients with chronic pruritus completed study in the dermatology outpatient clinic. Treatments with regular recommended therapeutic doses were administered. The effects of antihistaminic drugs on mood, daytime sleepiness, dream anxiety, and sleep quality were assessed on the first day and 1 month after.

RESULTS

Outpatients who received cetirizine and hydroxyzine treatments reported higher scores on the depression, anxiety, and fatigue sub-scales than those who received desloratadine, levocetirizine, and rupatadine. Pheniramine and rupatadine were found to be associated with daytime sleepiness and better sleep quality. UKU side effects scale scores were significantly elevated among outpatients receiving pheniramine. Classic antihistamines increased daytime sleepiness and decreased the sleep quality scores. New-generation antihistamines reduced sleep latency and dream anxiety, and increased daytime sleepiness and sleep quality.

CONCLUSION

Both antihistamines, significantly increased daytime sleepiness and nocturnal sleep quality. Daytime sleepiness was significantly predicted by rupadatine and pheniramine treatment. Cetirizine and hydroxyzine, seem to have negative influences on mood states. Given the extensive use of antihistamines in clinical settings, these results should be more elaborately examined in further studies.

Validation of the Turkish Version of the Obsessive-Compulsive Inventory-Revised (OCI-R) in Clinical and Non-Clinical Samples

INTRODUCTION

The Obsessive-Compulsive Inventory-Revised (OCI-R) is a widely used self-report instrument developed to overcome the problems with the available instruments. The aim of this study was to assess the psychometric properties of the revised Obsessive Compulsive Inventory (OCI-R) in Turkish sample.

METHODS

The psychometric properties of the Turkish version of the Obsessive-Compulsive Inventory-Revised (OCI-R) were assessed in clinical samples (n=44 for patients with obsessive-compulsive disorder (OCD), and n=44 for patients with major depression (MD) and a non-clinical student sample (n=287).

RESULTS

The confirmatory factor analysis demonstrated that the original six-factor structure was valid in the Turkish sample. The overall and each of the subscales showed moderate to good internal consistency and convergent validity as well as test-retest reliability. However, the Cronbach's alpha was excessively low for the hoarding subscale in the OCD group. The total and subscale scores of the OCI-R satisfied at discriminating patients with OCD from both patients with MD and healthy controls, with an exception of the neutralizing subscale.

CONCLUSION

The Turkish version of the OCI-R did not reveal sound psychometric properties. Findings are discussed in the light of current theoretical considerations.

Seasonality of self-destructive behaviour: seasonal variations in demographic and suicidal characteristics in Van, Turkey

OBJECTIVE

Seasonality is one of the most interesting but still elusive issue in suicide research. Linkages of seasonality in suicides to possible contributors such as gender, type of method used, and climatic factors have received attention in different cultures. We aimed at evaluating seasonal trends in suicidal behaviour according to demographic characteristics, reasons for self-destructive behaviour and means preferred in suicide.

METHODS

Our aim was to assess the seasonal variation in self-destructive behaviour in terms of completed and attempted suicides in a 3-year time period from 2008 to 2010 in Van, Turkey. A total of 1448 cases were registered over a 3-year time period in the city. Seasonal deviations in demographic characteristics, reasons for suicide, and methods of suicide were evaluated.

RESULTS

Seasonal distribution of both completed and attempted suicides by gender did not significantly deviate. On the other hand, we found a significant decline in self-destructive behaviours among those who were single and student in the spring. We found a peak in self-destructive behaviours in the autumn among Individuals who suffer from psychological problems.

CONCLUSIONS

Subjects with psychological difficulties were more prone to commit suicide in autumn. Seasonal differences in methods of suicide used by suicidal subjects were not significant.

Comparison of superoxide dismutase, glutathione peroxidase and adenosine deaminase activities between respiratory and nocturnal subtypes of patients with panic disorder

OBJECTIVE

There is mounting evidence indicating that oxidative and inflammatory processes may have an important role in the pathogenesis of panic disorder (PD). PD is a heterogeneous disease, and panic attacks are divided according to the different symptom clusters as respiratory, nocturnal, non-fearful, cognitive, or vestibular subtypes. The aim of this study was to compare whole-blood and serum superoxide dismutase (SOD), glutathione peroxidase and adenosine deaminase activities in PD patients with/without nocturnal, respiratory subtypes and healthy subjects.

METHODS

The study was conducted including 60 patients with PD and 30 healthy control subjects. The Panic Attack Symptom Checklist, Panic and Agoraphobia Scale, Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale were administered to the patients. Biochemical analyses were performed after all the blood samples were collected.

RESULTS

We found that whole-blood SOD and glutathione peroxidase activities of patients were significantly lower and adenosine deaminase activities of patients were higher than those of healthy controls. There were no statistically significant differences between respiratory and nocturnal subtypes. In addition, there were no marked relationships between the duration of illness and panic-agoraphobia scores of patients with nocturnal subtypes. Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale scores of patients with the nocturnal subtype were markedly higher than those of patients without the nocturnal subtype.

CONCLUSION

The results suggest that oxidative and inflammatory processes may play a role in the pathophysiology of PD. These findings may support the idea that both nocturnal and respiratory subtypes of PD have different symptom clusters of the same disease.

Antidepressants and menstruation disorders in women: a cross-sectional study in three centers

OBJECTIVE

The relationship between menstruation disorders and antidepressant drugs usage in women remains unclear. In this study, we aimed to investigate the incidence rate of antidepressant-related menstruation disorders and to examine whether or not antidepressant use is associated with menstrual disorders in women.

METHODS

The study sample was gathered from three centers and four hospitals. A total of 1432 women who met the criteria of inclusion were included in the study. The sample was divided into two groups: the antidepressant group (n=793) and the control group (n=639). The menstruation disorders were established with reports from the study participants on the basis of related gynecological descriptions.

RESULTS

The prevalence of menstrual disorders was significantly higher in the antidepressant group (24.6%) than the control group (12.2%). The incidence of antidepressant-induced menstruation disorder was 14.5%. The antidepressants most associated with menstrual disorders were paroxetine, venlafaxine, sertraline and their combination with mirtazapine. Overall, the incidence rate was similar in women receiving selective serotonin reuptake inhibitors and serotonin noradrenaline reuptake inhibitors.

CONCLUSIONS

The results of the present study suggest that menstruation disorders are frequently observed in women taking antidepressants and that it appears to be associated with antidepressant use at least in some women.

Oxidative stress in patients with primary insomnia

OBJECTIVE

Many physiological and pathological processes, such as infections, environmental toxins, and ionizing radiation increase bodily concentrations of oxidizing substances, known as free radicals, which lead to neurodegenerative disorders. Sleep is one of the most important factors contributing to health; however, insomnia is among the most prevalent health complaints.

METHODS

In this study, for the first time in the literature, we investigated the effects of primary insomnia on certain oxidative stress biomarkers. For this purpose, glutathione peroxidase (GSH-Px), superoxide dismutase (SOD), and myeloperoxidase (MPO) activities and levels of reduced glutathione (GSH) and malondialdehyde (MDA) were measured in 30 patients with primary insomnia and 30 healthy volunteers

RESULTS

Our results show that the patients with primary insomnia had significantly lower GSH-Px activity and higher MDA levels compared with the controls.

CONCLUSION

These results may indicate the important role of sleep in attenuating oxidative stress.

Relations between childhood traumatic experiences, dissociation, and cognitive models in obsessive compulsive disorder

OBJECTIVE

Previous studies have indicated that obsessive compulsive disorder (OCD) is associated with childhood traumatic experiences and higher levels of dissociation. Dissociative tendency may arise when individual attempt to incorporate adverse experiences into cognitive schema.

METHODS

We investigated the possible links among childhood trauma, dissociation, and cognitive processes. We evaluated 95 patients with OCD using the Beck Depression Inventory (BDI), Thought-Action Fusion Scale (TAFS), Metacognitions Questionnaire (MCQ-30), White Bear Suppression Inventory (WBSI), Dissociative Experiences Scale (DES), and Childhood Trauma Questionnaire (CTQ-28).

RESULTS

The CTQ-28 total scores were not associated with Y-BOCS total, Y-BOCS insight, BDI, TAFS, MCQ-30, and WBSI scores. The TAFS Total, MCQ-30, WBSI, and BDI scores were significantly associated with DES scores. Regression analysis revealed that MCQ-30 and WBSI scores significantly predicted the DES scores.

CONCLUSIONS

These results suggest that in spite of pathological connotation of dissociative experiences, dissociation may primarily constitute a cognitive trait which is strongly associated with cognitive processes.

Alterations in P wave duration and dispersion in depressive patients following electroconvulsive therapy

OBJECTIVE

Electroconvulsive therapy (ECT) consists of controlled convulsive seizure by electric stimulation of the brain. Although various electrocardiographic (ECG) changes have been reported during ECT, atrial conduction has not been studied extensively. The aim of the present study was to assess the effects of ECT on systemic arterial blood pressure and ECG parameters (P wave duration, P wave dispersion and heart rate).

METHODS

Thirty depressive patients undergoing ECT were included. Echocardiographic examination was performed on all patients before ECT sessions to exclude systolic heart failure and diastolic dysfunction which may affect P wave duration and dispersion. Twelve-lead ECG records were obtained before the first ECT and after the third session of ECT. Blood pressure was measured before and after convulsive therapy session.

RESULTS

Compared to baseline values, maximum P wave duration (99.3 ± 14.6 to 111.3 ± 8.2 ms, P=.001), P wave dispersion (50 ± 14.8 to 63.3 ± 10.3 ms, P=.001), and systolic (110.7 ± 12 to 116 ± 12.2 mmHg, P=.043) and diastolic blood pressures (70.7 ± 9.4 to 75.3 ± 8.2 mmHg, P=.028) were significantly increased after convulsive therapy session.

CONCLUSIONS

We proposed that ECT alone or in combination with atypical antipsychotics or antidepressants may influence atrial conduction as evidenced by the significantly prolonged maximum P wave duration and P wave dispersion. Longer-term follow-up of patients undergoing ECT may be appropriate to evaluate the possible long-term outcomes of our short-term results.