Investigating traumatic memory integration in people with and without post-traumatic stress disorder using the event-cueing paradigm

Poor integration and landmark views make opposing claims regarding the relationship between post-traumatic stress symptoms and trauma memory integration. This study tested these approaches using an event cluster paradigm. In total, 126 participants (Nptsd = 61; Nnon-ptsd = 65) remembered memories from the same story as trauma, positive and neutral memories and reported whether each memory was directly retrieved or generated. Moreover, the retrieval time (RT) was recorded. Finally, the participants completed the Centrality of Event Scale (CES) and Post-traumatic Stress Disorder Symptom Scale-Self Report (PSS-SR). The results demonstrated that participants with post-traumatic stress disorder (PTSD) recalled their clusters of memories more slowly and less directly than those without PTSD. However, the CES predicted PTSD severity more strongly than RT and retrieval strategy. These results suggest that traumatic memories are more disorganised but perceived as more central in PTSD.

Event centrality, transitional impact and symptoms of posttraumatic stress in a clinical sample

Background and Objectives: There is growing research indicating that event centrality strongly predicts posttraumatic stress disorder (PTSD). However, there is not much research on what makes a traumatic event central to one's life story. One reason a traumatic memory becomes a reference point for one's life story is that it brings about significant changes in one's life. This study investigated the relationships between transitional impact of an event, event centrality, and PTSD symptoms. Specifically, it tested whether higher negative changes were associated with higher levels of event centrality and PTSD symptoms. It also investigated whether event centrality mediated the relationship between transitional impact and PTSD severity.Methods: 101 individuals diagnosed with PTSD completed the Transitional Impact Scale (TIS), Centrality of Event Scale, and Impact of Event Scale-Revised regarding their traumatic experiences. Furthermore, they responded to the Posttraumatic Stress Disorder Symptom Scale-Self Report (PSS-SR), Traumatic Events Checklist (TELC), and Beck Anxiety Inventory (BAI).Results and Conclusions: Results indicate that (a) the TIS had valid and reliable psychometric properties in a PTSD sample, (b) most of the traumatic events received high negative psychological and material change scores, and (c) event centrality mediated the relationship between transitional impact and PTSD severity.

Rich club and reward network connectivity as endophenotypes for alcohol dependence: a diffusion tensor imaging study

We aimed to examine the whole-brain white matter connectivity and local topology of reward system nodes in patients with alcohol use disorder (AUD) and unaffected siblings, relative to healthy comparison individuals. Diffusion-weighted magnetic resonance imaging scans were acquired from 18 patients with AUD, 15 unaffected siblings of AUD patients and 15 healthy controls. Structural networks were examined using network-based statistic and connectomic analysis. Connectomic analysis showed a significant ordered difference in normalized rich club organization (AUD < Siblings < Controls). We also found rank ordered differences (Control > Sibling > AUD) for both nodal clustering coefficient and nodal local efficiency in reward system nodes, particularly left caudate, right putamen and left hippocampus. Network-based statistic analyses showed that AUD group had significantly weaker connectivity than controls in the right hemisphere, mostly in the edges connecting putamen and hippocampus with other brain regions. Our results suggest that reward system network abnormalities, especially in subcortical structures, and impairments in rich-club organization might be related to the familial predisposition for AUD.

Development and Preliminary Psychometric Properties of an Instrument for the Measurement of Obsessional Dissociative Experiences: The Van Obsessional Dissociation Questionnaire (VOD-Q)

A growing body of research evidence documents the substantial associations between obsessive-compulsive disorder (OCD) and dissociation. This article describes the development and preliminary psychometric properties of the Van Obsessional Dissociation Questionnaire (VOD-Q). Obsessional dissociation is defined as a tendency to dissociate in reaction to distressing, unwanted and intrusive thoughts, images and impulses. The screening tool is conceptualized to tap obsessional dissociation across three dimensions: obsessional absorption, obsessional depersonalization/ derealization and obsessional amnesia. The VOD-Q, the Padua Inventory-Revised (PI-R), the Dissociative Experiences Scale (DES), and the Obsessive Belief Questionnaire (OBQ-44) were administered in this study. The results showed that the VOD-Q had excellent test-retest reliability (ranging from 0.73 to 0.90) and internal consistency (ranging from 0.90 to 0.97). The VOD-Q total and subscale scores were significantly associated with measures of obsessive-compulsive symptoms and dissociative experiences. OCD patients scored significantly higher on the VOD-Q than community participants. Based on the present findings, the VOD-Q appears to be a reliable and valid instrument for the measurement of obsessional dissociative experiences.

Autism Spectrum Symptoms in Children and Adolescents with Obsessive Compulsive Disorder and Their Mothers

Introduction

Obsessive-compulsive disorder (OCD) affects 1-3% of children and adolescents. Although a close relation between OCD and autism spectrum disorder (ASD) has been pointed out, the relation between maternal ASD symptoms and subclinical ASD symptoms in OCD have not been evaluated adequately. In this study, children and adolescents with OCD diagnosis, and OSB indications in their mothers were investigated. The relationship between the clinical severity of these indications in children and adolescents with OCD, and maternal OSB indications will be examined.

Method

The study group consisted of 38 cases (8-18 years old) diagnosed with OCD. The control group (n=39) comprised patients of other clinics at hospital, and was matched for gender and age to the OCD patients. The Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children - Present and Lifetime Version (K-SADS-PL) was used to diagnose OCD and accompanying comorbidities. Social Communication Questionnaire (SCQ) was used to evaluate children's ASD symptoms while Autism Spectrum Quotient (ASQ) was used to evaluate maternal broad autism phenotype. OCD symptoms in children were evaluated with Children Yale-Brown Obsessive Compulsive Scale-(C-Y-BOCS), and OCD symptoms in mothers were evaluated with Yale-Brown Obsessive Compulsive Scale-(Y-BOCS).

Results

There was no significant difference between sociodemographic data of two groups. When cases and controls were compared with SCQ; all subscales' scores and total score of SCQ were statistically significant higher in OCD group and also mothers of OCD group had statistically significant higher scores in total score of ASQ and subscales except "imagination". Also in comparing the groups with Y-BOCS and C-Y-BOCS; OCD group had statistically significant higher scores in these scales.

Conclusion

ASD symptoms are prevalent in cases diagnosed with OCD and ASD symptoms increases with OCD severity. Further studies are needed to examine genetic and environmental common risk factors between OCD and ASD.

Abnormal white matter integrity in synthetic cannabinoid users

Synthetic cannabinoids have become increasingly popular in the last few years especially among adolescents and young adults. However, no previous studies have assessed the effects of synthetic cannabinoids on the structure of the human brain. Understanding the harms of synthetic cannabinoid use on brain structure is therefore crucial given its increasing use. Diffusion tensor imaging (DTI) was performed in 22 patients who used synthetic cannabinoids more than five times a week for at least 1 year and 18 healthy controls. Fractional anisotropy (FA) was significantly reduced in the cannabinoid group compared to controls in a cluster of white matter voxels spanning the left temporal lobe, subcortical structures and brainstem. This cluster was predominantly traversed by the inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, fornix, cingulum-hippocampus and corticospinal tracts. Long-term use of synthetic cannabinoids is associated with white matter abnormalities in adolescents and young adults. Disturbed brain connectivity in synthetic cannabinoid users may underlie cognitive impairment and vulnerability to psychosis.

Understanding Treatment Response and Resistance in Obsessive Compulsive Disorder in the Context of Cognitive Neuropsychological Model

Cognitive-behavioral therapies (CBT), antidepressants and neuromodulation techniques are current treatment options used in various stages of treatment procedure for obsessive-compulsive disorder (OCD). The factors that disparate treatment options from psychological approaches to invasive surgical techniques in a psychiatric disorder have in common have scarcely been described in the relevant literature. Cognitive neuropsychological model (CNM) as a novel approach offers a common framework in which psychological and neurobiological models of different psychopathologies are reconciled by means of impaired emotional processing. In this paper, an integrated approach of disrupted top-down and bottom-up emotional processing has been described to understand the efficacy of the different treatment modalities for OCD. In this model, the cognitive therapy is proposed to contribute to the gradual breakdown of schemata through the effect on top-down emotional processing instead of acting on information processing biases directly. Antidepressant drugs and behavioral therapy are proposed to alter the brain's emotion processing in a bottom-up process. Resistance to pharmacotherapy and CBT is a common problem in the patients with OCD, and a lot of factors have been described as negative predictors of these treatment options. The severity of symptoms, presence of specific symptoms, poorer insight, high level of dissociation and family accommodation are the factors associated with resistance to both pharmacotherapy and CBT. The underlying reasons establishing an association between the presence of these diverse factors and treatment resistance were discussed in the context of CNM.

Psychometric properties of the DY-BOCS in a Turkish sample of children and adolescents

BACKGROUND

Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) is a promising scale for assessing frequency and severity of symptom dimensions. The main objective of the study was to assess the psychometric properties of the DY-BOCS in a large sample of children and adolescents from Turkey.

METHODS

We studied 143 children and adolescents, 7-18years, with well characterized DSM-IV-R OCD, ascertained from seven collaborating university or state hospital sites. We compared the DY-BOCS scores with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS), the Children's Depression Inventory (CDI), the Yale Global Tic Severity Scale (YGTSS) and the Child Behavior Checklist 6-18years (CBCL 6-18).

RESULTS

The internal consistency of the DY-BOCS symptom dimensions and inter-rater agreement of component scores were excellent. The agreement between global DY-BOCS score and the total CY-BOCS score was highly significant (Pearson's r=0.55, p<0.0001). Severity scores for individual symptom dimensions were independent of one another, only modestly correlating with the global ratings, and were also differentially related to ratings of depression, anxiety and tic severity.

CONCLUSION

The DY-BOCS is a reliable and valid instrument for assessing multiple aspects of OCD symptom severity in children and adolescents from Turkey.

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.

[Psychopharmacological treatment and quality of life in obsessive compulsive disorder]

OBJECTIVE

Obsessive compulsive disorder (OCD) is an illness that considerably influences the family, academic, occupational and social functioning of patients. In this study, we aimed to investigate the impact of psychopharmacological treatment on quality of life in patients with OCD.

METHOD

Using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS) and the World Health Organization Quality of Life Measurement Instrument Short Form, Turkish Version (WHOQOL-Bref TR) we assessed 53 patients who met the DSM-IV criteria for OCD to establish baseline values. The patients were consecutively assigned to receive either sertraline (100-200 mg/day), fluvoxamine (200-300 mg/day) or paroxetine (40-80 mg/day). We reassessed 36 (68%) of the initial group after 12 weeks.

RESULTS

The scores of obsession, compulsion and depression severity at follow-up were significantly lower than those of baseline scores. There is no significant difference between the pre and post-treatment quality of life domain scores. While psychological health scores at follow-up was significantly associated with baseline HDRS scores (r=-0.35, p<0.05), social relationship scores at follow-up was significantly associated with baseline social relationship scores (r=0.63, p<0.001) and compulsion scores (r=-0.37, p<0.05). Regression analyses revealed that social relationship scores at follow-up was associated with baseline compulsion severity whereas other follow-up quality of life domain scores were not predicted by any baseline variable.

CONCLUSIONS

Clinical viewpoint and objective evaluations should be essential in the evaluation of treatment outcome, and quality of life researches may be important complement to clinical researches.

[Therapeutic response to plasmapheresis in four cases with obsessive-compulsive disorder and tic disorder triggered by streptococcal infections]

The acronym PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) has been assigned to a subgroup of patients experiencing pediatric onset obsessive-compulsive symptoms and tics as a result of autoimmune response to group A beta-hemolytic streptococcal infection. It has been hypothesized that an immune process initiated by infection affects the basal ganglia and causes neuropsychiatric symptoms. In cases with severe neuropsychiatric symptoms, the use of treatment strategies that interrupt the autoimmune process responsible for the pathogenesis of PANDAS, such as therapeutic plasmapheresis or intravenous immunoglobulin, has been proposed. In this paper, we discuss the effect of plasmapheresis treatment in 4 adult cases of obsessive-compulsive disorder and tic disorder triggered by streptococcal infections.

[The correlates of healthcare seeking behavior in obsessive-compulsive disorder: a multidimensional approach]

Obsessive-compulsive disorder (OCD) is a chronic, distressing, and disabling illness that influences the family, academic, occupational, and social functioning of patients. One of the 10 leading causes of disability worldwide is OCD; however, despite the considerable distress and disability associated with the disorder and the availability of treatment options, many OCD sufferers usually are not inclined to seek healthcare. The factors that may be central to healthcare seek behavior in OCD has scarcely been described in the literature. It has been thought that the best predictor of healthcare seeking is severity of illness; however, individuals with OCD may have various barriers to seeking healthcare. Although non-disease and disease-related factors that may influence health care seeking are related in complex ways through reciprocal influences and feedback, each factor might be an independent predictor of use of healthcare services. This review aims to discuss the impact of the disease and general factors that impact healthcare seeking behavior in OCD. In this way, new information might be provided for the identification of targets to enhance the use of mental health services among OCD sufferers in the community.

[The assessment of obsessive-compulsive symptoms: the reliability and validity of the Padua inventory in a Turkish population]

OBJECTIVE

We examined the reliability and validity of the 60-and 41-item versions of the Padua Inventory (PI and PI-R) which were developed to assess the frequency and severity of obsessive-compulsive symptoms, in a Turkish population.

METHOD

The sample consisted of 43 OCD patients, 30 non-OCD patients with other anxiety disorders, 30 nonobsessional depressed patients, 76 healthy adults, and 181 undergraduate students. We investigated internal consistency, test-retest reliability, and factor structure, concurrent and discriminant validity.

RESULTS

Psychometric analyses showed that both the original PI and PI-R had a high internal consistency and test-retest reliability. While principal factor analysis of the 41 items revealed six factors that are consistent with the PI-R, the factor structure of the original scale was not confirmed. All the subcales and total scores for both instruments were significantly correlated with the Yale-Brown scores except for the impulses subscale. There were significant differences between OCD patients and nonclinical samples in all total and subscale scores for both instruments. OCD patients scored significantly higher on the total, contamination/washing and checking subscales for both instruments than nonobsessional anxious, and depressed patients. While OCD patients scored significantly higher on the PI-R rumination scale than nonobsessional anxious patients, their PI impaired control subscale score was not different from that of the other clinical groups.

CONCLUSIONS

The Turkish version of the PI has appropriate reliability and validity for assessing the frequency and severity of obsessive-compulsive symptoms.

Serum lipid levels, suicidality, and panic disorder

Although the effects of serum total cholesterol and other lipids have been implicated as a predictor of suicidal behavior in major depression, the role of cholesterol level on suicide risk for panic disorder patients is not considered as a biological marker in the literature. In this study, we examined the relationship of suicidality with serum cholesterol concentration in panic disorder. The subjects of the study were 10 suicidal panic disorder patients, 19 nonsuicidal panic disorder patients, and 15 normal control subjects. The suicidal patients with panic disorder had lower serum total cholesterol and low-density lipoprotein (LDL) levels than normal control subjects. These findings suggest that there may be an association between suicidality and low serum cholesterol levels in panic disorder. We also discuss the possible role of serotonin in the brain in the relationship of suicidal behavior or ideation with low cholesterol concentration in panic disorder.

The predictors of health care seeking behavior in obsessive-compulsive disorder

A majority of individuals with obsessive-compulsive disorder (OCD) do not seek health care. To better understand why not, health care-seekers (HCS) with OCD (n = 25) were compared with non-health care-seekers (NHCS) with OCD (n = 23) regarding their sociodemographic variables, symptom severity, types of obsessions and compulsions, insight degree, comorbid diagnosis, and quality-of-life (QOL) level. There was no significant difference for sociodemographic characteristics between the groups. NHCS scored significantly lower on a measure of illness severity than HCS. The NHCS group had significantly poorer insight degree than the HCS group. Aggressive and religious obsessions were significantly less identified in the NHCS group compared to the HCS group. NHCS were significantly less likely to have comorbid diagnosis than HCS. The NHCS group reported significantly higher levels of QOL in psychological health and level of independence domains [corrected]. To identify the predictors of health care seeking behavior, probable variables were entered in a logistic regression model. Insight degree and level of independence emerged as the predictors of health care seeking. Our results suggest that health care seeking behavior in OCD is associated with the individuals' ability to recognize their symptoms as a disorder and subjective interpretation regarding the impact of OCD on their level of independence. Results of the present study extend findings of two recent studies that have investigated factors related to health care seeking in OCD.

[The reliability and validity of the White Bear Suppression Inventory]

OBJECTIVE

The White Bear Suppression Inventory (WBSI) is a self-report questionnaire measuring tendency to suppress unwanted intrusive thoughts. The aim of this study was to examine the reliability and validity of the WBSI in a Turkish sample.

METHOD

Thirty patients who were diagnosed with obsessive-compulsive disorder (OCD) according to DSM-IV criteria and 47 healthy subjects were included in the study. Internal consistency and homogeneity were tested by Cronbach a and Pearson correlation analysis. Student's t test and Pearson correlation analysis were used for test-retest reliability. Validity was assessed by Student's t test in independent groups.

RESULTS

Psychometric analyses showed that the WBSI had a high internal consistency (a=0.92). All of the items' scores were positively correlated with the total scores. The items of the WBSI discriminated the patients with OCD from the healthy subjects except for item 5.

CONCLUSIONS

The Turkish version of the WBSI has appropriate reliability and validity for assessing suppression tendency of unwanted intrusive thoughts.