Effect of Adjunct Psychosocial Skills Training on Social Functioning of Schizophrenia Patients Who Get Occupational Therapy in a Community Mental Health Center: A Comparative Study

Introduction

Antipsychotic drugs are effective in relieving symptoms in the treatment of schizophrenia, but decreased social functioning is resistant to drugs. In this study, the effect of adjunct Psychosocial Skills Training (PSST) on social functioning for schizophrenia patients who receive service in the community mental health center (CMHC) was investigated.

Method

Schizophrenia patients who received routine case management and occupational therapy in CMHC (n=22), patients receiving PSST in addition to CMHC service (n=21) and patients who were followed up in the Psychotic Disorders Outpatient Clinic as control group (n=21), three groups were formed. In the initial evaluations of the participants, the sociodemographic data form was filled. Social functioning and severity of clinical symptoms were evaluated at the beginning and at end of three-month follow-up period with the Social Functionality Scale (SFS), Personal and Social Performance Scale (PSP), Positive and Negative Syndrome Scale (PANSS).

Results

At the end of the follow-up period, there was a significant decrease in PANSS total scores, a significant increase in PSP and SFS total scores in the last test evaluations of the study groups. There was not any statistically significant change in the control group. The decrease in PANSS total score in PSST group is significantly higher than CMHC group. There was no significant difference between PSP and SFS scores between intervention groups.

Conclusion

The psychiatric rehabilitation in CMHC has a positive effect on the social functioning and clinical symptoms of schizophrenic patients. Adjunct PSST to routine service seems to help relieving clinical symptoms.

Long-Term Omalizumab Treatment: A Multicenter, Real-Life, 5-Year Trial

BACKGROUND

Omalizumab has demonstrated therapeutic benefits both in controlled clinical trials and real-life studies. However, research concerning the long-term effects and tolerability of omalizumab is needed. The main objective of this study was to evaluate the effectiveness and tolerability of treatment with omalizumab for up to 5 years.

METHODS

A multicenter, retrospective, chart-based study was carried out to compare documented exacerbations, hospitalizations, systemic steroid requirement, FEV1, and asthma control test (ACT) results during 1 year prior to omalizumab treatment versus at 1, 3, and 5 years of treatment. Adverse events and reasons for discontinuation were also recorded at each time point.

RESULTS

Four hundred and sixty-five patients were enrolled in the study. Outcome variables had improved after the 1st year and were sustained after the 3rd and 5th years of treatment with omalizumab. Omalizumab treatment reduced the asthma exacerbation rate by 71.3% (p < 0.001) at 1 year, 64.3% (p < 0.001) at 3 years, and 54.8% (p = 0.002) at 5 years. The hospitalization rate also decreased; by the 5th year of the treatment no patients were hospitalized. ACT results had also improved significantly: 12 (p < 0.001) at 1 year, 12 (p < 0.001) at 3 years, and 12 (p = 0.002) at 5 years. Overall, 12.7% of patients reported adverse events (most of these were mild-to-moderate) and the overall dropout rate was 9.0%.

CONCLUSION

Omalizumab had a significant effect on asthma outcomes and this effect was maintained over 5 years. The drug was found to be generally safe and treatment compliance was good.

Adults with common variable immunodeficiency: a single-center experience

BACKGROUND/AIM

In this study, we aimed to assess the clinical and immunological findings of our patients with common variable immunodeficiency (CVID).

MATERIALS AND METHODS

We analyzed the records of 31 adult patients with CVID (12 females, 19 males). The patients were classified into clinical and immunophenotypic subgroups for statistical comparisons.

RESULTS

Our patients had some clinical signs in considerable frequencies, such as low body weight (45.2%), urinary tract infections (41.9%), various dermatoses (35.5%), and oral aphthae (32.3%). The histological findings in the biopsy specimens of the gastrointestinal tract (nodular lymphoid hyperplasia, villous atrophy, and lymphocytic infiltrates at mucosa) were significantly associated with splenomegaly, hepatomegaly, or low body weight (P = 0.005, 0.045, and 0.007, respectively). The patients with low CD4/CD8 ratios had lower IgG levels and a lower percentage of CD19+ B cells, but a higher percentage of activated T cells (P = 0.023, 0.011, and 0.028, respectively).

CONCLUSION

In adults with CVID, there existed some clinical signs at considerable frequencies, but these are not overemphasized in the literature. The CD4/CD8 ratio is an important factor in antibody production and the clinical presentation of CVID. It seems that the adaptive immune system is on alert and subclinical immune activation insidiously continues in patients with CVID.

Psychometric properties of the Turkish version of the Internet Addiction Test (IAT)

OBJECTIVE

Of many instruments developed to assess Internet addiction, the Internet Addiction Test (IAT), an expanded version of the Internet Addiction Diagnostic Questionnaire (IADQ), has been the most widely used scale in English and non-English speaking populations. In this study, our aim was to investigate the psychometric properties of short and expanded versions of the IAT in a Turkish undergraduate sample.

METHOD

Overall, 455 undergraduate students from Turkey aged between 18 and 30 participated in the study (63.53% were females). Explanatory and confirmatory factor analytic procedures investigated factor structures of the IADQ and IAT. The Internet Addiction Scale (IAS), Coping Inventory for Stressful Situations (CISS), Obsessive Compulsive Inventory-Revised (OCI-R) and Dissociative Experiences Scale (DES) were administered to assess convergent and divergent validities of the IADQ and IAT. Internal consistency and 15-day test-retest reliability were computed.

RESULTS

In the factorial analytic investigation, we found a unidimensional factor structure for each measure fit the current data best. Significant but weak to moderate correlations of the IADQ and the IAT with the CISS, OCI-R and DES provided empirical evidence for divergent validity, whereas strong associations with the subscales of the IAS pointed to the convergent validity of Young's Internet addiction construct. Internal consistency of the IADQ was weak (α=0.67) and of the IAT was high (α=0.93). Temporal reliability of both instruments was very high (α=0.81 and α=0.87; respectively).

CONCLUSION

The IAT revealed promising and sound psychometric properties in a Turkish sample.

Continuous ambulatory peritoneal dialysis: CT peritoneography findings and assessment of related clinical complications

Purpose: To assess complications of continuous ambulatory peritoneal dialysis (CAPD) in uremic patients with and without clinical symptoms by CT peritoneography.

Material and Methods: A total of 64 patients with end-stage renal disease and on continuous CAPD were investigated. Twenty-eight had some clinical symptoms, which might be related to the complications of CAPD. Thirty-six patients had no complaints or symptoms due to the dialysis treatment.

Results: CT peritoneography revealed various complications including hernias (50%), dialysate leakage (46%), localized fluid collection (4%) and peritoneal adhesions (4%) in the patients who had clinical symptoms that might be related to the dialysis treatment. Moreover, similar complications were found in the asymptomatic patients at a lower rate: hernia (3%), dialysate leakage (17%), peritoneal adhesions (3%) and abdominal wall laxity (3%). Complication detection rate by CT peritoneography was 68% (n=19) in the symptomatic patients and 22% (n=8) in the asymptomatic patients. The number of complications found in each group was significant.

Conclusion: CT peritoneography was an effective modality in detecting complications from CAPD in patients with and without clinical symptoms.

Agomelatine vs fluoxetine: Efficacy and improvement of cognitive functions in patients with MDD

Introduction

In major depressive disorder (MDD) neurocognitive functions are impaired. In addition to melatonergic properties of agomelatine, via 5-HT2C antagonism it increases extracellular noradrenaline and dopamine in frontal cortex and may improve the neurocognitive functions of patients with MDD.

Aims and objectives

To investigate the extent of neurocognitive improvement and efficacy of agomelatine and fluoxetine in patients with MDD.

Material and method

Agomelatine 25 mg/day (n: 24) and fluoxetine 20 mg/day (n: 24) were administered to drug-naive unipolar, non-psychotic, non-suicidal MDD patients according to DSM-IV. Evaluations were performed just before the treatment and at the sixth week of treatment via administering Hamilton Depression Rating Scale, Rey Auditory Verbal Learning Test, Controlled Oral Word Association Test (COWAT), Digit Span Test (DST), Trail Making Test (TMT-A/B), Stroop Test and Wisconsin Card Sorting Test.

Results

Both agomelatine and fluoxetine was found to be efficacious for the treatment of MDD (P < 0.05 for both). Further there was no difference between the antidepressant efficacy of two drugs. Both of the drugs improved measured neurocognitive functions (P < 0.05), except scores of DST (P > 0.05) and only fluoxetine improved significantly scores of COWAT (P < 0.05). Only in terms of TMT-B there was significant difference between groups and agomelatine was superior to fluoxetine (P < 0.05).

Conclusion

Agomelatine and fluoxetine were efficacious in treatment of MDD. Furthermore both of the drugs improved cognitive functions in patients with MDD. Superiority of agomelatine in improvement of executive functioning (TMT-B) is important and therefore it could be an appropriate choice for MDD patients who have pronounced executive disturbances.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Killer-cell immunoglobulin-like receptor and human leukocyte antigen-C genes in common variable immunodeficiency

BACKGROUND

We aimed herein to investigate the killer-cell immunoglobulin-like receptor (KIR) genes and human leukocyte antigen (HLA)-C alleles in patients with common variable immunodeficiency (CVID), and to reveal their differences from those in healthy population.

METHODS

In all, 18 patients who have been diagnosed with CVID and 15 living donors of kidney transplant recipients were enrolled in the study. Polymerase chain reaction-sequence-specific primer (PCR-SSP) typing method was used in molecular genetic analysis. The frequencies of the genes in the study groups were statistically compared with each other using chi-square or Fisher exact tests, whichever were appropriate.

RESULTS

Although there was no significant difference between both study groups with respect to distribution of KIR and HLA-C2 group genes, HLA-Cw7 allele frequency in patients with CVID was significantly lower than that in healthy population (P = 0.008).

CONCLUSION

This present study results support that HLA-Cw7 allele, an inhibitor of KIR ligand, may play a role in the pathogenesis of CVID.

Development of a Psychometric Instrument Based on the Inference-Based Approach to Obsessive-Compulsive Disorder: The Obsessional Probabilistic Inference Scale

INTRODUCTION

The current article addresses the validation of the construct of obsessional probabilistic inference in clinical and non-clinical samples. Obsessional probabilistic inference or obsessional doubt refers to a type of inferential process resulting in the belief that a state of affairs "maybe" causes development of a maladaptive cognitive coping style in terms of obsessing.

METHODS

The latent structure of the Obsessional Probabilistic Inference Scale (OPIS) was evaluated with confirmatory factor analysis.

RESULTS

Explanatory and confirmatory factor analyses indicated that a one-factor solution was satisfactory for the instrument, assessing a unidimensional psychological construct. The OPIS was shown to have high internal consistency in all samples, as well as temporal stability, relying on predominantly non-clinical individuals. The scale exhibited high convergent validity and successfully discriminated patients with obsessive-compulsive disorder from both depressive patients and controls.

CONCLUSION

The findings replicated and extended the role of reasoning process in the development and maintenance of obsessive compulsive symptoms. The results are discussed in regard to assumptions of the inference-based approach to obsessive-compulsive disorder.

The comparison of folate and vitamin B12 levels between depressive and nondepressive postmenopausal women

BACKGROUND/AIM

To investigate if there is any association between the serum folate and vitamin B12 status and the depressive symptoms in postmenopausal women.

MATERIALS AND METHODS

The study included 95 postmenopausal women. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess their depressive symptoms. The investigated women were classified into 2 groups based on the existence of depressive symptoms. These 2 groups were compared in terms of folic acid and vitamin B12 levels.

RESULTS

Among 95 cases, 27 postmenopausal women scored 16 or more on the CES-D scale and were classified as the depressive group (Group 1), and 68 postmenopausal women scored 15 or less and were classified as the nondepressive group (Group 2). The serum levels of folate were 11.5 ± 5.4 ng/mL in group 1 and 12.3 ± 5.3 ng/mL in group 2. The concentrations of vitamin B12 were 456.2 ± 343.4 pg/mL in group 1 and 446.5 ± 165.1 pg/mL in group 2. The folate and vitamin B12 levels did not significantly correlate to the frequency of depressive symptoms (P = 0.52 and P = 0.24, respectively).

CONCLUSION

In this study, no correlation was detected between serum folate and vitamin B12 levels and depressive symptoms in postmenopausal women. Supplementation of folic acid and vitamin B12 for postmenopausal women does not seem to be an effective intervention to reduce depressive symptoms.

Treatment resistant late-onset depression with frontal cortical atrophy and neurocognitive impairment: A case report

Background

Late-onset depression (after age 60) has more frequently been reported to be associated with brain abnormalities compared to early-onset depression. Consistent with the hypothesized role of frontolimbic circuits in the etiology of depression, the preponderance of cross-sectional studies of late-life clinical depression have revealed structural and functional changes in the frontal lobes

Case report

NK was 70 years old female patient. She had a psychiatric history of five years with these symptoms. She had used several different antidepressants and benzodiazepines at adequate doses and some times low-dose atypical antipsychotics but she never had a full recovery. In this hospitalization, she was diagnosed as Major Depressive Disorder according to SCID-I. In MRI, we found generalized cortical atrophy especially in the frontal region. In neurocognitive tests, we realized that her minimental test score was 25. Wisconsin Card Sorting Test and Stroop test (main card reading time 54 seconds) showed disability in the executive functions such as cognitive flexibility, planning, decision making, overcoming of a strong habitual response or resisting temptation and in focused attention and working memory. The other cognitive domains evaluated with Rey Auditory learning test, Auditory trigram test, digit span test, trial making test, word association test were found to be normal. Conclusion: Treatment-resistant depression (TRD) is usually conceptualized as a failure to respond to several courses of adequate antidepressant treatment. Our findings can be suggested that cortical atrophy in especially frontal lobes can be consistent with a treatment resistance and neurocognitive impairment.

Severe generalize cortical atrophy inconsistent with her age, and neurocognitive impairment in an untreated schizophrenia patient: A case report

Background

In schizophrenia, frontal structural and functional deficits are replicated findings.

Case

AK was 40 years old. She had not been appealed to psychiatry department or took any medicine. She had had severe positive symptoms such as, grandiosity, delusions, auditory and visual hallucinations, hallucinatory behaviors, mystic contains of thoughts since her childhood. MRI had been showed that the severe cortical atrophy inconsistent with her age. In the assessment of neurocognitive tests we found that the signs of frontal - prefrontal and temporo-limbic impairment. On Rey Auditory learning test she could remember totally 34 words as a sum of the 1st to 5.th Readings. At 6.th reading she remembered 5 words and at 7th 6 words. At recognition part of the test she had 8 true positive and 3 false positive results. On Auditory trigram test, her score was 25 and on controlled word association test she could tell 20 total words. In digit span test her scores were 4 at forward section and 4 at backwards section. She could not perform trial making test part A or part B. On Stroop test she completed section 5 (main card reading time) at 26 seconds. These results suggested us that she had dysfunction in the cognitive domains such as; working memory, focused attention, short time verbal memory and frontal executive functions.

Conclusion

This sample has been attracted attention to neurodegenerative process notwithstanding without antipsychotic treatments effects.

[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 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.

Alveolar echinococcosis of the liver: correlative color Doppler US, CT, and MRI study

PURPOSE

To determine and compare the imaging features of hepatic alveolar Echinococcosis using color Doppler US, CT, and MRI.

MATERIAL AND METHODS

Abdominal CT and MRI with and without contrast agents and color Doppler US were performed on seven patients with hepatic alveolar Echinococcosis. The lesions were evaluated for location, features of echogenicity, intensity and density, calcification, and vascular, hilar, and perihepatic involvement. The diagnosis was confirmed histopathologically in all patients.

RESULTS

Six patients had solitary lesions, and one displayed multiple lesions. The lesions were generally seen as heterogeneous and hyper- or hypoechoic when imaged with color Doppler US, hypodense with CT, and hypointense with MRI, in comparison with the liver parenchyma. Calcification, central necrosis, and small peripheral cysts were observed in six, seven, and four patients, respectively. Vascular flow or contrast enhancement was not observed in any of the cases. A look at the respective advantages of each method reveals that calcification was best rendered visible via CT, small peripheral cysts with T2-weighted MRI, central necrosis with CT and MRI, and perihepatic invasion with multiplanar MRI. Vascular involvement was revealed by all methods.

CONCLUSION

Color Doppler US, CT, and MR imaging function extremely well as complementary methods in the diagnosis of HAE. Color Doppler US should be performed in these patients owing to its ability to efficiently detect the disease. Knowledge of imaging characteristics makes it possible to radiologically ascertain an early diagnosis.

Imaging of an atypical case of congenital toxoplasmosis

In this article we describe the cranial computerized tomography findings of an infant with congenital toxoplasmosis, which was performed because she showed an atypical clinical course consisting of meningitis and multiple cerebral abscesses. In this case the cranial computerized tomography allowed the diagnosis of hydrocephalus and multiple cerebral abscesses, and guided the therapeutic approach.

A study of the prevalence of having fractures and the affecting factors in young male adults throughout childhood and adolescence

Injuries due to accidents in children and adolescents, who are more sensitive to different risk factors in their social and physical environments, play an important part in mortality and morbidity. Fractures are the most commonly seen problems among these injuries. This cross-sectional study was carried out in a two-year vocational military school in Ankara between 1-10 May 2000. All, 2720 students in the school were included and data were collected via a questionnaire distributed to the students. It was found that 418 (17%) out of 2,461 students we could interview had had a fracture. No statistically meaningful relationship was found between the frequency of having fractures and the educational status of the parents or employment status of the mother. However, it was seen that the frequency of fractures increased as the economical status of the parents increased. The high frequency of fractures in childhood and adolescence in young males, and the traditional practice of going to unlicensed and medically untrained adults, and "bonesetters" (27% of those surveyed) are two important findings that should be taken into consideration.