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Objectives: Comorbidity of migraine and mood disorders has long been recognized. Most of the studies have focused on the relationship between migraine and major depression with only few studies suggesting a special association between migraine and bipolar spectrum disorders. We aimed to evaluate the prevalence of bipolar disorder in migraine patients in a specialized headache outpatient clinic., Methods: The sample consisted of 78 consecutive patients with migraine headache presenting to the specialized headache outpatient clinic in a Medical Faculty. Migraine diagnosis was established with the International Headache Society's criteria for migraine. Patients were evaluated with Structured Clinical Interview for DSM-IV for mood disorders. Bipolar spectrum definition was broadened with the presence of Akiskal's criteria for affective temperaments (cyclothymic, hyperthymic, irritable, and depressive)., Results: Patients in the bipolar spectrum comprised 10.3% (n=8) of the sample. 11 patients (14.1%) had a diagnosis of unipolar depression and 7 patients (9%) had a diagnosis of dysthymic disorder. 41% of the patients (n=32) had an affective temperament. Bipolar disorder was observed with increased frequency in this migraine sufferer population, supporting previous findings of increased prevalence of bipolar disorders in patients with migraine., Conclusion: Increased frequency of affective temperaments might be considered in the context of a common pathophysiological background for migraine and bipolar disorders where these temperaments are sub-threshold presentations of mood disorders. Therefore, the definition of patients with comorbid migraine and bipolar disorder may serve as a more homogenic subgroup of mood disorders for further studies.

Objective: To provide registry-based prevalence estimates of schizophrenia, schizoaffective, and bipolar I (BPI) disorders in a defined area of Sinop, Turkey., Material and Methods: All patients that presented to primary and secondary health services over three year time (2009-2011) with diagnosis of psychotic disorder (F06.1, F06.2, F10.5, F12.5, F19.5, F20-29, F30-31, F32.3, F33.3, F39 in ICD-10) covering a population of 73,503 aged 15-64 were included via case registry systems. All accessed case records were pooled. Case ascertainment and diagnostic assessment were achieved through structured clinical interview for DSM-IV, phone interview, or farming a best-estimated diagnosis via records on registers., Results: Registries provided 1,410 probable cases. The successful clinical reappraisal rate was 66.8% (n: 955) while, the final diagnoses were determined via phone interview or best-estimate diagnosis in the rest of the cases. Seven hundred twenty seven individuals were diagnosed with DSM-IV yielding a prevalence of 9.8 per 1,000 (95% confidence interval [CI]: 8.2-11.5). Registry-based prevalence of schizophrenia, schizoaffective disorder, BPI disorder, and depression with psychotic features were 3.6 (95% CI: 3.0-4.2), 1.1 (95% CI: 0.8-1.4), 2.7 (95% CI: 2.0-3.3), and 1.0 (95% CI: 0.6-1.3) per 1,000, respectively., Conclusion: Ten individuals per 1,000 adult persons admit for any disorder with psychotic symptoms. Registry-based prevalence estimates are lower than the lifetime prevalence estimates. However, analyses of administrative data appear to provide information needed for effectively plan and implement psychiatric services.

Objective: This study evaluates the influence of socioeconomic and demographic factors on the criminal behavior of male patients with bipolar type I disorder., Methods: A total of 48 male patients diagnosed with type I bipolar disorder according to DSM IV criteria and a criminal history in a forensic psychiatry facility and 53 male patients with the same diagnosis but without a criminal history who were treated at the Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery were included in the study group. Socioeconomic and sociodemographic characteristics were compared between the two patient groups., Results: The average duration of formal education in the forensic group (7.42 ± 3.74 years) was less than in the control group (9.74 ± 3.96 years) (p<0.05). The proportion of divorced and the widowed patients was greater among the forensic group (70%) relative to the control group (49%), (p<0.05). The proportion of people without professional training (50% vs. 22.6%) and the unemployment rate (75% vs. 45.3%) were greater among the forensic group relative to the control group (p<0.001). Fewer patients in the control group were enrolled in social insurance compared to the control group (54.2% vs. 5.7%), (p<0.001). Logistic regression analysis indicated a relationship between lower migration rate and lack of social insurance with criminal behavior among patients in the forensic group., Conclusion: The findings demonstrate the relationship between sociodemographic and socioeconomic factors and criminal behavior in male patients with a bipolar I disorder. To protect both the patient and the society, these factors are of importance and they should be taken into account by both juridical and psychiatric institutions.

Objective: To estimate the lifetime prevalence of 12 DSM-IV disorders with psychotic symptoms in a general population survey., Method: Addresses were contacted in a multistage clustered area probability sampling frame of administrative neighbourhoods and households, covering 9 districts and 302 neighbourhoods in the Izmir metropolitan area between November 2007 and October 2008. One household member aged between 15 and 64 years and available to complete the interview was randomly selected using a within-household sampling method. The primary screening instrument was the Composite International Diagnostic Interview 2.1. A systematic screening procedure was implemented to detect probable cases with any psychotic disorder. Those selected by the screens were re-interviewed with the Structured Clinical Interview for DSM-IV. Diagnoses of individuals who were not available for re-interview were made by combining screening information with case register diagnoses and/or the telephone interviews with relatives or spouse., Results: A total of 4011 individuals were screened for disorders with psychotic symptoms. After screening, 499 respondents were selected as a probable case. 277 of screen positive respondents were available for clinical reappraisal. Initial screening interviews and additional material were used for best estimate diagnoses of the remaining 172 respondents. Total lifetime prevalence of 12 DSM-IV disorders with psychotic symptoms was 2.62%. Lifetime prevalence of each disorder separately were as follows: 0.74% for schizophrenia, 0.20% for schizoaffective disorder, 0.05% for schizophreniform disorder, 0.10% for delusional disorder, 0.12% for brief psychotic disorder, 0.55% for major depressive disorder with psychotic features, 0.37% for bipolar I disorder, 0.20% for substance induced psychotic disorder, and 0.07% for psychotic disorders due to a general medical condition., Conclusion: Total lifetime prevalence of disorders with psychotic symptoms is higher than any previously reported estimates in Turkey; with a prevalence of approximately 2.5%, these disorders can be considered a major public health concern.

Introduction: Mood disorders are one of the significant mental disorders that decrease the quality of human life and disrupt the psychosocial functionality and interpersonal relationships. Recently, studies have suggested that affective temperaments are factors that determine the emergence and characteristics of mood disorders., Methods: 150 patients total were enrolled in the study, which aimed to compare the temperament, clinical and sociodemographic characteristics of 50 BD-I, 46 BD-II and 54 MDD patients. In order to determine clinical and sociodemographic features, we administered the SKIP-TURK structured follow-up questionnaire, the Hamilton Depression Rating Scale (HDRS), the Young Mania Rating Scale (YMRS) and the TEMPS-A temperament rating scale for all patients., Results: The following clinical, sociodemographic and temperament characteristics were evaluated: such as history of psychiatric disorder of first and second degree relatives, comorbid hypothyroidism, age of onset of the mood disorder symptoms, the nature of the first episode of the mood disorder, seasonal course, mean duration of the episode, total number of episodes, severity of the mood episodes, and total number of hospitalizations., Conclusion: Our results demonstrated that some sociodemographic, clinical and affective temperament characteristics may be good predictors for early diagnoses and treatment of BD and MDD.

Objective: This study aimed to identify the attachment style of bipolar patients and their children, and to investigate the relationship between attachment style, and temperament, personality characteristics, and clinical features of bipolar disorder., Method: The study included 44 euthymic bipolar patients, 35 of their healthy children (>16 years old), and 84 healthy controls (matched in terms of age, gender, and sociocultural background with the patients and their children). Diagnostic interviews were conducted using SCID-I, SCID-II, and SCID-NP. Bipolar symptoms were evaluated using SCIP-TURK. Temperament and attachment style were measured using TEMPS-A and AAS., Results: More of the bipolar patients had an avoidant attachment style and more of their children had an anxious/ambivalent attachment style than did the healthy controls (p < 0.001 and p << 0.001). There was a negative correlation between insecure attachment and hyperthymic temperament (p = 0.008 and r = -0.623, and p = 0.049, r = -0.386). Insecure attachment style in the bipolar patients was predicted by borderline personality disorder, the severity of manic/depressive episodes, and depressive temperament. Insecure attachment in their children was predicted by anxious-avoidant and anxious-ambivalent attachment styles, the number of depressive episodes, irritable temperament (children), low-level social functioning, and a depression-mania-remission pattern., Conclusion: We observed a reciprocal relationship between insecure attachment style and mood disorders. This study shows that depressive temperament in bipolar patients and irritable temperament in their children predicted insecure attachment in both patients and their children.

The prevalence of bipolar disorder (BD) in males and females is almost equal. The onset of BD in females typically occurs during the reproductive years, complicating its treatment. Although it was once believed that pregnancy prevents recurrence, studies have shown that recurrence is common and severe during pregnancy. On the other hand, the effects of pharmacological treatment on obstetrical outcome are not well known and some of these agents are considered teratogenic. Thus, the decision to treat pregnant patients with psychotropic agents requires solving an ethical dilemma. Risk-benefit decisions should be made while considering both the risk of relapse of BD and its morbidity, and the risk of fetal exposure to psychotropic medications. Moreover, the risk of recurrence increases dramatically in the postpartum period. It is well known that all of the psychotropic medications studied enter the breast milk. Thus, their effects on infants should be considered while prescribing for a breastfeeding mother. The aim of this review was to discuss the safety profiles of the treatment options for pregnant and breastfeeding BD patients. Firstly, each medication's effects on organ dysgenesis, neonatal toxicity, and neurobehavioral development, and their associated adverse events during pregnancy and the postpartum period are discussed, with a focus on the emerging literature. Given this background, practical suggestions on tailoring treatment in BD patients, from preconception to breastfeeding are highlighted.

Objective: The genetic phenomenon of anticipation is a pattern of inheritance that includes earlier age at onset and increased severity of symptoms in succeeding generations, and is a feature of some neurodegenerative diseases. This phenomenon is suggested to occur in bipolar disorder (BP) as well., Method: Anticipation in children with BP type 1 (s2) (n = 31) and their parents (s1) (n = 31) not-consecutive generations-was assessed by analyzing clinical characteristics and prognoses., Results: Age at onset of BP type 1 in s2 (mean: 19.3 +/- 4.2 years) occurred earlier than in s1 (mean: 29.5 +/- 10.2 years) (u = 345, P < 0.001). There was a direct negative correlation between the s1 and s2 cases (r = -0.554, P < 0.001). The total number of episodes in s1 (13.9 +/- 12.3) was greater than in s2 (8.7 +/- 7), which had a higher frequency of episodes (0.6 +/- 0.3 and 1.5 +/- 1.2) (u = 357, P < 0.001). There was a direct correlation between total episodes and the frequency of manic episodes between s1 and s2 (r = 0.312, P < 0.001 and r = 0.365, P < 0.001, respectively). We observed that 72.7% of BP type 1 parents that had episodes with psychotic features had offspring that had episodes with psychotic features., Conclusions: Results of this study show that age at onset was earlier and the frequency of episodes was greater in s2 BP type 1 cases. In addition, episodes with psychotic features might be a marker for genetic anticipation.

Objective: The aims of this study were to determine the rate of psychopathology in the children of parents with bipolar disorder and to examine the relationship between the psychopathology in these children and the characteristics of bipolar disorder in their parents., Method: The study included 36 children of 28 bipolar I parents and 33 children of 28 control parents, all between the ages of 6 and 17 years. The bipolar parents and all of the children were screened using the Schedule for Affective Disorders and Schizophrenia-Lifetime Version (SADS-L) and the Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version (K-SADS-PL), respectively. The spouses of bipolar parents completed the Symptom Checklist-90-Revised (SCL-90-R) and the children completed the Parenting Style Scale (PSS)., Results: The rate of psychopathology was higher in the children of bipolar parents than in those of the control parents. Affective disorders and disruptive behavior disorders were observed with significantly greater frequency in the children of the bipolar parents. Attitudes in study group parents were related to the presence of psychopathology in their children., Conclusion: The results of this study suggest that children of bipolar parents have an increased risk of developing psychiatric disorders, especially affective disorders and disruptive behavior disorders. The children of bipolar patients need to be screened for psychiatric symptoms and referred for psychiatric assistance when necessary.

Objective: This is a cross-sectional study designed to assess psychopathology and personality patterns in a group of high-risk subjects for bipolar disorder compared to a control group. As high-risk subjects first-degree relatives of bipolar patients were selected., Method: Ninety-five first-degree relatives of 54 bipolar patients and 93 first-degree relatives of 54 subjects without any psychiatric disorder were recruited in the study. Control subjects were matched to bipolar patients according to age, gender and educational status. SADS-L (Schedule for Affective Disorders and Schizophrenia-Lifetime Version) was used both to ascertain the psychiatric status of the patient and control subjects, and to evaluate the psychopathology in probands' and controls' relatives. MMPI-2 (Minnesota Multiphasic Personality Inventory-2) profiles of relatives of patient and control groups were compared as well., Results: In the relatives of bipolar patients the SADS-L diagnoses of hypomania, minor depression and schizotypal personality were statistically more prevalent than in the relatives of the control group. MMPI-2 profiles of both relatives of bipolar patients and controls were within "normal" range, whereas relatives of patients were more defensive in disclosing psychopathology. Any specific profile characteristic for relatives of bipolar patients could not be described., Conclusion: Minor mental disorders were more prevalent in the relatives of bipolar patients group. A personality pattern specific to high risk group for bipolar disorder couldn't be detected.

Objective: The aim of this study is to determine the relationship between age of onset and phenomenology of bipolar affective disorder (mania)., Method: The current and retrospective diagnoses of the patients were made according to DSM-IV Bipolar Affective Disorder (mania) criteria. Sociodemographic features, clinical features, type of episode, number and length of hospitalizations were investigated in three groups which were consisted of adolescent-onset adolescents (n=60), adolescent-onset adults (n=60) and adult-onset adults (n=60). The groups were determined according to age of onset and current age categories. All patients have been assessed by Structured Clinical Interview for DSM-IV-Clinical Version (SCID-I), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D) and Scale for the Assessment of Positive Symptoms (SAPS)., Results: The groups were consisted of equal numbers of women and men. Rate of single (%51.7) and divorced patients (%21.7), rate of unemployment status (%70) were higher in adolescent-onset patients than adult-onsets. Adolescent-onset adolescents and adolescent-onset adults were different from adult-onset patients with respect to mixt episodes (%26.7, %15) and mood congruent or incongruent psychotic features (%35/%50, %31.7/%66.7) and length of hospitalization (23.9+/-4.8, 23.8+/-3.9)., Conclusion: Adolescent-onset of illness causes higher probability of mixt episodes, psychotic features such as mood congruent or incongruent hallucinations and delusions. This study supports the hypothesis that adolescent-onset mania may be a different subtype than adult-onset mania with respect to type of episode, phenomenology, and clinical features.