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Bipolar disorder (BPD) is a psychiatric condition that often manifests together with Axis-I comorbidity. Comorbidity of psychiatric disorders influences the recognition, prognosis, and treatment of the disorder, posing difficulties for the patient and physician. This study aims at identifying Axis-I comorbidities and their characteristics in patients with BPD.This retrospective study included 255 patients diagnosed with BPD according to the DSM-IV. Comorbidities were determined using the SCID-I, a semistructured sociodemographic data form developed by the authors, and a mood chart assessing clinical aspects. The patients were divided into 2 groups, those with and without comorbidity, and compared.Out of these 255 patients, 35% was found to have a current and 84.3% a lifelong comorbid psychiatric disorder. About 33.1% of these patients had 1, 11.3% had 2, and 8.8% had more than 2 comorbid disorders. At least one comorbid anxiety disorder was found in 38.7% of the patients. Obsessive and compulsive disorder (OCD) being the most common comorbid psychiatric disorder, followed by social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Comparing the clinical parameters between the 2 groups due to the presence of psychiatric comorbidity in the BD patients, there were statistically significant differences in terms of the number of depressive episodes (P = .041) and mania/hypomania (P = .048), and the need for antipsychotic monotherapy (P = .007) and antidepressants (P = .001) for prophylaxis between the 2 groups.Axis-I psychiatric disorders and particularly OCD and anxiety disorders accompanying BPD prevail at a high rate. The presence of comorbid psychiatric disorder in BPD may negatively affect the clinical prognosis of the condition; therefore, this area requires more study and careful investigation.

Objective To examine the association between clinical and treatment characteristics and antidepressants (AD)-induced manic switch in bipolar disorder (BD). Methods Total of 238 euthymic BD patients, who had been followed-up for at least 6 months at the outpatient clinic of Haseki Training and Research Hospital in istanbul, Turkey, were enrolled in this cross-sectional study in 2016. Semi-structured data form, the mood chart, and the mirror-designated assessment were applied to all subjects. The files of the patients were retrospectively reviewed and the patients using ADs were compared as AD-monotherapy (AD-m) and AD-combination (AD-c) groups, then divided into 2 subgroups according to the presence/absence of manic switch under AD treatment. Results Fifty eight (47.15%) patients out of 123 who received ADs at least once had experienced a manic switch under AD treatment. The rate of manic switch in AD-m patients was significantly higher than the AD-c group. Independent from being monotherapy or combined treatment, AD use longer than 12 months was negatively associated with the occurrence of manic switch. Conclusion Our study suggests that the risk of manic switch is especially prominent in the first months of AD use. Antidepressants use in combining it with a mood stabilizers (MS) may not be adequate in preventing switches in shorter terms. However, in longer term uses addition of MS to ADs may decrease the risk of switches.

10th International Congress on Psychopharmacology & 6th International Symposium on Child and Adolescent Psychopharmacology[Abstract:0103][Mood disorders]A forgotten diagnosis: funeral maniaABSTRACT...

Aim: Factors such as personality traits, self-esteem, interpersonal relations and cognitive skills are considered among the risk factors of psychiatric disorders particularly for mood disorders. Presence of a single risk factor is not enough for the disease to emerge. The present study aimed to evaluate the presence of psychosocial triggering factors prior to the episodes of major depressive disorder (MDD) in female patients.Materials and Methods: This retrospective study included a total of 62 female patients, who visited the psychiatry policlinic and have been diagnosed with MDD alone according to SCID-I. After the diagnostic evaluation of the patients, detailed clinical interview was conducted to assess the presence of triggering factors for depressive episode. All of the participants described triggering factors for major depressive disorder.Results: Regarding the psychosocial factors as the potential triggers, 26 patients mentioned about the problem of communication and compliance with the spouse (42%), 10 mentioned about the presence of illness in the first-degree relatives (16%) and 10 mentioned about the conflict with the mother-in-law or other relatives (16%). When we collect “communication/compliance problem with the spouse” + “conflict with the mother-in-law/other family members” + “breaking up with the beloved one” + “husband’s cheating on her” stressor groups as a “relationship conflict” group, the mean of BDI and BAI scores of “relationship conflict” group were highest among the all groups.Conclusions: In the light of these outcomes, it can be concluded that particularly psychosocial factors associated with interpersonal relations play significant role as the triggering factors for depressive episodes in female patients. Among these factors, the problem of communication and compliance with the spouse is particularly striking., Amaç: Kişilik özellikleri, öz-saygı, kişilerarası ilişkiler ve bilişsel beceriler gibi faktörler, özellikle duygudurum bozuklukları başta olmak üzere psikiyatrik bozuklukların risk faktörleri arasında sayılmaktadır. Hastalığın ortaya çıkması için tek bir risk faktörünün varlığı yeterli değildir. Genetik yapının olumsuz çevresel faktörlerle etkileşimi de önemlidir. Bu çalışmada, kadın hastalarda major depresyon epizodlarından önce psikososyal tetikleyici faktörlerin varlığını değerlendirmeyi amaçladık.Gereç ve Yöntemler: Psikiyatri polikliniğine başvuran ve SCID-1 ile major depresyon tanısı konulan toplam 62 kadın hasta retrospektif şekilde dizayn edilmiş olan çalışmaya alındı. Hastaların tanısal değerlendirmesinden sonra, depresif atak için tetikleyici faktörlerin varlığını değerlendirmek amacıyla ayrıntılı klinik görüşme yapıldı.Bulgular: Potansiyel tetikleyiciler olarak psikososyal faktörlerle ilgili olarak, hastaların 26’sı eşi ile ilgili iletişim ve uyum hakkında (%42), 10’u birinci derece akrabalarda hastalık varlığından (%16), 10’u da kayınvalidesi ve veya başka akrabalarıyla olan anlaşmazlıktan bahsetmiş olup 8’i taşınmadan (%13), 6’sı sevgiliden ayrılmadan (%10) ve 2’si de eş aldatmasından bahsetmiştir (%3). “Eş ile iletişim / uyum sorunu”, “kayınvalidesiyle / diğer aile üyeleriyle anlaşmazlık”, “sevgilisinden ayrılmak” ve “eşi tarafından aldatılmak” stresörleri “ilişki çatışması” grubunda toplandığında bu grubun depresyon ve anksiyete skorlarının ortalaması tüm gruplar arasında en yüksek oranda bulunmuştur. Sonuç: Bu bulgular ışığında, özellikle kadınlarda depresyon atakları için tetikleyici faktörler olarak kişilerarası ilişkilerle ilişkili psikososyal faktörlerin önemli rol oynadığı sonucuna varılabilir. Bu faktörler arasında eş ile iletişim ve uyum sorunu özellikle dikkat çekicidir.

Objectives: To assess the impact of social anxiety disorder (SAD) comorbidity on the clinical features, illness severity, and response to mood stabilizers in bipolar disorder (BD) patients. Methods: This retrospective study included bipolar patients that were treated at the Department of Psychiatry, Haseki Training and Research Hospital, Istanbul, Turkey in 2015, and who provided their informed consents for participation in this study. The study was conducted by assessing patient files retrospectively. Two hundred bipolar patients were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition axis-I (SCID-I) in order to detect all possible comorbid psychiatric diagnoses. The sample was split according to the presence of SAD comorbidity and the groups were compared. Results: The SAD comorbidity was detected in 17.5% (35/200) of the BD patients. The SAD comorbid bipolar patients were more educated, had earlier onset of BD, lower number of manic episodes, and more severe episodes. There was no difference between groups in terms of total number of episodes, hospitalization, suicidality, being psychotic, treatment response to lithium and anticonvulsants. Conclusion: Social anxiety disorder comorbidity may be associated with more severe episodes and early onset of BD. However, SAD comorbidity may not be related to treatment response in bipolar patients. Saudi Med J 2016; Vol. 37 (3): 309-314 doi: 10.15537/smj.2016.3.13108 How to cite this article Berkol TD, Kirli E, Islam S, Pinarbasi R, Ozyildirim I. Comparison of clinical and sociodemographic features of bipolar disorder patients with those of social anxiety disorder patients comorbid with bipolar disorder in Turkey. Saudi Med J 2016; 37: 309-314.

Objective: Vaginismus is much more frequent in eastern societies than western societies and it is the sexual function disorder which is the most frequent application reason among female patients. This study aims to evaluate the frequency of vaginismus comorbidity in patients who were diagnosed with major depressive disorder (MDD) or anxiety disorder (AD) when they applied to a psychiatric clinic. Material and Methods: Participants of this study were 69 sexually active female patients who applied to a psychiatric clinic and who were primarily diagnosed with either major depressive disorder (24 patients) or anxiety disorder (45 patients) according to the DSM-IV criteria. In-depth interviews conducted by the psychiatrist evaluation of these patients were retrospectively with file scanning. Results: While none of the 69 patients have current vaginismus, 25 (36.2%) of them were found to have history of vaginismus. 45.8% of the MDD patients and 31.1% of the anxiety disorder patients had history of vaginismus. There was no significant difference between two groups in terms of frequency of vaginismus history. Only one of the patients with vaginismus history applied for sexual treatment in the past. Symptoms of other patients had disappeared without treatment. Improvement occurred in an average of 13 weeks. Conclusion: In MDD or AD patients, regardless of history of vaginismus Libido, arousal, sexual process inphase to the phase of vaginal lubrication and orgasm are not significantly affected suggesting that after treatment of vaginismus patients experienced no serious problems in the sexual phase.

Objective: The aim of this study was to find out the level of death anxiety among 3 groups: patients with acute myocardial infarction, patients with cancer and healthy individuals in two training and research hospitals; also to evaluate its relationship with several sociodemographic and clinical variables. Materials and method: This study was conducted with one hundred and eighty persons (108 male, 72 female) who have been referred to cardiology or oncology departments and the healthy individuals. Participants completed sociodemographic and clinical data form, State and Trait Anxiety Inventory (STAI-I, STAI-II), Thorson Powell Death Anxiety Scale (TPDAS), Death Depression Scale (DDS). Results: Participants included in the present study were 40% female with an average age of 53.48 for whole group. The mean TPDAS score for patients with AMI was 51.60 ± 16.40, for patients with cancer 37.10 ± 10.23 and for healthy individuals 43.40 ± 13.35. In AMI group there were positive correlations between STAI-I and TPDAS, DDS scores and also between STAI-II and DDS. In cancer group positive correlations were between STAI-I, II and TPDAS, DDS. TPDAS and DDS were positively correlated in all three groups. Women and participants who were unemployed scored higher on DDS. Conclusion: In this study patients with AMI had higher death anxiety than patients with cancer or healthy individuals. Generally death anxiety was related with education, employment and socioeconomic status. Prospective studies carefully searching for different variables in different medical groups would reveal and help us to understand the importance of death anxiety and its impact on courses of physical and mental disorders. Keywords: Death anxiety, Myocardial infarction, Cancer

Objective: Comorbidity of substance use disorders and other psychiatric disorders is common. However, data on the prevalence of substance use disorders in general psychiatric outpatient population is rather scarce. Method: In order to investigate the prevalence of substance use disorders among the patients who admitted to the general psychiatric outpatient unit and followed with any psychiatric diagnosis, 734 consecutive adult patients were included in this study. Michigan Alcoholism Screening Test–AD was administered to these patients. Substance screening form and SCID-I dependence module were administered to 47 patients (6.4%) who had a MAST-AD score above 4. Later, SCID-II and the rest of SCID-I were administered to 33 patients (4.5%) who met any diagnostic criteria on this module. Results: From these 734 patients, 33 (4.5%) had alcohol or substance use disorder: Five patients (0.7%) had alcohol dependence, 26 patients (3.5%) had alcohol abuse and 3 patients (0.4%) had multiple substance dependence. There were 9 patients (1.2%) with cannabis abuse, 4 patients (0.5%) with ecstasy abuse, 1 patient (0.1%) with heroin abuse, 1 patient with (0.1%) biperiden abuse and 9 patients (1.2%) with benzodiazepin abuse. From this 33 patients, 7 (1.0%) patients were diagnosed with borderline personality disorder, 2 (0.3%) with antisocial personality disorder, 1 patient (0.1%) with paranoid personality disorder, 1 patient (0.1%) with narcissistic personality disorder, 2 patients (0.3%) with avoidant personality disorder, 1 patient (0.1%) with schizoid personality disorder and 1 patient (0.1%) with dependent personality disorder. With SCID-I, we found 5 (0.7%) major depressive disorder, 3 (0.4%) bipolar I, 1 (0.1%) distimic disorder, 2 (0.3%) paranoid schizophrenia, 1 (0.1%) delusional disorder, 3 (0.4%) generalized anxiety disorder, 3 (0.4%) panic disorder, 1 (0.1%) panic disorder with agoraphobia, 1 (0.1%) anxiety disorder not otherwise specified, 1 (0.1%) social phobia and 1 (0.1%) post traumatic stress disorder. Conclusion: These results suggest that substance use disorders are prevalent among general psychiatric outpatients. Substance use disorders should be carefully assessed in the patients with diagnoses of mood disorders, anxiety disorders or personality disorders.

OZET Calismamizda OKB hastalari ile saǧlikli bireylerin aleksitimi duzeyleri karsilastirilip aralarinda anlamli bir fark olup olmadiǧi incelenmistir. Bununla birlikte kisilerin bazi sosyodemografik ozelliklerinin de OKB ve aleksitimi duzeyleri uzerinde etkili olup olmadiǧi arastirilmistir. Calismaya, Istanbul ilindeki Uskudar Universitesi NP Feneryolu Tip Merkezi'nde tani almis ve tedavileri halen devam eden, yaslari 18-45 araliǧinda olan 25'i kadin 15'i erkek olmak uzere 40 gonullu OKB hastasi ile Istanbul ilinde yasayan rastgele secilmis, herhangi bir psikiyatrik tanisi bulunmayan, yaslari 18-45 araliǧinda olan 25'i kadin 15'i erkek olmak uzere 40 gonullu saǧlikli birey katilmistir. Katilimcilar oncelikle calisma ve kisisel bilgilerin gizliliǧi konusunda bilgilendirilmistir. Arastirmada elde edilecek verileri toplamak amaciyla, 80 katilimciya, “Sosyodemografik Veri Formu, Toronto Aleksitimi Olceǧi (TAO-20) ve Yale-Brown Obsesyon Kompulsiyon Olceǧi ve Semptom Listesi (Y-BOCS)” uygulanmistir. Bu olceklerden elde edilen veriler ise SSPS v. 21 (Statistical Package for Social Sciences) programi ile istatistiksel analize tabi tutulmustur. Surekli deǧiskenlerin normallik daǧilimi Skewness-Kurtosis deǧerlerinin -1.5 ve +1.5 araliǧinda olusuna gore deǧerlendirilmistir. OKB tanili hastalarla saǧlikli kontrollerin olceklerden aldiklari puanlarin karsilastirilmasinda baǧimsiz orneklem t testi yurutulmustur. Sosyodemografik deǧiskenler bakimindan yurutulen gruplar arasi karsilastirmalarda baǧimsiz orneklem Mann Whintey U testi yurutulmustur. Olceklerden alinan puanlar arasindaki korelasyon deǧerleri ise puanlarin normal daǧiliyor olmasi nedeniyle Pearson korelasyon analizi ile yurutulmustur. Yapilan calismanin sonuclarina gore; OKB hastalarinin aleksitimi duzeyleri saǧlikli bireylerin aleksitimi duzeylerine gore anlamli bir bicimde daha yuksek bulunmustur. OKB hastalarinin TAO-20'nin alt boyutlari olan duygu ifadesinde zorluk puanlari ile duygu tanimlamada zorluk puanlari arasinda pozitif yonde anlamli iliski bulunmustur. Anahtar kelimeler: Aleksitimi, obsesif kompulsif bozukluk, OKB In this study, we compared the levels of alexithymia in healthy individuals with OCD patients and investigated whether there is a significant difference between them. Furthermore, some of the sociodemographic characteristics of the subjects were also examined to determine whether they had an effect on OCD and alexithymia levels. 40 volunteer OCD patients, 25 of whom were women and 15 men, aged 18-45 years, who were diagnosed at the NP Feneryolu Medical Center of Uskudar University, Istanbul, and who were randomly selected and living in Istanbul, 40 volunteer healthy individuals, 25 of whom are women and 15 of whom are men and whose ages are between 18 and 45, are attended to this study. Participants were first informed about the privacy of work and personal information. “Sociodemographic Data Form, Toronto Alexithymia Scale (TAS-20) and Yale-Brown Obsessive Compulsive Scale and Symptom List (Y-BOCS)” were applied to all 80 participants in order to collect the data obtained in the study. The data obtained from these scales were subjected to statistical analysis with the SSPS v. 21 (Statistical Package for Social Sciences) program. The normality distribution of continuous variables was evaluated according to the occurrence of Skewness-Kurtosis values in the range of -1.5 and +1.5. An independent sample t-test was conducted to compare the scores of healthy controls and OCD patients. Independent sample Mann Whintey U test was performed among the groups in terms of demographic variables. Correlation values between the scores obtained from the scales were analyzed by Pearson correlation analysis because the scores were normally distributed. According to the results of this study; a significant difference was found between the levels of alexithymia of healthy individuals and OCD patients. The levels of alexithymia in OCD patients were significantly higher than those of healthy individuals. Apart from this, there was a significant positive correlation between the difficulty describing feelings scores of OCD patients and the their difficulty identifying feelings scores of the TAS-20 subscales. In addition, a number of suggestions have been added in order to make contribution to the literature of this research which is also included in similar studies.

[Purpose] The aim of this study was to assess the effectiveness of a 6-week aerobic exercise program on pain, physical function, and psychological status, and to evaluate the personality characteristics of fibromyalgia syndrome (FMS) patients. [Subjects and Methods] Fourteen women with FMS were enrolled. They were trained for a 6-week home-based aerobic exercise program. The Fibromyalgia Impact Questionnaire, the Beck Depression Inventory, the visual analog scale of pain and sleep quality were measured at baseline and at the end of week 6. The personality profiles were evaluated using the Minnesota Multiphasic Personality Inventory (MMPI). [Results] After the exercise program, significant improvements were determined in pain, sleep quality, physical function, depression and FMS symptoms compared to baseline. In addition, the hysteria item (71.21±8.84) of the MMPI was significantly higher in FMS. [Conclusion] Our findings indicate that home-based aerobic exercise may be a useful treatment in the management of FMS. Personality characteristics should be considered during the planning process of the treatment of FMS. Personality is a filter between life events and psychological responses. It is defined to be the integration of effective and behavioral patterns. Long-term studies involving larger clinical samples are needed to define the role of personality characteristics in FMS.

Objective: The aim of this study is assessment of sexual dysfunction in female patients with major depressive disorder and panic disorder and compare the two groups. Methods: Total 76 female patients with primary diagnosis of major depressive disorder ( 46 patients) and panic disorder ( 30 patients) according to DSM-IV, who is sexually active and not use psychotropic medication were inclued. Sociodemographic data aqcusition form and the Arizona Sexual Experiences Scale (ASEX) were administered to all patients. The study was carried out retrospectively by analyzed patient files. Results: According to the suggested criteria to identify any sexual dysfunction in the original form of Arizona Sexual Experiences Scale, sexual dysfunction is determined to be more frequent in major depressive disorder group than panic disorder group. Arizona Sexual Experiences Scale sub-item score assessing sexual desire and Arizona Sexual Experiences Scale total score is significantly higher in major depressive disorder patients than panic disorder patients. Conclusion: Sexual dysfunction is frequent both in major depressive disorder patients and panic disorder patients. In female major depressive disorder patients any of sexual function and sexual dysfunction can be said to be more affected than in panic disorder patients. In depressive patients, especially sexual desire, is disrupted more significantly than patients with panic disorder. [JCBPR 2014; 3(2.000): 94-98]

Repetetively cutting own oral mucosa as a self-harming behavior: a case report Self-harm behavior, defined as repetitive and deliberate attempts of harm to self-body without suicidal intentions and resulting in tissue damage, is classified in the text revision of Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV-TR) under the sections of impulse-control disorder not otherwise specified and stereotypic movement disorder which falls under the category of disorders usually first diagnosed in infancy, childhood or adolescence. For DSM-V, a separate classification with the title of non-suicidal self-harm has been recommended and defined separately as personal history of selfharm under the section of other circumstances of personal history under the main category of other conditions that may be a focus of clinical attention. The most encountered form of self-harm behavior starting mostly in adolescence is harming by self-cutting and mostly legs and arms are chosen. Such behavior is generally accompanied with personality disorder, depression, substance abuse. In this article, a case of cutting, a common form of self harm behavior that involves one of the rare parts of the body, oral

Introduction The aims of this study were to determine the frequency of adult attention deficit and hyperactivity disorder (ADHD) comorbidity in bipolar patients and to investigate the influence of this comorbidity on the clinical characteristics of bipolar disorder (BD). Method A total of 135 patients with BD type I and II and BD not otherwise specified were included in this study. First, the Adult ADD/ADHD DSM-IV-Based Diagnostic Screening and Rating Scale (ADHD scale) was administered to all patients, and all of the patients were also interviewed for the diagnosis. Patients who were diagnosed as having ADHD comorbidity (n=23) on the basis of DSM-IV and those who were not diagnosed to have ADHD comorbidity (n=32) were compared in terms of sociodemographic and clinical correlates. Results Twenty-three of 135 patients (17%) were found to have ADHD comorbidity. In the ADHD comorbidity group, the level of education and the number of suicide attempts were higher (p=.011 and .043, respectively). Although not significant, subthreshold depressive symptoms in interepisodic periods, the lifetime history of antidepressant use and the total number of lifetime depressive episodes tended to be more frequent in bipolar disorder with ADHD comorbidity group than in the control group. Conclusion Bipolar disorder has a frequent comorbidity with ADHD, and contrary to expectations, it might be related to the depressive aspect, rather than the manic aspect, of bipolar disorder. Early diagnosis of ADHD comorbidity in bipolar patients might help to prevent serious risk factors.

Introduction The attachment processes give us a theoretical frame work to understand the psychopathological development. Unsafe attachment type is often associated with the emergence of psychopathology in the later periods of life. Method This study includes 65 patients from psychiatry outpatient clinic with a diagnosis of panic disorder and 65 healthy volunteers as a control group. In order to determine clinical status and disease severity of patients with panic disorder according to SCID-I (Structured Clinical Interview for DSM Disorders-I) Panic-Agoraphobia Scale, Adults Separation Anxiety Scale, Relationship Scale Questionnaire were used. Results Separation anxiety levels showed statistically significant difference among panic disorder group and control group. According to means of attachment style solely obsessive sub-dimension showed statistical significance difference among the two groups. In panic disorder group separation anxiety showed significant difference according to gender and the presence of agoraphobia. When attachment styles of patients with an early parent loss or divorce of parents assessed anxious and obsessive sub-dimensions the difference were found to be statistically significant. Conclusion High Comorbidity of panic disorder (dominantly coexisting with agoraphobia) and adult separation anxiety was observed. This comorbidity was even higher in females. In both groups obsessive attachment style was the highest among the attachment styles. In patients with panic disorder there was no significant correlation between adult separation anxiety and/or existence of agoraphobia and attachment styles. Coexistence of adult separation anxiety and panic disorder was found to result in higher depression comorbidity rates.

Septum pellucidum, which forms the medial wall of the lateral ventricles, consists of two laminates. Cavum septum pellucidum (CSP) is defined when there is a space between these laminae. In some MRI studies have shown a higher rate of large CSP in patients with schizophrenia than in normal subjects. Looking at the literature on psychiatric disorders, CSP has been shown to be most associated with schizophrenia. Large CSP supports the neurodevelopmental model, which is one of the etiological explanations of schizophrenia. In our study, two patients with a diagnosis of CSP are mentioned. One of our patients is a first episode of schizophrenia, and the other one chronic schizophrenia patient with a history of multi-drug resistance. The first episode of schizophrenia is consistent with the information available in the literature in terms of the severity of symptoms, weak-response to treatment, and insufficiency of neuropsychological tests. The apparent deficit of the chronic schizophrenia patient suggests that CSP has a neurodevelopmental model in the etiology of schizophrenia, as well as the duration of the disease and non-compliance with treatment. There is no study in the literature comparing the response to treatment with large CSP in schizophrenia. It is thought that investigation of response to treatment in future studies is important for demonstrating the effects of neurodevelopmental model on the treatment of psychiatric disorders.

Social anxiety disorder (SAD) is one of the most common psychiatric disorders and frequently co-exists with other psychiatric conditions, primarily with mood disorders. MD is the most common psychiatric comorbidity in patients with SAD, and the association of anxiety disorders and bipolar disorder with atypical depression, which is included in diagnostic guidelines for MD as a subgroup, has been well established. The present study aims to determine if SAD patients with comorbid atypical depression or bipolar disorder show differences in terms of symptomatology and disease course compared to SAD patients without bipolar disorder. We hypothesize that social phobia patients may have subgroups within themselves and the processes of these subgroups may be different from those of known SAD patients. In this study a retrospective chart review was performed for patients who had applied to the Psychiatry Outpatient Unit, Kartal Research and Training Hospital, during a 7-month period in 2018. The study had a retrospective design. A total of 82 patients diagnosed with Social Anxiety Disorder based on a SCID-I interview for DSM-IV were included in the study. Of the 82 SAD patients, 16 patients (19.5%) had also co-existing BPD. All SAD patients with comorbid BPD had at least one major depressive episode history, while 15 (93.7%) SAD patients with comorbid BPD exhibited atypical features in at least one episode. Thus, we identified an association between SAD/BPD and atypical depression and discussed the importance of this co-occurrence in terms of clinical evaluation.

Background In recent years, the relationship between schizophrenia and environmental factors has come into prominence. This study investigated the relationship between vitamin D levels and the positive and negative symptoms of schizophrenia by comparing vitamin D levels between patients with schizophrenia and a healthy control group. Methods The study included 80 patients diagnosed with schizophrenia and 74 age- and sex-matched controls. The Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) were used to evaluate symptom severity. The 25-hydroxyvitamin D (25OHD) levels of all subjects both patients and healthy controls were analyzed in relation to measurements of symptom severity. Results There were no significant differences between the groups in terms of age, sex, or physical activity. Their mean 25OHD levels were also similar (23.46±13.98ng/mL for the patient group and 23.69±9.61ng/mL for the control group). But when patients with schizophrenia were grouped based on their vitamin D levels, the results indicated a statistically significant differences between their vitamin D levels and their total SANS, affective flattening, and total SAPS, bizarre behavior and positive formal thought disorder scores (p = 0.019, p = 0.004, p = 0.015, p = 0.009 and p = 0.019, respectively). There is a negative correlation between 25OHD levels and SANS total points (r = -0.232, p = 0.038); a negative correlation for attention points (r = -0.227, p = 0.044) and negative correlation with positive formal thoughts (r = -0.257, p = 0.021). Conclusion The results of this study show a relationship between lower levels of vitamin D and the occurrence of positive and negative symptoms, along with increased severity of symptoms at lower levels of vitamin D, suggesting that treatment for schizophrenia should include assessment of patients’ vitamin D levels. We recommend that patients with schizophrenia should be assessed with regard to their vitamin D levels.

Aim: It is reported that clozapine maintenance treatment could be effective in treatment-resistant bipolar patients. The aim of this study is to evaluate the prescription rates of clozapine, features of patients on clozapine prophylaxis and efficacy of clozapine prophylaxis in patients with bipolar disorder. Material and Method: 280 patients with DSM-IV diagnostic criteria for bipolar disorder, type I were included in the study. The patients%u2019 medical records and life-charts were reviewed retrospectively and patients who took clozapine for maintenance treatment for at least one year were identified. Results: Twelve of 280 patients (4.8 %) took clozapine for prophylaxis for at least one period during lifetime. Among them 7 patients have only received clozapine, while 5 patients have used combination of clozapine and valproic acid. All of these twelve patients had resistance to at least two different maintenance treatments before clozapine prophylaxis. However, positive results were observed in all of the patients with clozapine prophylaxis. Discussion: These findings suggest that clozapine is regarded as an effective prophylactic choice for treatment of resistant patients with bipolar disorder. Consequently, this study demonstrates effectiveness and safety of clozapine use even in severe patients refractory to various strategies of prophylaxis. Retrospective nature of our study constitutes a limitation. However, when considering limited number of studies on this subject, it may still have a significant contribution. But more comprehensive prospective controlled studies are still needed.

Fibromyalgia syndrome (FMS) is associated with widespread musculoskeletal pain disorder characterized by various symptoms. Our aim was to compare the personality profiles and psychological aspects between FMS patients and control subjects. Additionally, we evaluated the FMS symptoms, pain and functional status. A total of 72 female patients with FMS and 64 age- and sex-matched healthy controls were included.Visual Analog Scale (VAS), to assess pain and sleep quality, and Fibromyalgia Impact Questionnaire (FIQ), to evaluate the functional status, were used in both groups. We assessed the psychological status with Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and the personality profiles were evaluated with Minnesota Multiphasic Personality Inventory (MMPI).Total BDI and BAI scores of FMS patients were higher than control subjects (p0.01, p0.01). In terms of psychopathology, hysteria parameters of MMPI were significantly higher in FMS. MMPI parameters except lie, infrequency, masculinity femininity and hypomania parameters (p0.05) were significantly higher in FMS group than the control group.The results of the present study suggest that there is a relationship between the psychological state and personality characteristics in FMS. Much more research is needed to better define the role of personality characteristics in the pathogenesis and symptoms of FMS.

The importance of gender on phenomenology and course of bipolar illness has been an increased focus of study over recent years. The purpose of present study was to examine whether gender differences exist in the sociodemographic characterictics, age of onset, severity of disease, number & type of episodes, symptomatology and treatment response of bipolar disorder. The life charts of 300 (193 female; 107 male) patients with BD type-I were evaluated retrospectively. BD diagnosis of patients was given by two experienced clinicians in accordance with DSM-IV-TR criteria. A semi-structured chart which was developed to assess sociodemographic and clinical features of patients and “mirror design” method was utilized for the assessment of patients’ response patterns to maintenance treatment. Bipolar women were significantly more likely to have history of (at least one) any mood episode than bipolar men. However no significant gender differences emerged in number of manic or mix episodes; whereas, women had more depressive episodes. Frequency of psychotic episodes (at least one episode during lifetime) was higher for men than women.. There was also no significant gender difference in terms of response to lithium and anticonvulsant maintenance treatment, mean episode severity and age of onset. The results of the present study show that some gender differences may be evident in patients with BD-I. In the highlight of that investigators studying bipolar disorder may need to consider gender as a variable for assessment and treatment strategies.

Mega cisterna magna (MCM) is a cystic malformation of the posterior fossa and characterized by enlarged cisterna magna with an intact vermis and cerebellar hemispheres. The lesion is frequently seen as isolated however it may also constitute a part of Dandy-Walker complex. The concurrence of MCM and psychiatric disorders has already been documented but the possible pathophysiological associations still remain elusive. We present a 36 years-old male patient with incidentally detected isolated MCM, who previously had persecutory and reference delusions as a possible non-index case of shared psychotic disorder. Shared psychotic disorder (folie a deux) is a relatively rare mental condition develops between two affected individuals in a close relationship. In this entity, the index patient already has a psychotic disorder and transmits delusional beliefs on a healthy -secondary- individual. It is firmly suggested that abnormalities of cerebellar structures could involve the pathophysiology of psychotic disorders and based on this fact, we aimed to contribute to the regarding literature with discussing the predisposing role of cerebellar neurodevelopmental abnormalities in psychosis with presenting a possible shared psychosis case.

Objective: Bipolar disorder (BD) affects 1-4% of the population worldwide and presents with seasonal patterns with an incidence of 20-30%. Limited studies exist on seasonality, its relation to sociodemographic and clinical characteristics, and effects on treatment in BD in Turkey. Methods: This retrospective study included 174 patients with a major diagnosis of BD according to the DSM-IV. Comorbidities were determined using the SCID-I. The study was conducted using a semi-structured interview schedule and a mood monitoring chart. The patients were divided into two groups, those with and those without seasonal patterns, and their sociodemographic and clinical characteristics were compared. Results: We found that 36.2% of patients with BD had seasonal patterns. Regardless of type, first episodes were significantly more frequent in the non-seasonal group. With respect to first-episode types, the manic type was significantly more frequent in the seasonal group and the depressive type in the non-seasonal group. The number of patients with a comorbid anxiety disorder (NOS) or dysthymia was significantly higher in the seasonal group and the hospitalized non-seasonal group. The rate of response to lithium monotherapy, mean duration of the disease, mean total number of episodes, and mean total number of mixed episodes were significantly higher in the seasonal group. Conclusion: The rate of dysthymia was significantly higher in the seasonal group, suggesting that those with seasonality have more depressive aspects. These results indicate that the prognosis for seasonal bipolar patients is poorer than for non-seasonal patients. Another important finding was the presence of a correlation between seasonality and a positive response to lithium protection. It has been established that the first episode of the disorder was manifested in the seasonal pattern. The first episode of BD is known to often develop as a depressive episode. These results suggest that it may be a predictor of seasonality.

The evidence base data regarding long-term treatment of bipolar disorder (BD) is less than satisfactory. With the first-line rank of lithium and valproate; antipsychotics (AP) and anticonvulsants (AC) considered options for prolonged treatment in remitted bipolar patients. Literature demonstrates various treatment options in remitted patients with different clinical features. The aim of this study to present and assess clinical outcomes of maintenance treatment for BD with various clinical features. In total 186 bipolar patients in remission were enrolled in this study. All the patients were evaluated with SCID-I (Structured Clinical Interview for DSM-IV) ; and lifelong psychiatric comorbidities were determined. Sociodemographical and clinical features, and lifelong pharmacological treatment of the patients were assessed. Semi-structured interview schedules were filled. 71% lithium, 44% AC, 18% AP monotherapies and 23% lithium-AC, 15% lithium-AP, 25% AC-AP combination therapies were used as maintenance treatment. 61% and 62% of the patients were responders of lithium and AC monotherapies respectively. AC and AP combination had the highest response level. The predictors on the probability of treatment response for lithium were being married, non-psychotic, to show seasonal pattern and less severe episodes. Anticonvulsants were effective in males, divorces, suicide attempters, and the patients with predominance of mixed features in periods. Obsessive-compulsive disorder was the most common comorbid diagnosis in study group. Lithium monotherapy was tended to use in prevention, however treatment combinations which contain APs might be effective alternative to monotherapy. Individualized medication ought to be administered for each patient, with the consideration of clinical features and tolerability.