Atila Erol

Do Ramadan Fasting Restrictions Alter Eating Behaviours

During Ramadan month, Muslims should refrain from drinking, eating and smoking from dawn to sunset. Ramadan fasting can be considered as a kind of dietary restriction. Eating restriction is a risk factor for later development of eating disorders. The purpose of this study is to evaluate whether Ramadan fasting changes the eating behaviours of young people, especially girls who are known as the most vulnerable group for eating disorders. Our sample consisted of 79 healthy volunteers from a high school (63 females; mean age = 16.29; 16 males; mean age = 16.31) who fasted during the Ramadan month. No statistically significant differences were found between the scores of EAT (Eating Attitude Test) and BITE (Bulimic Investigatory Test, Edinburgh) which were administered within the weeks before and after Ramadan. According to our results Ramadan fasting restrictions do not seem to change the eating behaviours of young girls and boys.

Impulsivity in bipolar and substance use disorders

BACKGROUND Bipolar disorder (BD) is commonly associated with increased impulsivity, particularly during manic and depressed episodes; also impulsivity remains elevated during euthymic phases. Impulsivity is also a factor in the initiation and maintenance of substance use disorders (SUD). Impulsivity can predispose to substance abuse or can result from it. Impulsivity appears to be relatively independent of mood state and is higher in individuals with past substance use. Thus, we wanted to compare the impulsivity of BD and SUD closely associated with impulsivity and identify potential differences. METHODS Impulsivity was evaluated by the Barratt Impulsiveness Scale (BIS-11A), in 35 bipolar interepisode disorder male patients without comorbid substance use disorder and 40 substance use disorder male patients. The BIS-11A mean scores for the two groups were compared through one-way between-groups ANOVA. RESULTS There was no difference between the BD and substance use disorder groups on total and subscale attentional, motor impulsivity measures. However, for the male patients there was difference on the nonplanning subscale. The male BD patient group scored higher than the male substance use disorder patient group regarding nonplanning impulsivity. CONCLUSIONS Our results replicate the findings that interepisode BD and substance use disorder patients both have increased total impulsivity; furthermore, the findings also indicate that trait impulsivity is not completely the same in subscales. Both groups were similar on attention and motor impulsivity subscales; however, on the nonplanning subscale, BD patients were more impulsive than the substance use disorder patients.

Smoking, alcohol, and substance use and rates of quitting during pregnancy: is it hard to quit?

Background Alcohol and substance use is a major health challenge in Turkey, as it is worldwide. Recently, there has been a rapid increase in the number of females using substances and although usage tends to reduce during pregnancy, it is of critical importance to determine its exact level as substance use negatively impacts on the health of both the mother and infant. Aim The aim of the present study was to investigate the frequency of smoking, alcohol, and substance use, and quitting rates during pregnancy. Method This study was conducted on pregnant females in Sakarya, Turkey. A total of 1,082 consecutively presenting females who agreed to participate in the study were evaluated. The study team prepared a sociodemographic data form and adapted the “Introduction” section, derived from the Addiction Profile Index, to cover substance use during pregnancy. Results The substances most frequently used by pregnant females in their previous pregnancies and current pregnancies were cigarettes/tobacco products (11% and 11.8%, respectively), alcohol (0.6% and 0.4%, respectively), and rarely, synthetic cannabinoids (0.3% and 0.2%, respectively). Daily tobacco smokers continued to smoke during pregnancy, with a rate of 42.5%. Based on research into predictors of smoking (cigarettes) in pregnancy, a correlation was found between lifetime smoking and smoking during a previous pregnancy. A similar link was found with respect to alcohol. Conclusion Cigarettes are the most frequently used substance in pregnancy, and to a lesser extent, alcohol and synthetic cannabinoids, also considered to be risky substances. A high incidence of smoking regularly during pregnancy was found in daily smokers. It is recommended that physicians should sensitively ask pregnant females presenting at clinics about all forms of substance use, including alcohol and synthetic cannabinoids, and to include such questions in their routine enquiries.

Addiction profile in probation practices in Turkey: 5-year data analysis.

Introduction While drug addiction is a global problem, it is important for every region to know the general features of its own addicts in order to develop effective treatment programs. This study presents sociodemographic data of the individuals diagnosed with drug addiction. Methods In this study, data of the patients between the years of 2009 and 2014 were retrospectively analyzed. The patients were assessed at psychiatry polyclinics according to probation practices of drug abuse. The study involved 513 patients in whom drug positivity was detected in urine analysis at least once and whose diagnoses were confirmed with a clinical interview. Results According to this study, a majority of the addicts were detected in 2013. Males made up 98.2% of the sample population, their average age was 32.12±10.21 years, and minimum and maximum ages for the first drug use were 7 years and 45 years, respectively. Marijuana use was found in 90.8% of the patients, 90% of them were living with their families, and 59.6% of them held a regular job. Treatment response was related with age of first use of drugs, duration of use drugs, and prior treatment anamnesis of the patients. Conclusion In this study, it was determined that the drug which was most frequently was used marijuana. The risk of drug addiction can affect any individual in society, regardless of their education, occupation, or social support levels. Alternative treatment models, especially for chronic and long-term users, should be researched.

Alterations of the hematologic cells in synthetic cannabinoid users

Functions, morphology, distributions, and index of the circulating cells are the most useful parameters that indicate various inflammatory and toxic conditions. The aim of this study was to investigate the clinical significance of these parameters in patients diagnosed with (synthetic) cannabis use disorder.

Delirium and High Creatine Kinase and Myoglobin Levels Related to Synthetic Cannabinoid Withdrawal

Synthetic cannabinoids (SCs) are included in a group of drugs called new psychoactive substances. Effects of SCs on the central nervous system are similar to other cannabinoids, but 2–100 times more potent than marijuana. Thus, addiction and withdrawal symptoms are more severe than natural cannabinoids. Withdrawal symptoms of SCs were reported in the literature previously. But there is no report about SC withdrawal delirium and its treatment. Several studies reported that agonists of CB1 receptors play a role in GABA and glutamatergic neurotransmission, which is similar to the effects of alcohol on GABA and glutamatergic receptors. Previous studies on alcohol delirium cases suggested that elevated creatine kinase (CK) can be a marker of progress. This study reports delirium and high serum CK levels related to SC withdrawal and offers a treatment with benzodiazepine for them. We described two cases treated in our inpatient clinic about SC withdrawal with increase of serum CK level and other laboratory parameters. One of them demonstrated delirium symptoms and the other did not with early rapid treatment.

Outstanding Awards Brief Reports

Objective: Smith and Burger developed the Structured Inventory of Malingered Symptomatology (SIMS) in 1997 as a self-report measure for malingering of psychiatric symptoms. The SIMS consists of 75 dichotomous (True–False) items that form into five subscales Psychosis (P), Neurologic Impairment (NI), Affective Disorder (AF), Amnestic Disorders (AM), Low Intelligence (LI), with each subscale containing 15 items. In this study, we aimed to examine the reliability, validity, and factor structure of the SIMS in a Turkish forensic psychiatry sample. Methods: A sample of 103 forensic patients (9 female, 94 male), aged 18–75, undergoing an inpatient forensic evaluations for competency assessment for criminal responsibility were recruited from a large forensic hospital in Turkey. The study protocol was approved by the local ethics committee. Socio-demographic information of the participants was collected and the SIMS, Miller Forensic Assessment of Symptoms Test (M-FAST), the Scales of Psychological Well-being, 36-Item Short Form Survey (SF-36), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered. All statistical analyses were performed by using SPSS version 23.0 for Windows. Results: The Cronbach’s alpha coefficients for the Turkish SIMS were ranging from 0.42 to 0.87. The lowest alpha coefficient was observed for the Amnestic Disorders (0.46). For the whole scale, Cronbach’s alpha coefficient was found to be 0.93. The test–retest (at after 1 week) correlation coefficients for Psychosis (P), Neurologic Impairment (NI), Affective Disorder (AF), Amnestic Disorders (AM), Low Intelligence (LI), and whole scale were found to be 0.97, 0.97, 0.95, 0.91, and 0.96, respectively. A positive and statistically significant correlation was found between the Turkish SIMS and BDI (r = 0.593, p < .01), BAI (r = 0.578, r < 0.01), M-FAST subscale Reported versus Observed Symptoms (r = 0.660, p <.01), M-FAST subscale Extreme Symptomatology (r = 0.686, p <.01), M-FAST subscale Rare Combinations (r = 0.729, p <.01), M-FAST subscale Unusual Hallucinations (r = 0.698, p <.01), M-FAST subscale Unusual Symptom Course (r = 0.568, p <.01), M-FAST subscale Negative Image (r = 0.514, p <.01), M-FAST subscale Suggestibility (r = 0.426, p <.01), and M-FAST Total (r = 0.794, p <.01) scores. Principal axis factor analyses with promax rotation were performed and four-factor solution that accounted for 39.87% of the variance observed. Conclusions: Our preliminary findings suggested that Turkish SIMS was a valid and reliable tool with a robust factorial structure for further use in detecting malingering of forensic psychiatric cases in Turkey.

Perinatal Anxiety Screening Scale validiy and reliability study in Turkish (PASS-TR validity and reliability)

ABSTRACT BACKGROUND: Anxiety disorders are common in women. This sensitivity extends into the perinatal period as well. Thus, screening for anxiety disorders during the aforementioned period is important for the proper management and treatment of conditions. This study was conducted to assess the validity and reliability of the Perinatal Anxiety Screening Scale, which was determined to be beneficial for the purposes listed above. METHOD: For this study, the “Perinatal Anxiety Screening Scale” (PASS) was translated into Turkish and relabelled “Perinatal Anksiyete Tarama Ölçeği” (PASS-TR). 312 perinatal women were then evaluated with: the ICD 10 diagnosis system, SCID-1, the Hamilton Anxiety Scale, Hamilton Depression Scale, Beck Anxiety Scale, and PASS-TR. The resulting data was examined using Pearson Correlation analysis, Reliability tests, ROC analysis, and Factor analysis. The generated sub-dimensions were re-examined again by confirmatory factor analysis and Root Mean Square Error of Approximation (RMSEA), Root Mean Square Residual (RMR), Standardized Root Mean Square Residual (SRMR) χ2/sd, the Goodness of Fit Index (GFI), Adjusted Goodness of Fit Index (AGFI), Comparative Fit Index (CFI), Akaikes Information Criterion (AIC), and the Bayesian Information Criterion (BIC). RESULTS: In this assessment, Cronbachs Alpha value for the scale is = 0.95, and the sub-dimensions obtained by explanatory factor analysis are: (1) general anxiety and specific fear, (2) perfectionism and control, (3) social anxiety and adjustment disorder, (4) acute anxiety and trauma. The cut-off score for the scale is 16. As a result, it was determined that PASS-TR is an accurate method for the scanning of anxiety disorders in the perinatal period. CONCLUSION: PASS-TR can be validly and reliably used to scan for anxiety disorders amongst perinatal women.

Affective temperaments during pregnancy and postpartum period: a click to hyperthymic temperament

Abstract Background: Pregnancy and postpartum periods are the main reproductive periods during which women experience mood disorders. Affective temperaments are known antecedents of mood disorders and their importance is increasing in time for early diagnosis and determining risky groups. But data about affective temperaments during perinatal period is limited. Methods: Women during pregnancy and perinatal period and healthy controls who are not in perinatal period are included in the study. 83 pregnant women in 1st trimester, 94 pregnant women in 2nd trimester and 115 pregnant women in 3rd trimester; 32 women in 1st month postpartum and 89 women in 2nd month postpartum; and 88 healthy non-pregnant women with similar ages were evaluated regarding their temperament evaluation of Memphis, Pisa, Paris and San Diego auto-questionnaire (TEMPS-A) scores. Results: Women in perinatal period had higher scores of hyperthymic temperaments than the control group. Women in the 2nd month of postpartum period had also higher anxious temperament scores. And women in the second trimester had the highest hyperthymic temperament scores. Conclusion: Pregnancy and postpartum periods correlate with hyperthymic temperament characteristics in women without active psychiatric diagnosis. Future studies will help to understand if this is a mental quietness or increased risk for bipolarity.

Depressive Temperament in Relatives of Patients with Schizophrenia Is Associated with Suicidality in Patients with Schizophrenia

Objective Suicide is a major cause of death in patients with schizophrenia; thus, predicting and preventing suicide in patients with schizophrenia is examined in various studies. Affective temperaments which are accepted as precursors of mood disorders may be an important factor in predicting suicidality. This study investigated the relationship between affective temperaments of relatives of schizophrenia patients and suicidal thoughts and other clinical correlates of patients with schizophrenia. Methods Patients with schizophrenia and their first degree relatives are included to the study. All of the participants were evaluated with Structured Clinical Interview for DSM-IV axis I disorders and relatives with active psychiatric diagnosis were excluded. Positive and Negative Symptom Scale, Clinical Global Impression Scale, Turkish version of cognitive assessment interview were administered congruently to the patients. Relatives of the patients were evaluated with Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Auto-questionnaire. Results Depressive temperament scores of relatives of schizophrenic patients who had suicidal thoughts were higher than the scores of the relatives of the patients who did not have suicidal thoughts. Depressive temperament also predicted number of suicide attempts in regression analysis. Number of suicide attempts was also related with number of hospitalization and functionality of the patient. Conclusion Suicidality in schizophrenia is related with relatives’ affective temperaments and patients’ own positive symptom scores. The relationship between suicidal thoughts and depressive temperament is high lightened in this study