Bülent Kayahan

Cognitive insight and acute psychosis in schizophrenia

Abstract  Cognitive insight is a new concept. There are very few data regarding the relationship between cognitive insight and positive symptoms. The goal of the present study was to investigate the impact of acute psychosis (delusions and hallucinations) on overconfidence in judgments and self‐reflectiveness of patients with schizophrenia. The Beck Cognitive Insight Scale was used to compare the cognitive insight of schizophrenia patients with (n = 93) and without (n = 45) current psychotic symptoms. Clinical symptoms and clinical insight of the patients were also assessed. The present findings suggest that both overconfidence in judgments and impaired self‐reflectiveness are associated with acute psychosis. Only diminished self‐reflectiveness seem to be improved following hospitalization. Although overconfidence of schizophrenia patients in their judgments was more severe in schizophrenia patients with psychotic symptoms, self‐certainty of schizophrenia patients may be a relatively persistent characteristic that is also present after recovery of psychosis. Studies with larger samples involving follow up for longer periods will be valuable to understand the nature of the relationship between cognitive insight and clinical symptoms of schizophrenia.

Deficits of social-cognitive and social-perceptual aspects of theory of mind in remitted patients with schizophrenia: effect of residual symptoms.

Although ToM deficit in schizophrenia is widely accepted, findings regarding remitted schizophrenia patients are contradictory. Because residual symptoms are present out of psychotic exacerbation periods, the differences between definition of remission may be important to interpret these findings. The purpose of this study was to investigate the relationship between performance of 2 different aspects of theory of mind (ToM) and residual clinical symptoms and other cognitive deficits in schizophrenia. Ninety-one stable outpatients with schizophrenia and 55 healthy controls were assessed with a neuropsychological battery. Both social-cognitive and social-perceptual aspects of ToM were impaired in schizophrenia, even in patients who were totally free of residual symptoms. Still, the results showed that ToM deficit is related to residual symptoms of schizophrenia. Social-cognitive ToM abilities seem to be related to both positive and negative symptoms. The ToM deficits of fully remitted patients without persistent negative symptoms may be secondary to a more general cognitive dysfunction in schizophrenia.

Obsessive‐compulsive symptoms in schizophrenia: Prevalance and clinical correlates

Abstract  Obsessive‐compulsive symptoms (OCS) have been observed in a substantial proportion of schizophrenic patients. In this study, the rate of occurrence of OCS and obsessive‐compulsive disorder (OCD) in schizophrenic patients, and also the interrelationship between OCS and schizophrenic symptoms and depressive symptoms were assessed. A total of 100 subjects with a diagnosis of schizophrenia from the 4th edition of the Diagnostic and Statistical Manual (DSM‐IV) were evaluated by the structured and clinical interview for axis‐1 DSM‐IV disorders – patient edition (SCID‐P), the Positive and Negative Syndrome Scale (PANSS), Yale‐Brown Obsessive‐Compulsive Scale (Y‐BOCS), and the Calgary Depression Rating Scale for Schizophrenia. The prevalance of OCS in individuals meeting criteria for schizophrenia was 64%. A total of 30 of these patients (Y‐BOCS total score ≥7) also met the DSM‐IV criteria for OCD. The total score on Y‐BOCS was significantly correlated with total score on PANSS, Positive‐PANSS score, General‐PANSS score and total score on Calgary Depression Rating Scale for Schizophrenia. OCS and OCD relatively frequent in schizophrenic patients and OCS are significantly correlated with the severity of psychosis, positive symptoms, and depressive symptoms in schizophrenic patients. These findings provide further evidence for the importance of OCS in schizophrenia.

Psychosocial skills training on social functioning and quality of life in the treatment of schizophrenia: a controlled study in Turkey.

OBJECTIVE This study assessed the impact of a psychosocial skills training program, consisting of psychoeducation, interpersonal group therapy and family education incorporated into social skills training, as an integrative approach on social functioning and quality of life of patients with schizophrenia, in comparison to standard care for an 8-month period. METHOD Thirty patients with DSM-IV schizophrenia were included in the study. Patients were assessed using the Positive and Negative Syndrome Scale (PANSS), Quality of Life Scale (QLS), Social Functioning Scale (SFS), and Global Assessment of Function (GAF) at baseline. Fifteen patients underwent an 8-month psychosocial skills training group program and another fifteen patients (waiting list) continued in standard care. Both groups were reassessed and analyzed at the end of the study. RESULTS Two groups were not statistically different in terms of total PANSS, QLS, SFS, GAF scores, and demographic characteristics at baseline. However, there was a significant improvement in the mean total QLS, SFS, GAF, and even in total PANSS scores (respectively from 64.46±19.58 to 89.67±24.10, P<0.001, from 93.20±22.85 to 132.60±33.85, P<0.002, from 57.40±8.78 to 63.86±7.57, P<0.012, and from 63.53±14.48 to 53.33±15.71, P<0.029) for those who underwent the PSST program, but there was no statistically significant change for those on standard care at the end of the study. CONCLUSION This study highlights the ‘social functioning’ and ‘quality of life’ benefits of the psychosocial skills training program for patients with schizophrenia. It can be concluded that this comprehensive psychosocial skills training program might be an important contribution to the functioning of the patients.

Is BDNF-Val66Met polymorphism associated with psychotic experiences and psychotic disorder outcome? Evidence from a 6 years prospective population-based cohort study

There is little research on genetic risk for the extended psychosis phenotype ranging from psychotic experiences (PEs) to psychotic disorders (PDs). In this general population‐based prospective cohort study, the longitudinal associations between BDNF‐Val66Met polymorphism and the different levels of the extended psychosis phenotype were investigated. Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighborhoods at baseline (n = 4011). A nested case‐control study (n = 366) recruited individuals with PEs and PDs as well as individuals with no psychotic symptoms. In this subgroup, blood sampling for genetic analysis and assessment of environmental exposures were carried out, followed by clinical re‐appraisal at follow‐up 6 years later (n = 254). The BDNF‐Val66Met polymorphism was significantly associated with the extended psychosis phenotype. The pattern of the association was that the BDNF‐Val66Met polymorphism impacted in a dose‐response but extra‐linear fashion, with stronger impact at the PD end of the extended psychosis phenotype. Associations were still significant after adjusting for sociodemographic factors and environmental exposures including life events, childhood adversity, socioeconomic status, urbanicity, and cannabis use. The BDNF‐Val66Met polymorphism may index susceptibility to expression of psychosis along a spectrum.

The effect of brain derived neurotrophic factor Val66Met polymorphism upon alcohol dependence tendency in Turkish alcohol dependents

Objective: The neurotrophine “brain derived neurotrophic factor” (BDNF) which is expressed in the brain is responsible for neuronal survive and functioning also plays a role in pathophysiology of alcohol dependence that show multifactorial and polygenic heredity. In the current study, we aimed to identify whether the functional Val66Met [G196A; (rs6265)] polymorphism in BDNF gene has effect upon tendency to alcoholism in Turkish male and female alcohol dependent cases. Methods: Genotype distribution and allele frequency of BDNF Val66Met polymorphism was identified via PCR-RFLP (Polymerase Chain Reaction-Restriction Fragment Length Polymorphism) method in 110 alcoholic cases (10 female, 100 male) and 376 healthy subjects (148 female, 228 male) constituting our study and control groups, statistical analyses were revealed by chi-square and ANOVA tests. Results: The distribution of the mutant AA genotype was 3.6% to 1.6% and frequency of the A allele was 16.0% to 15.0% in the study group when compared to control group. Our results didn’t show any significant differences in genotype distribution and allele frequencies of polymorphism neither between the study and control groups nor between female case and female controls and male alcoholics and male controls. The power of the study for genotype analysis was set at 80.2%. Conclusion: These results indicate that the polymorphic A allele of BDNF gene is not related with alcoholism in Turkish subjects. But since AA genotyped male subjects’ starting ages of alcohol usage and pathological drinking were detected to be earlier among other genotypes, this gave rise to a conclusion that BDNF polymorphism might be important in the alcoholism phenotype.

Paroxetine augmentation to tianeptine treatment causes exacerbation of depressive symptoms: presentation of two cases

We present two cases whose depressive symptoms partially remitted with tianeptine treatment but exacerbated after paroxetine augmentation to tianeptine. Although tianeptine has structural similarities with tricyclic antidepressants, unlike tricyclic agents or selective serotonin- reuptake inhibitors(SSRIs), it enhances 5-HT reuptake in brain, leading to decreased availability of the transmitter in the synaptic cleft. Thus, efficacy of tianeptine as an antidepressant agent caused a challenge to the concept of serotonergic deficit theory in depression. Both paroxetine and tianeptine are found equivalently effective in treatment of major depression, but no data are available for combined use of these two agents.