Figen C. Atesci

Psychiatric morbidity among cancer patients and awareness of illness

A significant proportion of cancer patients experience psychiatric morbidity. Potential predictors of psychiatric morbidity include patient disease-related factors and factors relating to the patient’s environment. The aim of this study was to investigate the prevalence of psychiatric morbidity and the relationship between the clinical or personal factors, especially psychiatric morbidity, and awareness of cancer diagnosis among a group of Turkish cancer patients. A total of 117 cancer patients were assessed using the Structured Clinical Interview for DSM-IV (SCID), the Hospital and Anxiety Depression Scale (HADS) and the General Health Questionnaire (GHQ). Of these patients, 30% had a psychiatric diagnosis. Adjustment disorders comprised most of the psychiatric diagnoses. Awareness of the diagnosis of cancer, history of previous psychiatric disorders, pain and stress factors were correlated with psychiatric morbidity. Of the 117 patients, 64 (54.7%) were unaware of the diagnosis of cancer. Most of the patients (67.9%) who were considered to be aware of the cancer diagnosis stated that they had guessed their illness from the treatment process or drug adverse effects. Psychiatric morbidity was significantly higher in the patients who knew that they had a cancer diagnosis (P=0.03). These findings suggest that the awareness of cancer diagnosis is related to the presence of psychiatric morbidity. In particular, the understanding of the diagnosis indirectly may be stressful to the patient because it arouses suspicion about the cancer and treatment, and consequently can lead to psychiatric disturbance. In Turkey honest disclosure of the true diagnosis is still not common for cancer patients and it seems to be essential to improve this situation.

Schizophrenia with obsessive-compulsive disorder and obsessive-compulsive disorder with poor insight: A neuropsychological comparison

Schizophrenia patients with obsessive-compulsive disorder (OCD) may be a subgroup of schizophrenia, and OCD patients with poor insight may show psychotic-like symptoms. The aim of this work is to compare the neuropsychological performance of those patients with schizophrenic patients who do not have OCD symptoms and with OCD patients who have good insight. The sample consisted of 89 patients (16 OCD-schizophrenic patients, 30 non-OCD schizophrenic patients, 30 OCD patients with good insight, 13 OCD patients with poor insight). Neuropsychological evaluation included executive functions, verbal and visual memory and attention tasks. While schizophrenic patients with OCD did not differ from the non-OCD schizophrenia and OCD with poor insight groups on long-term visual and verbal memory performance, they showed poorer performance than the OCD group on long-term visual and verbal memory tests. Considering executive function, the OCD group with poor insight performed significantly worse than their counterparts with good insight, and the latter group performed better than the schizophrenia patients. The results of this study suggest that the neuropsychological performance of schizophrenia patients with OCD did not differ from that of non-OCD schizophrenic patients, and that OCD patients with poor insight were more likely to share similar cognitive characteristics with the schizophrenia groups. Our results also provide neuropsychological support for the hypothesis that OCD and schizophrenia may be a spectrum disorders.

QUANTITATIVE EEG ANALYSIS IN OBSESSIVE COMPULSIVE DISORDER

Quantitative analysis of the EEG (q-EEG) in patients with obsessive compulsive disorder (OCD) showed a decreased beta and an increased theta power at frontotemporal regions. The patients who had higher scores in doubting test (Maudsley Obsessive Compulsive Questionnaire) and more severely ill patients shared similar q-EEG features. The relative theta powers were significantly increased and alpha powers were significantly decreased in these patients, particularly in the frontotemporal region. It was suggested that the q-EEG may be useful in investigating the OCD patients with heterogeneous characteristics.

Executive dysfunction and cognitive subgroups in a large sample of euthymic patients with bipolar disorder

Bipolar disorder (BP), at the group level, is associated with significant but modest cognitive deficits, including executive dysfunction. Among executive functions, response inhibition deficits have been suggested to be particularly relevant to BP. However, BP is associated with significant heterogeneity in neurocognitive performance and level of functioning. Very few studies have investigated neurocognitive subgroups in BP with data-driven methods rather than arbitrarily defined criteria. Other than having relatively small sample sizes, previous studies have not taken into consideration the neurocognitive variability in healthy subjects. Five-hundred-fifty-six euthymic patients with BP and 416 healthy controls were assessed using a battery of cognitive tests and clinical measures. Neurocognitive subgroups were investigated using latent class analysis, based on executive functions. Four neurocognitive subgroups, including a good performance cluster, two moderately low-performance groups, which differ in response inhibition and reasoning abilities, and a severe impairment cluster were found. In comparison to healthy controls, BP patients were overrepresented in severe impairment cluster (27% vs 5.3%) and underrepresented in good performance cluster. BP patients with lower educational attainment and older age were significantly more likely to be members of cognitively impaired subgroups. Antipsychotic use was less common in good performance cluster. These results suggest that there is a considerable overlap of cognitive functions between BP and healthy controls. Neurocognitive differences between BP and healthy controls are driven by a subgroup of patients who have severe and global, rather than selective, cognitive deficits.

Characteristics of Suicidal Behavior in a Turkish Sample

BACKGROUND Suicidal behavior is one of the most important problems in psychiatric clinics. Several sociodemographic and clinical characteristics may have different effects on suicidal behavior. AIMS To examine the sociodemographic and clinical characteristics of a sample of 144 suicide attempters admitted to a Turkish emergency clinic for a suicide attempt. METHODS All subjects were interviewed by a consultant psychiatrist. For all individuals, data on DSM-IV psychiatric diagnoses, sociodemographic data, Becks Hopelessness Scale (BHS), Beckss Suicidal Ideation Scale (SIS), and Becks Suicidal Intention Scale (BSIS) were collected. RESULTS The majority of suicide attempters were females characterized by low educational status and low religious orientation. Drug overdose was the most common method of suicide attempt and conflict within the family was the most frequent psychological stress factor. Three-quarters of attempters (74.6%) met DSM-IV criteria for at least one psychiatric diagnosis. Of these, 28.5% met criteria for major depressive disorder. Suicide attempters with depression tended to be immigrant, urban dwellers with high scores on the suicide intent scale. CONCLUSIONS In the present study, the findings are useful in showing the risk factors related to suicidal behavior.

Situation awareness in obsessive-compulsive disorder

Past studies have suggested that OCD patients suffer memory impairment on tasks using complex stimuli that require memory for combined elements to be maintained, but not for more simplistic memory tests. We tested this with 42 OCD patients and 42 healthy controls performed a computerized situation awareness task. In addition, participants completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Maudsley Obsessive-Compulsive Inventory (MOCI). The OCD patients had poorer accuracy in integration/comprehension and perception levels than controls. There were significant correlations between situational awareness scores (i.e., visuo-spatial monitoring and processing) and Y-BOCS obsession-compulsion and slowness and doubt scores of MOCI in OCD patients. In addition, there were also significant correlations between situational awareness and controlling, cleaning, slowness, rumination and total scores of MOCI in control group. Results indicated that (I) OCD patients have problems of perception, integration, and comprehension of complex visual perceptions; (II) situation awareness deficits associated with severity and prevalence of obsessions and compulsions.

Cognitive functions in euthymic patients with bipolar disorder

BACKGROUND Recent studies have focused on the nature of cognitive dysfunction in bipolar patients. The purpose of the current study was to investigate cognitive performance of individuals with bipolar disorder compared to healthy control subjects during a well-established euthymic period. METHODS The sample consisted of 27 bipolar euthymic patients and 21 control subjects. Verbal and visual memory performance, attention, executive functions and psychosocial functions were evaluated for each participant. RESULTS Bipolar patients showed significant attentional deficit and executive dysfunction and also poor performance on verbal and visual memory tasks compared to the controls. Illness duration and lifetime total episode number and previous episode with psychotic features was associated with worsened performance on attention, executive and memory tasks. Psychosocial functioning was not associated with cognitive deficit. CONCLUSIONS The present study showed persistent cognitive impairment on inhibitory control and selective attention as well as poor performance on verbal and visual memory tests in a group of bipolar euthymic patients. The impaired neuropsychological performance was associated with duration of illness, total number of episodes per lifetime, and previous episodes with psychotic features. Attentional dysfunction seemed to be a trait abnormality for the sample studied.

Is psychogenic dizziness the exact diagnosis

The main goal of the study is to determine the exact ratio of pure psychogenic dizziness. Patients from vertigo outpatient clinic were evaluated by SCL-90 R questionnaire, interviews, vestibular tests and magnetic resonance imaging (when needed). Five hundred and eighteen patients were evaluated for this study. While 45.2% of the patients have at least one abnormal psychogenic scale (somatization, obsessive-compulsiveness, interpersonal sensitivity, depression, anxiety etc.), only 9% of the patients were diagnosed as psychogenic dizziness according to the interview. One percent of 518 had no organic cause for dizziness and also diagnosed as pure psychogenic dizziness. Our results suggest that patients with dizziness need to be evaluated by psychological tests routinely and patients with high-test scores must consult a psychiatrist who is familiar with dizziness symptomatology.

The comparison of pre- and post-treatment 99mTc HMPAO brain SPECT images in patients with obsessive-compulsive disorder

The objective of the present study was to compare brain activation in patients with obsessive-compulsive disorder (OCD) who received pharmacotherapy (selective serotonin reuptake inhibitor (SSRI) or a SSRI-risperidone combination) with that in healthy controls using (99m)Tc-hexamethyl propyleneamine oxime (HMPAO) brain single photon emission tomography (SPECT). Twelve OCD patients achieving clinical response (seven SSRI responders, five patients responded to SSRI plus risperidone) underwent post-treatment SPECT scan. The baseline regional cerebral blood flow (rCBF) was significantly reduced in a large part of the cerebral cortex and the left cingulate gyrus in OCD patients compared with controls. After a 50% reduction of the OCD symptoms, bilaterally increased rCBF in the thalamus showed a significant effect of time in both of the patient groups. In the remitted state, although rCBF in the cingulate gyrus did not differ in SSRI responders compared with controls, patients who responded to the combination of SSRI+ risperidone showed significant hypoperfusion in the left anterior cingulate gyrus. SSRI responders had normalized rCBF in the frontal region relative to the control group. Consequently, based on our results, we attribute the observed thalamic rCBF alteration to SSRI treatment. Our results also suggested that brain perfusion changes associated with clinical remission may differ across patient subgroups.

Comorbidity of attention deficit hyperactivity disorder in adult bipolar I disorder: a preliminary study

Objective: Attention-deficit hyperactivity disorder (ADHD) is a disorder that typically first appears in childhood and has the main symptoms of inattention, overactivity, and impulsivity. Attention-deficit hyperactivity disorder and bipolar disorder are frequently comorbid and overlapping diagnoses. Although there is data describing the overlap of ADHD and bipolar disorder in childhood and youth, little is known about the comorbidity of these disorders in adulthood. In this study, our aim was to investigate comorbidity of attention deficit hyperactivity disorder in bipolar disorder and to compare several socio-demographic and clinical variables of bipolar patients with and without comorbid ADHD. Method: Sixty patients diagnosed with euthymic bipolar I disorder were enrolled in the study. Patients with bipolar disorder were observed in the outpatient setting during at least two months to ensure the existence of euthymia before the study procedures were conducted. Socio-demographic data form, Hamilton Depression, Young Mania, Wender Utah and Adult ADHD Rating Scales, and the Structured Clinical Interview for DSM-IV were applied to the participants. Socio-demographic data included variables such as age, gender, educational status, episode number, and the type of present treatment. Between group comparisons were made by using Mann-Whitney U test and Chi-square test. Results: The comorbidity rate of ADHD in our study sample with bipolar I disorder was 21.7%. There were no significant differences between with and without comorbid ADHD groups in terms of their age, gender, and educational level. Comorbid ADHD patients were smoking more cigarettes than those without comorbid ADHD. In addition, the number of their total episodes and manic episodes were relatively higher in the comorbid ADHD group. Conclusions: The results suggest that ADHD is a common comorbidity in adult bipolar patients. The existence of high rates of comorbidity leads to important diagnostic and therapeutic complications. Further study is needed to clarify the impact of ADHD on clinical outcomes of adult bipolar patients and to provide guidelines for therapeutic approaches.