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Liebowitz Social Anxiety Scale: The Turkish Version:

The present study aimed at establishing the Turkish version of the Liebowitz Social Anxiety Scale. For this aim interrater, test-retest, and internal reliability coefficients of the Turkish version were assessed as well as its convergent, discriminant, and criterion validity. Subjects were 88 patients with the diagnosis of generalized social phobia, 40 patients with a diagnosis of anxiety disorders other than generalized social phobia, and 40 people had no diagnosis of psychopathology. All reliability assessments indicated good reliability. For convergent and discriminant validity, correlations of 3 scores (2 subscales and the whole scale) and the Beck Anxiety Inventory were examined. Consistent with the expectations of the discriminant validity, correlations based on the whole sample were not significant. On the other hand, consistent with the expectations of the convergent validity, when patients with the diagnosis of generalized social phobia were considered, all the correlations were significant. Finally, the criterion validity of the Turkish version indicated that all 3 scores discriminated patients with the diagnosis of generalized social phobia, not only from the people who were free of psychopathology but also from the patients with the diagnosis of anxiety disorders other than generalized social phobia. Findings were discussed in the light of literature.

Secondary social anxiety in hyperkinesias

This is a comparison study that is aimed to investigate and compare the frequency and severity of secondary social anxiety disorder (SAD) in patients with hyperkinesias, which is associated with a significant sense of disfigurement and compromised social interaction. Patients with hemifacial spasm (n = 20), cervical dystonia (n = 20), and essential tremor (n = 20) were evaluated by SCID‐I, Liebowitz Social Anxiety Scale, Hamilton Anxiety and Depression Rating Scales, and Sheehan Disability Scale. The DSM‐IV H criterion excluding social anxiety related to a medical condition was disregarded for the diagnosis of secondary SAD. The control group (n = 60) consisted of matched healthy subjects. The frequency of the diagnosis and severity of symptoms were compared and associations with sociodemographic and clinical factors were explored. There was no difference between three patient groups in terms of the frequency or the severity of secondary SAD. Younger age and depressive symptoms were associated with the severity of secondary SAD, while severity or duration of the movement disorder or social disability was not. This study revealed a high frequency of secondary SAD in hyperkinesias, emphasizing the need for psychiatric assessment, especially for younger and depressed patients, who seem to be at greater risk.

Theory of Mind in Schizophrenia and Asperger’s Syndrome: Relationship with Negative Symptoms

OBJECTIVE Although previous studies have shown that the theory of mind (ToM) ability is impaired in Aspergers Syndrome (AS) and in schizophrenia, few controlled studies compared the ToM performance between the two disorders. Besides, the relationship between the degree of ToM impairment and symptom dimensions is unclear, and presence of ToM impairment in remitted patients with schizophrenia is controversial. Here, we tested the hypothesis that schizophrenia patients with prominent negative symptoms were closer to AS patients and different than schizophrenia patients without prominent negative symptoms and healthy controls in terms of ToM functioning. METHOD Fourteen patients with AS, 20 with schizophrenia and 20 healthy controls, matched by age, educational level and IQ scores were enrolled. AS was diagnosed according to the DSM-IV criteria and independently confirmed by two psychiatrists. Schizophrenia patients were diagnosed by the Turkish version of Structured Clinical Interview for DSM-IV Diagnosis (SCID-I) and symptom severity was evaluated with the Scale for the Assessment of Negative and Positive Symptoms. Schizophrenia group consisted of clinically stable patients. The ToM battery included stories to assess first and second order false belief tasks (ToM1 and ToM2). The full-scale IQ, Verbal Comprehension, Freedom from Distractibility and Perceptual Organization scores were assessed by Weschler Adult Intelligence Scale-Revised (WAIS-R). Non-parametric tests were used to compare the neuropsychological performances of the three groups. In order to investigate whether schizophrenia patients with prominent negative symptoms were similar to AS patients, schizophrenia patients were divided into high (Sch-HN) and low (Sch-LN) negative-symptom subgroups by median split. For these four groups (AS, Sch-HN, Sch-LN, and controls) between group comparisons were performed. Correlations between the clinical measures and ToM performance were assessed by Spearman correlation test. RESULTS AS and schizophrenia patients performed significantly worse than controls in the ToM2 task, while the AS group had worse ToM1 performance than both schizophrenia patients and healthy controls. The Sch-HN subgroup had significantly lower ToM2 scores than the Sch-LN patients, and worse ToM1 functioning than the controls. CONCLUSIONS These results suggest that clinically stable schizophrenia patients have ToM impairments. Sch-HN group performed comparably poorly as the AS group, while the Sch-LN group was relatively spared. The most profoundly impaired patients with schizophrenia in terms of ToM functioning were represented by those with high negative symptoms (Sch-HN). Similar to AS, as a neurodevelopmental impairment, these patients may not have developed ToM ability, or they may have lost their ToM capacity as a result of a neurodegenerative process during the illness. Supplementary studies using other methods (e.g., neuroimaging, neurophysiology) may highlight the brain regions that are affected differentially in AS and schizophrenia, the relationship of ToM impairments and negative symptoms, and the role of ToM impairments in the neurodevelopmental or neurodegenerative hypothesis of schizophrenia.

Cortical inhibition in first-degree relatives of schizophrenic patients assessed with transcranial magnetic stimulation

Although cortical inhibition deficit has been shown in schizophrenia patients by transcranial magnetic stimulation (TMS), some controversies remain, possibly due to confounding factors such as medication use and clinical state at the time of assessment. First-degree relatives of schizophrenia patients, who share various degrees of genetic vulnerability with the patients, but are free from confounds related to medication and/or florid psychosis, have not been studied to date. We compared 12 relatives with 14 controls on several paradigms with TMS. Three of the 12 healthy relatives lacked transcallosal inhibition (TI) in one or more of the stimulation levels. There were no significant differences in other parameters. The lack of TI in 25% of the relatives is an important finding that needs to be replicated in larger samples that are heterogeneous in terms of psychosis-proneness.

The effectiveness of intramuscular biperiden in acute akathisia: a double-blind, randomized, placebo-controlled study.

Neuroleptic-induced acute akathisia (NIA) is a distressing condition and an important clinical problem because it is associated with treatment noncompliance and suicidal or impulsive behavior. Anticholinergics are among the treatment options; however, a review of the literature fails to identify a double-blind, randomized, placebo-controlled study of these medications in NIA. In a randomized, double-blind, placebo-controlled design, we studied the effectiveness of intramuscular biperiden (n = 15) or isotonic saline (n = 15) in the treatment of NIA diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Injections were repeated up to 3 times unless akathisia was completely treated (scored 0 for global akathisia with the Barnes Akathisia Rating Scale). Patients were assessed for akathisia, other movement disorders, and psychiatric symptoms at baseline and 3 times after the first injection at 2-hour intervals. Response was defined as at least a 2-point decline in the global akathisia score. The numbers of responders in the 2 groups were not significantly different (7 and 5 in the biperiden and placebo groups, respectively). The courses of individual items on the Barnes Akathisia Rating Scale were also similar. Our results suggest that intramuscular biperiden should not be considered as a first-line treatment of NIA.

Attempted Suicides in Ankara in 1995

Since 1962, statistics of successful suicides have been available in Turkey(1).These statistics are collected sysematically by the State Institute of Statistics. However, suicide attempts have never been systematically registered. Our information about suicide attempts was from findings of some limited researches and from hospital records(2–9). The only comprehensive research about epidemiology of suicide attempts was carried out by Ankara University Crisis Intervention Centre in Ankara in 1990(10). The aim of this study was to replicate the research which was conducted in 1990, to find out the incidence of attempted suicide in Ankara in 1995, and to compare the results of 1990 and 1995.

Metabolic Effects of Olanzapine and Quetiapine: A Six-Week Randomized,Single Blind, Controlled Study

The objective of this study is to compare the course of metabolic effects of olanzapine and quetiapine, two atypical antipsychotics with similar structure and receptor binding affinities but clinically observed different metabolic ef- fects. This 6 week, single blind, randomized, controlled study was carried out during a structured treatment protocol in a female inpatient service, thus enabled to control effects of energy expenditure and other life style related factors. Subjects were randomly assigned into olanzapine (n=15) and quetiapine (n=15) groups. Weight and calorie intake (CI) were meas- ured daily. Symptom severity and serum leptin levels (SLL) were measured biweekly. Serum lipids were measured at baseline and 6th week. Olanzapine treatment was associated with more severe weight gain (F=11.2, p<0.01), increase in CI (F=8.1, p<0.01) and a more disturbed lipid profile than quetiapine. The course of SLL were similar between the groups (F=1.39, p=0.26). Weight, CI and SLL changed in a similar pattern within the groups but the patterns were different for each drug, suggesting that the two drugs have different mechanisms for weight change. The explanation probably involves different affinities for 5HT2C receptors leading to different patterns of CI which we propose as possible targets of inter- vention to manage antipsychotic induced weight gain.

Dissociation between Inattentiveness during Mental Status Testing and Social Inattentiveness in the Scale for the Assessment of Negative Symptoms Attention Subscale

The Scale for the Assessment of Negative Symptoms (SANS) attention subscale has been found valid and reliable by some studies; however, there is some evidence to the contrary. We hypothesized that social inattentiveness (SANS 22) and inattentiveness during mental status testing (SANS 23) might be describing discrete constructs, and this dissociation might be a source of controversy. Thirty-five patients with DSM-IV schizophrenia were assessed by the Scale for the Assessment of Positive Symptoms (SAPS), SANS and a neuropsychological battery. The 2 attention items were not significantly interrelated. SANS 22 was correlated with bizarre behavior and alogia, and none of the neuropsychological test scores, whereas SANS 23 showed strong correlations with the Wechsler Memory Scale mental control subscore, total errors on the Benton Revised Visual Retention Test, and the information, similarities and the general verbal subscores on the Wechsler Adult Intelligence Scale. Regression analyses showed that SANS 23 could be a good estimate of general verbal abilities. These findings point to a dissociation between the 2 SANS attention items. Similar analyses should be repeated in larger and heterogeneous samples and include a factor analysis of the individual items rather than the global ratings.

Psychiatric morbidity in patients with vitiligo / Vitiligolu hastalarda psikiyatrik morbidite

Psychiatric morbidity in patients with vitiligo Objective: The aim of this study was to determine the frequency of psychiatric morbidity in vitiligo patients treated at the dermatology outpatient clinic and to investigate the relation between anxiety, depression, social anxiety levels, and self esteem and disability in these patients. Method: Fourty-two patients with vitiligo were assessed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Hospital Anxiety Depression Scale (HADS), Rosenberg Self-Esteem Scale (RSES), Liebowitz Social Anxiety Scale (LSAS) and Sheehan Disability Scale (SDS). Control group included subjects matched to patients in terms of age, sex and education level. Results: In comparison to healthy controls, the rate of psychiatric morbidity was found to be higher and mean self-esteem score was found to be lower in the vitiligo group. There was no significant difference between groups in terms of social anxiety. Majority of the patients were mildly disabled. Among the vitiligo cases, psychiatric morbidity was found more frequent in female and young participants. Anxiety and social avoidance scores negatively correlated with age. Conclusion: These findings suggest that the rate of psychiatric morbidity is higher in patients with vitiligo than healthy control subjects. Patients with vitiligo treated at dermatology clinics should be assessed in terms of psychiatric disorders and psychiatric interventions may become necessary in the course of illness.

Psychiatric Comorbidity, Sexual Dysfunction, and Quality of Life in Patients Undergoing Hemodialysis: A Case-Control Study

INTRODUCTION Due to disabilities caused by the disease and the requirement of dialysis, end-stage renal disease (ESRD) is frequently comorbid with psychiatric disorders, adversely affects quality of life, and causes significant sexual dysfunction (SD). We aimed to investigate the psychiatric comorbidity, quality of life, depression and anxiety levels, and SD in ESRD patients undergoing hemodialysis. METHODS Forty-nine patients undergoing hemodialysis treatment in a dialysis center and 44 non-ESRD control subjects selected with snowball sampling were enrolled in the study. All subjects were assessed using Structured Clinical Interview for Axis-I Disorders (SCID-I). Sociodemographic data form, Hospital Anxiety and Depression Scale (HADS), Arizona Sexual Experience Scale (ASEX), and World Health Organization Quality of Life Short Form Turkish Version Scale (WHOQOL-BREF-TR) were applied to both groups. RESULTS There was no difference between the groups in terms of sex, age, education period, marital status, presence of additional physical illness, and past history of psychiatric disorders. Compared with the control group, HADS depression subscale and ASEX scores were significantly high (p<0.01) in the patient group, and WHOQOL-BREF-TR psychological and physical domain scores were low (p<0.05 and p<0.01, respectively). There was a significant negative relationship between HADS scores and WHOQOL-BREF-TR psychological, environmental, and national environmental scores in the patient group (p<0.05). When the differences between the groups were re-analyzed after controlling HADS depression scores with covariance analysis, the significant difference in ASEX and WHOQOL-BREF-TR physical domain scores between the groups remained, but the significant difference in WHOQOL-BREF-TR psychological domain scores disappeared. CONCLUSION The quality of life of ESRD patients was lower, especially in the psychological and physical domains, and psychiatric comorbidities and SD rates were higher than in non-ESRD control subjects. Quality of life is affected by SD. Recognizing and treating depressive symptoms will help improve the quality of life, especially in the psychological domain.