İlker Özyıldırım

Childhood trauma and treatment outcome in bipolar disorder

ABSTRACT The aim of the present study was to investigate the potential influence of childhood trauma on clinical presentation, psychiatric comorbidity, and long-term treatment outcome of bipolar disorder. A total of 135 consecutive patients with bipolar disorder type I were recruited from an ongoing prospective follow-up project. The Childhood Trauma Questionnaire and the Structured Clinical Interview for DSM–IV Axis I Disorders were administered to all participants. Response to long-term treatment was determined from the records of life charts of the prospective follow-up project. There were no significant differences in childhood trauma scores between groups with good and poor responses to long-term lithium treatment. Poor responders to long-term anticonvulsant treatment, however, had elevated emotional and physical abuse scores. Lifetime diagnosis of posttraumatic stress disorder (PTSD) was associated with poor response to lithium treatment and antidepressant use but not with response to treatment with anticonvulsants. Total childhood trauma scores were related to the total number of lifetime comorbid psychiatric disorders, antidepressant use, and the presence of psychotic features. There were significant correlations between all types of childhood abuse and the total number of lifetime comorbid psychiatric diagnoses. Whereas physical neglect was related to the mean severity of the mood episodes and psychotic features, emotional neglect was related to suicide attempts. A history of childhood trauma or PTSD may be a poor prognostic factor in the long-term treatment of bipolar disorder. Whereas abusive experiences in childhood seem to lead to nosological fragmentation (comorbidity), childhood neglect tends to contribute to the severity of the mood episodes.

Suicide attempts and clinical features of bipolar patients

Objectives: To identify clinical predictors of suicide attempts in patients with bipolar disorder. Methods: This study included bipolar patients who were treated in the Psychiatry Department, Haseki Training and Research Hospital, Istanbul, Turkey, between 2013 and 2014; an informed consent was obtained from the participants. Two hundred and eighteen bipolar patients were assessed by using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis-I (SCID-I) in order to detect all possible psychiatric comorbid diagnoses. Clinical predictors of suicide attempts were examined in attempters and non-attempters. The study design was retrospective. Results: The lifetime suicide attempt rate for the entire sample was 19.2%. Suicide attempters with bipolar disorder had more lifetime comorbidity of eating disorder. Female gender and family history of mood disorder were significant predictors for suicide attempts. There was no difference between groups in terms of bipolar disorder subtype, onset age of bipolar disorder, total number of episodes, first and predominant episode type, suicide history in first degree relatives, severity of episodes, and hospitalization and being psychotic. Conclusion: Our study revealed that female gender, family history of mood disorder, and eating disorder are more frequent in bipolar patients with at least one suicide attempt.

Yetişkin Bipolar Bozuklukta Erişkin Dikkat Eksikliği ve Hiperaktivite Bozukluğu: Sıklık, Sosyodemografik ve Klinik İlişkiler

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.

Maintenance treatment trends, therapeutic outcomes and their association with clinical features in remitted bipolar disorder

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.

Comparison of clinical and sociodemographic features of bipolar disorder patients with those of social anxiety disorder patients comorbid with bipolar disorder in Turkey

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.

Bipolar hastalarda alkol kullanım bozuklukları eştanısının değerlendirilmesinde Michigan Alkolizm Tarama Testi’nin (MATT) geçerliliği

Validity of Michigan alcoholism screening Test (MAST) in assessment of bipolar patients with comorbid alcohol use disorders Objective: Alcohol use in patients with bipolar disorder (AUP) comorbidity is reported to be frequent. Although the validity study of MATT has been performed in Turkish; there is no spesific study in bipolar patients describing precitive diagnosis. Determining the diagnostic validity of MATT upon AUP comorbidity in bipolar patients is aimed in this study. Material and Methods: Structured clinical interview for DSM-IV Axis I Disorders (SCID-I) and MATT were applied to 111 bipolar patients. MATT scores were compared in two group of bipolar patients who have prior diagnosis of AUP comorbidity and those have not. Thus in order to define the AUP comorbidity in bipolar patients, required MATT cutting score for adequate sensitivity and specificity was tried to be determined. Results: SCID-I interview now, six of 111 bipolar patients (n=3) or past (n=3) AUP (2 patient dependency, abuse 4 patients) was to meet the diagnosis. The opener 32 in two points of alcohol dependence, 18, 17, 7 and 0 in four patients with alcohol abuse has been detected. MATT score between 0 and 7 patients who in the past, is now 17 and 18 who met the diagnosis of abuse. MATT score of five or above on the four patients, respectively. MATT scores of 5 or more (5 with five, 9 of the two, 6 and 10 with a patient) not diagnosed, nine patients diagnosed with any alcohol use disorder. Conclusion: Five or above MATT scores is reported to be associated with “problematic” alcohol use. However, this cut-off scores may vary in different populations both in sensitivity and specificity. When MATT cut-off scores were accepted to be above 10 in screening studies to define the AUP comorbidity in bipolar patients; specificity, sensitivity and positive predictive values were measured higher.

A Comparison of Sexual Dysfunctions in Female Patients with Major Depressive Disorder and Panic Disorder

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.