Okan Ekinci

Relationship of trait impulsivity with clinical presentation in euthymic bipolar disorder patients

The purpose of this study was to examine trait impulsivity in patients with bipolar disorder and explore the possible connections between impulsivity and clinical presentation of the illness. Diagnoses were based on the Structured Clinical Interview for DSM-IV. The sociodemographic and clinical properties of 71 patients with bipolar disorder, who were euthymic according to Young Mania Rating Scale and Hamilton Depression Scale scores, were recorded. Their trait impulsivity was evaluated by using the Barratt Impulsiveness Scale (BIS) and impulsivity subscale of the Temperament and Character Inventory, and the results were compared with 50 age- and sex-matched healthy controls and among patients with different clinical properties. All BIS-11 subscale scores were higher in bipolar than in comparison subjects. There were no effects of education and age. Elevated BIS-11 scores were associated with predominant depressive polarity, longer duration of illness and a history of psychotic mood episodes and suicide attempts. These relationships persisted when age, gender, and education were taken into account. These results show that after accounting for common confounding factors, trait-like impulsivity was substantially higher in subjects with bipolar disorder than in nonbipolar comparison subjects and may vary according to different clinical presentations.

The relationship between cognitive insight, clinical insight, and depression in patients with schizophrenia.

Despite comorbid depression being relatively common even in subjects with schizophrenia, to the best of our knowledge, there is, to date, no report in the literature specifically and detailed examining the cognitive and clinical insight in subjects with schizophrenia and a comorbid depressive syndrome. Hence, in this study, we sought to compare the cognitive and clinical insight in our subjects with schizophrenia with and without a comorbid depressive syndrome. We found that participants in the depressive group scored significantly higher on self-reflectiveness and the reflectiveness-certainty (R-C) index scores than those in the nondepressive group. There was no significant difference among groups on the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and clinical insight scores assessed by the Scale to Assess Unawareness of Mental Disorder. In addition, self-reflectiveness scores significantly correlated with depression, observed depression, hopelessness, and suicidality subscores of the Calgary Depression Scale for Schizophrenia. A better understanding of the cognitive component of insight in schizophrenia with comorbid depression may contribute to develop more efficient cognitive strategies, thus improving patient outcome. However, clinicians should be aware of the possibility of exacerbating a sense of hopelessness and suicide risk during the interventions that improve cognitive insight.

Association between insight, cognitive insight, positive symptoms and violence in patients with schizophrenia

Background: Violence is a significant clinical and public concern and is a frequent occurrence in patients with schizophrenia. The relationship between insight and violence remains controversial. In addition, there is a lack of research on insight, cognitive insight, demographic and psychopathologic variables in violent versus nonviolent schizophrenia patients. Aim: We aimed to compare insight, cognitive insight, psychopathological and demographic variables in violent and nonviolent subjects suffering from schizophrenia. In addition, we aimed to determine the demographic and clinical predictors of violent behaviour in patients with schizophrenia. Method: We recruited 133 schizophrenic patients without concomitant substance abuse or axis II disorder. Diagnoses were based on the SCID-I and SCID-II. Violent behaviours were assessed using the Overt Aggression Scale. Insight and cognitive insight were assessed with the Scale to Assess Unawareness of Mental Disorder and the Beck Cognitive Insight Scale, respectively. Results: We compared 47 patients with violent schizophrenia with 86 nonviolent patients. Non-violent patients had more severe depression, lower scores on positive symptoms, better clinical insight, more self-reflectivity and higher R-C index scores than did violent patients. In addition, history of violence, lower self-reflectiveness, worse clinical insight and delusion severity were significant predictors of violence in schizophrenia. Conclusion: The present study suggests that the inclusion of insight and cognitive insight may increase the prediction of violence in this population. In addition, clinicians should consider using non-pharmacological techniques that are based on cognitive behaviour therapy and enhance insight, particularly cognitive insight, among patients with schizophrenia who exhibit violent behaviour.

Temperament and Character in Euthymic Major Depressive Disorder Patients: The Effect of Previous Suicide Attempts and Psychotic Mood Episodes

Objective The purpose of this study was to examine personality traits of patients with major depressive disorder and explore the possible connections between personality and clinical and sociodemographic variables. Methods The sociodemographic and clinical properties of 80 patients with major depression, who were euthymic according to Hamilton Depression Scale scores, were recorded. Their personality was evaluated by using Temperament and Character Inventory and results were compared with 80 age- and sex-matched healthy controls. We used general linear model analysis to evaluate the manner in which the variables contributed to TCI scores. Results Remitted depressive patients scored significantly lower on on self-directedness and higher on harm avoidance than HC. Previous suicide attempts had a main effect only on harm avoidance while previous psychotic mood episodes were significantly associated with novelty seeking, self-directedness and cooperativeness. With respect to numeric clinical variables, only duration of illness was significantly and negatively correlated with NS and RD scores. Conclusion Patients with euthymic major depressive disorder may have significantly different personality traits than the normal population, and patients with different clinical and sociodemographic characteristics may show different personality patterns. In addition, assessment of major depressed patients by means of the Temperament and Character Inventory may be helpful to get a deeper insight into those personality traits underlying suicidality and the emergence of psychotic mood episode.

Duloxetine-associated tardive dyskinesia resolved with fluvoxamine: a case report.

To the Editors: Tardive dyskinesia is characterized by involuntary, repetitive, purposeless movements that can affect different parts of the body. It is strongly associated with a history of antipsychotic use and usually occurs after several years of treatment. Sometimes antidepressants or calcium channel blockers may be responsible. To our knowledge, there are only 2 case reports describing duloxetine-induced tardive dyskinesia, and there is no report on the effectiveness of fluvoxamine in the treatment of tardive dyskinesia. We describe a patient who was treated with duloxetine for 4 months and developed tardive dyskinesia and subsequently benefited from switching to fluvoxamine in terms of both the depressive disorder and tardive dyskinesia.

Temperament and character personality profile in relation to suicide attempts in patients with schizophrenia

INTRODUCTION Schizophrenia is associated with a significant risk of suicide, and suicide still remains one of the main causes of death in schizophrenic patients. Beside classic risk factors for suicidality, temperament and character traits have been researched and considered as risk factors for suicidal behavior in recent years. METHOD Subjects were 94 patients with schizophrenia who were under treatment. All patients were in a stable phase of the illness. Patients with lifetime suicide attempt (n = 46) and without suicidal attempt (n = 48) were compared with each other in terms of temperament and character traits by using the Temperament and Character Inventory. RESULTS Harm avoidance and persistence scores were higher in suicidal schizophrenic patients compared with nonsuicidal schizophrenic patients. The scores of self-directedness and cooperativeness were lower in suicidal schizophrenic patients compared with nonsuicidal schizophrenic patients. These 4 variables remained significant predictors of lifetime suicidal attempts in a logistic regression model. CONCLUSION To the best of our knowledge, the present study is the first that specifically compares schizophrenic patients with and without suicidal behavior by the Cloninger temperament and character model. Our data indicate that schizophrenic patients will show a greater risk for suicide according to certain personality configurations. However, to establish causal relationships between personality and suicidality in schizophrenia, longitudinal studies are warranted within a multifactorial interactive framework of biologic and clinical variables.

The connections among suicidal behavior, lipid profile and low-grade inflammation in patients with major depressive disorder: a specific relationship with the neutrophil-to-lymphocyte ratio

Abstract Objectives: The role of inflammation and lipid metabolism in the pathophysiology of suicidal behavior has received particular attention in recent years. The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a new and more reliable indicator of low-grade inflammation. NLR has been found to be altered in major depressive disorder (MDD) and has been related to various factors, including chronic stress and impulsivity that were previously reported to be related to suicidal behavior. We aimed to explore the roles of NLR, C-reactive protein (CRP) and serum lipid levels on suicidal behavior in patients with MDD. Methods: The study group consisted of 139 inpatients diagnosed with MDD [37 suicide attempters (SA); 102 suicide non-attempters (NSA)], 50 healthy controls and matched according to age, gender and education. NLR, PLR, CRP and lipid values were obtained from digital inpatient records. Results: CRP levels and NLR were substantially higher in patients with SA than in subjects with NSA and healthy comparison subjects after adjusting the confounding factors. The logistic regression included two predictive variables for suicide status in patients with depressive disorder (A) previous suicidal history; (B) NLR. Conclusions: This is the first study suggesting that NLR may be a trait marker for suicidal vulnerability via a relationship between NLR and a recent suicide attempt in depressed inpatients. Future prospective studies are needed to determine the exact roles of NLR, and other inflammatory markers on suicidality in MDD.

Cognitive insight and its relationship with symptoms in deficit and nondeficit schizophrenia.

Abstract Patients with deficit schizophrenia have worse cognition and poorer social functioning compared with those with nondeficit schizophrenia. Insight is another domain in which these two groups might differ. However, there is no literature data specifically on cognitive insight impairment in deficit versus nondeficit schizophrenia. We compared 40 patients with deficit schizophrenia with 81 nondeficit patients and found that schizophrenic patients with deficit syndrome were more self-reflective and have higher self-reflectiveness−self-certainty index scores than did those without deficit syndrome. These differences remained significant when analysis was controlled for sex, age, education, and depression severity. On the other hand, there was no significant difference in self-certainty scores between two groups. In addition, we found significant relationships between cognitive insight and specific psychotic symptoms. A better understanding of the cognitive component of insight in schizophrenia with deficit syndrome may help us to understand the true relationship between insight and negative symptoms and contribute to the development of more efficient cognitive strategies, thus improving patients’ outcome in a severely disabled psychiatric patient group.

Amisulpride-induced tardive dystonia: a case report.

Tardive dystonia (TDt) is a delayed side effect of antipsychotic exposure that occurs at a frequency of 1% to 4.0%. It is characterized by development of twisting and sustained muscle contraction, usually involves the head and neck, producing torticollis, retrocollis, or anterocollis (Marsalek, 2000; van Harten and Kahn, 1999). This adverse effect is usually associated with conventional antipsychotics, though it has also been observed in patients treated with atypical antipsychotics (Duggal and Mendhekar, 2007; Charfi et al., 2004). TDt is indicated in the summary of product characteristics (SPC) as an uncommon undesirable effect of amisulpride. However, to our knowledge, there is only one report of TDt caused by amisulpride in the literature (Sevincok et al., 2008). We here report on amale patient who developed TDt while receiving stable dose amisulpride treatment and partially remitted following a switch to quetiapine and initiation of biperiden therapy.

The relationship between clinical characteristics, metacognitive appraisals, and cognitive insight in patients with obsessive-compulsive disorder

Abstract Background: Cognitive insight, a recently developed insight measure, refers to metacognitive processes of the re-evaluation and correction of distorted beliefs and misinterpretations. However, to the best of the authors’ knowledge, no study has specifically examined cognitive insight, demographics, psychopathological variables, and distorted beliefs in OCD. Aim: The aim of this research was to examine links between cognitive insight and demographics, clinical factors, and distorted beliefs among patients with OCD. Method: Eighty-four consecutive outpatients with a diagnosis of OCD underwent a detailed clinical assessment for OCD, including the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), Beck Cognitive Insight Scale (BCIS), Thought-Action Fusion Scale (TAFS), White Bear Thought Suppression Inventory, Metacognition Questioniarre-30 (MCQ-30), and a sociodemographic questionnaire. In addition, 82 control subjects matched for age, education, and gender were tested. Results: BCIS-self-certainty scores were all substantially higher in subjects with remitted and unremitted OCD than in healthy comparison subjects, while BCIS-composite scores were significantly lower in both patient groups than controls. Obsession and compulsion severity had significant effects on BCIS scores. In addition, it was found that the specific symptoms were linked to self-certainty scores. Self-reflectiveness and composite scores had positive correlations with the sub-scale scores of the MCQ-30, while the TAF-morality score was positively correlated with self-certainty scores. Conclusion: The results demonstrated poor cognitive insight among remitted and unremitted OCD patients. In addition, the present study suggested significant associations between sociodemographic and clinical features and dysfunctional appraisals. Cognitive-behavioural techniques aimed at enhancing cognitive insight may be beneficial for patients with OCD, particularly patients who have prominent dysfunctional beliefs.