Sedat Batmaz

The distinction between unipolar and bipolar depression: A cognitive theory perspective

BACKGROUND There is very limited data about the cognitive structure of bipolar depression when compared to unipolar depression. The aim of the study was to look into the differences between unipolar and bipolar depressed patients regarding their cognitive structure in view of Becks cognitive theory. METHODS In this study, 70 bipolar patients during a depressive episode, 189 unipolar depressed patients and 120 healthy subjects were recruited. The participants were interviewed by using a structured clinical diagnostic scale. To evaluate the cognitive structure differences, the Automatic Thoughts Questionnaire (ATQ) and the Dysfunctional Attitude Scale (DAS) were used. RESULTS We found that on the mean ATQ total score, the unipolar depressed patients scored significantly higher (92.9±22.7) than both the bipolar depressed patients (73.2±24.7) and the healthy subjects (47.1±19.6), even after controlling for all confounding factors, e.g. gender, marital status, depressive symptom severity (F = 157.872, p<0.001). The bipolar depressed patients also scored significantly higher on the mean ATQ total score than the healthy controls. On the mean DAS total score, and on the mean score of its subscale of need for approval, the bipolar depressed patients scored (152.8±21.2 and 48.2±7.4, respectively) significantly higher than both the unipolar depressed patients (160.9±29.0 and 51.9±9.7, respectively) and the healthy subjects (127.9±32.8 and 40.2±12.2, respectively), even after controlling for any confounding factor (F=45.803 [p<0.001] and F=43.206 [p<0.001], respectively). On the mean score of the perfectionistic attitude subscale of the DAS, the depressed groups scored significantly higher than the healthy subjects, but they did not seem to separate from each other (F=41.599, p<0.001). CONCLUSIONS These results may help enhance the understanding of the potentially unique psychotherapeutic targets and the underlying cognitive theory of bipolar depression.

Duration of the depressive episode is correlated with ganglion cell inner plexifrom layer and nasal retinal fiber layer thicknesses: Optical coherence tomography findings in major depression

Optical coherence tomography (OCT) is a relatively new, noninvasive imaging technique that has been used increasingly to diagnose and manage a variety of retinal diseases. Since the axons in retinal nerve fiber layer (RNFL) are nonmyelinated within the retina, OCT has been used in various neurodegenerative diseases to visualize the process of neurodegeneration. Decreases in RNFL and ganglion cell inner plexiform layer (GCIPL) thicknesses were observed in patients with schizophrenia. To date, there is no clinical research investigating OCT parameters in patients with MD. We compared the RNFL thickness, GCIPL thickness in 58 MD patients and 57 healthy controls, and investigated their correlation with clinical variables of depression. Depressed patients were not different from the healthy controls with regard to OCT parameters. GCIPL and nasal RNFL were correlated with the duration of the latest depressive episode. Some measures of OCT were negatively associated with clinical variables like a family history of psychiatric diagnosis and the duration of the latest episode. Larger studies including depressed patients of different severity, including structured interviews and controlling for the effect of antidepressant treatment will provide better results.

The role of tumour necrosis factor alpha and soluble tumour necrosis factor alpha receptors in the symptomatology of schizophrenia

Abstract Background Immunological mechanisms may be responsible for the development and maintenance of schizophrenia symptoms. Aim The aim of this study is to measure tumour necrosis factor-alpha (TNF-α), soluble tumour necrosis factor-alpha receptor I (sTNF-αRI), and soluble tumour necrosis factor-alpha receptor II (sTNF-αRII) levels in patients with schizophrenia and healthy individuals, and to determine their relationship with the symptoms of schizophrenia. Methods Serum TNF-α, sTNF-αRI and sTNF-αRII levels were measured. The Positive and Negative Syndrome Scale (PANSS) was administered for patients with schizophrenia (n = 35), and the results were compared with healthy controls (n = 30). Hierarchical regression analyses were undertaken to predict the levels of TNF-α, sTNF-αRI and sTNF-αRII. Results No significant difference was observed in TNF-α levels, but sTNF-αRI and sTNF-αRII levels were lower in patients with schizophrenia. Serum sTNF-αRI and sTNF-αRII levels were found to be negatively correlated with the negative subscale score of the PANSS, and sTNF-αRI levels were also negatively correlated with the total score of the PANSS. Smoking, gender, body mass index were not correlated with TNF-α and sTNF-α receptor levels. Conclusions These results suggest that there may be a change in anti-inflammatory response in patients with schizophrenia due to sTNF-αRI and sTNF-αRII levels. The study also supports low levels of TNF activity in schizophrenia patients with negative symptoms.

Turkish Version of the Cognitive Distortions Questionnaire: Psychometric Properties.

Cognitive distortions are interrelated with all layers of cognitions, and they may be part of the treatment once they are accessed, identified, labeled, and changed. From both a research and a clinical perspective, it is of utmost importance to disentangle cognitive distortions from similar constructs. Recently, the Cognitive Distortions Questionnaire (CD-Quest), a brief and comprehensive measure, was developed to assess both the frequency and the intensity of cognitive distortions. The aim of the present study was to assess the psychometric properties of the Turkish version of the CD-Quest in a psychiatric outpatient sample. Demographic and clinical data of the participants were analyzed by descriptive statistics. For group comparisons, Students t-test was applied. An exploratory principal components factor analysis was performed, followed by an oblique rotation. To assess the internal consistency of the scale Cronbachs α was computed. The correlation coefficient was calculated for test-retest reliability over a 4-week period. For concurrent validity, bivariate Pearson correlation analyses were conducted with the measures of mood severity and negatively biased cognitions. The results revealed that the scale had excellent internal consistency, good test-retest reliability, unidimensional factor structure, and evidence of concurrent and discriminant validity.

The validity and reliability of the Turkish version of the bipolar depression rating scale

INTRODUCTION Unipolar depression and bipolar depression differ in their clinical presentations, and the conventional depression rating scales fail to capture these differences. Recently, a new scale to rate the severity of depression in bipolar disorder was developed, and this study aims to evaluate the validity and reliability of this scale in a Turkish clinical sample. METHODS A total of 81 patients (30 males, 51 females) diagnosed with bipolar depression according to the DSM-IV-TR criteria at three different sites in Turkey were interviewed with the Bipolar Depression Rating Scale (BDRS), the Montgomery Asberg Depression Rating Scale, the Young Mania Rating Scale, and the Positive and Negative Syndrome Scale Depression and Excitement subscales. Internal consistency, interrater reliability and concurrent validity of the BDRS were evaluated. RESULTS The Turkish version of the BDRS had an acceptable internal consistency (Cronbachs alpha=0.786). Moderate to strong correlations between the BDRS, and the MADRS (r=0.808), and the PANSS-D (r=0.426) were observed, and the BDRS correlated weakly to moderately with the PANSS-E (r=0.297), and the YMRS (r=0.368). The mixed symptom cluster score of the BDRS significantly correlated with the YMRS (r=0.755), and the PANSS-E (r=0.712). Exploratory factor analysis showed a three-factor solution. These factors corresponded to somatic depression, psychological depression, and mixed symptoms. CONCLUSIONS This study shows that the Turkish version of the BDRS is a valid and reliable instrument to measure depressive symptomatology in bipolar disorder. The scale has good internal validity, strong interrater reliability, and moderate to strong correlations with other depression rating scales.

Simple markers for subclinical inflammation in the different phases of bipolar affective disorder

Recently, a growing number of publications have suggested that the immune-inflammatory system may be involved in the etiology of bipolar disorder (BD). Objective: The aim of this study was to investigate neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) in the three different phases of BD patients compared to each other and controls. Methods: One hundred eighty-seven bipolar patients (78 euthymic, 53 manic/hypomanic and 56 depressed), and 62 age and sex matched controls were enrolled. Sociodemographic variables and complete blood count parameters of the patients and the control group were recorded. Results: The groups did not differ from each other on the hematological parameters, except for NLR and RDW. Post-hoc analyses revealed that NLR values were significantly higher in the euthymic and manic/hypomanic bipolar groups compared to control group. In addition, post-hoc analyses revealed that RDW values were significantly higher in the manic/hypomanic bipolar group relative to the control group. Discussion: Longitudinal studies evaluating the levels of inflammatory markers in the early phases of the disorder, and their relationship with the development of different episodes and medical comorbidities may be useful to understand the role of inflammation in BD

Analysis of the psychiatric consultations for inpatients and from the emergency room in a university hospital: A comparison with studies from Turkey (tur)

Burcu Eser1, Sedat Batmaz2, Emrah Songur3, Mesut Yýldýz4, Esma Akpýnar Aslan5 1Dr., 2Doç.Dr., 5Dr. Öðr. Üyesi, Gaziosmanpaþa Üniversitesi, Týp Fakültesi, Ruh Saðlýðý ve Hastalýklarý Anabilim Dalý, Tokat, Türkiye 3Uzm.Dr., Saðlýk Bilimleri Üniversitesi, Keçiören Eðitim ve Araþtýrma Hastanesi, Psikiyatri Kliniði, Ankara, Türkiye 4Dr. Öðr. Üyesi,Marmara Üniversitesi, Týp Fakültesi, Ruh Saðlýðý ve Hastalýklarý Anabilim Dalý, Ýstanbul, Türkiye

METACOGNITIVE BELIEFS IN ALEXITHYMIC INDIVIDUALS

We aimed to determine the differences between metacognitive beliefs in individuals with and without alexithymia, and to identify the relationship between alexithymia and metacognitive beliefs and the predictive role of metacognitive beliefs in individuals with alexithymia. The study included a total of 160 participants who were diagnosed with depressive disorder, anxiety disorder or somatoform disorder in remission according to DSM-5, or who were not diagnosed with any psychiatric disorders. Sociodemographic and clinical data collection form, Metacognitive Questionnaire-30, Toronto Alexithymia Scale, Hospital Anxiety and Depression Scale were used. Individuals with alexithymia scored higher in terms of all alexithymia subscales than those without alexithymia. There was a relationship between difficulty describing feelings and cognitive confidence, cognitive self-consciousness; and between alexithymia and positive beliefs about worry, negative beliefs about uncontrollability. Difficulty identifying feelings was predictive of negative beliefs about uncontrollability and danger; difficulty describing feelings was predictive of cognitive self-consciousness; externally-oriented thinking was predictive of positive beliefs about worry; and negative beliefs about uncontrollability and danger and cognitive self-consciousness were predictive of alexithymia. This study demonstrated that metacognitive beliefs increased in alexithymia, specific alexithymia dimensions were related with specific metacognitive beliefs and that they might be predicted by specific metacognitive beliefs. These results suggest that metacognitive therapy might be used to better conceptualize individuals with alexithymia.

Psychometric Properties of the Revised and Abbreviated form of the Turkish Version of the Dysfunctional Attitude Scale

Dysfunctional attitudes are considered to be important risk factors in the onset and maintenance of depression. Thus, a psychometrically reliable and valid measure is necessary for understanding depression. The Dysfunctional Attitude Scale (DAS) is widely used and has good psychometric properties, but there is no consensus about its factor structure. To examine its psychometric properties and factor structure, a total of 885 individuals consisting of patients with depression and healthy controls were evaluated. After the sample was randomly divided into two subsets, exploratory and confirmatory factor analyses were performed. Then the DAS was abbreviated according to the factor profiles and theoretical background. Analyses indicated two factors, named Perfectionism/Achievement and Need for Approval/Dependency for the revised DAS. Reliability analyses revealed a good internal consistency, and the concurrent validity indicated significant correlations with the Beck Depression Inventory and the Automatic Thoughts Questionnaire.

A Case in the Bipolar Spectrum

It has been reported that the correct diagnosis and treatment are delayed when subsyndromal bipolar mood disorder symptoms are overlooked. Patients in this spectrum are reported to have a diminished level of functioning, and these patients fail to accept their diagnosis; therefore, there is a low level of treatment adherence. This case report focuses on the diagnosis and treatment of a patient in the bipolar spectrum.