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Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder

Aims:  The aims of the present study were to examine the rate of nightmare disorder (ND) and to determine the levels of dream anxiety and subjective sleep quality in patients with borderline personality disorder (BPD). Another aim was to determine whether dream anxiety was associated with childhood trauma, dissociative experiences, and subjective sleep disturbance in BPD patients. Finally, the hypothesis as to whether BPD patients with ND exhibited a more severe clinical profile than those without ND, was also tested.

Body dysmorphic disorder in patients with acne

There is growing evidence that the prevalence of body dysmorphic disorder (BDD) is significantly higher in specially selected populations as compared to the general population. The goal of the current study was to evaluate prevalence of BDD in Turkish patients with mild acne presenting to a dermatologist for treatment. This study was the first empirical investigation of BDD in acne patients in Turkey. One hundred fifty-nine outpatients diagnosed with acne who consulted to the dermatology clinic were included in the study. The diagnosis of BDD was based on DSM-IV criteria and the Structured Clinical Interview for DSM-IV (SCID-I). A study-specific questionnaire was administered to document and investigate the demographic and clinical characteristics of the cases. Fourteen (8.8%) patients were diagnosed with BDD. Three (21.4%) patients with acne and BDD also had concomitant psychiatric diagnoses. All of the patients were psychiatric management-naive, never received any psychological or physical treatments. BDD was a common psychiatric condition in acne cases. We suggest that dermatologists should routinely explore symptoms and screen such patients for BDD.

Effects of diagnostic comorbidity and dimensional symptoms of attention-deficit-hyperactivity disorder in men with antisocial personality disorder

Objective: Although children with attention deficit hyperactivity disorder (ADHD) are at increased risk for later onset of antisocial personality disorder (APD) as adults, the utility of ADHD as either a comorbid diagnosis (ADHDc) or dimensional symptoms (ADHDd) in predicting behaviour and substance use problems in APD subjects has not been examined. Method: A total of 105 adult male offenders with Structured Clinical Interview for Axis II Disorders (SCID-II)-based DSM-III-R APD were studied in terms of: (i) psychopathy scores on the Hare Psychopathy Checklist–Revised (PCL-R); (ii) ADHDc diagnostic comorbidity on clinically administered DSM-IV questionnaire; and (iii) ADHDd dimensional symptoms by means of Wender Utah Rating Scale (WURS) and Conners Adult ADHD Rating Scale (CAARS) during a 12 month study period (May 2005–May 2006). Results: Sixty five per cent of APD subjects met criteria for ADHDc diagnostic comorbidity with significantly increased rates of childhood neglect, parental divorce and suicide attempt, but not of psychopathy. APD subjects with ADHDd symptoms were noted to have earlier onset and increased rate of self-injurious behaviour (SIB), suicide attempt, and psychopathy. The psychopathy scores, in turn, were predictive of earlier onset of SIB and behavioural problems. Conclusion: Both ADHDc diagnostic comorbidity and ADHDd symptoms need to be assessed in APD subjects and the dimensional measures may be better in detecting earlier onset SIB, suicide attempt and other behavioural problems.

Serum interleukin 1α and interleukin 2 levels in patients with schizophrenia

It has been suggested that altered interleukin (IL) regulation may be involved in the pathogenesis of schizophrenia. In this cross-sectional, case-controlled study, patients with schizophrenia and a control group of healthy subjects, matched by age, sex and body mass index, were evaluated. The levels of IL-1α and IL-2 in blood serum were measured by enzyme-linked immunosorbent assay. The fasting serum IL-2 levels were significantly higher in patients with schizophrenia compared with the control subjects, but there was no difference between the fasting serum levels of IL-1α in patients with schizophrenia and the control subjects. Our results suggest that patients with schizophrenia have altered IL-2, but not IL-1α, regulation.

Plasma orexin A, ghrelin, cholecystokinin, visfatin, leptin and agouti-related protein levels during 6-week olanzapine treatment in first-episode male patients with psychosis.

The objective of the study was to investigate the change of body mass index (BMI), waist circumference, lipid profile, leptin, ghrelin, orexin, visfatin, agouti-related protein, and cholecystokinin levels during 6 weeks of olanzapine treatment in newly diagnosed first-episode drug naive, young adult, nonobese male patients with psychosis. Twenty male participants who were all first-episode drug naive psychotic patients without prominent affective signs and symptoms and 22 healthy male controls of similar age were included. BMI, waist circumference, fasting glucose, and lipid profiles were measured, and Positive and Negative Syndrome Scale and Brief Psychiatric Rating Scale scores were obtained at baseline, during the second and sixth week of treatment, and the aforementioned neuropeptide levels were measured at baseline and during the sixth week of treatment. Treatment was associated with significant increases in BMI, waist circumference, serum triglyceride, and low-density lipoprotein levels. BMI levels increased more than 7% in over 75% of the patients. Leptin increased, and ghrelin and orexin decreased significantly with olanzapine treatment, whereas cholecystokinin, visfatin, and agouti-related protein levels did not change significantly. In conclusion, consistent with previous studies, we found increased BMI, leptin and lipids during olanzapine treatment. Association of neuropeptide level changes with symptom improvement might be mediated by the dopaminergic and serotonergic systems.

Childhood trauma history and dissociative experiences among Turkish men diagnosed with antisocial personality disorder

ObjectiveThis study investigated the association between antisocial personality disorder (APD), childhood trauma history, and dissociative symptoms in a sample of Turkish recruits.MethodsA total of 579 male patients diagnosed with APD were examined in a military hospital setting. An age and gender matched control group of 599 normal persons with no known medical or psychiatric disorder were also chosen among military personnel. The subjects were evaluated with an assessment battery using a semi-structured interview for socio-demographic characteristics, APD section of SCID-II, an adapted version of the Structured Trauma Interview, and Dissociative Experiences Scale.ResultsChildhood sexual abuse, physical abuse, neglect, and early separation from parents were significantly more common among antisocial subjects than among controls. APD group reported significantly more dissociative symptoms and 50.4% of them reported pathological level of dissociation. Overwhelming childhood experiences of all four types were significant predictor of the APD diagnosis. Analyses also showed that childhood traumatic events and comorbid psychopathological features relevant to antisocial personality were significantly associated with pathological level of dissociation.ConclusionThese results revealed the importance of inquiring about patient’s history of childhood traumatization and dissociative experiences when diagnosed with APD.

Body dysmorphic disorder in patients with borderline personality disorder: prevalence, clinical characteristics, and role of childhood trauma.

Objective: The prevalence of body dysmorphic disorder (BDD) in patients with borderline personality disorder (BPD) is unidentified. We hypothesised that BDD would be more common than realised in patients with BPD and comorbidity with BDD would result in a more severe clinical profile. Also, childhood trauma may play a predictive role in this association. Methods: The study included 70 BPD in-patients and 70 matched healthy controls. The subjects were evaluated with a comprehensive assessment battery using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) diagnostic tool for BDD, Global Assessment of Functioning, Traumatic Experiences Checklist and Hamilton Depression Rating Scale. Results: The prevalence of BDD was 54.3% in the borderline sample. The BPD patients with BDD had significantly lower overall functioning and higher levels of BPD pathology, childhood traumatic experiences, suicide attempts, substance abuse and self-mutilation than those without BDD. Traumatic experiences were significant predictor of comorbid BDD diagnosis in BPD patients. Conclusions: Our results suggest a relatively high prevalence of BDD among patients with BPD, and co-occurrence of BDD and BPD remains to be clarified. The additional diagnosis of BDD in patients with BPD may cause a more severe global illness, and these two disorders may share, at least partly, a common psychopathologic mechanism.

A Case with Euprolactinemic Galactorrhea Induced by Escitalopram

Endocrine and reproductive side effects of serotonergic antidepressants are uncommon and galactorrhea is only rarely mentioned among SSRI-related side effects. Perhaps through suppression of dopamine neurotransmission releasing prolactin from tonic inhibitor control of dopamine, serotonin-enhancing antidepressants may result in a rise in prolactin levels. However, we here describe a case of euprolactinemic galactorrhea induced by the SSRI escitalopram and discuss potential mechanisms of action.

Premenstrual exacerbation and suicidal behavior in patients with panic disorder.

This study examined the relationship between premenstrual exacerbation and suicidal behavior in patients with panic disorder. Twenty-eight patients who reported a premenstrual exacerbation of panic disorder and 42 patients who reported never having an exacerbation were included in the study. The subjects completed a self-rating instrument assessing the 13 DSM-III-R panic symptoms on a 5-point scale (0 = absent, 1 = mild, 2 = moderate, 3 = severe, and 4 = very intense). They also completed the severity scale of the Clinical Global Impression. The Schedule for Affective Disorders and Schizophrenia (SADS) suicide subscale was used to rate the severity of active suicidality. We found that patients with premenstrual exacerbation of panic disorder had higher SADS suicidality scores than patients with panic disorder without premenstrual exacerbation. They were also more likely to be classified as suicidal than the others. It may be that premenstrual exacerbation is a risk factor for suicidal behavior independent of major depression in patients with panic disorder.

A magnetic resonance spectroscopy study of antisocial behaviour disorder, psychopathy and violent crime among military conscripts

Background: Prefrontal and/or temporo-limbic abnormalities associated with antisocial personality disorder (APD), high psychopathy scores and violent behaviours can readily be evaluated by neuroimaging methods. Objectives: In this study, we compared the brain metabolites in adult male military conscripts with APD, high psychopathy scores and serious violent crimes (n = 15) with age- and educational-level-matched healthy controls (n = 15) by means of magnetic resonance spectroscopy. Methods: All cases were diagnosed by means of the Diagnostic Statistical Manual-IV APD module of the Structured Clinical Interview for DSM III-R Axis II Disorders (SCID-II) semistructured questionnaire in Turkish. The psychopathy scores were evaluated by means of the Hare Psychopathy Checklist-Revised translated into Turkish (PCL-R). PCL-R is a 20-item, reliable and valid instrument for assessment of psychopathy, both in categorical and dimensional natures. All patients had a total score of 29 (of possible 40) or higher from PCL-R, indicating a high degree of psychopathy. Results: Our results showed no significant differences in ratio of N-acetyl aspartate (NAA), creatine (Cr) and choline-related compounds in the right dorsolateral prefrontal cortex, anterior cingulate cortex (ACC) and amygdala–hippocampus regions of cases compared with controls. ACC NAA/Cr was significantly negatively correlated with both the PCL-R total score and the PCL-R factor I score (interpersonal/affective problems) among the cases. Conclusion: As ACC plays an important role in decision-making and emotional information processing, we postulate that the lower NAA/Cr ratio, suggesting impaired neural integrity, may increase the severity of interpersonal/affective problems of the psychopathy factor in male subjects exhibiting APD, high psychopathy overall scores and violent crimes.