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Purpose: The term of ‘Theory of mind’ (ToM), is the ability to understand one’s own others’ mental states, is an important capacity for social cognition and there is increasing data that theory of mind is compromised in bipolar patients even in euthymic periods. The aim of this study was to investigate theory of mind deficits in euthymic bipolar disorder patients and its relation to the clinical features. Materials and method:Fifty two euthymic patients with bipolar I disorder according to DSM IV-TR and 60 matched healthy control subjects were involved in this study. ToM was assessed by Reading the Mind in the Eyes test and the Dokuz Eylül Theory of Mind Scale. Results: The patient group had significantly lower performance on both of the ToM tests. We observed significant correlation between age of onset, the number of hospitalizations, the number of manic/mixed episodes and theory of mind performance. Conclusion: The result we showed is that ToM is impaired in euthymic bipolar I patients, which is consistent with the studies suggesting that ToM might be a trait marker for bipolar disorder.

SummaryObjectives Obesity is associated with significant morbidity and mortality rates. Even modest weight loss may be associated with health benefits. Alpha-lipoic acid (ALA) is a naturally occurring antioxidant. Studies have suggested anti-obesity properties of ALA; however, results are inconsistent. The purpose of this study is to conduct a meta-analysis of the effect of ALA on weight and body mass index (BMI). Methods A comprehensive, systematic literature search identified 10 articles on randomized, double-blind, placebo-controlled studies involving ALA. We conducted a meta-analysis of mean weight and BMI change differences between ALA and placebo treatment groups. Results Alpha-lipoic acid treatment coincided with a statistically significant 1.27 kg (confidence interval = 0.25 to 2.29) greater mean weight loss compared with the placebo group. A significant overall mean BMI difference of −0.43 kg/ m2 (confidence interval = −0.82 to −0.03) was found between the ALA and placebo groups. Meta-regression analysis showed no significance in ALA dose on BMI and weight changes. Study duration significantly affected BMI change, but not weight change. Conclusions Alpha-lipoic acid treatment showed small, yet significant short-term weight loss compared with placebo. Further research is needed to examine the effect of different doses and the long-term benefits of ALA on weight management.

Tardive dyskinesia is defined as involuntary athetoid or choreiform movements that develop due to the use of neuroleptic drugs for at least a few months. Tongue, lower face, jaw, upper and lower extremities are the most affected parts of the body in tardive dyskinesia. Quality of life is negatively affected because of the low remission rates. Besides tardive dyskinesia, involuntary movements may appear after discontinuation, change or a reduction in the dose of antipsychotic medications, which is called withdrawal-emergent dyskinesia (WED). Unlike tardive dyskinesia, the involuntary movements involve mainly the neck, trunk, and limbs and regress in shorter period of time in WED. A consensus has not yet been reached for the treatment of WED. Restarting the previous antipsychotic agent with slow titration or switching to an atypical antipsychotic with low affinity for dopamine D2 receptors are among the primary options for treatment. As WED is one of the predictors of tardive dyskinesia development, early detection and treatment is believed to have positive effect on the quality of life. In this report, the case of a patient followed up for bipolar disorder type I (BD-I) and started on clozapine for WED after discontinuation of haloperidol on account of adverse effects is discussed. It is necessary for clinicians to consider these types of complications when discontinuing or changing treatment. Further research is needed in order to reach a common approach for the treatment of WED.

Background We have limited knowledge about the effects of antipsychotic exposure on the development of gestational diabetes mellitus (GDM). Aim of this study is to perform a systematic review and meta-analysis to assess GDM risk associated with antipsychotic exposure in pregnancy. Methods Systematic literature search was performed using PubMed, Science Direct, Scopus, and Web of Science databases up to August 22, 2018. No restrictions to language or date were applied. Randomized, controlled trials, case-control, or cohort studies reporting GDM risk in antipsychotic-exposed, healthy controls or antipsychotic-ceased patients were included in the meta-analysis. The primary outcomes were study defined GDM, including number of events, odds ratios, and/or risk ratios (RR) with confidence intervals (CI). Results Ten studies were included in the meta-analysis. The total number of subjects was 6213 for the antipsychotic-exposed group, 6836 for antipsychotic-ceased control group, and 1 677 087 for the healthy control group. Compared with the healthy controls, the unadjusted cumulative RR for GDM associated with antipsychotic use was 1.63 (95% CI = 1.20-2.22). Adjusted risk for GDM was significantly higher in antipsychotic exposure group than in healthy controls (RR = 1.30, 95% CI = 1.023-1.660). The adjusted RR for GDM was similar between the antipsychotic-exposed group and the antipsychotic-ceased group (RR = 0.78, 95% CI = 0.281-2.164). No significant association was found between study quality, smoking, alcohol use, gestational age, and cumulative GDM risk. Discussion Our results indicate an increased risk of GDM with antipsychotic exposure in pregnant women, who may benefit from close pregnancy monitoring, early testing for GDM, targeting modifiable risk factors, and lifestyle modifications.

The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and metabolic morbidity decades later. Antipsychotic (AP)-induced weight gain is one modifiable factor in this period. The purpose of this study is to conduct a meta-analysis of AP-induced weight and body mass index (BMI) change in FEP.A comprehensive literature search identified 28 articles that reported data on AP-specific weight or BMI change in FEP. We conducted a meta-analysis of short- and long-term mean weight and BMI differences between placebo and AP medications. We also performed subgroup and meta-regression analysis to examine weight, BMI outcomes and their relationship with location (Asian vs. Western), sponsorship and baseline weight and BMIs.Compared to placebo, AP-caused mean weight gain was 3.22 kg and 1.4 points BMI in the short-term, and 5.30 kg and 1.86 points BMI in the long term. Clinically significant weight gain risk increased about twofold with AP use. Weight gain was associated with duration of AP use. AP medications were associated with more weight gain in Western samples as opposed to Asian samples. Most AP medications were associated with significant body weight gain and BMI increase in FEP patients, except for ziprasidone. Olanzapine and clozapine caused the highest weight gain compared to placebo.Except for ziprasidone, most AP medications were associated with body weight gain and BMI increase in FEP patients. Early and continuing effects of various AP medications on weight gain and BMI increase should be taken into consideration by clinicians.

This secondary analysis of a randomized clinical trial assesses the association of specialty team-based services for first-episode psychosis with criminal justice outcomes compared with usual treatment.

BACKGROUND: Research in treatment-naïve, first episode patients with severe mental illnesses (SMIs) suggest a pre-diabetic condition at the onset of illness. However, we have limited knowledge on glucose metabolism differences across diagnostic categories of SMIs. AIMS: To compare the differences of glucose metabolism outcomes between treatment-naïve, patients with first episode psychosis (FEP) and mood disorders. METHOD: We conducted a systematic review and meta-analysis of glucose intolerance in treatment-naïve, first episode patients with SMIs. RESULTS: We identified 31 eligible studies. Compared to healthy controls, FEP group have higher insulin and insulin resistance levels, and both groups have higher glucose tolerance test results. No significant differences were found in glucose metabolism outcomes between FEP and mood disorder groups. CONCLUSIONS: Our results highlight impaired glucose metabolism at the onset of SMIs, suggesting both patients with psychosis and mood disorders are high-risk groups for diabetes development.

Aim The first-episode psychosis (FEP) represents a critical period to prevent cardiovascular and metabolic morbidity decades later. Antipsychotic (AP)-induced weight gain is one modifiable factor in this period. The purpose of this study is to conduct a meta-analysis of AP-induced weight and body mass index (BMI) change in FEP. Methods A comprehensive literature search identified 28 articles that reported data on AP-specific weight or BMI change in FEP. We conducted a meta-analysis of short- and long-term mean weight and BMI differences between placebo and AP medications. We also performed subgroup and meta-regression analysis to examine weight, BMI outcomes and their relationship with location (Asian vs. Western), sponsorship and baseline weight and BMIs. Results Compared to placebo, AP-caused mean weight gain was 3.22 kg and 1.4 points BMI in the short-term, and 5.30 kg and 1.86 points BMI in the long term. Clinically significant weight gain risk increased about twofold with AP use. Weight gain was associated with duration of AP use. AP medications were associated with more weight gain in Western samples as opposed to Asian samples. Most AP medications were associated with significant body weight gain and BMI increase in FEP patients, except for ziprasidone. Olanzapine and clozapine caused the highest weight gain compared to placebo. Conclusion Except for ziprasidone, most AP medications were associated with body weight gain and BMI increase in FEP patients. Early and continuing effects of various AP medications on weight gain and BMI increase should be taken into consideration by clinicians.

Objective: Our aim in this study was to identify treatment adherence in bipolar disorder patients who regularly use medications and to examine the factors and beliefs associated with treatment compliance. Method: Our sample consisted of 92 patients who were followed up by bipolar disorder. Participants assessed for diagnosis and remission by criteria of affective disorders part of SCID I then Sociodemographic data form, Morisky Medication Adherence Scale (MMAS) and The Beliefs about Medication Compliance Scale (BMCS) was given. Results: Treatment non-adherence rate were %29,3. Variables that differ significantly in non-adherent group then adherent as follows: low education (p=0.03), medications that causes sedation (p=0,001), not educated about treatment (p=0,05), young age (p=0,04), difficulty in obtaining medicine (p=0,003) and treatment complexity (p=0,01). Particularly training the patient with written/visualized materials were higher in adherent group (p=0,02). While there was no significant difference in terms of BMCS benefit subscale (p=0,47), patients with poor treatment compliance reported significantly higher scores on the BMCS barrier subscale (p=0,01). In the logistic regression analysis, sedative medications, difficulty in obtaining medication and treatment complexity were found to be significant predictors of treatment non-adherence. Conclusion: providing access to medication, informing the prescribing medicines with using visual material and patient-centered approaches would increase the compliance of the medication, especially with minimal use of sedative drugs.

INTRODUCTION Unipolar depression is an important psychiatric disorder that leads to an increased risk of suicide. However, not all depression patients attempt suicide. This reflects the presence of other factors that may be related to suicide other than the sole presence of psychopathology. Drawing upon the clinical evidence linking childhood abuse and neglect experiences with suicide; this study aimed at investigating the relationship of childhood abuse and neglect experiences with suicide attempts in patients with unipolar depression. METHOD One hundred six unipolar depressed patients between the ages of 18 and 65 were included in the study. Patients with comorbid psychiatric disorders, neurological disorders, alcohol-substance abuse problems, and a Beck Depression Inventory (BDI) score of

INTRODUCTION The aim of the study was to determine the rate of exposure to domestic violence among female inpatients at any period of their lives; to investigate the effect of different forms of violence on the diagnoses and the course of the illness. METHOD The study was conducted on 102 female inpatients treated at Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) was administered and socio-demographic and clinical data was collected. A form designed for the assessment of violence was used to evaluate domestic violence. RESULTS Ninety patients reported that they had been subjected to some kind of violence at some period of their lives. The parents or husbands were the most frequently reported persecutors. Seventy-three patients reported that they had been subjected to violence before the onset of their illness. Seventy-one had been subjected to physical, 79 to verbal, 42 to sexual, 52 to economic violence, and 49 to constraints on social relationship formation. Comorbid diagnosis of post traumatic stress disorder (PTSD) was related to all types of violence. The rate of suicide attempt was found to be significantly related to verbal-emotional violence. Only 12 patients had previously reported being subjected to domestic violence to their psychiatrist. CONCLUSION Domestic violence, an often overlooked phenomenon, is prevalent among women with psychiatric disorders. Subjection to domestic violence is found to be correlated with PTSD and suicidal attempt.

The relationship of childhood trauma, dissociative experiences and depression with pain in female patients with fibromyalgia: a cross-sectional study Objective: The aim of this study was to investigate childhood trauma (CT) and dissociative symptoms in patients with fibromyalgia and evaluate the relationship of these characteristics with pain intensity. Methods: Forty patients followed up with fibromyalgia diagnosis in the physical therapy and rehabilitation outpatient clinic; and as a control group, 38 healthy individuals who have similar age, gender, and educational status, were included in the study. A sociodemographic and clinical data form, Beck Depression Inventory (BDI), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ) and Visual Analogue Scale (VAS) were administered to participants. Results: Emotional abuse, physical neglect, physical abuse, CTQ total, SDQ and DES scores were found to be significantly higher in the fibromyalgia group than the control group. Only the difference for SDQ scores remained significant when a comparison made between groups by controlling depression levels. Somatoform dissociation scores were found to be a significant predictor of pain intensity in patients with fibromyalgia. Conclusion: Somatoform dissociative symptoms are found to be higher in patients with fibromyalgia than the control group. These symptoms may contribute to development and exacerbation of pain in fibromyalgia. Taking the dissociative symptoms into account have an important role in the treatment of patients with fibromyalgia who have a frequent history of CT, so the treatment of these patients should be carried out in cooperation with psychiatrists.

The aim of this study was to compare the incidence of sexual dysfunction between patients with tension-type headaches (T), migraines (M) and healthy controls (C) in order to investigate the relationship between sexual dysfunction and the features of headaches. The population comprised of 44 patients with M, 30 with T and 30 with C. They have completed Arizona Sexual Experiences Scale (ASEX), Visual Analog Scale. The number of sexual activities over the past 30 days and the frequency of masturbation behavior in C were considerably higher than those in the headache groups. The averages for ASEX item no. 1, 2, 3 and 4 were significantly higher in those with M versus C; and both the subscales and total scores of ASEX were also higher in those with T than C. The mean score for ASEX item no. 3 and the total ASEX score were significantly higher in T versus M. In both headache groups, no significant relationship was observed between headache features and ASEX. The present study showed that patients with either M or T do experience problems in several aspects of sexuality compared with C. Further research is essential to augment our understanding of the sexual dysfunction in this field.

Relationship between dissociative experiences, abnormal sleep experiences, and sleep quality in undergraduate students Objective: To investigate the association between dissociative experiences, sleep related experiences and sleep quality. Method: 127 undergraduate students have completed the Dissociative Experiences Scale (DES), the Iowa Sleep Experiences Scales (ISES) and the Pittsburg Sleep Quality Index (PSQI). Results: DES total and DES Taxon scores were moderately correlated with total ISES and ISES General Sleep Experiences (GS) subscale scores. PSQI total scores as well as the scores from PSQI subscales of sleep disturbances, use of sleeping medication and daytime dysfunction were weakly correlated with total ISES and ISES GS subscale scores. DES and PSQI total and subscale scores were not correlated with the lucid dreaming (LD) subscale of ISES. DES total scores explained a considerable amount of variance in ISES GS scores. Sleep disturbances and use of sleeping medication as indicators of sleep problems, were related to ISES GS. Conclusions: The present study showed the association between dissociative experiences and nighttime experiences and further revealed that some aspects of general sleep quality, especially the ones related to sleep problems are also related to both dissociation and general sleep experiences.

Two cases with antiepileptic barbexoclone (maliasin®) addiction Barbexoclone (Maliasin®) is an antiepileptic drug, which has been found to be effective in the treatment of epilepsy. Inpatient treatment seeking cases with the diagnosis of barbexoclone abuse accumulate. In this report, we presented 2 inpatient cases in an addiction treatment center with barbexoclone dependence. Also we discussed the non-medical use of prescribed drugs according to these cases.

Bipolar I disorder is characterized by full blown manic episodes and is not only affected by biological factors but also by psychological and cultural factors. This fact attracted the attention onto the psychological resilience, which is the ability of dealing with stressful life-events and overcoming the traumatic experiences, and it has become a phenomenon that is taken into consideration to empower the protective factors for the disorder. The object of this study was to examine social, clinical and physical factors that could enhance the psychological resilience. The subjects of the study were between the ages of 18 and 69, literate and in the phase of euthymic mood. In the study, the 67,4 % of the subjects were women and the average age was 37,7. The scales were Personal Information Form and Psychological Resilience Scale for Adults. It was found that there was a meaningful relationship between attempting to suicide and psychological resilience (p: 0,02 and t: -2,4). When the relationship between being physically active and psychological resilience was examined, it was found that there was a meaningful and a negative correlation between psychological resilience and having a sedentary life style (p: 0,02 and r: -0,35), and between psychological resilience and the time spent in sleep (p: 0,021 and r: -0,35). As a result, resilience is a factor that can be enhanced with different factors and it takes roles both in the process of the disorder to smoothen the course of the disorder and before the symptoms of the disorder appears. [JCBPR 2018; 7(3.000): 120-126]

This study sought to determine the effectiveness of a comprehensive first-episode service, the clinic for Specialized Treatment Early in Psychosis (STEP), in an urban U.S. community mental health center by comparing it with usual treatment.This pragmatic randomized controlled trial enrolled 120 patients with first-episode psychosis within five years of illness onset and 12 weeks of antipsychotic exposure. Referrals were mostly from inpatient psychiatric units, and enrollees were randomly allocated to STEP or usual treatment. Main outcomes included hospital utilization (primary); the ability to work or attend age-appropriate schooling-or to actively seek these opportunities (vocational engagement); and general functioning. Analysis was by modified intent to treat (excluding only three who withdrew consent) for hospitalization; for other outcomes, only data for completers were analyzed.After one year, STEP participants had less inpatient utilization compared with those in usual treatment: no psychiatric hospitalizations, 77% versus 56% (risk ratio [RR]=1.38, 95% confidence interval [CI]=1.08-1.58); mean hospitalizations, .33±.70 versus .68±.92 (p=.02); and mean bed-days, 5.34±13.53 versus 11.51±15.04 (p=.05). For every five patients allocated to STEP versus usual treatment, one additional patient avoided hospitalization over the first year (number needed to treat=5; CI=2.7-26.5). STEP participants also demonstrated better vocational engagement (91.7% versus 66.7%; RR=1.40, CI=1.18-1.48) and showed salutary trends in global functioning measures.This trial demonstrated the feasibility and effectiveness of a U.S. public-sector model of early intervention for psychotic illnesses. Such services can also support translational research and are a relevant model for other serious mental illnesses.

Early intervention services for psychotic disorders optimally interlock strategies to deliver: (i) Early Detection (ED) to shorten the time between onset of psychotic symptoms and effective treatment (i.e. Duration of Untreated Psychosis, DUP); and (ii) comprehensive intervention during the subsequent 2 to 5 years. In the latter category, are teams (‘First-episode Services’ or FES) that integrate several empirically supported treatments and adapt their delivery to younger patients and caregivers. There is an urgent need to hasten access to established FES in the U.S. Despite improved outcomes for those in treatment, these FES routinely engage patients a year or more after psychosis onset. The Scandinavian TIPS study was able to effectively reduce DUP in a defined geographic catchment. The guiding questions for this study are: can a U.S. adaptation of the TIPS approach to ED substantially reduce DUP and improve outcomes beyond existing FES? The primary aim is to determine whether ED can reduce DUP in the US, as compared to usual detection. ED will be implemented by one FES (STEP) based in southern Connecticut, and usual detection efforts will continue at a comparable FES (PREPR) serving the greater Boston metropolitan area. The secondary aim is to determine whether DUP reduction can improve presentation, engagement and early outcomes in FES care. A quasi-experimental design will compare the impact of ED on DUP at STEP compared to PREPR over 3 successive campaign years. The campaign will deploy 3 components that seek to transform pathways to care in 8 towns surrounding STEP. Social marketing approaches will inform a public education campaign to enable rapid and effective help-seeking behavior. Professional outreach and detailing to a wide variety of care providers, including those in the healthcare, educational and judicial sectors, will facilitate rapid redirection of appropriate patients to STEP. Finally, performance improvement measures within STEP will hasten engagement upon referral. STEP-ED will test an ED campaign adapted to heterogeneous U.S. pathways to care while also improving our understanding of these pathways and their impact on early outcomes. ClinicalTrials.gov: NCT02069925 . Registered 20 February 2014.

Introduction The purpose of this study is to investigate the prevalence and the clinical features of night eating syndrome (NES) in patients with depression and anxiety disorders. Method The study was conducted at Bakirkoy State Hospital for Mental Health and Neurological Disorders. Three-hundred out-patients who had major depression (MD), panic disorders (PD), general anxiety disorders (GAD) and obsessive-compulsive disorders (OCD) participated in the study. The semi-structured socio-demographic form, the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Night Eating Questionnaire, and NES Evaluation Questionnaire were implemented. Results In our sample, the prevalence of the NES was 15.7% (n=47). NES frequency was significantly higher in the patients diagnosed with major depression (MD 22%, GAD 7.8%, OCD 12.5%, PD 14%). Smoking, presence of past suicide attempts, rates of antipsychotic drugs use, and average scores of body mass index (BMI) were significantly higher in the patients who had NES. In this sample, depression, BMI, and smoking were found to be determinants of NES. Conclusion This study shows that NES may be frequently observed in patients admitted to psychiatric clinics, especially in those with major depression. Evaluation of NES in psychiatric patients may help the treatment of the primary psychopathology and prevent the adverse effects, like weight gain, which may reduce the quality of life.

Night Eating Syndrome (NES) is a unique disorder characterized by a delayed pattern of food intake in which recurrent episodes of nocturnal eating and/or excessive food consumption occur after the evening meal. NES is a clinically important disorder due to its relationship to obesity, its association with other psychiatric disorders, and problems concerning sleep. However, NES often goes unrecognized by both health professionals and patients. The lack of knowledge regarding NES in clinical settings may lead to inadequate diagnoses and inappropriate treatment approaches. Therefore, the proper diagnosis of NES is the most important issue when identifying NES and providing treatment for this disorder. Clinical assessment tools such as the Night Eating Questionnaire may help health professionals working with populations vulnerable to NES. Although NES treatment studies are still in their infancy, antidepressant treatments and psychological therapies can be used for optimal management of patients with NES. Other treatment options such as melatonergic medications, light therapy, and the anticonvulsant topiramate also hold promise as future treatment options. The purpose of this review is to provide a summary of NES, including its diagnosis, comorbidities, and treatment approaches. Possible challenges addressing patients with NES and management options are also discussed.

Skin picking (SP) behavior is characterized by repetitive episodes of scratching or picking skin causing significant tissue damage, functional deterioration and severe distress.The aim of this study was to investigate the SP frequency in and SP characteristics of the Turkish student population.MethodsAll participants, 270 students, were selected from different universities in Turkey between March 2010 and January 2010. Twenty-five students (9.2%) were excluded because of missing information. One hundred fourty-five (59.2%) of the participants were female, 100 (40.8%) were male and mean age was 22.02 ± 2.1.All participants were assessed by Skin Picking Inventory, Skin Picking Impact Scale and Skin Picking Scale which were translated to Turkish by the authors.Descriptive statistical methods were utilized for SP frequency and characteristics. Chi square analysis was utilized for distributional analyses.ResultsTwo hundred fifteen students (87.8% of total participants) endorsed engaging in SP. One hundred seven participants (43.6%) reported recurrent SP episodes defined as one or more daily SP episodes, with an estimated daily SP time of more than 5 minutes. Thirty (12.2%) students engaged in SP despite lack of any dermatological problems and felt significantly distressed, functionally impaired and had tissue damage. There was no significant difference between females and males regarding the frequency of SP (Women n = 16, 11.0%; Men n = 14, 14.0%; X2 = 0.484, p > 0.05).ConclusionOur study showed that SP is a common behavior in Turkish student population. The literature on SP behavior in student populations is limited and there is need for further research on this topic.