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Background. Familial liability to both severe and common mental disorder predicts psychotic disorder and psychotic symptoms, and may be used as a proxy in models examining interaction between genetic risk and the environment at individual and contextual levels. Method. In a representative general population sample (n = 4011) in Izmir, Turkey, the full spectrum of expression of psychosis representing (0) no symptoms, (1) subclinical psychotic experiences, (2) low-impact psychotic symptoms, (3) high-impact psychotic symptoms and (4) full-blown clinical psychotic disorder was assessed in relation to mental health problems in the family (proxy for familial liability) and the wider social environment. Quality of the wider social environment was assessed in an independent sample using contextual measures of informal social control, social disorganization, unemployment and low income, aggregated to the neighbourhood level. Results. The association between familial liability to severe mental illness and expression of psychosis spectrum was stronger in more deprived neighbourhoods [e.g. this association increased from β=0.33 (p=0.01) in low-unemployment neighbourhoods to β=0.92 (p<0.001) in high-unemployment neighbourhoods] and in neighbourhoods high in social control, while neighbourhood variables did not modify the association between familial liability to common mental disorder and the psychosis outcome. Neighbourhood variables mediated urbanicity effects. Conclusions. Contextual effects may be important in moderating the expression of psychosis liability in populations, representing a specific pathway independent of the link between common mental disorder and psychosis. [ABSTRACT FROM AUTHOR]

Background: The incidence of psychotic disorders varies in different geographic areas. As there has been no report from Turkey, this study aimed to provide the treated incidence rate of first-episode psychosis (FEP) in a defined area., Methods: All individuals, aged 15-64 years, presenting with FEP (ICD-10 F20-29, F30-33) to mental health services in a defined catchment-area in Sinop which is located in the Black Sea region of the northern Turkey were recorded over a 4-year period (2009 to 2012). Incidence rates of psychotic disorders and their 95% confidence intervals (CIs) were estimated. Poisson regression was applied to estimate the differences in incidence rate ratio (IRR) by age, sex, and urbanicity., Results: One hundred and fifteen FEP participants were identified during the 4 years. Crude incidence rates of all psychoses, schizophrenia, other psychotic disorders, and affective psychotic disorders were respectively 38.5 (95% CI 27.1-49.9), 10.7 (95% CI 6.6-14.8), 10.0 (95% CI 5.7-14.3) and 17.7 (95% CI 11.3-24.2) per 100 000 person-years. After age-sex standardisation the rates increased slightly. There were no gender differences in the incidence rates. IRR of any psychotic disorder was highest in the youngest age group (15-24 years) compared to the oldest age group (55-64 years), 7.9 (95% CI 2.8-30.5). In contrast with previous studies, the incidence rate of any psychotic disorder was not significantly increased in urban areas compared with rural areas., Conclusions: The current study, the first of its kind from Turkey, indicates that the risk of schizophrenia and other psychotic disorders in a lowly urbanised area of Turkey is comparable to those reported in Western European cities.

Background: Psychotic experiences (PEs) may predict a range of common, non-psychotic disorders as well as psychotic disorders. In this representative, general population-based cohort study, both psychotic and non-psychotic disorder outcomes of PE were analysed, as were potential moderators., Methods: Addresses were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011). Participants were interviewed with the Composite International Diagnostic Interview (CIDI) both at baseline and at 6-year follow-up. Participants with PE at baseline were clinically re-interviewed with the SCID-I at follow-up. The role of socio-demographics, characteristics of PE, co-occurrence of mood disorders and family history of mental disorders were tested in the association between baseline PE and follow-up diagnosis., Results: In the participants with baseline PE, the psychotic disorder diagnosis rate at follow up was 7.0% - much lower than the rates of DSM-IV mood disorders without psychotic features (42.8%) and other non-psychotic disorders (24.1%). Within the group with baseline PE, female sex, lower socio-economic status, co-occurrence of mood disorders, family history of a mental disorder and persistence of PE predicted any follow-up DSM diagnosis. Furthermore, onset of psychotic v. non-psychotic disorder was predicted by younger age (15-30 years), co-presence of delusional and hallucinatory PE and family history of severe mental illness., Conclusion: The outcome of PE appears to be a consequence of baseline severity of multidimensional psychopathology and familial risk. It may be useful to consider PE as a risk indicator that has trans-diagnostic value.

Objective: Psychotic disorders were previously associated with catechol- O-methyltransferase (COMT) val158met (rs4680) and brain-derived neurotrophic factor (BDNF) val66met (rs6265) polymorphisms. This article evaluates the association between COMT/BDNF polymorphisms and the extended psychosis phenotype which covers not only schizophrenia but also subclinical expressions of psychotic experiences., Method: The participants of this study were part of the TürkSch (Izmir Mental Health Survey for Gene-Environment Interaction in Psychoses), a longitudinal study Psychotic experiences and disorders were screened 437. The extended psychosis phenotype was grouped into four: (1) no psychotic experiences (n: 194), (2) subclinical psychotic experiences (n: 87), (3) clinically relevant psychotic experiences (n: 104), and (4) schizophrenia-like disorders (n: 52). BDNF rs6265 was genotyped occurred in every participant whereas COMT rs4680 genotyping could be done on 366 individuals., Results: There was no association between the extended psychosis phenotype and BDNF rs6265/COMT rs4680 polymorphisms. The frequency of met carriers in the BDNF rs6265genotype was slightly higher in individuals with subclinical psychotic experiences than in the group with no psychotic experiences, which was just below the significance level (p=0.08)., Conclusion: The lack of an association between different expression levels of the extended psychosis phenotype and the BDNF rs6265/ COMT rs4680 polymorphism might be related to sample characteristics, underlying gene-gene, gene-environment and gene-environment-gene interactions.

Objective: To overview and evaluate the main findings, methodological shortcomings, and time trends of the recent psychiatric epidemiology studies in Turkey, as well as to provide areas prone for development in forthcoming research., Method: PubMed and Turkish Psychiatry Index were screened to identify relevant studies. Any epidemiological study from 2000 to 2012 with a general population or unique sub-population sample was included. Papers and results were classified as depression, anxiety, psychotic, dissociative, conversion, personality, alcohol and substance abuse, and trauma-related disorders, and common geriatric disorders., Results: There are various epidemiological studies on various psychiatric disorders in Turkey. However, there are main shortcomings and trends in research that subsequently stagnate current psychiatric epidemiological research. First, epidemiological studies were mainly conducted for academic purposes, not for addressing epidemiological issues or issues of health policy. Second, studies mainly focused on particular fields and institutions, which led to non-systematic accumulation of epidemiological results. Third, although Turkey is a natural laboratory of social conflicts and disasters, there were few studies with a focus on probable outcomes. Fourth, high-quality epidemiological studies with disseminating results tended to decrease, even in common mental disorders such as depression. Fifth, there were very few epidemiological studies using contemporary designs such as follow-up, genetic, or biomarker data in the general-population., Conclusion: Although psychiatric epidemiological studies of the last decade provide a suitable ground for future challenges, current trends in this research area has tended to stagnate, despite the potential for unique contributions. Forthcoming studies and researchers may notice novel methodological developments in epidemiology, with a growing attention on rapid urbanization, natural disasters, social conflicts, and migration.

A growing number of studies demonstrate high rates of subthreshold psychotic experiences, but there is considerable heterogeneity in rates due to study cohort and design factors, obscuring how prevalent psychotic experiences may or may not relate to rare psychotic disorders. In a representative general population sample (n = 4011) in Izmir, Turkey, the full spectrum of expression of psychosis was categorized across 5 groups representing (1) absence of psychosis, (2) subclinical psychotic experiences, (3) low-impact psychotic symptoms, (4) high-impact psychotic symptoms, and (5) full-blown clinical psychotic disorder and analyzed for continuity and discontinuity in relation to (1) other symptom dimensions associated with psychotic disorder and (2) proxies of genetic and nongenetic etiology. Results were tested for linear and extralinear contrasts between clinical and nonclinical and between disorder and nondisorder expression of psychosis. Demographic variables, indexing premorbid social adjustment and socioeconomic status, impacted mostly linearly; proxy variables of genetic loading (more or more severely affected relatives) impacted in a positive extralinear fashion; environmental risk factors sometimes impacted linearly (urbanicity and childhood adversity) and sometimes extralinearly (cannabis), occasioning a disproportional shift in risk at the clinical disorder end of the spectrum. Affective symptoms were associated with a disproportionally higher risk below the disorder threshold, whereas a disproportionally higher risk above the threshold was associated with psychotic symptom load, negative symptoms, disorganization, and visible signs of mental illness. Liability associated with respectively affective and nonaffective symptom domains, in interaction with environmental risks, may operate by impacting differentially over a quasi-continuous extended psychosis phenotype in the population.

Objective: To provide an overview of incidence and prevalence estimates, admission rates, and related features of psychotic disorders among immigrants from Turkey in Western Europe., Method: Articles published in all languages between 1990 and 2010 were included. In order to detect relevant studies, a string ([schizo* OR psych*] AND [Turk*] AND [migra* OR immigra*]) was used in MEDLINE and PsychINFO. Turkish indexes and abstracts books of national congresses were also screened to locate additional papers., Results: We included 21 studies which yielded 25 rates on psychotic disorders among immigrants from Turkey. Fifteen papers reported rates for the immigrants from Turkey in The Netherlands, four for Germany, one for Denmark and one for Switzerland. The incidence estimates of non-affective and affective psychosis among immigrants from Turkey were between 38.5 and 44.9 per 100,000 while incidence estimates of schizophrenia were between 12.4 and 63.8 per 100,000. The prevalence estimates of schizophrenia and other psychotic disorders were between 1.1 and 6.2 per 1,000. Rates and relative risks of psychotic disorders in immigrants from Turkey tended to be higher than the natives and lower than other immigrant groups with similar sociocultural background. In addition to other risk factors, social contextual factors including discrimination and neighbourhood characteristics were the key environmental factors that modulate rates of psychotic disorders among immigrants from Turkey. Males were under a higher risk of incidence, prevalence estimates, and admission rates., Conclusion: Variations in rates and relative risks indicate a possible etiological role of social experiences in immigrants. Studies with a focus on comparing the rates and the social factors of psychotic disorders between immigrants from Turkey in Western Europe and their family members residing in Turkey may provide additional insight into the epidemiology of psychotic disorders.

Objective: To describe the objectives and design of a multistage study on the prevalence and risk factors of mental health problems, in particular psychotic disorders and psychotic symptoms, by assessing a probabilistic sample of household residents in the Izmir Metropolitan Area, aged 15-64 years., Method: The study included three different observation frames. In the first stage, of which methodology is in the focus of this paper, the primary screening instrument was the Composite International Diagnostic Interview 2.1, which assesses lifetime and/or last one year occurrence of several DSM-IV disorders. Second, a parallel survey of social capital of administrative wards was conducted in the same neighbourhoods. Third, a nested-case control study was performed to study effects of genetic and environmental risk factors on wide psychosis phenotype., Results: A total of 4011 males and females were contacted through a multistage clustered area probability sample of administrative neighbourhoods and households, covering 9 districts and 302 neighbourhoods. The response rate for the first stage was 76.5% in 5242 eligible households. Respondents were interviewed at home in 2008 for the screening of included mental health problems. The screened disorders were mood disorders (last 1 year), schizophrenia and other non-affective psychotic disorders (lifetime), and dependence and abuse of psychoactive substances (lifetime)., Conclusion: Although cross-sectional in nature, the TürkSch has a unique study design and yields data of high quality. This enables study of the prevalence, risk and higher-order interactions underlying ill-health in the Turkish population, with a specific focus on psychosis.

The aim of the study was to evaluate the adherence and efficacy of quetiapine treatment in a 6-month, multicentre, noninterventional naturalistic design. Overall, 710 schizophrenia patients using quetiapine or who had switched to quetiapine were included. The continuation rate for quetiapine treatment during 6-month follow-up period was 69%. Adherence improved with each subsequent visit for continued patients, 92.9% at the second visit to 96.1% at the last. Treatment adherence was correlated to improvement of symptoms, though not significantly. Patients having lower clinical global impression severity scores at the beginning were twice as likely to improve compared with patients with higher clinical global impression scores. Schizophrenia patients with antisocial behaviour problems had two and a half times higher drop-out rates. In conclusion, this naturalistic study showed that adherence to quetiapine treatment was high, and treatment was effective in schizophrenia patients during long-term treatment. Remission of symptoms in schizophrenia is much related to severity of symptoms at baseline, treatment adherence and characteristics of patients such as antisocial behavioural patterns.

Aim: To determine the primary health care working general practitioners' knowledge, attitude and behavior towards alcohol use disorders., Method: In this descriptive and cross-sectional study 135 general practitioners (GPs) completed the questionnaire., Results: Pre and post graduate education on alcohol use disorders is low (25.4 % and 11.7% respectively). Most of the GPs do not know the levels of risky alcohol use, screening tests, and biochemical markers. The mean knowledge score is 6.67+/-1.70. Most GPs think that alcohol use disorders are not an important issue in primary health care (57%), they do not have time to deal with patients' alcohol problems (74.1%), it is difficult to diagnose risky alcohol users without clear symptoms (91.1%), patients do not follow advice on alcohol use (85.2%), and physicians themselves are tolerant towards alcohol (71.1%). Half of the GPs reported that they find it difficult to talk about alcohol use with patients and think that patients may be angered by alcohol consumption questions. Mean attitude score is 4.44+/-2.15. Most of the GPs reported that they would ask questions about alcohol use to their patients (91.7%) and declare that the patients' problems were related to alcohol (90.2%). More than half of them reported that they would refer the patient to a specialist or an alcohol treatment center (58.5%). The mean behavior score is 5.96+/-1.46., Conclusion: In our country it is clear that more education and support for GPs is needed due to their important role in intervention for alcohol use problems.

Background: Psychotic symptoms, psychotic-like experiences and schizotypal signs can emerge in different socio-cultural circumstances and cause clinical or non-clinical pictures. Transient or self-limiting psychotic-like experiences are more prevalent than clinical psychotic disorders. The aim of this study is to determine the prevalence and sociodemographic correlates of psychotic symptoms in an urban area., Methods: A cross-sectional study was conducted among the residents of two districts in the urban area of Izmir, Turkey. Among the systematically selected 1,500 residents of 85,212-study population, a total of 1,268 individuals (response rate: 84.5%) were screened for any lifetime psychotic symptoms., Results: Composite International Diagnostic Interview (CIDI) was used to assess psychotic symptoms. CIDI (+) psychotic symptoms were found in 3.6% of the screened sample. Logistic regression analysis showed that being a female (OR=2.4, 95% CI=1.2-5.1), having a first degree family history of any mental disorders (OR=13.9, 95% CI=5.7-34.3), lack of social support (OR=4.5, 95% CI=2.3-8.6) and alcohol use (OR=4.9, 95% CI=2.3-10.6) were all related to psychotic symptoms., Conclusion: Prevalence of any psychotic symptom is lower compared to European studies. Alcohol might be considered as a risk factor for developing psychotic symptoms in the Turkish cultural setting.

Decreased quality of life is often an important cause or consequence of psychiatric illness, and needs to be included in a comprehensive treatment plan. The authors aimed to identify how psychiatric patients characterize the quality of their lives compared to others who are suffering from a chronic physical illness (diabetes) and healthy individuals. A total of 100 psychiatric patients were recruited from Dokuz Eylül University Psychiatry Department outpatient clinic. Of these, 34 had 4(th) edition Diagnostic and Statistical Manual diagnosis of alcohol dependence, 38 had schizophrenia, and 28 had bipolar disorder. A total of 35 patients with diabetes and 49 healthy individuals were also included in the study. The World Health Organization's Quality of Life Questionnaire was used to measure the quality of life. Patients with alcohol dependence, bipolar disorder, and schizophrenia scored lower than healthy subjects on the physical aspects of quality of life. Patients with schizophrenia had lower scores in the psychological domain compared to patients with bipolar disorder, patients with diabetes, and healthy subjects. In the social relationship domain, patients with schizophrenia and alcohol dependence scored lower compared to healthy subjects. Patients with schizophrenia were worse with respect to social relationships than bipolar patients and diabetics. World Health Organization's Quality of Life Questionnaire is useful for evaluating the needs and targets for interventions in psychiatric patients.

Background: SF-36 has been both translated into different languages and adapted to different cultures to obtain comparable data on health status internationally. However there have been only a limited number of studies focused on the discriminative ability of SF-36 regarding social and disease status in developing countries. The aim of this study was to obtain population norms of the short form 36 (SF-36) health survey and the association of SF-36 domains with demographic and socioeconomic variables in an urban population in Turkey., Methods: A cross-sectional study. Face to face interviews were carried out with a sample of households. The sample was systematically selected from two urban Health Districts in Izmir, Turkey. The study group consisted of 1,279 people selected from a study population of 46,290 people aged 18 and over., Results: Internal consistencies of the scales were high, with the exception of mental health and vitality. Physical health scales were associated with both age and gender. On the other hand, mental health scales were less strongly associated with age and gender. Women reported poorer health compared to men in general. Social risk factors (employment status, lower education and economic strain) were associated with worse health profiles. The SF-36 was found to be capable of discriminating disease status., Conclusion: Our findings, cautiously generalisable to urban population, suggest that the SF-36 can be a valuable tool for studies on health outcomes in Turkish population. SF-36 may also be a promising measure for research on health inequalities in Turkey and other developing countries.

People with schizophrenia are amongst the most stigmatized of those with mental illnesses. The purpose of this study was to examine whether an antistigma program which consists of education, contact, and viewing a film that depicts an individual with schizophrenia, can change attitudes towards people with schizophrenia. The antistigma program was carried out with first-year medical students (n=25). Students' attitudes towards people with schizophrenia were assessed before and after the program. In parallel, a control group of first-year medical students were questioned (n=35). Assessment was repeated after 1 month. Favorable attitudinal changes were observed in terms of 'belief about the etiology of schizophrenia', 'social distance to people with schizophrenia', and 'care and management of people with schizophrenia'. In contrast, no significant change was observed in the control group. Attitude changes tended to decrease at the 1-month follow up. These results suggest that attitudes towards schizophrenia could be changed favorably with this program. To sustain changed attitudes towards people with schizophrenia, antistigma programs should be offered on a regular basis.

Schizophrenia may cause disability leading to restrictions on many domains of daily life such as hygiene, self-management, vocational and leisure activities, and family and social relationships. The aim of this study was to assess the level of disability with the Brief Disability Questionnaire (BDQ), developed by the World Health Organization, and to identify the clinical correlates and predictors of disability during a 1-year follow-up period in 382 patients with schizophrenia. All patients were assessed at the beginning of the study, and 168 (44%) of them were re-evaluated after 1 year. Total disability scores of the patients with schizophrenia were significantly decreased at follow-up. Female patients seemed to be more disabled than males. Disability showed a positive correlation with the total, positive symptoms and negative symptoms scores on the Brief Psychiatric Rating Scale, as well as scores on the UKU Side Effects Rating Scale. Patients with the disorganized subtype of schizophrenia and residual symptoms were more disabled than patients with other subtype diagnoses. Negative symptoms and duration of untreated psychosis were significant predictors of disability after 1 year. Early-onset schizophrenia had a twofold increased risk for developing disability. Disability in schizophrenia is a clinical phenomenon closely linked to negative symptoms and poor outcome.

Quality of life of first-degree relatives living in the same household with patients having schizophrenia has not been sufficiently explored. 30 patients with schizophrenia (16 women, 14 men), diagnosed using DSM-IV criteria, 31 of their relatives (15 women, 16 men), and 34 control subjects (21 women, 13 men) were included in the study. The mean age of the patients, their relatives, and the control subects were 39.8 +/- 10.9, 58.1 +/- 12.5 and 37.3 +/- 17.0, respectively. The World Health Oranization Quality of Life-Brief Form was administered to all subjects. Quality of life was worse for the patient group than for their relatives and control subjects, but relatives of the patients and control subjects were not significantly different on Quality of life. Quality of life was negatively correlated with the severity of psychopathology and extrapyramidal side effects induced by antipsychotic drugs in the patients.